Transcortical Motor Research Articles

Language and executive functions in patients with transcortical motor aphasia and Broca’s aphasia

ABSTRACT This study investigated language and executive functions (EF) in people with transcortical motor aphasia (TMA) and Broca’s aphasia (BA). Participants included 19 patients with TMA, 19 patients with BA, and 25 healthy controls. Verbal Fluency tests, Stroop tests and Trail-Making tests were administered to all participants, and the Boston Diagnostic Aphasia Examination (BDAE) was administered to participants with aphasia. Results showed that (1) both groups of patients with aphasia had poorer performance on Verbal Fluency tests, Stroop tests and Trail-Making tests than healthy controls; (2) participants with BA had superior performance on Stroop tests and Trail-Making tests, but not on Verbal Fluency tests, than participants with TMA, and (2) the performance on Verbal Fluency tests, Stroop tests and Trail-Making was significantly correlated with the performance on BDAE for participants with TMA, but not for participants with BA. These results suggest that EF deficits are present in both patients with TMA and those with BA. They also show that the relationship between EF deficits and language impairments in people with aphasia might depend on the type of aphasia, aspects of language, and the components of EF measured.

Can Lesions in the Right Basal Ganglia Cause Aphasia? Crossed Aphasia in a Right-Handed Patient.

Aphasia is a common neurocognitive disorder caused by impaired speech and language, with stroke being the most frequent cause. The neuroanatomical mechanism underlying this condition is not yet fully understood. This case describes a 74-year-old Caucasian woman admitted with a clinical picture of right total anterior circulation infarct (TACI) and aphasia, scoring 17 on the National Institutes of Health Stroke Scale. Neuroimaging showed a large cortico-subcortical frontotemporoparietal and insular infarct involving the basal ganglia of the right hemisphere and bilateral focal atherosclerotic stenosis on the M1 segment of the middle cerebral artery. There was no left hemispheric lesion or abnormal electric activity on the electroencephalogram. A formal evaluation was compatible with transcortical motor aphasia. The aetiological study revealed atrial fibrillation, and the case was admitted as an ischaemic stroke of undetermined aetiology with two possible causes - intracranial atherosclerotic stenosis or atrial fibrillation. Our patient fulfilled all the formal criteria for crossed aphasia in dextral (CAD): aphasia, a lesion in the right hemisphere coupled with the structural integrity of the left hemisphere, an established preference for right-hand use without a familial history of left-handedness individuals, and an absence of brain damage in childhood. Our patient's case adds to the evidence that deep structures - alone or in combination with cortical structures - are primarily affected in CAD. The diagnostic criteria for crossed aphasia in dextral (CAD) are derived from clinical case studies and include aphasia, a lesion in the right hemisphere, a strong preference for using the right hand, the structural integrity of the left hemisphere and no history of brain damage during childhood.The right lentiform nucleus was found to be the most frequent anatomical substrate involved in CAD patients, consistent with our case description.Our patient experienced transcortical motor aphasia due to a stroke in the right hemisphere, adding to the evidence that in CAD patients, deep structures are primarily affected. In contrast, in left hemispheric lesions, cortical structures seem to be the main culprits.

Case Report: Callosal disconnection syndrome manifesting as mixed frontal-callosal-posterior alien hand syndrome following extensive corpus callosum infarct

Alien hand syndrome (AHS) is a rare neurological phenomenon first described by Van Vleuten over a century ago. The most widely recognized variants in literature are frontal, callosal, and posterior AHS. AHS due to the corpus callosum lesion can occur alone or as part of callosal disconnection syndrome (CDS). This report presents a unique CDS case manifesting clinical features from all three AHS variants, resulting from an extensive corpus callosum infarct. Our patient exhibited various clinical features from the three AHS variants, which include grasping, groping, and difficulty releasing objects from the hand (anterior); intermanual conflict (callosal); arm levitation, mild hemiparesis, and hemisensory loss (posterior). Additionally, the extensive disruption of the corpus callosal fibers produced neurological manifestations of CDS, such as cognitive impairment, ideomotor and constructional apraxia, behavioral disorder, and transcortical motor aphasia. We employed a range of rehabilitation interventions, such as mirror box therapy, limb restraint strategy, verbal cue training, cognitive behavioral therapy, bimanual hand training, speech and language therapy, and pharmacological treatment with clonazepam. The patient showed almost complete resolution of CDS and AHS features by nine months post-stroke Our case report highlights distinctive clinical variations of AHS and the challenging correlation between clinical manifestations and neuroanatomical substrates. Future studies are necessary to explore the intricate neural connections and the precise function of the corpus callosum. This can be achieved by combining comprehensive neuropsychological testing with diffusion tensor tractography studies. It is also essential to develop a validated tool to standardize AHS assessment. Finally, the scarcity of evidence in rehabilitation interventions necessitates further studies to address the wide knowledge gap in AHS and CDS management.

