Comprehensive Aphasia Test Research Articles (Page 1)

Background: Research on primary progressive aphasia (PPA) in minority languages and bilingual speakers remains limited, which can compromise accurate diagnosis and intervention. This is the case for Catalan, which lacks standardized tools for this population. Objectives: This study aimed to evaluate the Catalan version of the Comprehensive Aphasia Test (CAT-CAT) for detecting and characterizing PPA in Catalan-dominant bilingual individuals. Methods: We administered the CAT-CAT to four participants clinically diagnosed with PPA. Results: The test detected participants’ core linguistic impairments, such as anomia, and revealed distinct severity profiles consistent with PPA variant types. Moreover, it captured deficits that were not identified by routine clinical observation or informal assessment. Conclusions: This study provides the first detailed characterization of PPA in Catalan-speaking individuals and, although based on a small sample, its findings address a critical gap in neurodegenerative language research and highlight the importance of standardized tools to improve diagnosis and guide clinical interventions in bilingual speakers of minority languages.

Abstract BACKGROUND Spontaneous speech analysis is a reliable method to detect language problems in neurological populations. Deviations in spontaneous speech of glioma patients consist of incomplete sentences, shorter mean length of utterance (MLU), repetitions, self-corrections and phonological paraphasias. So far, in glioblastoma patients spontaneous speech analyses are scarce. As spontaneous speech analysis is time consuming, an oral picture description task (semi-spontaneous speech) is an alternative which is proven to be sensitive in stroke patients. MATERIAL AND METHODS We analyzed a cohort of 28 patients (part of the ongoing randomized controlled SAFE-trial) with a glioblastoma in left hemispheric eloquent areas who underwent awake surgery. An oral picture description task (Comprehensive Aphasia Test) was administered preoperatively and three months postoperatively and analyzed at conceptual level, productivity, grammatical organization and language errors. Performance was compared to normative data of healthy population. RESULTS In the pre- and postoperative semi-spontaneous speech, most common errors were interjections, incomplete sentences and repetitions. Compared to healthy population, pre- and postoperatively significant (p < 0.05) fewer adequate content words, a shorter MLU, fewer compound sentences and more language errors were produced; fewer causal relations were produced preoperatively. Between pre- and postoperative performance, most variables did not significantly change (p > 0.05) except for a higher percentage of repetitions and more initiation problems postoperatively. Preoperatively, patients with a frontal tumor expressed significantly more causal relations than patients with a temporal tumor (p = 0.025). CONCLUSION An oral picture description task appeared to be sensitive to detect language disturbances in glioblastoma patients. In accordance with earlier research, most errors concerned incomplete sentences. Compared to healthy population, glioblastoma patients are less efficient in transferring content information, using shorter, less syntactically complex sentences with more language errors. The characteristics of spontaneous speech in glioblastoma resemble the performance of lower graded glioma patients albeit more severely impaired. Tumor location in the frontal lobe has a beneficial effect on the expression of causal relations compared to tumor location in the temporal lobe. Oral picture description is less time-consuming than the traditional interviewing setting serving as an efficient clinical tool in standard language examination. As most variables did not significantly change postoperatively, it seems that spontaneous speech in this patient group was spared by awake resection. An RCT is ongoing to prove the benefit of awake surgery in glioblastoma in a larger cohort in relation to survival and quality of life.

