Aachener Aphasie Test Research Articles

Neuroanatomical correlates of screening for aphasia in NeuroDegeneration (SAND) battery in non-fluent/agrammatic variant of primary progressive aphasia.

Non-fluent/agrammatic variant of Primary Progressive Aphasia (avPPA) is primarily characterized by language impairment due to atrophy of the inferior frontal gyrus and the insula cortex in the dominant hemisphere. The Screening for Aphasia in NeuroDegeneration (SAND) battery has been recently proposed as a screening tool for PPA, with several tasks designed to be specific for different language features. Applying multivariate approaches to neuroimaging data and verbal fluency tasks, Aachener Aphasie Test (AAT) naming subtest and SAND data may help in elucidating the neuroanatomical correlates of language deficits in avPPA. To investigate the neuroanatomical correlates of language deficits in avPPA using verbal fluency tasks, AAT naming subtest and SAND scores as proxies of brain structural imaging abnormalities. Thirty-one avPPA patients were consecutively enrolled and underwent extensive neuropsychological assessment and MRI scan. Raw scores of verbal fluency tasks, AAT naming subtest, and SAND subtests, namely living and non-living picture naming, auditory sentence comprehension, single-word comprehension, words and non-words repetition and sentence repetition, were used as proxies to explore structural (gray matter volume) neuroanatomical correlates. We assessed univariate (voxel-based morphometry, VBM) as well as multivariate (source-based morphometry, SBM) approaches. Age, gender, educational level, and disease severity were considered nuisance variables. SAND picture naming (total, living and non-living scores) and AAT naming scores showed a direct correlation with the left temporal network derived from SBM. At univariate analysis, the left middle temporal gyrus was directly correlated with SAND picture naming (total and non-living scores) and AAT naming score. When words and non-words repetition (total score) was considered, a direct correlation with the left temporal network (SBM) and with the left fusiform gyrus (VBM) was also evident. Naming impairments that characterize avPPA are related to specific network-based involvement of the left temporal network, potentially expanding our knowledge on the neuroanatomical basis of this neurodegenerative condition.

Video-Oculography During Free Visual Exploration to Detect Right Spatial Neglect in Left-Hemispheric Stroke Patients With Aphasia: A Feasibility Study.

Spatial neglect has been shown to occur in 17–65% of patients after acute left-hemispheric stroke. One reason for this varying incidence values might be that left-hemispheric stroke is often accompanied by aphasia, which raises difficulties in assessing attention deficits with conventional neuropsychological tests entailing verbal instructions. Video-oculography during free visual exploration (FVE) requires only little understanding of simple non-verbal instruction and has been shown to be a sensitive and reliable tool to detect spatial neglect in patients with right-hemispheric stroke. In the present study, we aimed to investigate the feasibility of FVE to detect neglect in 10 left-hemispheric stroke patients with mild to severe aphasia as assessed by means of the Token Test, Boston Naming Test and Aachener Aphasie Test. The patient’s individual deviation between eye movement calibration and validation was recorded and compared to 20 age-matched healthy controls. Furthermore, typical FVE parameters such as the landing point of the first fixation, the mean gaze position (in ° of visual angle), the number and duration of visual fixations and the mean visual exploration area were compared between groups. In addition, to evaluate for neglect, the Bells cancellation test was performed and neglect severity in daily living was measured by means of the Catherine Bergego Scale (CBS). Our results showed that the deviation between calibration and validation did not differ between aphasia patients and healthy controls highlighting its feasibility. Furthermore, FVE revealed the typical neglect pattern with a significant leftward shift in visual exploration bahaviour, which highly correlated with neglect severity as assessed with CBS. The present study provides evidence that FVE has the potential to be used as a neglect screening tool in left-hemispheric stroke patients with aphasia in which compliance with verbal test instructions may be compromised by language deficits.

Efficacy of exercise rehabilitation program accompanied by experiential music for recovery of aphasia in single cerebrovascular accidents: a randomized controlled trial.