Characterization of Speech and Language Deficits in the Postanesthesia Care Unit: A Novel, Qualitative Cognitive Assessment

BACKGROUND: Assessing recovery after general anesthesia is complicated because patients must be sufficiently arousable to pay attention to the verbal instructions probing cognitive function. All delirium screens that have been used in the postanesthesia care unit (PACU) rely heavily on a patient’s ability to process language information and respond appropriately. However, postanesthesia effects on speech-language functions have not been specifically evaluated. Here we present a novel, qualitative PACU evaluation for cognitive domains critical for speech-language functions, and we compare this assessment against a multidomain neurocognitive examination: Telephonic Montreal Cognitive Assessment (t-MoCA). This may be used to identify trajectories of neurocognitive recovery after surgery with general anesthesia and provide neuroanatomic correlates for specific deficits. METHODS: We investigated 48 patients undergoing general anesthesia for noncardiac and nonneurologic elective surgeries. Preoperatively, participants were administered our PACU speech-language assessment (PACU-SLA) and t-MoCA. Both assessments were again administered postoperatively in the PACU. Different versions of PACU-SLA were administered pre- versus postoperatively. Twenty-three participants randomly received the same t-MoCA versions (group AA), and 25 participants received different versions (group AB), pre- versus postoperatively. Assessments were administered ≥30 minutes after PACU arrival, and before PACU discharge. Statistical analysis was performed using Wilcoxon-signed-rank tests for nonnormally distributed paired data, analysis of covariance for assessing the impact of group (AA versus AB) and preoperative scores on postoperative scores, and χ2 tests for unpaired categorical data (P < .05 indicating significance). RESULTS: After adjusting for preoperative scores, the postoperative t-MoCA scores of group AB were significantly lower than group AA (F[1–46] = 21.7, P < .001). Similarly, the t-MoCA scores of episodic-memory (delayed-recall) decreased in group AB (F[1–46] = 48.6, P < .001). For PACU-SLA, there were no postoperative changes in auditory-comprehension and object-naming scores, but a decrease was observed in (1) scores of a 9-point narrative-production task of expressive-fluency (n = 48; median [25th–75th]; preoperative: 9[9–9], postoperative: 7[7–8], P < .001), and (2) total words generated in 2 30-second tasks of verbal-fluency (n = 48; median[25th–75th]: preoperative: 23[12.5–33.5], postoperative: 16.5[9.5–26.5], P < .001). Scores on a 4-point sentence-repetition task were also noted to decrease postoperatively (n = 48; median[25th–75th]; preoperative: 4[3–4], postoperative: 4[3–4], P = .04). When grouping participants by preoperative cognitive status (pMCI, n = 9; preoperative normal, n = 39), both groups showed postoperative changes in verbal-fluency (F[1–46] = 6.97, P = .01) and narrative-production scores (F[1–46] = 5.51, P = .02). CONCLUSIONS: The PACU-SLA revealed lower fluency (hypophonia) with relatively intact comprehension, naming, and repetition, during recovery from general anesthesia. These deficits share features with transcortical motor aphasia.

A Case Report in the Management of Dysphagia in Osmotic Demyelination Syndrome Using Mann Assessment of Swallowing Ability (MASA).