ABSTRACT Background Standardised language tests provide a reliable framework for assessing language deficits in individuals with aphasia, but have long been lacking for various languages, including Swedish. The purpose of this study was to examine the diagnostic accuracy and establish the norm-references of the Swedish version of the Comprehensive Aphasia Test (CAT-S). Methods Consecutive patients with acute first-ever ischemic stroke were included prospectively in the Lund Stroke Register Study (LSR) at Skåne University Hospital, Sweden. Inclusion criteria were native Swedish speakers and age > 18 years. People with aphasia (PWA) at baseline, according to the Language Screening Test (LAST) (score <15), n = 60, were assessed with The Comprehensive Aphasia Test (CAT) at one to three months post stroke. To compare language test performance between individuals with, and without aphasia, CAT was administered to two different reference groups: 1) stroke patients without aphasia (n = 21), and 2) neurotypical controls (n = 100). The reference groups were matched regarding gender and age, with included consecutive stroke patients in LSR. ROC and sensitivity/specificity analyses were performed to examine the diagnostic accuracy of CAT and establish cut-off scores. Linear regressions were performed to evaluate differences in language performance between the three groups, and Pearson correlations were used to examine associations within CAT domains. Results CAT had a sensitivity of 92% (CI 0.82; 0.96), and a specificity of 90% (CI 0.83; 0.94). ROC analysis showed that CAT discriminates between persons with, and without aphasia with excellent diagnostic accuracy (AUC = 0.97, CI 0.95; 0.99). PWA scored significantly worse on CAT in comparison to reference groups, with 178.3 points (95% CI 149.6; 207.1) less than neurotypical controls, and 167.3 points (95% CI 124.1; 210.5) less than stroke patients without aphasia. The pairwise associations between the different domains of CAT for PWA showed significant correlations (r ≤ .72 ≥ .90, all p < 0.001). Conclusions This study validates CAT-S as a diagnostic test for post-stroke aphasia. CAT-S can be used as a new reference standard for aphasia assessment in Sweden.

ABSTRACT Background Although people with aphasia should receive rehabilitation services on an equal basis to others, irrespective of their cultural and linguistic backgrounds, the current research on aphasia does not adequately reflect the diversity of cultures and languages worldwide. Aims This paper aims to discuss language rights and the impact of giving preference to publishing aphasia research and clinical resources in English. We present an example of researchers adapting an aphasia assessment, the Comprehensive Aphasia Test (CAT), to diverse languages and cultures as a lens for language rights. Methods & Procedures The paper discusses the language rights of people with aphasia regarding language of assessment and intervention. To provide a concrete lens on the fulfilment of language rights in publishing aphasia assessments, a survey was designed to examine the experiences of researchers adapting the CAT to diverse languages and cultures. The survey comprised ten questions about their adaptation experiences from the initial language selection to the time of publication. The survey results are discussed in terms of linguistic justice. Outcomes & Results We obtained responses from eight languages to which the CAT has been adapted (Norwegian, Catalan, Spanish, Mandarin, Swedish, Turkish, Cantonese Chinese, and Croatian). Most CAT adaptations were driven by the pressing need to develop assessments in a primary or widely spoken language. The timeline of the adaptation process shows the complexity and time-consuming task of adapting aphasia assessments. Major challenges to the adaptation process include funding, lack of publisher guidelines, and the existence of databases with specific linguistic features. Conclusions There is a pressing need to address barriers to equal access to aphasia evidence. International collaborations are attempting to address the lack of a worldwide clinical and research workforce in aphasia, however structural barriers to research dissemination and publishing in diverse languages must be urgently addressed to realise language rights in aphasiology.

Predicting language outcome after stroke using machine learning: in search of the big data benefit.

Background: There are insufficiently clear and contradictory results in literature about how patient-related, stroke-related and language-related variables predict the aphasia severity after stroke and how these variables are interrelated. This study aimed to explore the association between aphasia severity and naming, verbal fluency, and demographic variables. Methods: 40 PwA with a left hemisphere stroke and nonfluent aphasia are included in this study. The entire battery of the Comprehensive Aphasia Test (CAT-HR, Swinburn et al., 2020), was administered to all subjects. Data on the severity of aphasia based on the total score on the Language Battery and performance on subtests Naming and Verbal fluency were extracted. Hierarchical regression model evaluated the association between Aphasia severity and Naming, Verbal fluency and demographic variables. Using nonparametric Spearman’s Rho coefficient, the correlations analyses between those variables and additional subtests of Verbal fluency (animals, sound) were conducted. Results: The results showed that demographic variables do not predict aphasia severity while naming explains most of the variance of aphasia severity. Additional correlation analysis showed significant correlation between aphasia severity and language variables, but not with demographic ones. Demographic variables Time post-stroke and Age were significantly correlated with Verbal fluency (sound). Conclusion: In this study, aphasia severity cannot be explained by used demographic variables. However, naming was found to be a strong predictor of aphasia severity. It is possible that the aphasia severity of nonfluent PwA is more dependent on stroke-related variables than demographic variables.

