Severe Aphasia Research Articles

The Relationship Between Memory, Type, and Severity of Aphasia With Confrontation Naming in Post-stroke Patients With Chronic Aphasia

Objectives: The brain’s widespread neural functions lead to aphasia in which the patients experience difficulties in cognitive and language functions. Memory, type, and severity of aphasia are associated with language and the naming process. In the current study, we investigated the relationship between memory, type, and severity of aphasia using the confrontation naming test in post-stroke patients with chronic aphasia. Methods: This research was a descriptive-analytic cross-sectional study. We selected 45 chronic aphasia patients aged 35-70 years. The participants with a mild to moderate score in Mini-Mental State Examination (MMSE) were assessed with the Persian naming test, Wechsler Memory Scale, and Persian Western Aphasia Battery. Results: There was a significant difference between memory with correct answers without a cue, correct answers with a semantic cue, and the total correct answers from confrontation naming (P<0.001, r=0.62; P=0.01, r=0.37; and P<0.001, r=0.71; respectively). Furthermore, the results indicated a significant difference between the type of aphasia with subtests of confrontation naming involving correct answers with semantic cues and total correct answers (P=0.02). Also, the results showed a significant difference between the severity of aphasia with correct answers without a cue, correct answers with a semantic cue, and the total correct answers from confrontation naming (P<0.001, r=0.77; P=0.03, r=0.31; and P<0.001, r=0.67; respectively). In comparing semantic and phonetic cues, memory, type, and severity of aphasia indicated significant association only with semantic cues. Discussion: There is an association between memory, type, and severity of aphasia with confrontation naming in patients with aphasia. The data have highlighted the importance of factors that need to be considered to formulate a comprehensive treatment plan to achieve further improvement in naming skills.

Applying core lexicon analysis in patients with anomic aphasia: Based on Mandarin AphasiaBank.

Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort-saving approach but has not been developed in Mandarin discourse. This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia. The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age- and education-matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well. The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia. Core lexicon analysis may potentially serve as a clinician-friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia. What is already known on the subject Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work? The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia.

Comparing the brain-behaviour relationship in acute and chronic stroke aphasia.

In stroke aphasia, lesion volume is typically associated with aphasia severity. Although this relationship is likely present throughout recovery, different factors may affect lesion volume and behaviour early into recovery (acute) and in the later stages of recovery (chronic). Therefore, studies typically separate patients into two groups (acute/chronic), and this is often accompanied with arguments for and against using data from acute stroke patients over chronic. However, no comprehensive studies have provided strong evidence of whether the lesion-behaviour relationship early in recovery is comparable to later in the recovery trajectory. To that end, we investigated two aims: (i) whether lesion data from acute and chronic patients yield similar results in region-based lesion-symptom mapping analyses and (ii) if models based on one timepoint accurately predict the other. Lesions and aphasia severity scores from acute (N = 63) and chronic (N = 109) stroke survivors with aphasia were entered into separate univariate region-based lesion-symptom mapping analyses. A support vector regression model was trained on lesion data from either the acute or chronic data set to give an estimate of aphasia severity. Four model-based analyses were conducted: trained on acute/chronic using leave-one-out, tested on left-out behaviour or trained on acute/chronic to predict the other timepoint. Region-based lesion-symptom mapping analyses identified similar but not identical regions in both timepoints. All four models revealed positive correlations between actual and predicted Western Aphasia Battery-Revised aphasia-quotient scores. Lesion-to-behaviour predictions were almost equivalent when comparing within versus across stroke stage, despite differing lesion size/locations and distributions of aphasia severity between stroke timepoints. This suggests that research investigating the brain-behaviour relationship including subsets of patients from only one timepoint may also be applicable at other timepoints, although it is important to note that these comparable findings may only be seen using broad measures such as aphasia severity, rather than those aimed at identifying more specific deficits. Subtle differences found between timepoints may also be useful in understanding the nature of lesion volume and aphasia severity over time. Stronger correlations found when predicting acute behaviour (e.g. predicting acute: r = 0.6888, P < 0.001, predicting chronic r = 0.5014, P < 0.001) suggest that the acute lesion/perfusion patterns more accurately capture the critical changes in underlying vascular territories. Differences in critical brain regions between timepoints may shed light on recovery patterns. Future studies could focus on a longitudinal design to compare acute and chronic patients in a more controlled manner.