The current study aims to evaluate the effects of daily traditional experiential music listening for clinical recovery of post-stroke aphasia. This was a prospective randomized trial with seventy-nine stroke survivors who suffered from post-stroke aphasia. All patients underwent a neuropsychological evaluation, at time = 0 during the admission at the rehabilitation structure (baseline), and 6months post-stroke. All cases received standard treatment for stroke and post-stroke aphasia in terms of medical care and rehabilitation. Furthermore, patients were randomized to receive either standard care only or standard care with daily traditional experiential music listening. Computer tomography perfusion and neurological examination were assessed to all patients. Recovery was measured by the score at Aachener Aphasie Test. The statistically significant differences between the control group (CG) and the rest of the patients were the clinical characteristics (hemiparesis) (p = 0.002), the cerebral blood flow in affected areas (p = 0.000), and the Mini-Mental Test (mMT) (p = 0.000). Only group and mMT were independent predictor factors for recovery, according to multivariate analysis odd ratio (ΟR) (95% confidence interval) 0.022 (0.009-0.435) and 0.658 (0.142-0.224) respectively. The results of this study are promising and suggest that an enriched sound environment is beneficial for patients with post-stroke aphasia since the recovery rate is higher when standard care was combined with daily music listening.

Evidence for language-specificity of a BCI-based language training

Evidence for language-specificity of a BCI-based language training

Italian adaptation of the functional outcome questionnaire – aphasia: initial psychometric evaluation

Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia.Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated.Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α = 0.98; ICC = 0.95) and subscales (α = 0.89 for the communicating basic needs (CBN), α = 0.92 for the making routine requests (MRR), α = 0.96 for the communicating new information (CNI), α = 0.93 for the attention/other communication skills (AO); ICC = 0.95 for CBN, ICC = 0.96 for MRR, ICC = 0.97 for CNI and ICC = 0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity.Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia.Implications for RehabilitationFunctional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia.This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life.Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.

Motor recovery in post-stroke patients with aphasia: the role of specific linguistic abilities

Background: Aphasia is a serious consequence of stroke but aphasics patients have been routinely excluded from participation in some areas of stroke research.Objective: To assess the role of specific linguistic and non-verbal cognitive abilities on the short-term motor recovery of patients with aphasia due to first-ever stroke to the left hemisphere after an intensive rehabilitation treatment.Methods: 48 post-acute aphasic patients, who underwent physiotherapy and speech language therapy, were enrolled for this retrospective cohort-study. Four types of possible predictive factors were taken into account: clinical variables, functional status, language and non-verbal cognitive abilities. The motor FIM at discharge was used as the main dependent variable.Results: Patients were classified as follows: 6 amnestic, 9 Broca’s, 7 Wernicke’s, and 26 global aphasics. Motor FIM at admission (p = 0.003) and at discharge (p = 0.042), all linguistic subtests of Aachener AphasieTest (p = 0.001), and non-verbal reasoning abilities (Raven’s CPM, p = 0.006) resulted significantly different across different types of aphasia. Post-hoc analyses showed differences only between global aphasia and the other groups. A Multiple Linear Regression shows that admission motor FIM (p = 0.001) and Token test (p = 0.040), adjusted for clinical, language, and non-verbal reasoning variables, resulted as independent predictors of motor FIM scores at discharge, while Raven’s CPM resulted close to statistical significance.Conclusions: Motor function at admission resulted as the variable that most affects the motor recovery of post-stroke patients with aphasia after rehabilitation. A linguistic test requiring also non-linguistic abilities, including attention and working memory (i.e. Token test) is an independent predictor as well.

EP 6. Longitudinal resting state functional connectivity patterns in the early phase of recovery from Aphasia in temporoparietal stroke

Background Poststroke aphasia recovery evolves in space and time. Substantial language improvements can be observed within the first days after stroke. However, underlying changes in the functional status of the language network during the acute phase remain to be demonstrated. Methods In a resting-state functional connectivity (RSFC) fMRI study we assessed changes in functional connectivity repeatedly (acute( t 1) = 2 ± 1, subacute( t 2) = 10 ± 2 days post-onset) in aphasic patients ( N = 12, 62 ± 14 years, 10 male) with left temporoparietal stroke. Language comprehension and production scores were calculated based on the Aachener Aphasie-Test. For RSFC analysis 9mm spherical ROIs reflecting core language regions in the left anterior inferior frontal (aIFG: x = −54 y = 32 z = 1, MNI-space), posterior middle temporal gyrus (pMTG: x = −54 y = −43 z = 4) and their right hemisphere homologous were selected. Results Seed-to-whole-brain analysis from left aIFG or pMTG revealed RSFC to right hemisphere homologous frontal or temporal areas at t 1 and t 2 ( p > .05, FWE corrected). Longitudinally, RSFC from left pMTG to left aIFG as well as RSFC from left aIFG to left frontal (operculum, insula, premotor cortex) and to right frontal (IFG, premotor cortex) areas increased significantly from t 1 to t 2 ( p > .001, uncorrected). Subsequent ROI-to-ROI analysis revealed increased RSFC between left aIFG and pMTG from t 1 to t 2 associated with improved language production ( r = .579, p = .049). During the acute phase ( t 1) better scores for language comprehension and production were predicted by higher RSFC between left aIFG and right aIFG ( r = .736 p = .006). Conclusion We observed early ipsi- and contralesional changes in the language network’s functional connectivity and associated language improvements indicative of acute diaschisis and subsequent reorganization within the distributed language network.