BackgroundA range of language impairments have been reported in people with epilepsy both pre- and post-surgically, however language is not routinely comprehensively assessed in epilepsy clinics. When language is assessed, this is typically as part of a broader neuropsychological battery of assessment, often limited to tests of noun naming and/or verbal fluency, despite evidence to suggest these tests are not sufficiently sensitive to detect the often-subtle deficits present in chronic focal epilepsy. Many areas of language function, including the production of connected speech, have also not been adequately explored in this population, and research relating to subjective report of language and communication difficulties is limited. A more comprehensive assessment of language, which includes patient report, is required to determine the presence and extent of language impairment in people with focal epilepsy. AimThe aim of the present study was to systematically investigate the prevalence and pattern of language impairment in a group of people with chronic focal epilepsy using a comprehensive aphasia battery and a patient reported outcome measure. MethodLanguage skills were assessed in 26 right-handed people with chronic focal epilepsy using the Comprehensive Aphasia test (CAT), in addition to standard clinical assessments of noun naming and verbal fluency. Participants’ self-report of their language and communication skills was also collected, using the La Trobe Communication Questionnaire (LCQ). Outcomes and results85% of participants with focal epilepsy were impaired on one or more language subtests of the CAT. In contrast, only 15% of participants were impaired on tests of confrontation noun naming, and none were impaired on a test of verbal fluency. The CAT findings were supported by subjective data, with 82% of participants self-reporting a communication difficulty. ConclusionsOur results show that current approaches to language assessment are inadequate for identifying language impairments in people with focal epilepsy, and likely underestimate the prevalence of language impairment in this population. In particular, verb naming and picture description subtests revealed deficits across the majority of the sample, highlighting the need for more comprehensive assessment of language to be routinely conducted in this population.

BackgroundsRecovery for poststroke aphasia has a decelerating trajectory, with the greatest improvement is within weeks and the slope of change decreasing over time. Therefore, it is essential to predict the prognosis of aphasia at an early stage as it could provide useful data in specific plans for management strategies. The aim of this work was to assess the arcuate fasciculus in stroke patients with aphasia and its impact on predicting the outcome. A prospective study was performed including 25 patients with acute ischemic stroke and aphasia and 10 healthy control subjects with no history of neurologic or psychiatric disease. All patients underwent language assessment using an Arabic version of the Comprehensive Aphasia Test (Arabic CAT), with the resultant mean T-score aphasia quotient (AQ). Early assessment of stroke and delayed assessment at three months. All patients had diffusion-weighted magnetic resonance imaging (DWI-MRI) of the brain to localize the lesion and 3D diffusion tensor imaging (DTI) of the arcuate fasciculus (AF) within 30 days of stroke.ResultsPatients in whom the AF could not be reconstructed had a poor score in early and late AQ and a poor prognosis compared to those in whom the AF could be reconstructed. Preservation of the left AF on DTI could mean the potential recovery of aphasia after stroke.ConclusionThe prognosis of aphasia in patients whose left AF could be reconstructed was better than those whose left AF could not be reconstructed, irrespective of the AF's integrity. That is why, we can assume that evaluation of the DTI of the left AF at early stages of stroke can help in predicting outcome of aphasia.

