Multilingual Aphasia Examination Research Articles

Abstract PO2-19-01: A Single-Arm Prospective Study of the Neurocognitive Changes Occurring in Breast Cancer Patients on Aromatase Inhibitors. Is There a Difference Between Objective and Perceived Neurocognition?

Abstract Background: Estrogen (ER) and Progesterone (PR) receptors are rich in regions of the brain involved in cognitive functions, like the hippocampus and cerebral cortex. Animal models have shown that estradiol regulates neurocognition and plays an important role in the normal brain development. Hormone positive (HR+) breast cancers (BC) comprise 70% of the disease and the standard of care in the post-menopausal group is the use of Aromatase Inhibitors (AI) for at least 5 years. While “chemo brain” is a well-recognized term, neurocognitive changes from estrogen inhibition by AI have not been clearly defined. As neurocognition is multi-faceted, information on specific aspects affected by AI use is unclear. We hope to answer this through our trial. Design: The study is a single arm, self-controlled prospective observational cohort study in which, post-menopausal BC patients who are to be started on AIs will undergo a battery of neurocognitive tests just before starting AI, at 6 months and at 12 months after being on AI. The changes at 6 and 12 months will be compared to baseline. The tests will involve objective [Hopkins verbal learning test revised (HVLT), Controlled Oral Word Association Test from Multilingual Aphasia Examination, Trial Making Test A and B, and Recall and Recognition of Word List encoded from the HVLT] and subjective/patient-reported [The Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog)] components. Tests for anxiety [Generalized Anxiety Disorder (GAD)–7], depression [Patient Health Questionnaire (PHQ)-9] and working memory (Working Memory Tasks from the Wechsler Adult Intelligence Scale) will also be assessed. While the objective tests involve providing patients with specific instructions and asking them to complete the tasks, the FACT Cog questionnaire uses a self-reported 37-item questionnaire enabling assessment of their perceived symptoms. The tests have been summarized in the table. Eligibility criteria: ER/PR+ post-menopausal BC and DCIS patients who are English speaking and are planning to start AIs will be included. Patients who have received hormonal therapy or chemotherapy in the past, those who are scheduled to receive chemotherapy, those who have undergone Whole brain Radiation therapy (RT), those with a premenopausal status, and those having comorbid conditions that could affect cognitive functioning (like any form of dementia or brain metastasis) will be excluded. Specific aims: Our aim is to see if there are progressive neurocognitive changes compared to an age-appropriate baseline and to see if changes to both objective and perceived cognitive changes occur over the course of AI use, in post-menopausal HR+ BC patients. Statistical methods: The T-test and McNemer test will be used. The normal values provided from the test may be used as a standard to justify normal or abnormal values from the collected data. Therefore, a percentage of normal (or abnormal) subjects in each time point can be derived and compared using the McNemar's test. Present accrual and target accrual: 4 patients have been accrued as of June 2023 with a target accrual of 80 patients [80% power to detect a significant change, at a p of 0.05]. Contact information for people with a specific interest in the trial: Dr Abirami Sivapiragasam (abisiva2019@yahoo.com), Dr Sam Benjamin (benjamis@upstate.edu), Dr Prashanth Ashok Kumar (ashokkup@upstate.edu), Amy Bubb (bubbam@upstate.edu). Summary of the neurocognitive tests employed in the trial. Citation Format: Prashanth Ashok Kumar, Erinn McDowell, Amy Bubb, Danning Huang, Susan Sperry, Sam Benjamin, Abirami Sivapiragasam. A Single-Arm Prospective Study of the Neurocognitive Changes Occurring in Breast Cancer Patients on Aromatase Inhibitors. Is There a Difference Between Objective and Perceived Neurocognition? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-19-01.

