Word-finding Abilities Research Articles

Identifying the Active Ingredients of a Computerized Speech and Language Therapy Intervention for Poststroke Aphasia: Multiple Methods Investigation Alongside a Randomized Controlled Trial.

Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]). This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia. We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period. Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences. The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual's specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences. ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818.

Preoperative word-finding difficulties in children with posterior fossa tumours: a European cross-sectional study.

Posterior fossa tumour surgery in children entails a high risk for severe speech and language impairments, but few studies have investigated the effect of the tumour on language prior to surgery. The current crosslinguistic study addresses this gap. We investigated the prevalence of preoperative word-finding difficulties, examined associations with medical and demographic characteristics, and analysed lexical errors. We included 148 children aged 5-17years with a posterior fossa tumour. Word-finding ability was assessed by means of a picture-naming test, Wordrace, and difficulties in accuracy and speed were identified by cut-off values. A norm-based subanalysis evaluated performance in a Swedish subsample. We compared the demographic and medical characteristics of children with slow, inaccurate, or combined slow and inaccurate word finding to the characteristics of children without word-finding difficulties and conducted a lexical error analysis. Thirty-seven percent (n = 55) presented with slow word finding, 24% (n = 35) with inaccurate word finding, and 16% (n = 23) with both slow and inaccurate word finding. Children with posterior fossa tumours were twice as slow as children in the norming sample. Right-hemisphere and brainstem location posed a higher risk for preoperative word-finding difficulties, relative to left-hemisphere location, and difficulties were more prevalent in boys than in girls. The most frequent errors were lack of response and semantically related sideordinated words. Word-finding difficulties are frequent in children with posterior fossa tumours, especially in boys and in children with right-hemisphere and brainstem tumours. Errors resemble those observed in typical development and children with word-finding difficulties.

Verbal ability in postmenopausal women in relation to age, cognitive and reproductive factors

Word-finding difficulties have been associated with age and, in women, lowered sex hormone levels following menopause. However, there is limited understanding of the ways that specific aspects of word-finding are shaped by women's age, reproductive histories, and background factors such as education. The current study investigated the effects of age, cognitive and reproductive factors on word-finding abilities in 53 healthy postmenopausal women aged 48–79. A questionnaire was used to gather demographic information and reproductive history. A battery of verbal fluency, continuous series, and naming tasks was designed to assess word-finding across different sensory modalities and cognitive demands. Category and letter fluency were quantified as total number of correct words produced on each task. For continuous series, switch rates and switch costs were computed. For the naming tasks, accuracy and latency measures were used. There were three key findings. Firstly, there was a consistent positive association between education and all word-finding measures, i.e., verbal fluency, continuous series, and naming. Secondly, age-related declines were seen on tasks heavily dependent on working memory such as the continuous series task. Thirdly, reproductive factors across the lifespan such as age at menarche and reproductive years showed subtle effects on naming abilities, but not on verbal fluency or continuous series. The results highlight that word-finding abilities in healthy postmenopausal women are shaped by factors associated with their early years (education, age at menarche) and later adult life (age, reproductive years). The study also distinguished between the more global effects of education, and the more task-specific associations with age and reproductive variables, on verbal task performance after menopause.

The Feasibility and Benefits of a Virtual Yoga Practice for Stroke Survivors With Aphasia.

The purpose of this study was to (a) examine the feasibility of a virtual, adapted, aphasia-friendly yoga program for people with aphasia; (b) evaluate evidence of improvement in patient-reported outcomes and word retrieval; (c) explore the immediate impact of a yoga session on participant subjective emotional state; and (d) assess participant motivation and perceived benefits of participating in a yoga program. This feasibility study employed a mixed-method design to document the feasibility of a virtual, 8-week adapted yoga program. A pre-/posttreatment design was used to assess patient-reported outcome measures for resilience, stress, sleep, and pain, as well as word-finding abilities. Semistructured interviews with participants were thematically analyzed to provide insight into participants' motivation and perceptions regarding their experience. Comparisons of pre- and postprogram group means suggest that participation in an 8-week adapted yoga program may positively impact perceptions of resilience (large effect), stress (medium effect), sleep disturbance (medium effect), and pain (small effect) for people with aphasia. Findings from within-session reports and brief, semistructured interviews with participants indicated positive outcomes and subjective experiences and suggest that people with aphasia are motivated to participate in yoga for a variety of reasons. This study is an important first step in confirming the feasibility of an adapted, aphasia-friendly yoga program offered via a remote platform for people with aphasia. The findings support recent work suggesting that yoga may be a potent adjunct to traditional rehabilitation efforts to improve resilience and psychosocial aspects in persons with aphasia. https://doi.org/10.23641/asha.22688125.