Awake Surgery for a Patient With Glioblastoma and Severe Aphasia: Case Report

BACKGROUND AND IMPORTANCE: Patients with severe aphasia rarely become candidates for awake surgery because the intraoperative tasks of awake surgery for patients with aphasia have not been established. CLINICAL PRESENTATION: A 50-year-old, right-handed woman presented with recurrent glioblastoma invading her left superior temporal gyrus and inferior parietal lobule. She had severe aphasia, as she could barely verbalize her own name. However, we noticed that she could sing nursery rhymes with simple melodies and applied her singing ability as an axis of awake surgery. During awake surgery, she continuously sang simple songs to detect language dysfunction. As a result, 90% of the tumor was resected, preserving her language function and allowing for improvement. She was discharged 9 days after surgery without further neurological deterioration. CONCLUSION: Awake surgery is usually not indicated in patients with severe aphasia. However, for patients with aphasia who retain the ability to sing, intraoperative singing could be a possible alternative to maximize tumor resection while minimizing neurological dysfunction.

Evaluating Fluency in Aphasia: Fluency Scales, Trichotomous Judgements, or Machine Learning

ABSTRACT Background Speech-language pathologists (SLPs) and other clinicians often use aphasia batteries, such as the Western Aphasia Battery-Revised (WAB-R), to evaluate both severity and classification of aphasia. However, the fluency scale on the WAB-R is not entirely objective and has been found to have less than ideal inter-rater reliability, due to variability in weighing the importance of one dimension (e.g. articulatory effort or grammaticality) over another. This limitation has implications for aphasia classification. The subjectivity might be mitigated through the implementation of machine learning to identify fluent and non-fluent speech. Aims We hypothesized that two models consisting of convolutional and recurrent neural networks can be used to identify fluent and non-fluent aphasia as judged by SLPs, with greater reliability than use of the WAB-R fluency scale. Methods & Procedures The training and testing dataset for the networks was collected from the public domain, and the validation dataset was collected from participants in post-stroke aphasia studies. We used Kappa scores to evaluate inter-rater reliability among SLPs, and between the networks and SLPs. Outcome and Results Using public domain samples, the model for detecting non-fluent aphasia achieved high accuracy on the training dataset after 10 epochs (i.e., when algorithm scans the entire dataset) and 81% testing accuracy using public domain samples. The model for detecting fluent speech had high training accuracy and 83% testing. Across samples, using the WAB-R fluency scale, there was poor to perfect agreement among SLPs on the precise WAB-R fluency score, but substantial agreement on non-fluent (score 0-4) versus fluent (score of 5-9). The agreement between the model and the SLPs was moderate for identifying non-fluent speech and substantial fpr identifying fluent speech. When SLPs were asked to identify each sample as fluent, non-fluent, or mixed (without using the fluency scale), the agreement between SLPs was almost perfect (Kappa 0.94). The agreement between the SLPs’ trichotomous judgement and the models was fair for detecting non-fluent speech and substantial for detecting fluent speech. Conclusions Results indicate that neither the WAB-R fluency scale nor the machine learning algorithms were as useful (reliable and valid) as a simple trichotomous judgement of fluent, non-fluent, or mixed by SLPs. These results, together with data from the literature, indicate that it is time to re-consider use of the WAB-R fluency scale for classification of aphasia. It is also premature, at present, to rely on machine learning to rate spoken language fluency.