A-196 BVRT Copy and Memory Trial Omission Errors Are Associated With Working Memory and Auditory Comprehension Deficits

Abstract Objective The goal of this study is to examine the cognitive factors that account for omission errors on the Benton Visual Retention Test (BVRT) copy and memory trials using factorial indices based on raw subtest scores of the Wechsler Adult Intelligence Scale-III (WAIS-III) and the Multilingual Aphasia Examination (MAE). Method Participants were referred for assessment at the VA Palo Alto Health Care System. One hundred and forty-three participants were sampled. BVRT omission error scores for the copy and memory trials were factor analyzed with age, education level, WAIS-III Digit Span Forward (DSpF), and Letter-Number Sequencing (LNS). These variables were refactored with the spoken language components of the MAE (naming, repetition, verbal fluency, and auditory comprehension). Results BVRT copy and memory omission scores were factorially grouped with age and inversely correlated with LNS. A second factor was composed of positive loadings on DSpF, LNS, and education. The BVRT Copy-and-Memory-Omissions-Age-LNS component was inversely and specifically related to the MAE measure of auditory comprehension. The Digit Span Forward-LNS-Education variable loaded strongly on the MAE Repetition component and secondarily on the MAE Verbal Fluency and Naming components. Conclusions BVRT copy and memory trial omission errors are strongly and specifically related to failure of auditory comprehension. Errors of this type are not related to the other three components of spoken language.

A-176 Primary Components of Spoken Language are Specifically Associated with Dimensional Components of Intelligence

Abstract Objective We compared the factorial dimensional structure of the four components of spoken language from the Multilingual Aphasia Examination (MAE) with the factorial dimensions of the WAIS-III to test the hypothesis that these intellectual and linguistic components are systematically related. Method Factorial components of spoken language from MAE subtest measures of visual naming (VN), verbal fluency (VF), sentence repetition (SR), and auditory comprehension (AC) were factor analyzed with the factorial components of the WAIS-III index score measures. The sample consisted of 107 neuropsychiatric patients who were administered the WAIS-III and the MAE as clinical procedures. There were no exclusion criteria. Results Specific, independent, robust relationships were demonstrated between each of the four components of spoken language and each of the four factorial components of the WAIS-III. The factorial model explained 70.42% of the total variance among the component measures. VN loaded uniquely with the Verbal Comprehension component. SR loaded uniquely with the Working Memory component. VF loaded uniquely with the Processing Speed component. AC loaded uniquely with the Percentual Organization component. Conclusions The four components of spoken language each provide a unique component of verbal mediation for each of the verbal and nonverbal modular components of the WAIS-III cognitive dimensions. These findings suggest that systematic evaluation of spoken language abilities would complement the assessment of intellectual abilities in both clinical and empirical examinations.

A-65 Verbal Abilities May Influence Performance in Assessment of Verbal Short-Term Memory Tasks

Abstract Objective Examine whether verbal abilities may help explain the learning strategies people employ when completing a short-term verbal memory task. Methods The assessment records of 296 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Benton Serial Digit Learning Test – 9 Digits (SDL-9) and Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-9 was co-factored with the verbal components of the MAE to identify common sources of variance. Results A three-factor solution of the SDL-9 separated trials into three overlapping factors consisting of early (SDL-9_Early), middle (SDL-9_Middle), and late (SDL-9_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a four-factor model explaining 67.85% of the shared variance: 1) SenRep loaded with SDL-9_Early, 2) COWAT loaded with SDL-9_Middle and SDL-9_Late, 3) Token loaded with SDL-9_Late, and 4) Vis Nam loaded with SDL-9_Late. Conclusions The results suggest that individuals may engage verbal abilities differently as they progress from simpler to more difficult verbal short-term memory tasks. It appears performance in early trials is mostly associated with rote repetition and performance on middle trials is mostly associated with verbal fluency, while performance on the late trials is associated with a combination of verbal fluency, auditory comprehension, and conceptual organization/naming. This may therefore indicate a shift in learning strategy to meet increased cognitive demands.

A-52 An Exploratory Factor Analysis Investigation of the Role of Verbal Mediation in the Interaction between Intelligence and Visual Memory Tasks