ABSTRACT Background Intensive Comprehensive Aphasia Programmes (ICAPs) are increasingly considered the preferred option for high intensity aphasia rehabilitation. This is due to the emerging evidence that shows the potential of the programme to improve language impairment as well as psychosocial wellbeing and quality of life (QoL) in persons with chronic aphasia. Aims The aim of the study was to investigate whether a university-based, student-led, online ICAP led to measurable improvements in language, functional communication and QoL in persons with aphasia (PwAs). Methods & Procedures Eleven PwAs (six women, five men; M age = 60.4 years; M time post onset = 14.6 months) participated in a 10-week ICAP that provided 36 hours of treatment in total. Outcome measures relating to language impairment, functional communication and QoL were administered before and after the ICAP and included a range of subtests of the Comprehensive Aphasia Test (CAT) and the Communication Activities of Daily Living – second edition (CADL-2), the Assessment for Living with Aphasia (ALA), the Aphasia Impact Questionnaire (AIQ-21) and the Communication Outcomes after Stroke Scale (Carer COAST). Pre- and post-ICAP performances were tested for significance using Wilcoxon signed-rank tests. In addition, effect sizes were calculated. Outcomes & Results Post-ICAP, significant gains occurred in the CAT subtests of auditory and reading comprehension as well as naming objects, with large effect sizes being noted for the subtests of reading comprehension and naming objects. Significant changes were also observed between the pre- and post-assessment scores for the AIQ-21 and the Carer COAST, whereby the latter yielded large effect sizes. By contrast, CADL-2 and ALA scores did not change significantly as a result of the ICAP intervention. Conclusions Results indicate that the ICAP effectively improved participants’ language and functional communication skills, as well as QoL for both PwAs and their communication partners. Findings further indicate that a student-led ICAP implemented in a university setting can be considered a viable and pragmatic solution to offering ICAPs to achieve the high intensity needed to effect positive changes in communication.

ABSTRACT Background The demand for telehealth aphasia assessment is increasing, yet only a limited number of instruments’ validity and feasibility in telehealth have been evaluated. The Comprehensive Aphasia Test (CAT) is a widely available language test with established psychometric properties in several languages, including Hungarian. Aims The current study aimed to evaluate the validity of administering the Hungarian version of the CAT (CAT-H) via videoconference and explore the satisfaction of people with aphasia (PWA) with videoconference assessment compared to in-person assessment. Methods & Procedures Twelve PWA with left hemisphere stroke (mean age = 50.83 years, mean post-onset = 19 months), exhibiting mild-to-moderate aphasia, completed both in-person and videoconference assessments using the CAT-H Language Battery. The study used a comparison design, incorporating elements of counterbalancing and blinding. The assessments were conducted by speech-language pathologists (SLPs), with one person leading the in-person assessment and another leading the videoconference assessment for each participant. The order of administration (in-person or videoconference) was counterbalanced across participants. SLPs leading the second assessments were blind to the results of the first assessments. One key adjustment for the videoconference assessment was the utilisation of the screen sharing and/or control sharing features within the videoconferencing software. Participants also filled out a satisfaction questionnaire after each assessment and expressed their preference between the two assessment methods at the end of the study. Intraclass correlation coefficients (ICCs) were calculated to compare the CAT-H modality summary scores and the CAT-H language battery score between in-person and videoconference assessments. Outcomes & Results There was good-to-excellent agreement between in-person and videoconference assessments, with ICCs ranging from 0.80 to 0.96 (p < 0.001) for the CAT-H modalities and an ICC of 0.97 for the CAT-H language battery score. At the individual level, minor inconsistencies were observed in the language battery score between the two assessments. Participants reported high satisfaction with both assessment methods, with satisfaction levels for the videoconference assessment being comparable to those for the in-person assessment. While the majority of participants did not exhibit a preference between the two methods in terms of understanding the clinician, approximately half of them favoured the in-person assessment for expressing themselves and comfort. Conclusions Obtained results suggest that the CAT-H can be effectively administered via videoconference, offering a viable alternative to in-person assessment when necessary. Future studies should replicate these findings with a larger and more diverse study sample, involving participants with moderately severe and severe aphasia.