A systematic review: Idiom comprehension in aphasia: The effects of stimuli and task type

Idioms differ from other forms of figurative language because of their semantic dimensions of familiarity (frequency of encounter), ambiguity (possibility to have a literal interpretation), decomposability (possibility of the idiom's words to assist in its figurative interpretation) and transparency (possibility to deduce the original metaphorical motivation of an idiomatic phrase from its literal analysis). A variety of approaches have been used to investigate the way idioms are processed in the brain. Studying clinical populations is one of them. Supporting evidence has been drawn from studies examining subjects suffering from aphasia, typically caused by lesions to a complex language network involving the main language areas in the Left Hemisphere (LH) of the brain. Patients with aphasia sometimes show selective impairment in idiom comprehension, implying that there are types of idioms, less impaired in comprehension, which do not depend solely on the LH of the brain. However, recent literature does not seem to agree in terms of when such preference exists and if the types of idioms and tasks employed play a crucial role. This study investigates idiom comprehension in aphasia and seeks to explore (1) the effect of idiomatic stimuli in terms of their semantic dimensions on the patients' language performance (2) a potential effect of the tasks employed on the patients' language performance. A systematic review was done following the PRISMA approach. Starting from an initial find of n = 457, after applying inclusion and exclusion criteria, 15 articles were retained for further analysis. Relevant information that was extracted included differences and similarities across studies, especially focusing on patient characteristics (age, type of aphasia, severity of aphasia, post onset period, handedness, type of lesion (i.e., single focal vs. multiple), lesion location, etiology and test used for diagnosis), stimuli (types of stimuli, stimuli's assessment, consistent use of terminology) and task employed (type of task, task options, modality of presentation and response, and types of measurements) and language comprehension patterns. Results indicated that studies in idiom comprehension in aphasia are characterized by great heterogeneity regarding the experimental task and the type of idiomatic stimuli employed. Heterogeneity in these key aspects, results in unclear interpretation of idiom comprehension patterns in aphasia across studies. In addition, the nature of idiomatic stimuli and more specifically their semantic dimensions were insufficiently described, and their descriptions were sometimes accompanied by terminological inconsistencies. Moreover, patient profiles were occasionally incomplete and more importantly, language comprehension patterns were reported after considering patients with aphasia as one homogenous group irrespective of their aphasic syndrome. Last, this review proposes recommendations for future research, focusing on patient profiles, experimental tasks and stimuli as well as the interpretation of language comprehension patterns.

The longitudinal trajectory of discourse from the hyperacute to the chronic phase in mild to moderate poststroke aphasia recovery: A case series study.

Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24h; acute: 24-72h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia. What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.

Evaluating the Efficacy of a Self-administered Speech-Language App for People With Chronic, Nonfluent Aphasia: A Pilot Study

Background Aphasia is a language deficit that is most often caused by stroke. Speech-language therapy is effective in helping people recover lost language, and it should lead to generalization to untrained tasks and gains in functional language. However, not everyone is able to receive therapy due to a lack of finances; a lack of insurance coverage; or, most recently, COVID-19. Objective This study has 3 aims. For aim 1, we investigated whether a person with moderate to severe aphasia could manage the setup of an app-based treatment independently. Our second aim was to evaluate whether conducting an intensive treatment without speech-language pathologist (SLP) involvement was feasible. Participants with aphasia were asked to use the app 2 hours per day for 10 days, and we were interested to see if they could maintain this regimen or if frustration or boredom would promote dropout. For the third aim, we determined whether participants with aphasia in our digital treatment would make the same kinds of language gains that they would if they were working with an SLP and whether treatment gains would generalize to other language modalities, indicating that neuroplastic changes occurred due to treatment. Methods Our pilot study used a single-subject design, with 3 participants experiencing nonfluent aphasia at least 1 year poststroke. Participants were trained to use a comprehension and production app, with instructions to use the app 2 hours per day for 10 days (total treatment time=20 hours). Multiple standardized assessments were taken at the following three time points: pretreatment, 1 week posttreatment, and 10 weeks posttreatment. A recording device was used to capture pretreatment and 10-week posttreatment at-home conversations between the participants with aphasia and the conversational partner. Results Data were variable among our 3 participants (P1, P2, and P3). P1 and P3 showed clinically significant improvements on several measurements of language; P2 did not. Aphasia severity also decreased in P1 and P3. The analysis of the discourse recorded in the home environments showed that P1 and P3 each made use of the app-trained words in spontaneous conversation (increase of &gt;63%). All 3 participants with aphasia reported positive increases in quality of life, and all continued to use the app even after the treatment period ended. Conclusions Independently administered, intensive treatment had salubrious effects on 3 participants with aphasia. P2’s lack of improvement on language measures was attributed to not feeling challenged enough by the app. In general, the participants in this study were able to guide themselves in an independent manner to complete an intensive study, without using any SLP support. Though this study was only piloted on 3 individuals, it lays the groundwork for future studies assessing the independence of participants with aphasia in managing their own treatment. Conflicts of Interest None declared.