Abstract Objective Examine whether verbal mediation may play a role in the interaction between visual memory tasks and the four-factor model of intelligence as operationalized by standard neuropsychological assessment instruments. Method The assessment records of 101 American Veterans with diverse neuropsychiatric conditions were examined using Exploratory Factor and Principal Component Analyses (EFA and PCA respectively). There were no exclusion criteria. All participants completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Benton’s Visual Retention Test (BVRT), and Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using PCA. The factor solution of the BVRT was co-factored with the scales of the WAIS-III, then the resulting factor scales were again factored with the verbal components of the MAE to identify common sources of variance. Results A three-step analysis revealed a four-factor model explaining 69.44% of the shared variance: 1) Items 1-4 of the BVRT (BVRT-E) loaded with Verbal Comprehension and Visual Naming. 2) BVRT-E also loaded with Processing Speed and Controlled Word Association. 3) Items 5-10 of the BVRT (BVRT-L) loaded with Perceptual Organization and the Token Test. 4) Working Memory loaded with Sentence Repetition on a fourth factor. Conclusions The results indicate a strong relationship between assessed performance on visual memory tasks and performance on measures based on the four-factor model of intelligence. The results also appear to support the idea that verbal mediation plays a role in the interaction between visual memory and intelligence, particularly when comparing performance on simple versus more complex visual memory tasks.

A-49 Visual Memory Errors and Intelligence: The Role of Verbal Mediation

Abstract Objective Examine the relationship of verbal mediation with visual memory errors and intelligence to understand the role of spoken language on other assessment measures. Method Assessment records were obtained from a Veteran Affairs clinic for veterans (n=100) with diverse neuropsychiatric conditions who completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Multilingual Aphasia Examination (MAE), and Benton Visual Retention Test (BVRT). A Principal Component Analysis (PCA) was used to examine the interrelationship among these assessments. The components of spoken language, types of errors on the BVRT, and the four factors of the WAIS-III were factored using the PCA to identify common sources of variance. Results A principal component analysis revealed a six-factor model explaining 68.16% of the shared variance among the WAIS-III factors, MAE components, and BVRT Errors. Omission errors loaded with Processing Speed and Controlled Word Association. Distortions and size errors loaded with Perceptual Organization. Size errors also loaded with Verbal Comprehension and Visual Naming. Misplacements loaded with Working Memory and Sentence Repetition. Misplacements, perseverations, and omissions loaded with the Token Test (a measure associated with auditory comprehension). Rotation errors loaded with Perceptual Organization. Conclusions Results indicated significant shared variance between visual memory errors, spoken language, and intelligence factors. This suggests that spoken language is involved in the process of visual memory, and deficits in spoken language may result in increased errors on visual memory tasks. Therefore, treatment recommendations for visual memory difficulties should take into consideration verbal capabilities and intelligence factors to better individualize treatment.

A-53 Exploring the Relationship between Spoken Language and Verbal Short-term Memory Assessment Tasks

Abstract Objective Examine whether performance on spoken language assessment measures may be associated with performance at different phases of verbal learning and recall tasks. Method The assessment records of 222 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE), and Benton Serial Digit Learning Test – 8 Digits (SDL8). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-8 was co-factored with the spoken language components of the MAE to identify common sources of variance. Results A three-factor solution of the SDL8 separated trials into three overlapping factors consisting of early (SDL8_Early), middle (SDL8_Middle), and late (SDL8_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a five-factor model explaining 84.563% of the shared variance: 1) SDL8_Early loaded with SenRep, 2) SDL8_Middle loaded with SenRep, 3) SDL8_Late loaded with Token, 4) SDL8_Late loaded with COWA, and 5) VisNam alone formed the fifth factor. Conclusions The results suggest that rote repetition is largely associated with early trials and slightly associated with middle trials, while late trials are largely associated with auditory comprehension and slightly associated with verbal fluency. This may be indicative of a shift in use of spoken language abilities to accommodate increasing levels of complexity in presented verbal short-term memory tasks and thus reflective of a change on learning strategy to optimize performance.

Examination of the Construct Validity of the Repeatable Battery for the Assessment of Neuropsychological Status Language Index in a Mixed Neurological Sample.

We sought to examine the construct validity of the Language Index of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Archival neuropsychological data were collected for 2,057 individuals of diverse neurological etiologies. Correlations were seen between the RBANS Language Index and its indices (Semantic Fluency r = .727; Picture Naming r = .786), between Semantic Fluency and both Category Fluency (r = .379) and the Controlled Oral Word Association test (r = .375), and between Picture Naming and both Visual Naming from the Multilingual Aphasia Examination (r = .447) and the Boston Naming Test (r = .519). Finally, Picture Naming predicted performance on both Visual Naming [F(1,495) = 123.36, p < .000] and the Boston Naming Test [F(1,262) = 96.28, p < .000]. Given these results, support for the interpretation of RBANS Language Index appears warranted in a diverse clinical sample.