Osmotic Demyelination Syndrome (ODS) is one of the primary cause of demyelination in alcoholics and malnourished resulting in various kind of clinical manifestations in pontine symptoms, neuro-behavioural symptoms movement disorders as well as speech and language and swallowing difficulties. The study was done to introspect the prognosis of swallowing therapy in a patient with ODS using MASA (Mann Assessment of Swallowing Ability). A 36years old male with a history of regular alcohol intake and hypertensiom reported in our healthcare centre with hypoaklemia and speech, language and swallowing difficulty. Magnetic resonance imaging of the brain showed bilateral symmetrical T2 and T2 FLAIR (fluid attenuated inversion recovery) hyperintensity lesion in the bilateral basal ganglia involving the caudate nuclei, putaminal region and bilateral thalami with similar lesion along the mid brain. There were no areas of acute restriction in diffusion study. The findings suggested of Osmotic Demyelination Syndrome (ODS).When accessed with N-DAT, WAB and MASA; patient was diagnosed with Spastic Dysarthria, Transcortical Motor Aphasia and Moderate Dysphagia. Intervention was provided using speech and swallowing therapy and when introspected with MASA scores, improvement was seen within 5days and statistically 97% of variance was seen inferring the progressing trend in the MASA scores. This study concludes that MASA can be an effective tool in introspecting the prognosis of Dysphagia in ODS and early intervention in the management of dysphasia shows positive results.

Characteristics of Aphasia in Ischemic Stroke Patients at Dr. Mahar Mardjono National Brain Center Hospital Indonesia in 2021

Highlights: 1. To author’s knowledge, this study is the first study done in National Brain Center Hospital In Jakarta2. No similar studies have been done during the pandemic era3. This study can add additional data to further studies about aphasia in comparison with post pandemic era Abstract Global aphasia, sensory transcortical aphasia, motor transcortical aphasia, motor aphasia, sensory aphasia, conduction aphasia and anomic aphasia can occur in ischemic stroke. There are different locations of lesions in each type of aphasia. There has been an increase in incidence and mortality of stroke patients during the COVID-19 pandemic. Before the pandemic, global aphasia was the most common type of aphasia. This study was conducted to determine the type of aphasia, clinical and radiological features, and also management of aphasia in ischemic stroke during the pandemic. This research is a descriptive study with a cross sectional approach. Sampling was done by total sampling technique. The research sample was ischemic stroke subjects with aphasia diagnosed from January 1, 2021 - December 31, 2021 at the National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta. Statistical analysis was done using IBM SPSS Statistics for Mac, Version 25.0 (IBM Corp., Armonk, N.Y., USA). There were 162 aphasic subjects with ischemic stroke. Age range was 34 – 87 years. Most subjects were male (59.9%), aged 55-65 years (37.0%). Hypertension (90.1%), diabetes mellitus (50.0%), and dyslipidemia (75.9%) were the dominant risk factors. The most common type of aphasia is global aphasia (43.8%) and motoric aphasia. (33,3%). The parietal lobe was the dominant location of global aphasia (38 subjects) and motoric aphasia (47 subjects). The therapy given to aphasic subjects with a history of ischemic stroke includes speech therapy (85.2%), antiplatelet therapy (98.1%), anticoagulants (19.1%), rTPA (1.2%), and neuroprotectors (3.0 %). In conclusion, in ischemic stroke subjects with aphasia at the National Brain Center Hospital during the pandemic, global aphasia was found to be the most common with the dominant global aphasia lesion location in the parietal lobe.

Current situation and trend of translational research of acupuncture-moxibustion in treatment of aphasia based on knowledge graph analysis.

To investigate the hot topics in acupuncture-moxibustion research for treatment of aphasia and explore the current situation and trend of technology transformation in this field through analyzing the relevant Chinese literatures in recent 30 years by means of knowledge graph technology. CiteSpace 6.1.R 2 and VOSviewer V1.6.16 software were used to collate the data, draw knowledge graphs and conduct visual analysis of the literatures related to acupuncture-moxibustion treatment of aphasia, searched from CNKI, WanFang and VIP databases.The time line view and strongest bursts of keywords were formed in the field of acupuncture-moxibustion treatment for aphasia. The treatment-based keyword networks were visualized. A total of 773 Chinese articles were included. Through visual analysis of the co-occurrence networks, the top 10 high-frequency overall keywords and the top 10 clusters of overall keywords were listed. The top 5 high-frequency aphasia categories were Broca aphasia, hysterical aphasia, transcortical motor aphasia, nominal aphasia and sensory aphasia. Regarding the keywords of the techniques of acupuncture-moxibustion, the occurrence frequencies of scalp acupuncture, tongue acupuncture, body acupuncture and electroacupuncture were ≥ 10 times.The occurrence frequencies of 16 acupoints were ≥25 times. After collation and cluster analysis of acupoints and techniques of acupuncture-moxibustion, 7 keyword clusters of "acupuncture techniques-acupoints" were obtained. The time line view showed that the strongest burst of keywords were transcranial magnatic stimulation, language rehabilitation training, acupuncture-medicine therapy and stroke, etc. in the recent 5 years. Acupuncture-moxibustion displays its unique advantage in treatment of aphasia. With the deepening of modern research, the hot topics for aphasia treated with acupuncture-moxibustion are present and the achievements enriched. In future, these therapeutic methods should be further investigated to explore a model of translational medicine for aphasia in line with the characteristics of acupuncture-moxibustion.