The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility.

The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features. Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence. Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence. The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease. https://doi.org/10.23641/asha.21817584.

Exploring the usability and feasibility of a mobile music listening application for people living in the community with post-stroke aphasia

Purpose Language and communication disorders can inhibit participation in activities that have potential therapeutic benefits for recovery. This exploratory research examined the usability and feasibility of a purpose-built music listening mobile application for people living in the community with post-stroke aphasia, and examined relationships between useability and participant age, aphasia severity and time post-stroke. Methods Nineteen participants with chronic aphasia tested the application for two weeks. Prior to use, music preferences, technology use and confidence, self-efficacy and music engagement questionnaires were completed. System usability scale, music listening data and a satisfaction rating were completed following use. Results Overall, the application was perceived as being usable and feasible with a high system usability rating and moderate effectiveness, efficiency and satisfaction. The system usability scores were not associated with aphasia severity, age, years post-stroke, self-efficacy or music engagement. Technology confidence was positively associated with system usability. Conclusion The music listening application is a feasible and usable option for listening to music in people with chronic post-stroke aphasia. This study provides a foundation for the rigorous examination of the usability of music listening technology for people with post-stroke aphasia and the potential investigation of use in acute care facilities and other clinical populations. IMPLICATIONS FOR REHABILITATION Music listening has potential therapeutic benefits for people with post-stroke aphasia. Applications for music listening require customisation to enable people with post-stroke aphasia opportunity to listen to their preferred music. Music listening applications that are perceived as usable and feasible by people with post-stroke aphasia may have potential application within rehabilitation and community settings.

Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial.

The ability to produce words through singing can be preserved in severe aphasia, but the benefits of group-based singing rehabilitation in aphasia are largely unknown. Our aim was to determine the efficacy of a multicomponent singing intervention on communication and speech production, emotional-social functioning and caregiver well-being in aphasia. Fifty-four patients with acquired brain injury and chronic aphasia and their family caregivers (n = 43) were recruited. Using a crossover randomized controlled trial design, participants were randomized to two groups who received a 4-month singing intervention either during the first or second half of the study in addition to standard care. The intervention comprised weekly group-based training (including choir singing and group-level melodic intonation therapy) and tablet-assisted singing training at home. At baseline, 5- and 9-month stages, patients were assessed with tests and questionnaires on communication and speech production, mood, social functioning, and quality of life and family caregivers with questionnaires on caregiver burden. All participants who participated in the baseline measurement (n = 50) were included in linear mixed model analyses. Compared with standard care, the singing intervention improved everyday communication and responsive speech production from baseline to 5-month stage, and these changes were sustained also longitudinally (baseline to 9-month stage). Additionally, the intervention enhanced patients' social participation and reduced caregiver burden. This study provides novel evidence that group-based multicomponent singing training can enhance communication and spoken language production in chronic aphasia as well as improve psychosocial wellbeing in patients and caregivers. https://www.clinicaltrials.gov, Unique identifier: NCT03501797.