Flavonol Intake and Cognitive Decline in Middle-Aged Adults.

Cognitive decline occurs with age and may be slowed by dietary measures, including increased intake of dietary phytochemicals. However, evidence from large and long-term studies of flavonol intake is limited. Dietary intakes of flavonols were assessed from a large biracial study of 10,041 subjects, aged 45-64, by analysis of a food frequency questionnaire administered at visit 1 of triennial visits. Cognitive function was assessed at visits 2 and 4 with the following three cognitive performance tests: the delayed word recall test, the revised Wechsler Adult Intelligence Scale digit symbol subtest, and the word fluency test of the Multilingual Aphasia Examination. The change in each score over 6 years was calculated, and a combined standardized change score was calculated. Generalized linear models controlled for age, ethnicity, gender, education level, energy intake, current smoking, physical activity, body mass index, diabetes, and vitamin C intake. Total flavonols across quintiles of intake were positively associated with preserved combined cognitive function (P<.001). This pattern with preserved combined cognitive function was consistent for the three major individual flavonols in the diet, myricetin, kaempferol, and quercetin (each P<.001). The positive association with total flavonols was strongest for the digit symbol subtest (P<.001). In this cohort, flavonol intake was correlated with protected cognitive function over time.

Cognitive Dysfunctions Associated With PTSD: Evidence from World War II Prisoners of War

The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.

Differential neuropsychological test sensitivity to left temporal lobe epilepsy

We examined the sensitivity of the Rey Auditory Verbal Learning Test (AVLT), California Verbal Learning Test (CVLT), Boston Naming Test (BNT), and Multilingual Aphasia Examination Visual Naming subtest (MAE VN) to lateralized temporal lobe epilepsy (TLE) in patients who subsequently underwent anterior temporal lobectomy. For the AVLT (n = 189), left TLE patients performed more poorly than their right TLE counterparts [left TLE = 42.9 (10.6), right TLE = 47.7 (9.9); p < .002 (Cohen's d = .47)]. Although statistically significant, the CVLT group difference (n = 212) was of a smaller magnitude [left LTE = 40.7 (11.1), right TLE = 43.8 (9.9); (p < .03, Cohen's d = .29)] than the AVLT. Group differences were also present for both measures of confrontation naming ability [BNT: left LTE = 43.1 (8.9), right TLE = 48.1 (8.9); p < .001 (Cohen's d = .56); MAE VN: left TLE = 42.2, right TLE = 45.6, p = .02 (Cohen's d = .36)]. When these data were modeled in independent logistic regression analyses, the AVLT and BNT both significantly predicted side of seizure focus, although the positive likelihood ratios were modest. In the subset of 108 patients receiving both BNT and AVLT, the AVLT was the only significant predictor of seizure laterality, suggesting individual patient variability regarding whether naming or memory testing may be more sensitive to lateralized TLE.

The temporal stability of cluster and switch scores using a modified COWAT procedure

This study examined the impact of instructional changes on the temporal stability of cluster and switch scores for the Controlled Oral Word Association Test [COWAT; Benton, A. L., Hamsher, K., & Sivan, A. B. (1994). Multilingual Aphasia Examination (3rd ed.). Iowa City, IA: AJA Associates]. Healthy undergraduates were assigned randomly into experimental ( N = 60) and control ( N = 60) groups. Experimental group participants were administered three letters as customary, then informed about clustering strategies prior to completing three additional letters. Control group participants received the original instructions only for all six letters. All participants were examined on two separate occasions. The mean inter-assessment interval was 38.6 days (ranging from 29 to 47 days). Stability coefficients for cluster and switch scores on the last set of letters differed significantly between groups, as higher coefficients were observed for the experimental group. In contrast, stability coefficients for the total words produced and mean cluster size did not differ between groups. Although the temporal stability improved, the resulting coefficients were modest (e.g., r icc = .76 for clusters; r icc = .79 for switches). We present implications of these findings and considerations for future research.

Neuropsychological executive functions of adolescent sex offenders and nonsex offenders.