ABSTRACT Background Standardised aphasia assessment tools may not always be available in a variety of languages, posing challenges for speech and language therapists to adequately assess and diagnose aphasia in speakers of those languages. In 2013, Working Group 2 (WG2) Aphasia Assessment & Outcomes, part of the Collaboration of Aphasia Trialists network, was formed with the purpose of developing reliable and valid aphasia assessment tools and their cross-linguistic adaptations. Over the past decade, WG2 has undertaken important adaptation projects, including the cross-linguistic adaptation of the Comprehensive Aphasia Test (CAT; Swinburn et al., 2004). Aims This review aims to achieve three objectives: (a) describe the adaptation procedure of the CAT within WG2, (b) summarise common guidelines and recommendations for future adaptations, and (c) provide concrete solutions for specific cross-linguistic and cross-cultural challenges encountered during the adaptation and validation procedures of the CAT. Methods Between 2013 and 2023, WG2 employed a committee approach and fully adapted the CAT into Catalan, Croatian, Dutch, French, Hungarian, Norwegian, Spanish, and Turkish. Further adaptations are in progress for Arabic (Moroccan), Basque, Cantonese Chinese, German, Greek, Icelandic, Lithuanian, Serbian, Slovenian and Swedish. The review comprehensively addresses the linguistic/cultural adaptation and validation procedure for the three components of the battery: the Cognitive screening, the Language battery and the Aphasia Impact Questionnaire. Critical outcomes and some best practice recommendations from psychometric norming and piloting are also discussed. Outcomes and results This review builds upon prior work (Fyndanis et al., 2017) and serves as a practical guide for researchers and clinicians undertaking cross-linguistic adaptations of the CAT, with specific conclusions and recommendations drawn from WG2’s adaptations in 19 languages with diverse typological properties. Building on the work exemplified in this paper, future initiatives can direct their efforts towards adapting the CAT for PWA from different linguistic backgrounds for whom validated assessment instruments may be unavailable. This can be achieved through rigorous systematic adaptation procedures for the establishment of comparable language versions of this tool, valuable for various clinical applications. Such endeavours have the potential to provide access to valuable shared datasets for their use across international aphasia trials, and for comparable clinical work within the aphasiology community.

ABSTRACT Background People with aphasia (PWA) after ischemic stroke often have difficulties in communication and social participation. To individualise rehabilitation and optimise recovery, there is a need for knowledge regarding prevalence of aphasia, and language functions in relation to long-term recovery and health-related quality of life (HRQoL). In this study, we examined these issues in a Swedish setting. Methods We screened consecutive persons with first-ever ischemic stroke admitted to Skåne University Hospital, Sweden, at baseline (median day 4 post stroke onset) for aphasia with the Language Screening Test (LAST). We then performed a detailed follow-up of PWA at 1, 3, and 12 months after stroke onset with the Swedish version of the Comprehensive Aphasia Test (CAT) for evaluation of cognition and language, and with the self-reported Aphasia Impact Questionnaire (AIQ) for evaluation of HRQoL. We analysed aphasia recovery and potential associations between aphasia severity, language functions, stroke severity according to National Institutes of Health Stroke Scale (NIHSS), and HRQoL. Results Initial aphasia was present in 27% (n = 60 of 221) of stroke persons in the acute phase. At 1 month after stroke onset, 74% (n = 40 of 54 survivors with initial aphasia) had remaining aphasia, at 3 months 67% (n = 34 of 51) had aphasia and at 12 months post stroke 61% (n = 30 of 49) had remaining aphasia. Improvement of aphasia was greatest during the first months after onset, with significant improvement regarding naming (p= 0.01), repetition (p= 0.03) and comprehension of written language (p= 0.01). HRQoL remained significantly associated with aphasia severity after adjusting for stroke severity and age. At 3 months, 87% (n = 26) of PWA reported that aphasia affected their ability to communicate with the environment, had negative consequences on level of participation (73%, n = 22), and their emotional well-being (87%, n = 26). There were no significant temporal changes regarding HRQoL between 3 and 12 months post stroke. Conclusion Chronic aphasia was observed in 61% of all alive persons presenting with baseline aphasia after ischemic stroke. Aphasia has negative consequences on HRQoL for PWA and aphasia severity impacts HRQoL regardless of stroke severity.