Teaching NeuroImages: Hemimeningitis mimicking acute ischemic stroke

A 78-year-old man with sudden-onset right-sided weakness and mutism had no history of fever, seizures, or headache. On examination, abulia, transcortical motor aphasia, and right dense hemiplegia were noted. Contrast-enhanced brain MRI suggested meningitis (figure 1) and ruled out stroke (figure 2). On CSF analysis, lymphocytic (94%) pleocytosis (163 cells/mm3), abundant Gram-positive cocci, and hyperproteinorrachy (48 mg/dL) with normal CSF:serum glucose ratio were noted. After 14 days of ceftriaxone plus vancomycin and recovery of hemiparesis (MRC 4/5), speech (improved fluency), and CSF–pleocytosis resolution (2 cells/mm3), the patient was discharged. Localized meningitis is rare. We found 2 reports: one stroke mimic1 and another associated with necrotizing vasculitis.2

Motor rehabilitation of aphasic stroke patient: the possibility of Rood's approach.

Motor rehabilitation of aphasic stroke patient: the possibility of Rood's approach.

Profile of Language Disorders in Clients of Motor Transcortical Aphasia

Aphasia is a language disorder that occurs due to an injury to the brain. The classification of aphasia is divided into fluent aphasia and nonfluent aphasia. One of the non-fluent aphasia is transcortical motor aphasia. The characteristics that distinguish Broca's aphasia from other aphasia are disorders in receptive language, difficulty in answering questions, difficulty understanding spoken language, difficulty understanding written language, difficulty writing, accompanied by linguistic symptoms such as ecolalia. The implementation of this research starts from the assessment (observation, interview, and test). The purpose of this research is to find out the language disorder that exists in the client. To see the language disorder that exists in clients, interviews with families and clients are carried out. Then an observation of the client's activity is carried out and a test is carried out to determine the language disorder in the client. The conclusion of this study is that clients experience problems in understanding spoken and written language, clients also have difficulty starting to talk to other people. So the authors recommend that clients get treatment for language disorders.

HUMAN LANGUAGE DISORDER

This research is related to psycholinguistics, neurolinguistics. It is one of the interdisciplinary studies between linguistics and the human brain. Here, it is more to describe the definition and types of human language disorders (language disorder). Language disorders are disorders that involve the processing of lainguistic information. Language disorder problems experienced can involve grammar (syntax and / or morphology), semantics (meaning), or other aspects of language. These problems may be responsive (involving impaired understanding of language), expressive (involving language production), or a combination of the two. The types of language disorders are as follows (1) disturbance of speech mechanism: interference due to pulmonary factors, disturbance due to laryngeal factors, disturbances due to lingual factors, disturbance due to resonance factors. (2) multifactorial distraction: random speaking, speaking propulsively, mutis speaking (mutism). (3) psychogenic disturbances: spoiled speech, seductive speech, stuttering, talkative talk. (4) aphasia: (1) motor aphasia (cortical motor aphasia, subcortical motor aphasia, transcortical motor aphasia). (2) sensory aphasia.

Awake craniotomy with transcortical motor evoked potential monitoring for resection of gliomas within or close to motor-related areas: validation of utility for predicting motor function.