A growing body of research now suggests that a substantial number of criminal offenders display neuropsychological deficits, especially frontal-executive dysfunctions. The present study investigated the possibility of similar deficits by comparing the performance of 60 adolescent sex offenders court-ordered to a residential treatment facility with the performance of 60 nonsexual delinquent offenders matched on several pertinent sociodemographic characteristics and scores on four neuropsychological tests: (1) the Trail Making Test, (2) the Controlled Oral Word Association test of the Multilingual Aphasia Examination, (3) the Tower of London, and (4) the Wisconsin Card-sorting Test. Analysis indicated a pattern of frontal-executive dysfunction in a subset of both groups of offenders; this pattern has both theoretical and treatment implications.

Preoperative assessment of confrontation naming ability and interictal paraphasia production in unilateral temporal lobe epilepsy

The present study examined the diagnostic utility of confrontation naming tasks and phonemic paraphasia production in lateralizing the epileptogenic region in patients with temporal lobe epilepsy (TLE). Further, the role of intelligence in moderating the diagnostic utility of confrontation naming tasks was assessed. Eighty patients with medically intractable complex partial seizures (40 left TLE, 40 right TLE) received the Boston Naming Test (BNT) and the Visual Naming subtest (VNT) of the Multilingual Aphasia Examination. The BNT was diagnostically more sensitive than the VNT in identifying left TLE (77.5% vs 17.5%, respectively). The utility of BNT performance and paraphasias was maximal in patients with Full Scale IQs ⩾90 who were 6.8 times more likely to have left TLE than patients without paraphasias. Preoperative assessment of confrontation naming ability and phonemic paraphasia production using the BNT provided diagnostically useful information in lateralizing the epileptogenic region in left TLE.

The reliability of cluster and switch scores for the controlled oral word association test

This study examined the interrater reliability and temporal stability of a scoring system developed by Troyer, Moscovich, and Winocur [Neuropsychologia 11 (1997) 138] to measure clustering and switching on verbal fluency (VF) tasks such as the Controlled Oral Word Association Test (COWAT) [Benton, A.L., Hamsher, K., & Sivan, A.B. (1983). Multilingual aphasia examination (3rd ed.). Iowa City, IA: AJA Associates]. Seven independent raters scored COWAT protocols of 125 healthy participants in accordance with the rules proposed by Troyer et al. Intraclass coefficients were near perfect, ranging from.96 for total number of clusters to.99 for total number of switches. Test-retest reliability coefficients (n=55) were poor to modest (r=.47 for clusters, r=.58 for switches, and r=.70 for total words). Significant improvement in performance was observed across most COWAT indices, suggesting a practice effect. Modifications to test administration are suggested to improve the stability of cluster and switch scores, as well as other variables for further study.

Relation between cognitive function and mortality in middle-aged adults: the atherosclerosis risk in communities study.

An independent, inverse association between cognitive function and all-cause mortality has been reported in elderly cohorts. The purpose of this study was to determine whether the same association exists in middle-aged persons. The Atherosclerosis Risk in Communities Study is a cohort study initiated in 1987 to investigate the development of atherosclerosis in middle-aged persons. Three cognitive function measures were included in the second cohort examination conducted from 1990 to 1992 when the participants were aged 48-67 years: the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST) (a subtest from the Wechsler Adult Intelligence Scale-Revised), and the Word Fluency Test from the Multilingual Aphasia Examination. Cox proportional hazards modeling was used to determine whether all-cause mortality ascertained through 1997 was associated with each measure after adjustment for sociodemographic, biologic, psychologic, and behavioral risk factors. Without adjustment, there was a significantly lower mortality hazard associated with higher scores on all three measures. After covariate adjustment, the hazard ratios for the DWRT and the DSST remained significant (hazard ratio1-point DWRT score increment = 0.90, 95% confidence interval: 0.84, 0.97; hazard ratio 7-point DSST score increment = 0.86, 95% confidence interval: 0.80, 0.93). Cognitive function measured in middle age appears to have prognostic importance for life expectancy similar to that reported in elderly adults.