ABSTRACT Introduction Aphasia assessments in languages other than English are scarce. In the case of Spanish, this scarcity includes a need for assessments with linguistic and cultural adaptations that consider dialectal varieties and cultural traits across Spanish-speaking populations. Aims of the study This study discusses the linguistic and cultural adaptation of the Comprehensive Aphasia Test (CAT) to Spanish (SP-CAT), a version that can be used in Spain and Spanish-speaking Latin American countries, and provide pilot results assessing whether performance is comparable across samples. Methods For the linguistic adaptation, we discuss considerations such as typological differences between English and Spanish, Spanish varieties, gender cues, spelling-sound regularities, transparency, and other syntax-related aspects. For the cultural adaptation, we discuss considerations such as culturally relevant items and images, and covering different Spanish varieties within the SP-CAT. The pre-testing of items for the SP-CAT included controlling variables such as name agreement of visual stimuli (examined in n=237 healthy participants), imageability (examined in n=244 healthy participants), and lexical frequency (from the Corpus of Reference of Current Spanish). We also conducted a pilot study of the SP-CAT with 82 healthy participants from Chile, Colombia, and Spain to assess differences in performance within tasks between the included countries; analysis of such differences was completed within a Bayesian framework. Results The SP-CAT provides a linguistic and cultural adaptation of the original English CAT. Item pre-testing included name agreement, lexical frequency, and imageability tests to ensure comparability with the English original version. Our pilot study confirmed that there are no clinically significant differences in performance within tasks between the included countries in healthy participants, a necessary step towards the final validation of a test for the Spanish-speaking world. Discussion The SP-CAT responds to a need to develop linguistically and culturally sensitive adaptations of assessments for Spanish-speaking people with aphasia to be used in clinical practice. Pilot results indicate that the adaptation meets the criteria to be used across Spanish varieties. In light of promising pilot results, the next phase of this study will assess the validity and reliability of the SP-CAT, providing normative data for its administration.

ABSTRACT Background and Aims Glioma growth in eloquent language areas induces adaptive activation changes in the language network. The present study aimed to (1) investigate the pre- to postoperative evolution of neural phoneme perception processes in glioma patients and (2) assess if event-related potentials (ERPs) reflecting phoneme perception can provide added value to the diagnostic approach in individuals undergoing awake surgery. Methods and Procedures In five persons undergoing an awake craniotomy for the resection of a glioma, pre- and postoperative behavioural language assessment (Aachen Aphasia Test, Comprehensive Aphasia Test and Boston Naming Test) and electrophysiological investigation of phoneme perception was performed. For the latter, ERPs were obtained through the administration of an inattentive (Mismatch Negativity; MMN) and attentive (P300) oddball paradigm containing a phonemic articulation place contrast during EEG recording. Outcomes and Results Aberrant phoneme categorization processing was evidenced in all five participants preoperatively based on the MMN and P300 amplitude and latency. Moreover, mild behavioural impairments were found in four participants at this time. Postoperatively, three out of five participants reached behavioural ceiling effects, while four individuals displayed normalization of electrophysiological measures. Conclusions While neural processing of phoneme contrasts was preoperatively affected by glioma-induced disturbances, a high potential for postsurgical plasticity was shown. As four participants presented with a high grade glioma, tumour grade might partially account for this pattern. Addition of electrophysiological tests to the language assessment could provide benefits in both the pre- and postoperative clinical diagnostic approach in glioma patients. These preliminary results need validation in a larger sample.

