Non-aphasic Stroke Patients Research Articles

Assessing naming ability in elders without stroke and non-aphasic stroke patients with confrontational and category naming to detect anomia

Assessing naming ability in elders without stroke and non-aphasic stroke patients with confrontational and category naming to detect anomia

Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion.

The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient's performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman's partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests' corrected scores. Of the 37 patients enrolled in this study, 29.7% made 3-11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = -0.408, p = 0.013; r = -0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = -0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = -0.468, p = 0.007; r = -0.499, p = 0.003). The orientation also correlated with the TT part III (r = -0.504, p = 0.002). Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory-verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.

The Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in non-aphasic hemispheric stroke patients

IntroductionCASP specifically assesses post-stroke cognitive impairments. Its items are visual and as such can be administered to patients with severe expressive aphasia. We have previously shown that the CASP was more suitable than the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in aphasic patients. Our objective was to compare the above scales in non-aphasic stroke patients, and assess to what extent the solely visual items of the CASP were problematic in cases of neurovisual impairments. MethodsFifty non-aphasic patients admitted to Physical Medicine and Rehabilitation (PM&R) units after a recent left- or right-hemisphere stroke were evaluated with the CASP, MMSE and MoCA. We compared these three scales in terms of feasibility, concordance, and influence of neurovisual impairments on the total score. ResultsTwenty-nine men and 21 women were included (mean age 63±14). For three patients, the MoCa was impossible to administer. It took significantly less time to administer the CASP (10±5min) than the MoCA (11±5min, P=0.02), yet it still took more time than MMSE administration (7±3min, P<10−6). Neurovisual impairments affected equally the total scores of the three tests. Concordance between these scores was poor and only the CASP could specifically assess unilateral spatial neglect. ConclusionThe sole visual format of the CASP scale seems suitable for administration in post-stroke patients.

Effect of Duration, Participation Rate, and Supervision During Community Rehabilitation on Functional Outcomes in the First Poststroke Year in Singapore

Koh GCHK, Saxena SK, Ng TP, Yong D, Fong NP. Effect of duration, participation rate, and supervision during community rehabilitation on functional outcomes in the first poststroke year in Singapore. ObjectiveTo examine the effect of duration, participation rate, and supervision during community rehabilitation on functional outcome during the first poststroke year. DesignProspective longitudinal study with interviews at admission, discharge, 1 month, 6 months, and 1 year after discharge. SettingTwo subacute inpatient rehabilitation units and the community after discharge in Singapore. ParticipantsSubacute nonaphasic stroke patients (N=215). InterventionParticipation rate in supervised therapy (at an outpatient rehabilitation center) and unsupervised therapy (at home) as defined as proportion of time performing therapy as prescribed by the subacute hospital's multidisciplinary rehabilitation team at discharge. Main Outcome MeasurePerformance of activities of daily living as measured by Barthel Index (BI) score at 1 year and improvement in BI scores between adjacent timepoints. ResultsAt 1 month after discharge, 33.3% were performing supervised therapy more than 25% of the recommended time, and 66.3% of subjects were performing unsupervised therapy more than 75% of the recommended time. On a mixed-model analysis, the independent predictors of lower BI scores were older age, hypertension, greater cognitive impairment, greater depressive symptoms, and greater neurologic impairment. Adjusting for these independent factors, performance of supervised therapy at 1 (β=8.8; 95% confidence interval [CI], 0.5–17.0; P=.039) and 6 (β=20.1; 95% CI, 11.0–29.2; P<.001) months postdischarge, but not unsupervised therapy, predicted better BI score at 1 year. Those who performed supervised therapy more than 25% of the recommended time achieved their maximal functional recovery faster than those who performed supervised therapy 25% or less of the recommended time (1mo vs 6mo). ConclusionsSupervised stroke rehabilitation in the community at 1 and 6 months was associated with better functional status at 1 year than unsupervised therapy, and a higher participation rate in supervised therapy was associated with greater and faster functional recovery.