Language impairment in the genetic forms of behavioural variant frontotemporal dementia

BackgroundBehavioural variant fronto-temporal dementia (bvFTD) is characterised by a progressive change in personality in association with atrophy of the frontal and temporal lobes. Whilst language impairment has been described in people with bvFTD, little is currently known about the extent or type of linguistic difficulties that occur, particularly in the genetic forms.MethodsParticipants with genetic bvFTD along with healthy controls were recruited from the international multicentre Genetic FTD Initiative (GENFI). Linguistic symptoms were assessed using items from the Progressive Aphasia Severity Scale (PASS). Additionally, participants undertook the Boston Naming Test (BNT), modified Camel and Cactus Test (mCCT) and a category fluency test. Participants underwent a 3T volumetric T1-weighted MRI, with language network regional brain volumes measured and compared between the genetic groups and controls.Results76% of the genetic bvFTD cohort had impairment in at least one language symptom: 83% C9orf72, 80% MAPT and 56% GRN mutation carriers. All three genetic groups had significantly impaired functional communication, decreased fluency, and impaired sentence comprehension. C9orf72 mutation carriers also had significantly impaired articulation and word retrieval as well as dysgraphia whilst the MAPT mutation group also had impaired word retrieval and single word comprehension. All three groups had difficulties with naming, semantic knowledge and verbal fluency. Atrophy in key left perisylvian language regions differed between the groups, with generalised involvement in the C9orf72 group and more focal temporal and insula involvement in the other groups. Correlates of language symptoms and test scores also differed between the groups.ConclusionsLanguage deficits exist in a substantial proportion of people with familial bvFTD across all three genetic groups. Significant atrophy is seen in the dominant perisylvian language areas and correlates with language impairments within each of the genetic groups. Improved understanding of the language phenotype in the main genetic bvFTD subtypes will be helpful in future studies, particularly in clinical trials where accurate stratification and monitoring of disease progression is required.

Advanced Brain Age and Chronic Poststroke Aphasia Severity.

Chronic poststroke language impairment is typically worse in older individuals or those with large stroke lesions. However, there is unexplained variance that likely depends on intact tissue beyond the lesion. Brain age is an emerging concept, which is partially independent from chronologic age. Advanced brain age is associated with cognitive decline in healthy older adults; therefore, we aimed to investigate the relationship with stroke aphasia. We hypothesized that advanced brain age is a significant factor associated with chronic poststroke language impairments, above and beyond chronologic age, and lesion characteristics. This cohort study retrospectively evaluated participants from the Predicting Outcomes of Language Rehabilitation in Aphasia clinical trial (NCT03416738), recruited through local advertisement in South Carolina (US). Primary inclusion criteria were left hemisphere stroke and chronic aphasia (≥12 months after stroke). Participants completed baseline behavioral testing including the Western Aphasia Battery-Revised (WAB-R), Philadelphia Naming Test (PNT), Pyramids and Palm Trees Test (PPTT), and Wechsler Adult Intelligence Scale Matrices subtest, before completing 6 weeks of language therapy. The PNT was repeated 1 month after therapy. We leveraged modern neuroimaging techniques to estimate brain age and computed a proportional difference between chronologic age and estimated brain age. Multiple linear regression models were used to evaluate the relationship between proportional brain age difference (PBAD) and behavior. Participants (N = 93, 58 males and 35 females, average age = 61 years) had estimated brain ages ranging from 14 years younger to 23 years older than chronologic age. Advanced brain age predicted performance on semantic tasks (PPTT) and language tasks (WAB-R). For participants with advanced brain aging (n = 47), treatment gains (improvement on the PNT) were independently predicted by PBAD (T = -2.0474, p = 0.0468, 9% of variance explained). Through the application of modern neuroimaging techniques, advanced brain aging was associated with aphasia severity and performance on semantic tasks. Notably, therapy outcome scores were also associated with PBAD, albeit only among participants with advanced brain aging. These findings corroborate the importance of brain age as a determinant of poststroke recovery and underscore the importance of personalized health factors in determining recovery trajectories, which should be considered during the planning or implementation of therapeutic interventions.

Behavioural and neural structure of fluent speech production deficits in aphasia.