ABSTRACT Background To be able to conduct comparative research on aphasia assessment and rehabilitation across languages, there is a need for comparable assessment tools. Croatian and Norwegian are among the first languages for which the Comprehensive Aphasia Test (CAT) versions have been published within the Working Group 2 of the Collaboration of Aphasia Trialists network. Comparing the performance of PwA and the psychometric properties of the CAT in these two languages is an interesting test case for the validity of the adaptation process due to the linguistic and cultural differences between the two languages. Aims The aim of this article is to investigate whether the goal of creating comparable versions of the CAT – the Croatian (CAT-HR) and the Norwegian (CAT-N) – could be achieved. First, we compare the performance of the two groups of PwA, and second, we investigate the psychometric properties of the two tests and the influence of age and education level on performance. Analogous (psycho)linguistic decisions during test adaptations should secure the comparability of the two versions. Moreover, education level is expected to influence outcome more than age. Methods and procedure Two groups of persons with aphasia (PwA), native speakers of Croatian and Norwegian (N Cro = 114; N Nor = 85), were included, as well as two groups of healthy controls (HS: N Cro = 123; N Nor = 84). Data was collected during the norming process of CAT-HR and CAT-N. We compared the performance of HS and PwA on 20 subtests across six language modalities, using nonparametric tests for independent samples. Psychometric properties were assessed through item difficulty and alpha reliability coefficients. The influence of socio-demographic variables on performance was examined using ANOVA. Outcomes and results Between-group differences were obtained on six subtests and two modalities, with the Norwegian PwA achieving higher scores on all but one subtest. All HS scored almost at ceiling, but differences were found on twelve subtests; Norwegian HS achieved higher scores on nine. Items in CAT-N have lower overall item difficulty, but alpha reliability coefficients are comparable across subtests. In the Croatian sample, mainly education level influenced performance. In the Norwegian sample, this was observed to a much lesser extent. Conclusion Between-group differences can be explained by differences in language structure, reflected also in the item difficulty. On the other hand, reliability of CAT-HR and CAT-N is high and comparable. Implications are discussed in the context of the test adaptation process.

Apraxia of speech (AOS) is a motor speech disorder impairing the coordination of complex articulatory movements needed to produce speech. AOS typically co-occurs with a non-fluent aphasia, or language disorder, making it challenging to determine the specific brain structures that cause AOS. Cases of pure AOS without aphasia are rare but offer the best window into the neural correlates that support articulatory planning. The goal of the current study was to explore patterns of apraxic speech errors and their underlying neural correlates in a case of pure AOS. A 67-year-old right-handed man presented with severe AOS resulting from a fronto-insular lesion caused by an ischemic stroke. The participant's speech and language were evaluated at 1-, 3- and 12-months post-onset. High resolution structural MRI, including diffusion weighted imaging, was acquired at 12 months post-onset. At the first assessment, the participant made minor errors on the Comprehensive Aphasia Test, demonstrating mild deficits in writing, auditory comprehension, and repetition. By the second assessment, he no longer had aphasia. On the Motor Speech Evaluation, the severity of his AOS was initially rated as 5 (out of 7) and improved to a score of 4 by the second visit, likely due to training by his SLP at the time to slow his speech. Structural MRI data showed a fronto-insular lesion encompassing the superior precentral gyrus of the insula and portions of the inferior and middle frontal gyri and precentral gyrus. Tractography derived from diffusion MRI showed partial damage to the frontal aslant tract and arcuate fasciculus along the white matter projections to the insula. This pure case of severe AOS without aphasia affords a unique window into the behavioral and neural mechanisms of this motor speech disorder. The current findings support previous observations that AOS and aphasia are dissociable and confirm a role for the precentral gyrus of the insula and BA44, as well as underlying white matter in supporting the coordination of complex articulatory movements. Additionally, other regions including the precentral gyrus, Broca's area, and Area 55b are discussed regarding their potential role in successful speech production.