Verbal and nonverbal memory impairment in aphasia

Repetition is frequently impaired in aphasia, most strikingly in conduction aphasia. The still not fully answered question is whether this relates to a linguistic deficit or to a general impairment of working memory extending to other modalities as well. To contribute to this problem, we assessed 49 aphasic and 50 non-aphasic stroke patients using an aphasia test plus three memory tests in forward and backward fashion, taxing verbal, numerical, spatial, and facial retention. The results show that in aphasics there is a memory gradient declining gradually from verbal to nonverbal content reflecting aphasia severity and that aphasics generally perform worse than non-aphasics, even if they present with similar cerebral lesions.

Differentiating between Aphasic and Nonaphasic Stroke Patients Using Semantic Verbal Fluency Measures with Administration Time of 30 Seconds

Administration time of 1 min for semantic verbal fluency measures can be overly long and therefore bothersome for aphasic patients because they can often retrieve only a few items after a certain period of time. The purpose of this study was to determine whether an administration time of 30 s would be more efficient in differentiating among aphasics, nonaphasic stroke patients, and normal controls. The subjects were 53 stroke patients and 28 normal controls. They had to generate as many animal names as they could within a given time. The number of animal names is gradually diminished in three groups (p < 0.001) in each time frame, that is, during the entire 60 s, the initial 30 s, and the following 30 s. The reaction time (RT) measure indicated that the RT of the aphasic patients was significantly increased compared to those of the other two groups (p < 0.001). The most optimal cutoff scores that differentiated each group are presented. These results suggest that an administration time of 30 s has discriminative validity to differentiate between the two patient groups. This shorter administration time could make the test more efficient by reducing the burden on both examiners and aphasic patients.

Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada

Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Objectives To determine the incidence rate of inpatient stroke-induced aphasia in Ontario, Canada, and to examine the demographic and clinical characteristics for stroke patients with and without aphasia. Design Age- and sex-specific incidence rates for aphasia in Ontario were calculated using the Ontario Stroke Audit. In addition, data collected from the Registry of the Canadian Stroke Network (RCSN) were used to determine the demographic and clinical characteristics for stroke patients with and without aphasia. Setting All hospitals and regional stroke centers in Ontario, Canada. Participants The Ontario Stroke Audit is a representative weighted sample of more than 3000 stroke inpatients admitted to emergency departments in all hospitals in Ontario within the 2004/2005 fiscal year. RCSN data included a cohort of more than 15,000 consecutive patients presenting with stroke at 12 regional stroke centers in Ontario from 2003 to 2007. Interventions Not applicable. Main Outcome Measures Presence of aphasic symptoms on admission to hospital and at discharge, age and sex, stroke type and severity, severity of disability, services received in hospital, length of stay, and discharge destination. Results Thirty-five percent (1131/3207) of adult patients admitted with a diagnosis of stroke in the province of Ontario during the 2004 to 2005 Ontario Stroke Audit had symptoms of aphasia at the time of discharge. This amounts to an incidence rate of 60 per 100,000 persons per year. Risk of aphasia increased significantly with age. In comparison with nonaphasic stroke patients, patients with aphasia were older, presented with more severe strokes on admission, had more severe disability, and were more frequently discharged to long-term care and/or rehabilitation (unadjusted results). Adjusting for stroke severity, age, sex, comorbidity, and stroke subtype, the presence of aphasia was found to be an independent predictor of longer hospital stays, increased use of rehabilitation services, and higher rates of thrombolytic therapy. Conclusions A significant number of people with stroke experience aphasia, with advancing age associated with a higher risk. The profile and patterns for stroke patients with aphasia differed significantly from those who did not experience aphasia as a residual disability after stroke, particularly in relation to service usage. Given the personal and system cost associated with aphasia, best practices in the area of stroke should include recommendations on how to best serve this population throughout the clinical pathway.