Rehabilitation of aphasia: application of melodic-rhythmic therapy to Italian language.

Aphasia is a complex disorder, frequent after stroke (with an incidence of 38%), with a detailed pathophysiological characterization. Effective approaches are crucial for devising an efficient rehabilitative strategy, in order to address the everyday life and professional disability. Several rehabilitative procedures are based on psycholinguistic, cognitive, psychosocial or pragmatic approaches, including amongst those with a neurobehavioral approach the Melodic Intonation Therapy (MIT). Van Eeckhout’s adaptation of MIT to French language (Melodic-Rhythmic Therapy: MRT) has implemented the training strategy by adding a rhythmic structure reproducing French prosody. The purpose of this study was to adapt MRT rehabilitation procedures to Italian language and to verify its efficacy in a group of six chronic patients (five males) with severe non-fluent aphasia and without specific aphasic treatments during the previous 9 months. The patients were treated 4 days a week for 16 weeks, with sessions of 30–40 min. They were assessed 6 months after the end of the treatment (follow-up). The patients showed a significant improvement at the Aachener Aphasie Test (AAT) in different fields of spontaneous speech, with superimposable results at the follow-up. Albeit preliminary, these findings support the use of MRT in the rehabilitation after stroke. Specifically, MRT seems to benefit from its stronger structure than the available stimulation-facilitation procedures and allows a better quantification of the rehabilitation efficacy.

Validation of the Italian version of the American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults (I-ASHA-FACS)

Background: Impairment of communicative-linguistic and cognitive functions is common after stroke and traumatic brain injury (TBI). While assessment of language function is usually performed in clinical practice, standardised assessment of pragmatic, functional, and communicative competences is less common, even though suggested by many recent national and international guidelines. The “American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults” (ASHA-FACS) is a measure of communication disability that investigates functional communication. It has been translated and adapted into Italian in 2001, but psychometric properties of Italian version of ASHA-FACS (I-ASHA-FACS) have not yet been investigated.Aims: To investigate psychometric properties of the I-ASHA-FACS scale and provide normative data.Methods & Procedures: Participants included 100 healthy adult persons without neurological disorders nor communicative-cognitive deficits and 80 post-acute outpatients with aphasia following stroke (n = 60) or TBI (n = 20). Mini Mental State Examination (MMSE) was used to exclude control participants with cognitive decline (MMSE > 24). I-ASHA-FACS was completed for all participants. All patients were also assessed with Functional Independent Measure (FIM) and either Aachener Aphasie Test (AAT) for persons with aphasia due to stroke or Levels of Cognitive Functions scale (LCF) for TBI persons. I-ASHA-FACS internal consistency, inter- and intra-rater reliability and construct validity were calculated; normative data were also calculated for healthy controls stratified by age and education. Cronbach’s alpha was used for internal consistency analysis. Spearman’s test was used to correlate I-ASHA-FACS and FIM, AAT, and LCF scores.Outcomes & Results: I-ASHA-FACS showed good internal consistency (α > .84) and strong intra- and inter-rater reliability (r > .97 and >.89). All healthy persons showed very high level of functional communication abilities in all domains of communication independence (higher than 6, on a 7-point scale) and all qualitative dimensions scores (higher than 4, on a 5-point scale). Correlations between I-ASHA-FACS scores and FIM were strong in aphasic persons, particularly in problem solving (r > .71) and comprehension (r > .73) subscales. Correlations between I-ASHA-FACS and AAT were generally from moderate to strong (r values ranging from r = .31 to r = .81), and particularly strong in spontaneous speech subtest (r > .70). Correlations between I-ASHA-FACS and LCF did not reach statistical significance.Conclusions: I-ASHA-FACS shows good internal consistency, strong intra- and inter-rater reliability and satisfactory validity. The application of I-ASHA-FACS to the Italian population of patients with communicative deficits due to aphasia or TBI is recommended.