ABSTRACT Background Ivanova and Hallowell 2013 emphasise the importance of reporting on test development and psychometric properties of tests in international journals. Such documentation may serve as references for other test developers and enable researchers and clinicians to assess reliability and validity issues in tests made for a language unknown to them. The CAT (Comprehensive Aphasia Test) is a general aphasia test which examines linguistic skills broadly, within the cognitive neuropsychological tradition; it has been and is being adapted to a number of languages. Aims The aim of this article is to document the statistical procedures used in the development and standardisation of the Norwegian adaptation of the CAT (CAT-N), to document its psychometric properties, and to discuss validity and reliability issues. Methods & procedures The adaptation of the CAT-N involved careful design of subtests and test items, taking into account features like word frequency, imageability and phonological and other language-specific linguistic variables. The prototype was tested on a normative sample of 85 persons with aphasia and a control group of 84 persons without aphasia. The items of some subtests were reordered based on the norming. A new scoring scheme was developed for two subtests of Picture description. The CAT-N includes the Aphasia Impact Questionnaire (AIQ), which is a new patient reported outcome measure developed for the CAT. Outcomes & Results Statistical methods are documented and discussed. Descriptive statistics for subtests and linguistic domains are presented. Internal consistency and partial inter-rater and intra-rater reliability aspects are investigated and documented. Construct validity is investigated and documented by factor analysis. Sensitivity and specificity are investigated through pairwise comparisons for subtests and domains and the use of normal-language cutoff values. Concurrent validity is investigated through comparisons with results from an existing aphasia test for Norwegian (NBAA). Conclusions The CAT-N is shown to have good reliability and validity, and it distinguishes well between persons with and without aphasia. The article provides explicit documentation of design decisions which may be useful in future adaptations of the CAT.

Defining aphasia: Content analysis of six aphasia diagnostic batteries

Individuals produce discourse for various purposes as part of their daily functioning. Therefore, the ability to form a discourse should be one of the main goals of functional speech-language therapy for persons with aphasia (PwA). In addition to assessing the language skills required to form a discourse, it is important to analyse how PwA form general ideas that need to be narrated. This study had two specific aims: (1) to investigate the ability of PwA, with special consideration to the stage of their recovery—the acute and the chronic phase—to form main concepts in a discourse, and (2) to examine the relationship between the number of main concepts and different types of language measures related to productivity, informativeness, and grammaticality in all tested groups. Participants included a total of 38 persons with mild and moderate aphasia (19 in the acute and 19 in the chronic phase of recovery) and 38 healthy speakers (HS) who were matched in age, gender, and level of education. In order to effectively compare the discourse produced by the groups, a single structured stimulus was used, whereby all participants were asked to orally describe a picture from the Croatian version of the Comprehensive Aphasia Test. Compared to the HS, the main concepts produced by PwA were different in number, as well as in terms of their accuracy and completeness. However, when analysing the success in the production of the main concepts with regard to the time post-stroke—acute and chronic—the difference was not confirmed, indicating great individual differences between PwA that undermine the differences on a group level. Linguistic measures of informativeness (CIUs and CIU/words) and only one measure of grammaticality (number of clauses) showed a significant correlation with the number of main concepts in PwA. When analysing correlations for PwA in the acute and chronic phases, only CIU showed a significant association with MC, confirming it as a robust measure of discourse production in PwA. PwA did not produce long and complex sentences, and they showed difficulties in the use of verbs and the marking of argument structures.

The main goal of the present study is to investigate visual and verbal short-term memory side to side with sentence comprehension in Catalan-speaking subjects with aphasia in comparison with subjects without brain damage. We aim to examine whether there are any significant correlations between their performance on short-term memory and comprehension tasks in order to evaluate the hypothesis that linguistic and memory deficits in aphasia are the result of a dysfunction of a common mechanism, usually short-term memory. Eigthy-four control subjects and twelve individuals suffering from different types of aphasia were assessed using the Catalan version of the Comprehensive Aphasia Test (CAT-CAT), which includes one recognition task and two digit and word span tests to evaluate visual and verbal short-term memory, respectively, as well as a sentence-to-picture comprehension task. The results showed that the performance of subjects with aphasia was significantly low on all tasks. Yet, the logistic regression analysis revealed that the magnitude of the differences between the control and experimental group varied across subtests, and that visual short-term memory was better preserved than verbal memory. The results also showed that there were no significant correlations between memory and language comprehension, which rules out the hypothesis that the deficits observed are due to a common underlying mechanism. Individual variation was also observed, specially on memory subtests, which suggest that memory impairments cannot explain the comprehension deficit in aphasia.