Deficits in fluent speech production following left hemisphere stroke are a central concern because of their impact on patients' lives and the insight they provide about the neural organization of language processing. Fluent speech production requires the rapid coordination of phonological, semantic, and syntactic processing, so this study examined how deficits in connected speech relate to these language sub-systems. Behavioural data (N = 69 participants with aphasia following left hemisphere stroke) consisted of a diverse and comprehensive set of narrative speech production measures and measures of overall severity, semantic deficits, and phonological deficits. These measures were entered into a principal component analysis with bifactor rotation-a latent structure model where each item loads on a general factor that reflects what is common among the items, and orthogonal factors that explain variance not accounted for by the general factor. Lesion data were available for 58 of the participants, and each factor score was analysed with multivariate lesion-symptom mapping. Effects of connectivity disruption were evaluated using robust regression with tract disconnection or graph theoretic measures of connectivity as predictors. The principal component analysis produced a four-factor solution that accounted for 70.6% of the variance in the data, with a general factor corresponding to the overall severity and length and complexity of speech output (complexity factor), a lexical syntax factor, and independent factors for Semantics and Phonology. Deficits in the complexity of speech output were associated with a large temporo-parietal region, similar to overall aphasia severity. The lexical syntax factor was associated with damage in a relatively small set of fronto-parietal regions which may reflect the recruitment of control systems to support retrieval and correct usage of lexical items that primarily serve a syntactic rather than semantic function. Tract-based measures of connectivity disruption were not statistically associated with the deficit scores after controlling for overall lesion volume. Language network efficiency and average clustering coefficient within the language network were significantly associated with deficit scores after controlling for overall lesion volume. These results highlight overall severity as the critical contributor to fluent speech in post-stroke aphasia, with a dissociable factor corresponding to lexical syntax.

Magyar Afázia Szűrőteszt: új szűrőeljárás a poststroke aphasia gyors felismerésére

Although aphasia screening tools are widely used internationally, in Hungarian, to date, there have been no aphasia screening tests with reported psychometric properties available. (1) To provide an overview of the international practice and the tools of post-stroke aphasia screening. (2) To present a recently developed aphasia screening test in Hungarian. The Hungarian Aphasia Screening Test comprises five tasks assessing speech comprehension and production, and takes 5-10 minutes to complete. The test is easy to score and needs little equipment, therefore it can be useful in any clinical setting that allows for quick test administration and diagnostics. Based on results of two studies, we evaluate the psychometric properties and the diagnostic accuracy of the test, and determine three impairment severity ranks (mild, moderate, severe aphasia) for the test. The severity ranks were defined based on results of 70 people with post-stroke aphasia (35 women; average age: 61.4 years; average postonset: 12.6 months). The test has high diagnostic accuracy, a sensitivity of 92.5% and a specificity of 88.5%. It shows acceptable structural and concurrent (MR = 0.68) validity as well as good internal consistency (Mα = 0.74). The cut-off score for diagnosing aphasia is 17. The test can differentiate stroke patients with and without aphasia. With the use of the test, patients' aphasia can be rated as mild (score 14-17), moderate (score 9-13), or severe (score 0-8). Our results suggest that it is a reliable and valid screening tool. The test can detect the presence and quantify the severity of aphasia. We discuss the importance of aphasia screening in clinical settings and of the use of the Hungarian Aphasia Screening Test in the context of the international practices. Orv Hetil. 2022; 163(50): 2000-2008.

Donepezil alone and combined with intensive language-action therapy on depression and apathy in chronic post-stroke aphasia: A feasibility study

This study explored the feasibility and effectiveness of a short-term (10-week) intervention trial using Donepezil administered alone and combined with intensive language action therapy (ILAT) for the treatment of apathy and depression in ten people with chronic post-stroke aphasia. Outcome measures were the Western Aphasia Battery and the Stroke Aphasia Depression Questionnaire-21. Structural magnetic resonance imaging and 18fluorodeoxyglucose positron emission tomography were acquired at baseline and after two endpoints (Donepezil alone and Donepezil-ILAT). The intervention was found to be feasible to implement. Large treatment effects were found. Donepezil alone and combined with ILAT reduced aphasia severity, while apathy and depression only improved with Donepezil-ILAT. Structural and functional neuroimaging data did not show conclusive results but provide hints for future research. Given these overall positive findings on feasibility, language and behavioral benefits, further studies in larger sample sizes and including a placebo-control group are indicated.