Getting the brain into gear: An online study investigating cognitive reserve and word-finding abilities in healthy ageing.

Lifetime experiences and lifestyle, such as education and engaging in leisure activities, contribute to cognitive reserve (CR), which delays the onset of age-related cognitive decline. Word-finding difficulties have been identified as the most prominent cognitive problem in older age. Whether CR mitigates age-related word-finding difficulties is currently unknown. Using picture-naming and verbal fluency tasks, this online study aimed to investigate the effect of CR on word-finding ability in younger, middle-aged, and older adults. All participants were right-handed, monolingual speakers of British English. CR for both the period preceding and coinciding with the COVID-19 pandemic was measured through years of education and questionnaires concerning the frequency of engagement in cognitive, leisure, and physical activities. Linear mixed-effect models demonstrated that older adults were less accurate at action and object naming than middle-aged and younger adults. Higher CR in middle age predicted higher accuracies for action and object naming. Hence, high CR might not only be beneficial in older age, but also in middle age. This benefit will depend on multiple factors: the underlying cognitive processes, individual general cognitive processing abilities, and whether task demands are high. Moreover, younger and middle-aged adults displayed faster object naming compared to older adults. There were no differences between CR scores for the period preceding and coinciding with the pandemic. However, the effect of the COVID-19 pandemic on CR and, subsequently, on word-finding ability might only become apparent in the long term. This article discusses the implications of CR in healthy ageing as well as suggestions for conducting language production studies online.

The effect of processing semantic features on spoken word retrieval in a case series of people with aphasia

Purpose: There is a growing body of evidence showing the benefit of Semantic Feature Analysis in the treatment of word finding abilities in people with aphasia. The original technique was grounded in the hypothesis that the activation of semantic features spreads to the target and thereby facilitates its subsequent retrieval. However, it remains unclear the extent to which the focus on semantic features influences the treatment effects. The aim of this study was therefore to shed light on this issue by examining the effect of priming with semantic features (parts and functions) on target retrieval across a case series of people with aphasia. Method: 10 people with aphasia and word retrieval impairments were primed with spoken forms of words that were either the target name (identity condition, e.g. car), parts of the target (e.g. wheel) or functions of the target (e.g. drive) before later being asked to name a picture of that target. An unrelated prime condition (e.g. employ) was used as a control for test-retest effects. Result: At a group level, there was speeding of reaction times in picture naming in the identity condition relative to the unrelated condition; however, no effect of priming was found for either parts or functions. There was significantly better response accuracy in post-priming naming, but this effect did not reach significance for any individual experimental condition (identity, parts, functions) as compared to the unrelated condition, although the identity condition showed numerical improvement while the other two conditions showed decline. Conclusion: Given the lack of evidence for facilitatory effects from parts and functions of a target in a priming task, this research suggests that further research is warranted on the extent to which the improvement in word retrieval subsequent to Semantic Feature Analysis is caused by the emphasis on production of semantic features rather than from the repetition of the target name.

Constraint-induced Aphasia Therapy Improves the Use of Spoken Language and Word-finding Ability in Chronic Subcortical Aphasia: A Case Report

Constraint-induced aphasia therapy (CIAT) has been reported as a short-term, intensive language training program for improving language function in patients with chronic aphasia. We report the recovery of language function in a patient with chronic aphasia who was evaluated in the baseline assessment as having reached a plateau. The patient with subcortical aphasia was a 62-year-old, right-handed man. At 192 days after left putamen hemorrhage, he visited our hospital to begin CIAT. The patient's language and speech abilities were evaluated 1 month before and immediately before the start of CIAT. To evaluate the training effect, language function was assessed immediately after, 1 month after, 3 months after, and 6 months after the end of CIAT. The Western Aphasia Battery (WAB), the single-word-naming task in the Test of Lexical Processing in Aphasia (TLPA), and the Verbal Activity Log (VAL) were used to assess his language function and the amount of spoken language. From 1 month before CIAT to 6 months after CIAT, the WAB Aphasia Quotient increased by 6.1 points. Compared with before therapy, the errors of apraxia of speech in the TLPA disappeared from immediately after to 6 months after CIAT. Although the VAL score at 3 months after CIAT was higher than that before the start of CIAT, the score decreased after 6 months because of reduced opportunities for communication with friends. CIAT improved the word-naming ability and amount of spontaneous, real-world spoken language in a patient with chronic aphasia.