The authors previously showed that combined evaluation of changes in intraoperative voluntary movement (IVM) during awake craniotomy and transcortical motor evoked potentials (MEPs) was useful for predicting postoperative motor function in 30 patients with precentral gyrus glioma. However, the validity of the previous report is limited to precentral gyrus gliomas. Therefore, the current study aimed to validate whether the combined findings of IVM during awake craniotomy and transcortical MEPs were useful for predicting postoperative motor function of patients with a glioma within or close to motor-related areas and not limited to the precentral gyrus. The authors included 95 patients with gliomas within or close to motor-related areas who were treated between April 2000 and May 2020. All tumors were resected with IVM monitoring during awake craniotomy and transcortical MEP monitoring. Postoperative motor function was classified into four categories: "no change" or "declined," the latter of which was further categorization as "mild," "moderate," or "severe." The authors defined moderate and severe deficits as those that impact daily life. Motor function 6 months after surgery was classified as no change in 71 patients, mild in 18, moderate in 5, and severe in 1. Motor function at 6 months after surgery significantly correlated with IVM (p < 0.0001), transcortical MEPs (decline ≤ or > 50%) (p < 0.0001), age, preoperative motor dysfunction, extent of resection, and ischemic change on postoperative MRI. Thirty-two patients with no change in IVM showed no change in motor function at 6 months after surgery. Five of 34 patients (15%) with a decline in IVM and a decline in MEPs ≤ 50% had motor dysfunction with mild deficits 6 months after surgery. Furthermore, 19 of 23 patients (83%) with a decline in IVM and decline in MEPs > 50% had a decline in motor function, including 13 patients with mild, 5 with moderate, and 1 with severe deficits. Six patients with moderate or severe deficits had the lowest MEP values, at < 100 µV. This study validated the utility of combined application of IVM during awake craniotomy and transcortical MEP monitoring to predict motor function at 6 months after surgery in patients with a glioma within or close to motor-related areas, not limited to the precentral gyrus. The authors also validated the usefulness of the cutoff value, 100 µV, in MEP monitoring.

How Do Clinicians Judge Fluency in Aphasia?

Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency. In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic. Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments. This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets. https://doi.org/10.23641/asha.19326419.

Teaching NeuroImage: Atypical Anterior Cerebral Artery Syndrome From Pericallosal Artery Infarct.

A 76-year-old right-handed woman presented with sudden right-sided weakness and mutism. Examination revealed transcortical motor aphasia, right arm apraxia and spasticity, and right leg hemiplegia. She demonstrated abulia, anosognosia, and emotional lability. CT angiogram demonstrated a left pericallosal artery occlusion (Figure 1). The patient received tPA. MRI demonstrated an infarct spanning the left supplementary motor area (SMA) and anterior cingulate cortex (Figure 2).1

Language Processing in Individuals with Non-fluent Aphasia: Evidence from Root and Synthetic Compound Nouns

Background: Neurolinguists are increasingly inclined to study the language behavior of patients with aphasia (PWAs) to discover more about the relationship between the brain and language. Objectives: This study investigated the production of synthetic and root compound nouns in the PWAs to discover how these lexemes were processed. Methods: Using a confrontation naming task, four PWAs (two patients with Broca aphasia and two patients with transcortical motor aphasia) named 80 random black and white drawings of simple and compound nouns. They also repeated the nouns through an auditory repetition task. Compound nouns were of two root and synthetic types. Root nouns belonged to the noun-noun, and synthetic compounds belonged to the noun-verb category. Results: There was a significant difference between the affected components in naming and repetition of compound nouns. Moreover, there was a significant difference between naming and repetition of simple and compound nouns. There was no significant difference between naming and repetition of root and synthetic nouns. Conclusions: PWAs process compound nouns through the dual-route model. They cannot retrieve the phonological forms of compound nouns, but they retain their knowledge of word-formation, indicating the modularity of linguistic ability. Morphological structure plays a role in word processing.

Prevalence of Verb and Sentence Impairment in Aphasia as Demonstrated by Cluster Analysis