Measuring Usability of a Computer-Based Treatment for Aphasia using Eye-tracking

<h3>Research Objectives</h3> To investigate the usability of a treatment software designed for conversational practice in persons with aphasia. <h3>Design</h3> Pilot cross-sectional study utilizing eye-tracking and the System Usability Scale (SUS) to understand how people with aphasia interact with a computer-based software, AphasiaScripts®. <h3>Setting</h3> Outpatient rehabilitation research hospital in Chicago. <h3>Participants</h3> Three individuals with aphasia. <h3>Interventions</h3> AphasiaScripts® is a computer-based software that provides conversational practice to people with aphasia. Participants practice choral reading repeatedly with a virtual therapist. Words are highlighted and the virtual therapist's mouth movements approximate those of a real person. The sentence structures used in the software allow people with aphasia to practice language that may arise in different situations. AphasiaScripts® is designed to be easy to use with a simple interface and minimal directions during practice. <h3>Main Outcome Measures</h3> The primary outcome measures are the gaze dwell time (as measured by eye-tracking) on the sentences and on the virtual therapist. Usability was also measured by the SUS. <h3>Results</h3> Participants looked at the sentences more than the virtual therapist at both the beginning and end of a practice session. Participants rated AphasiaScripts® as above average on the SUS. <h3>Conclusions</h3> Participants tended to look at the text more than the virtual therapist during practice. This suggests that attention to the text is more important than attention to the virtual therapist. Participants also found the software easy to use. Future directions involve recruiting a larger sample of people with aphasia and investigating variables such as aphasia severity and characteristics of the virtual therapist that may influence where participants tend to gaze during practice. <h3>Author(s) Disclosures</h3> AphasiaScripts is commercially available from the Shirley Ryan AbilityLab. The authors receive salary from the Shirley Ryan AbilityLab but have no financial interest in the software sales.

Automated Analysis of Written Language in the Three Variants of Primary Progressive Aphasia.

Despite the important role of written language in everyday life, abnormalities in functional written communication have been sparsely investigated in PPA. We developed a Python program which uses a language parser and quantifies content units (CU) and total utterances in language samples. The program was used to analyze written descriptions of the WAB Picnic scene, based on a pre-defined CU corpus, from a cohort with 95 participants (20 controls, 28 nonfluent variant Primary Progressive Aphasia (nfvPPA), 30 logopenic variant (lvPPA), 17 semantic variant (svPPA)). We then compared written functional communication between the three PPA variants and controls. We analyzed the measurements in relation to aphasia severity (Progressive Aphasia Severity Scale Sum of Boxes (PASS SoB) and Clinical Dementia Rating Supplemental Language (CDR-L) scores), and dementia severity (Clinical Dementia Rating Sum of Boxes (CDR SoB)). The reliability of the automated analysis was high as compared to manual scoring of 239 samples (99.6%). One-way ANOVAs revealed patients with lvPPA and svPPA wrote fewer CU than controls (mean+/-SD 11.97+/-7.87 and 10+/-4.5, vs 18.5+/-9.32) (F(3, 91)=[4.897], p=0.003). There was a trend towards a decrease in CU in nfvPPA (13.89+/-6.33) (p=0.144). Patients with all PPA subtypes (nfvPPA mean+/-SD 34.64+/-18.89; lvPPA 38+/-24.54; svPPA 28.88+/-20.36) wrote fewer total utterances than controls (61.7+/-27.86) (F(3, 91)=[7.778], p<0.001). The CU/utterance ratio was higher in nfvPPA and svPPA than in controls and lvPPA (0.42+/-0.14 and 0.43+/0.22 vs 0.3+/-0.05 and 0.32+/-0.12 respectively) (F(3, 91)=[5.592], p=0.001). Considering all PPA samples, regression analysis showed a decrease in CU relative to an increase in PASS SoB (R=0.24, p=0.04), CDR-L (R=0.22, p=0.06), and CDR SoB (R=0.34, p=0.004). As expected, we found impairments in informative written language in patients with PPA. Automated CU analysis is a tool that can improve assessment of functional written communication, and may be an objective tool to track aphasia progression. More studies are required to assess individual changes over time and whether these findings could be extrapolated to other forms of cognitive impairment.