Aphasia induced by gliomas growing in the ventrolateral frontal region: Assessment with diffusion MR tractography, functional MR imaging and neuropsychology

IntroductionLesions in the ventrolateral region of the dominant frontal lobe have been historically associated with aphasia. Recent imaging results suggest that frontal language regions extend beyond classically defined Broca’s area to include the ventral precentral gyrus (VPCG) and the arcuate fasciculus (AF). Frontal gliomas offer a unique opportunity to identify structures that are essential for speech production. The aim of this prospective study was to investigate the correlation between language deficits and lesion location in patients with gliomas. MethodsNineteen patients with glioma and 10 healthy subjects were evaluated with diffusion tensor imaging magnetic resonance (MR) tractography, functional MR (verb generation task) and the Aachener Aphasie Test. Patients were divided into two groups according to lesion location with respect to the ventral precentral sulcus: (i) anterior (n=8) with glioma growing in the inferior frontal gyrus (IFG) and underlying white matter; (ii) posterior (n=11) with glioma growing in the VPCG and underlying white matter. Virtual dissection of the AF, frontal intralobar tract, uncinate fasciculus (UF) and inferior frontal occipital fasciculus (IFOF) was performed with a deterministic approach. ResultsSeven posterior patients showed aphasia classified as conduction (4), Broca (1), transcortical motor (1) and an isolated deficit of semantic fluency; one anterior patient had transcortical mixed aphasia. All posterior patients had invasion of the VPCG, however only patients with aphasia had also lesion extension to the AF as demonstrated by tractography dissections. All patients with language deficits had high grade glioma. Groups did not differ regarding tumour volume. A functional pars opercularis was identified with functional MR imaging (fMRI) in 17 patients. ConclusionsGliomas growing in the left VPCG are much more likely to cause speech deficits than gliomas infiltrating the IFG, including Broca’s area. Lesion extension to the AF connecting frontal to parietal and temporal regions is an important mechanism for the appearance of aphasia.

Tense/aspect category in fluent and nonfluent German aphasia: An experimental training programme for verb production

Background: Results from previous studies on tense production in aphasia have not provided a homogeneous picture of which temporo-aspectual structures are most affected. It is postulated that the aphasic individuals have problems with encoding the [+past] feature into inflectional morphology, and then they are unable to generate the past forms of the verbs. In addition, typically agrammatic data have been analysed, with scarce information on fluent aphasia. Finally, the category of aspect has rarely been considered in verb production therapy. Aims: We present data regarding the experimental training of aspect in fluent and nonfluent German aphasia. On the basis of the results, some linguistic theories are discussed in terms of the semantic character of aspect processing. Methods & Procedures: Four aphasic German speakers (two fluent and two nonfluent) took part in the treatment. The participants were diagnosed as moderate Broca's or Wernicke's aphasic by means of the Aachener Aphasie Test (Huber, Poeck, Weniger, & Willmes, 1983). The training focused on the inflected verb elicitation and was carried out by means of a specially designed computer program. Altogether, 38 triplets of depictable verbs were used. The patients were exposed to three drawings depicting the prospective, ongoing, and completed action, and asked to fill in the gaps with appropriate verb forms. In addition, the comprehension task including three drawings and a distractor was also conducted to check the potential training influence on receptive skills. Outcomes & Results: We demonstrated that the experimental training on tense/aspect production proved to be effective. The significant improvement was noted in the case of three patients, for whom the overall frequency of errors and the sum of aspect substitutions were significantly reduced. Moreover, the data collected showed that German aphasic speakers had problems not only with the past/perfective aspect, but also with the future/prospective condition. However, no influence on the receptive performance was noted. Conclusions: The study showed that combinations of tense/aspect errors are not typical exclusively of agrammatism, but might also be observed in the verbal output of participants with fluent aphasia. The initial results from our experimental treatment showed that the reduction of tense/aspect errors is possible, regardless of aphasia type. We concluded that the complexity of verbal morphology (especially in the past tense) cannot explain the tense/aspect substitutions that were noted in the present and future conditions. Therefore a morpho-semantic deficit related to tense/aspect production in German aphasia is suggested.