ABSTRACT Background: Verb and sentence processing impairments are frequently observed in people with aphasia (PWA). However, patterns of impairment (i.e. combinations of deficits that are revealed by arrays of tasks) are usually investigated at the group level, by selecting groups of patients with specific aphasia types (e.g., non-fluent variants with signs of agrammatism), or in case-series with relatively small samples. Aims: We aimed to explore patterns of impairment in verb and sentence processing in a large (N = 54) group of PWA with various aphasia types, using methods that do not require a priori aphasia-type information. Methods & Procedures: To assess verb and sentence processing impairments in production and comprehension, we used the Verb and Sentence Test (VAST) adapted to Russian (VAST-Ru). As our main method, we used k-means cluster analysis to group individuals based on their scores on different tasks of the VAST-Ru. We then compared cluster allocations to aphasia types (according to Alexander Luria’s classification) established by a standard clinical evaluation procedure. As a follow up, we investigated performance of each person with aphasia on each task by comparing their individual scores to the control group. Outcomes & Results: The k-means analysis grouped the PWA into two clusters. The main difference between the clusters was the severity of impairment across most of the tasks, both at the single verb and at the sentence level, both in production and in comprehension. All participants with efferent motor aphasia (roughly corresponding to Broca’s aphasia) and most of the participants with acoustic-mnestic aphasia (roughly corresponding to anomic aphasia) were in the less-impaired cluster. Complex aphasia types (complex motor and complex temporal aphasia) pertained to the more-impaired cluster, while other aphasia types (dynamic aphasia, corresponding to transcortical motor, and sensory, corresponding to Wernicke’s aphasia) were more or less evenly distributed over two clusters. Individual-level analysis revealed heterogeneous patterns of impairment in both clusters and across different aphasia types. Conclusions: These results demonstrate that verb and sentence impairments are prevalent in aphasia, irrespective of the aphasia type. They also indicate that aphasia severity mediates verb and sentence impairment in aphasia. We could not find a clear correspondence between individual patterns of impairment and aphasia type at this stage. The clinical implications are discussed.

Alexia and agraphia in Spanish.

Every language has certain specific idiosyncrasies in its writing system. Cross-linguistic analyses of alexias and agraphias are fundamental to understand commonalities and differences in the brain organization of written language. Few reports of alexias and agraphias in the Spanish language are currently available. To analyse the clinical manifestations of alexias and agraphias in Spanish, and the effect of demographic variables. Spanish versions of the Western Aphasia Battery (WAB) and Boston Diagnostic Aphasia Examination (BDAE) were used for language assessment. Lesion localization was obtained by using computed axial tomography and magnetic resonance imaging. The final sample included 200 patients: 195 (97.5%) right-handed and five (2.5%) left-handed; 119 men and 81 women with a mean age of 57.37 years (SD = 15.56), education of 13.52 years (SD = 4.08), and mean time post-onset of 6.58 months (SD = 12.94). Using the WAB, four quotients were calculated: aphasia quotient (AQ), reading-writing quotient (RWQ), language quotient (LQ) and cortical quotient (CQ). The types of aphasia were: global = 11 patients (5.5%), Broca = 31 (15.5%), Wernicke = 30 (15.0%), conduction = 22 (11.0%), transcortical sensory = 17 (8.5%), transcortical motor = 3 (1.5%), amnesic or anomic = 54 (27.0%) and mixed non-fluent = 32 (16.0%). The degree of oral and written language impairment differed across the various aphasia types. Most severe reading and writing difficulties were found in global, mixed non-fluent and transcortical motor aphasia; fewer difficulties were observed in amnesic, Broca and conduction aphasia. The severity of the written language impairments paralleled the severity of the oral language disturbances. Age negatively, while schooling positively, correlated with the scores in reading and writing tests. No effect of sex and time since onset was found. In Spanish-speaking aphasia patients, difficulties in reading and writing are similar to oral language difficulties. This similarity of performance is mostly based on severity rather than the participants' patterns of errors. What this paper adds What is already known on the subject There is limited information about alexia and agraphia in Spanish. What this paper adds to existing knowledge An extensive study with a large sample of patients. What are the potential or actual clinical implications of this work? The study contributes to the clinical management of patients with reading and writing disturbances.