Temporal Overlap Between Gestures and Speech in Poststroke Aphasia: Is There a Compensatory Effect?

If language production is impaired, will gestures compensate? Evidence in favor of this prediction has often been argued to come from aphasia, but it remains contested. Here, we tested whether thought content not present in speech due to language impairment is manifested in gestures, in 20 people with dysfluent (Broca's) aphasia, 20 people with fluent (Wernicke's) aphasia, and 20 matched neurotypical controls. A new annotation scheme was created distinguishing types of gestures and whether they co-occurred with fluent or dysfluent/absent speech and were temporally aligned in content with coproduced speech. Across both aphasia types, noncontent (beat) gestures, which by their nature cannot compensate for lost speech content, constituted the greatest proportion of all types of gestures produced. Content (i.e., descriptive, referential, and metaphorical) gestures were largely coproduced with fluent rather than dysfluent speech and tended to be aligned with the content conveyed in speech. They also did not differ in quantity depending on whether the dysfluencies were eventually resolved or not. Neither aphasia severity nor comprehension ability had an impact on the total amount of content gesture produced in people with aphasia, which was instead positively correlated with speech fluency. Together, these results suggest that gestures are unlikely to have a role in compensating for linguistic deficits and to serve as a representational system conveying thought content independent of language. Surprisingly, aphasia rather is a model of how gesture and language are inherently integrated and aligned: Even when language is impaired, it remains the essential provider of content.

Clinical Profiles of Persons Who Progress to Cognitive Impairment in the Alzheimer’s Prevention Initiative (API) ADAD Colombia Trial

AbstractBackgroundIn Colombia, 13 pathogenic variants of presenilin 1 (PSEN1) causing Autosomal Dominant Alzheimer’s Disease (ADAD) have been identified. Some cases have atypical presentations, with variability in the age of onset and course of the disease. We characterized clinical profiles of cognitively unimpaired PSEN1 E280A mutation carriers who progress to MCI or dementia in the API ADAD Colombia Trial.MethodThe API ADAD Colombia Trial enrolled 252 cognitively unimpaired 30–60 year‐old participants into a 5‐8‐year double‐blind placebo controlled randomized prevention trial with a common close design. About 1/3 of participants were PSEN1 E280A mutation carriers who were randomized to the investigational anti‐oligomeric amyloid‐β antibody therapy crenezumab, 1/3 were mutation carriers who were randomized to placebo, and 1/3 were non‐carriers from the same kindred who were randomized to placebo. Trial results are pending. We used standardized procedures to blindly assess clinical features of participants who progressed to MCI and/or dementia during the trial, reviewed by an independent progression adjudication committee (PAC), to confirm the first instance of clinical progression.ResultDuring the trial 45 participants had an initial progression to MCI due to AD and 2 to dementia due to AD confirmed by the PAC. Among the 45 adjudicated with MCI due to AD, 32 subsequently progressed to dementia (30 due to AD and 2 due to other causes as determined by the site clinicians by consensus). The mean age onset of MCI was 45 (range 36–60 years) and of dementia was 47 (range 36–62 years). Three participants developed dementia before 40 years and one participant at 62 years. At the time of MCI, 43 participants had a predominantly amnesic profile, one had a predominantly behavioral disinhibition, and one had a Capgras syndrome, severe aggression and myoclonus. One participant developed severe global aphasia two years after the onset of dementia; two of the participant’s first‐degree relatives had language impairment in conjunction with MCI; one developed primary progressive logopenic aphasia.ConclusionSome persons with ADAD have an atypical clinical presentation. Additional studies are needed to clarify the biological changes, genetic/environmental risk factors, clinical course and response to treatment in these individuals.