The reliability of cluster and switch scores for the Controlled Oral Word Association Test

This study examined the interrater reliability and temporal stability of a scoring system developed by Troyer, Moscovich, and Winocur [Neuropsychologia 11 (1997) 138] to measure clustering and switching on verbal fluency (VF) tasks such as the Controlled Oral Word Association Test (COWAT) [Benton, A.L., Hamsher, K., & Sivan, A.B. (1983). Multilingual aphasia examination (3rd ed.). Iowa City, IA: AJA Associates]. Seven independent raters scored COWAT protocols of 125 healthy participants in accordance with the rules proposed by Troyer et al. Intraclass coefficients were near perfect, ranging from .96 for total number of clusters to .99 for total number of switches. Test–retest reliability coefficients ( n=55) were poor to modest ( r=.47 for clusters, r=.58 for switches, and r=.70 for total words). Significant improvement in performance was observed across most COWAT indices, suggesting a practice effect. Modifications to test administration are suggested to improve the stability of cluster and switch scores, as well as other variables for further study.

Assessment of executive function in patients with mild traumatic brain injury.

The nature of functional deficit after mild traumatic brain injury (TBI) defined by Glasgow Coma Score of 13-15 is not fully described. This study explored the sensitivity of several neuropsychological tests to identify sequelae of mild traumatic brain injury (TBI). Eleven adult patients with mild TBI admitted to a Level 1 trauma center were studied. The battery of tests included the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Trails A and B, the Boston Naming Test, The Multilingual Aphasia Examination: Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Task. Control subjects performed significantly better than patients with mild TBI on Trails A and B, the Controlled Oral Word Association Test, and Paced Auditory Serial Addition Task (subtests 2-4). No significant differences in performances between patients and controls was found for the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Boston Naming Test, and Paced Auditory Serial Addition Task Subtest 1. The results suggest that tests of specific frontal lobe executive functions are valuable in diagnosing and monitoring recovery from mild TBI.

Naming decline after left anterior temporal lobectomy correlates with pathological status of resected hippocampus.

To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming. In a group of 99 patients undergoing lobectomy of the left, language-dominant anterior temporal lobe, we examined naming ability using two measures: the 60 item Boston Naming Test (BNT), and the Visual Naming (VN) subtest of the Multilingual Aphasia Examination (MAE). ATL entailed resection of lateral temporal lobe followed by microsurgical complete removal of hippocampus. Language mapping was not performed. The status of the resected hippocampus was graded on a scale 0-4 of hippocampal sclerosis (HS). A dichotomous grouping HS- (grades 0 and 1, n = 34) and HS+ (grades 3 and 4, n = 61) was effected. Age at surgery, age of epilepsy onset, sex, extent of lateral temporal resection, Full-Scale IQ (FSIQ), and preoperative naming scores were also examined as potential predictors of pre- versus postoperative naming change. Preoperative BNT and VN scores were significantly worse for HS+ than for HS- (BNT, p < 0.05; VN, p = 0.001). Postoperatively, BNT and VN scores significantly declined for HS- as compared with HS+ patients (p < 0.001). For individual risk, the 90th centile of reliable change index (RCI) was used. By this criterion, of the total sample, 39% evidenced decline on the BNT and 17% evidenced decline on the VN. Logistic regression analysis with backward elimination showed HS to be the only predictor of decline in BNT and HS and sex to be the only predictors of VN decline. Males were more at risk than females. Age, age at onset, extent of lateral resection, preoperative scores, and FSIQ were not predictors. Using age at onset as a proxy for HS+/HS- we calculated probabilities for naming decline for given onset age. Both preoperative and postoperative change in naming ability are associated with the pathological status of the hippocampus. The potential interpretations and implications of these findings are discussed.

Verbal Abilities in Healthy Elderly Adults

The Multilingual Aphasia Examination, a short battery of language measures, was administered to 61 healthy, community-dwelling adults (42 female, 19 male) 70 to 90 years old, and their performances were compared with the norms for younger participants. The intent was to investigate the decline of verbal abilities with advancing age and to consider the implications of such a decline for the interpretation of the performances of other elderly individuals. A significant age-related decline in performance was found on only one (Sentence Repetition) of the nine tests. Of note, Sentence Repetition is also the only test that makes specific demands on both short-term memory and serial auditory information processing. The relative stability of verbal performances from the early adult years to the ninth decade suggests that the occurrence of defective performances in older individuals is more likely to reflect the presence of "age-associated" disease rather than "normal" aging. Further, the findings suggest that normative standards derived from the performances of unselected, representative samples of elderly adults may not be adequate bases for clinical interpretation.