Non-linguistic abilities in aphasia

Abstract Background Understanding the pattern of non-linguistic abilities in aphasia has been a controversial question. We hypothesized that only some aphasia patients, particularly patients with fluent forms of aphasia and global aphasia, would present deficits in non-linguistic abilities. Methods & procedures We studied 200 vascular aphasia patients (119 men and 81 women; mean age = 57.37 years, SD = 15.56) at the Cognitive Communicative Speech Language Pathology Unit at the Clinical Hospital University of Chile (Santiago, Chile). The mean time post onset was 6.57 months (SD = 12.94). The Spanish versions of Western Aphasia Battery Revised (SWAB-R) and the Spanish version of the Boston Diagnostic Aphasia Examination (SBDAE) were administered. We used the SWAB-R Part 1 to determine the aphasia severity (Aphasia Quotient: AQ). SWAB-R Part 2 was used to study nonverbal abilities; a Non-Linguistic Quotient (NLQ) was calculated. The SBDAE was used in determining the type of aphasia. Outcomes & results Deficits were particularly evident in Global, Mixed non-fluent, and Transcortical Motor aphasia, followed by Wernicke and Transcortical Sensory aphasia. Deficits were mildest in Amnesic, Conduction, and Broca aphasia. Correlation between linguistic and non-linguistic deficits were found to be statistically significant. Conclusion Our results support previous studies: non-linguistic abilities can be affected in aphasia, but there is an important variability. Some aphasia patients can present non-linguistic deficits. Verbal and nonverbal deficits are significantly correlated, suggesting some communality in their brain organization.

Triple motor mapping: transcranial, bipolar, and monopolar mapping for supratentorial glioma resection adjacent to motor pathways.

Maximal safe resection of gliomas near motor pathways is facilitated by intraoperative mapping. The authors and other groups have described the use of bipolar or monopolar direct stimulation to identify functional tissue, as well as transcranial or transcortical motor evoked potentials (MEPs) to monitor motor pathways. Here, the authors describe their initial experience using all 3 modalities to identify, monitor, and preserve cortical and subcortical motor systems during glioma surgery. Intraoperative mapping data were extracted from a prospective registry of glioma resections near motor pathways. Additional demographic, clinical, pathological, and imaging data were extracted from the electronic medical record. All patients with new or worsened postoperative motor deficits were followed for at least 6 months. Between January 2018 and August 2019, 59 operations were performed in 58 patients. Overall, patients in 6 cases (10.2%) had new or worse immediate postoperative deficits. Patients with temporary deficits all had at least Medical Research Council grade 4/5 power. Only 2 patients (3.4%) had permanently worsened deficits after 6 months, both of which were associated with diffusion restriction consistent with ischemia within the corticospinal tract. One patient's deficit improved to 4/5 and the other to 4/5 proximally and 3/5 distally in the lower limb, allowing ambulation following rehabilitation. Subcortical motor pathways were identified in 51 cases (86.4%) with monopolar high-frequency stimulation, but only in 6 patients using bipolar stimulation. Transcranial or cortical MEPs were diminished in only 6 cases, 3 of which had new or worsened deficits, with 1 permanent deficit. Insula location (p = 0.001) and reduction in MEPs (p = 0.01) were the only univariate predictors of new or worsened postoperative deficits. Insula location was the only predictor of permanent deficits (p = 0.046). The median extent of resection was 98.0%. Asleep triple motor mapping is safe and resulted in a low rate of deficits without compromising the extent of resection.

Post-stroke Aphasia in Spanish language: the effect of demographic variables

ABSTRACT Background: The pattern of post-stroke aphasia in Spanish speakers has not previously been reported. Furthermore, the association between aphasia type and demographic variables is not clearly understood. Aims: To investigate the incidence and type of aphasia in first-ever acute stroke during the early chronic and later chronic periods in native Spanish speakers and the effect of demographic variables. Methods & Procedures: Spanish versions of Western Aphasia Battery and Boston Diagnostic Aphasia Examination were used for language assessment. Lesion localization was done by using computerized axial tomography and magnetic resonance imaging. Final simple included 243 (97.98%) right-handed, and five (2.02%) left-handed participants; 143 men and 105 women with a mean age of 58.68 years. Outcomes & Results: The types of aphasia included – 14.1% Broca’s, 15.3% Wernicke’s, 10.1% Conduction, 9.3% Transcortical Sensory, 1.6% Transcortical Motor, 28.2% Anomic, 4.8% Global, and 16.5% Mixed non-fluent. Wernicke’s aphasia, along with Transcortical Sensory aphasia was more frequently observed in older people. Broca’s aphasia was more prevalent but less severe in women than in men. Auditory Comprehension and Naming negatively correlated with age, while schooling positively correlated with Auditory Comprehension. Time since onset did not significantly affect the type of aphasia. Schooling correlated with the severity of Anomic aphasia. Conclusions: The most common type of aphasia in our sample was Anomic aphasia. Older people had an increased probability to present a fluent type of aphasia. Broca’s aphasia was more frequent but less severe in women.