Voice recognition in aphasic and non-aphasic stroke patients

Voice recognition in aphasic and non-aphasic stroke patients

Deficit of Episodic Memory: Anatomy and Related Patterns in Stroke Patients

Background/Aims: Despite numerous studies performed in selected populations, major uncertainties regarding the anatomy and patterns of episodic memory deficit still persist. Such objectives require the analysis of consecutive unselected patients with well-delimitated lesions and the use of specific methodology. Methods: Nonaphasic stroke patients (n = 73) referred for cognitive complaints or deficits were examined using a standardized neuropsychological battery. Verbal episodic memory was assessed by the Grober and Buschke test. Results: Episodic memory deficit was related to lesions of medial temporal, thalamic, frontal, lenticular, and centrum semiovale regions, with a left hemisphere predominance. Although not specific, an immediate recall deficit was frequently observed in thalamic lesions (OR: 5.2, 95% CI: 1.09–24.9). False recognitions (OR: 25.7, 95% CI: 2.7–249) and efficiency of cued recall (OR: 8.6, 95% CI: 1.3–57) were highly specific of frontal damage. When combined with the usual ‘frontal lobe’ tests, this pattern of memory disorder was an independent predictor (OR: 36, 95% CI: 4.3–302) and increased the sensitivity of diagnosis of frontal damage (sensitivity: 0.92, specificity: 0.89). Conclusions: This study extends the classical anatomy of episodic verbal memory. In addition, the ‘frontal memory pattern’ was found to be relatively specific and to be an independent predictor of frontal damage.

Voice recognition in aphasic and non-aphasic stroke patients

Whereas denotative recognition of meaning via spoken language is undoubtedly a function of the dominant hemisphere, there are hints as to the superiority of the non-dominant hemisphere in detecting the author of a language message, at least if it is written (Heckmann et al. 2001). This study was undertaken to show if similar notions hold true for oral language. 20 patients (5 female, 15 male) with left (LH; N=11, mean age 66.3±7.7 years) or right (RH; N=9, mean age 64.1±11.1 years) hemisphere ischemic strokes (mean time post-onset 2.4±2.8 months) were compared on a task which required them to identify one familiar person (partner) out of six by listening to recordings of vowels, consonant-vowel combinations, words, and sentences. All LH patients were aphasic, all RH were not. The lesions were distributed symmetrically. All patients were right-handed and spoke German as their mother language. Patients with bilateral lesions, multiple infarcts, dementia, apparent attentional problems, depression or amnesia were not included. In addition, 17 healthy controls (HC) were assessed (mean age 64.1±5.2 years).

Epidemiology of Aphasia Attributable to First Ischemic Stroke

In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). A 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information. Among 188,015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100,000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients' age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset-assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96). Annually, 43 of 100,000 inhabitants had aphasia resulting from first ischemic stroke. Advancing age and cardioembolism were associated with an increased risk for aphasia. Severity and fluency of aphasia were not affected by demographic variables.

Post-Stroke depression and pathological crying: Clinical aspects and new pharmacological approaches

Despite it having been firmly established that depression and pathological crying are common and debilitating sequelae of stroke, one of the major unmet needs of stroke patients is still for these conditions to be recognized and treated. About 40% of stroke survivors become depressed the first year following stroke, with most cases developing within the early stroke period. Half of initially depressed patients will recover spontaneously within the first months, whereas the remainder are likely to develop chronic depression. As a consequence their quality of life suffers, greater stress is placed on the family and social activity decreases. While less is known of depression in aphasic patients, because of the lack of reliable assessment methods, the frequency is probably the same as in non-aphasic stroke patients. The aetiology of post-stroke depression seems to involve mainly organic but also non-organic factors, although no single factor has been identified which is able to explain the majority of cases. Pathological crying is extremely socially embarrassing for stroke patients. The frequency is lower than that of depression, the 1-year incidence being about 20%. In contrast to depression most cases occur in the very acute stroke period and 10% are still afflicted 1 year after stroke. There is now increasing evidence that post-stroke pathological crying is attributable to stroke-induced partial destruction of the serotoninergic raphe nuclei in the brainstem or their ascending projections to the hemispheres. Although the condition is classically described as being unrelated to depression, stroke patients with pathological crying have higher mood scores on quantitative measures, and are more likely to have depression than are other stroke patients. The need for active treatment of pathological crying is therefore two-fold. With both conditions effective and well tolerated treatment is provided by the selective serotonin re-uptake inhibitor, citalopram, side-effects if any being sparse, mild and transient.

Disfluent speech associated with brain damage

The frequency and type of disfluencies in the spontaneous speech of 15 people with Broca's aphasia and right hemiplegia was studied. Two aged-matched control groups (15 nonaphasic stroke patients with left hemiplegia and 15 normals) were also studied. The frequency of disfluencies in the speech of aphasics was three times greater than that in the speech of either control group. However, most of the disfluencies uttered by aphasics were of the types commonly found in speech of normals.