Language plasticity in aphasics after recovery: Evidence from slow evoked potentials

With the present experiment we sought to investigate brain plasticity underlying language recovery in a group of seventeen patients with non-fluent aphasia mainly caused by stroke. Patients were screened along three domains of measures: analysis of linguistic components by the Aachener Aphasie Test, combined mapping of their lesion from CT/MRI scans, and functional measure of the reorganized linguistic processes by means of mapping of slow evoked potentials. The spatial dimension and temporal dynamics of word processing were measured in three tasks, Phonological, Semantic and Orthographic. Compared with the matched control group, patients showed relative inhibition (decreased negativity) of left central regions in perisylvian areas, which were damaged in most subjects. In addition, reorganization of linguistic functions occurred within the left hemisphere both at frontal and posterior sites corresponding to spared brain regions. Correlations between linguistic lateralization in the three tasks and AAT subtests point to functional reorganization of phonological processes over left frontal sites and dysfunctional reorganization of semantic processing over left posterior regions.

Nonparellel recovery of languages in a quadrilingual aphasic patient

This case study aims to investigate whether the treatment of only one language (L2) of a multilingual fluent aphasic(L1 Slovenian, L2 Italian, L3 Friulian, L4 English) results in a parallel improvement of all languages and whether the hypothesized benefits of rehabilitation last four years after the end of treatment. After a first assessment by means of the Aachener Aphasie Test (AAT) and the Bilingual Aphasia Test(BAT), the patient has been treated for six months in Italian(L2), subsequently tested again, and finally retested four years after the ischaemic lesion. The resulting recovery pattern is non parallel, with a significant improvement of the language of treatment—Italian—L2—and of Friulian—L3 and of English—L4 and a significant decrease of Slovenian—L1 between the second and the third assessments. Results seem to provide evidence that rehabilitation effects are maintained four years after the end of treatment.

Impairment of language is related to left parieto-temporal glucose metabolism in aphasic stroke patients

Twenty-six aphasic patients who had an ischaemic infarct in the territory of the left middle cerebral artery (MCA) were investigated. Cranial computed tomography (CT) showed various lesion sites: infarcts restricted to cortical structures in 12 patients, combined cortical and subcortical infarcts in 7 and isolated subcortical infarcts sparing the left cortex in another 7 cases. 18F-2-fluoro-2-deoxyglucose positron emission tomography revealed remote hypometabolism of the left convexity cortex and of the left basal ganglia, which was extended further than the morphological infarct zone in all cases. Types and degrees of aphasia were classified using the Aachener Aphasie Test (AAT): 10 patients had global aphasia, 2 Broca's, 5 Wernicke's, and 5 amnesic aphasia. Four patients suffered from minimal or residual aphasic symptoms. The AAT results were compared with the regional cerebral metabolic rates of glucose of the left hemisphere. Irrespective of the infarct location all five AAT subtests (Token test, repetition, written language, confrontation naming, auditory and reading comprehension) were closely correlated among each other and with left parieto-temporal metabolic rates, whereas left frontal and left basal ganglia metabolism showed no significant correlation. The close relation between left temporo-parietal functional activity and all five AAT subtests suggests that the different aspects of aphasia tested by AAT can be related to a common disorder of language processing in those areas.

Sprechstörung nach operativer Entfernung eines linkshemisphärischen zentroparietal lokalisierten Glioms: Kortikale Dysarthrie oder Sprechapraxie?

A 38-year-old male patient with a deep central parietal lesion in the left hemisphere reveals a motor speech disorder but no aphasia as evidenced by linguistic testing with the Aachener Aphasietest. Nuclear magnetic resonance tomography of the brain shows no lesion of the brainstem. Whether the speech disorder can be termed cortical dysarthria or apraxia of speech is left open to discussion.

Cognitive impairments of aphasics in picture sorting and matching tasks.

On the basis of earlier experiments showing a differential deficit of aphasics in picture sorting and matching tasks, two experiments were conducted to test the conjecture of a specific deficit of aphasics in the analytical appraisal of individual features. Broca's and Wernicke's aphasics--according to clinical diagnoses and the Aachener Aphasie Test--were compared with patients having right-hemisphere lesions or left-hemisphere lesions without aphasia. Both groups of aphasics differed from the control groups in the sorting task, irrespective of the sorting criterion, but the differences were small. The picture matching task did not discriminate between groups. Obviously, the basic assumption has to be modified with respect to specific conditions of task requirements. The experimental literature is reviewed.