Using Digital Speech Assessments to Detect Early Signs of Cognitive Impairment.

Detecting early signs of cognitive decline is crucial for early detection and treatment of Alzheimer's Disease. Most of the current screening tools for Alzheimer's Disease represent a significant burden, requiring invasive procedures, or intensive and costly clinical testing. Recent findings have highlighted changes to speech and language patterns that occur in Alzheimer's Disease, and may be detectable prior to diagnosis. Automated tools to assess speech have been developed that can be used on a smartphone or tablet, from one's home, in under 10 min. In this study, we present the results of a study of older adults who completed a digital speech assessment task over a 6-month period. Participants were grouped according to those who scored above (N = 18) or below (N = 18) the recommended threshold for detecting cognitive impairment on the Montreal Cognitive Assessment (MoCA) and those with diagnoses of mild cognitive impairment (MCI) or early Alzheimer's Disease (AD) (N = 14). Older adults who scored above the MoCA threshold had better performance on speech composites reflecting language coherence, information richness, syntactic complexity, and word finding abilities. Those with MCI and AD showed more rapid decline in the coherence of language from baseline to 6-month follow-up, suggesting that this score may be useful both for detecting cognitive decline and monitoring change over time. This study demonstrates that automated speech assessments have potential as sensitive tools to detect early signs of cognitive impairment and monitor progression over time.

Differential Associations of White Matter Brain Age With Language-Related Mechanisms in Word-Finding Ability Across the Adult Lifespan.

Research on cognitive aging has established that word-finding ability declines progressively in late adulthood, whereas semantic mechanism in the language system is relatively stable. The aim of the present study was to investigate the associations of word-finding ability and language-related components with brain aging status, which was quantified by using the brain age paradigm. A total of 616 healthy participants aged 18–88 years from the Cambridge Centre for Ageing and Neuroscience databank were recruited. The picture-naming task was used to test the participants’ language-related word retrieval ability through word-finding and word-generation processes. The naming response time (RT) and accuracy were measured under a baseline condition and two priming conditions, namely phonological and semantic priming. To estimate brain age, we established a brain age prediction model based on white matter (WM) features and estimated the modality-specific predicted age difference (PAD). Mass partial correlation analyses were performed to test the associations of WM-PAD with the cognitive performance measures under the baseline and two priming conditions. We observed that the domain-specific language WM-PAD and domain-general WM-PAD were significantly correlated with general word-finding ability. The phonological mechanism, not the semantic mechanism, in word-finding ability was significantly correlated with the domain-specific WM-PAD. In contrast, all behavioral measures of the conditions in the picture priming task were significantly associated with chronological age. The results suggest that chronological aging and WM aging have differential effects on language-related word retrieval functions, and support that cognitive alterations in word-finding functions involve not only the domain-specific processing within the frontotemporal language network but also the domain-general processing of executive functions in the fronto-parieto-occipital (or multi-demand) network. The findings further indicate that the phonological aspect of word retrieval ability declines as cerebral WM ages, whereas the semantic aspect is relatively resilient or unrelated to WM aging.

A-157 Lexical-Semantic Analysis of Verbal Naming Test Performance in Older Adult Veterans

Abstract Objective The Verbal Naming Test (VNT), a validated non-visual measure of word-finding ability in older adults, was designed to include words from distinct lexical (i.e., verbs vs. nouns) and semantic (i.e., action vs. object) categories to better capture various naming deficits. This study examined specific contributions of lexical and semantic categories to the convergent and discriminant validity of the VNT, and to how well it detects Mild Cognitive Impairment (MCI). Method The sample of older Veterans included 157 healthy controls (mean age = 74.23, SD = 6.67; range:60–89) and 39 diagnosed with MCI (mean age = 72.97, SD = 8.24; range:60–88). VNT item subscales were constructed for verbs/actions (ActionW) and nouns/objects presented either with (Obj+) or without (ObjW) an action component in the prompt. Correlations were calculated between VNT total/subscales and several other neuropsychological measures. ROC analyses compared relative contributions of each VNT subscale in detecting MCI. Results The ActionW subscale showed poor reliability (Cronbach’s alpha = 0.303) and did not correlate with any other measures. The ObjW, and Obj + subscales showed better reliability (Cronbach’s alpha>0.62) and correlated with age, measures of memory, and the Boston Naming Test. The Area Under the Curve (AUC) for detection of MCI was as follows: ActionW = 0.616; Obj + =0.635; ObjW = 0.689; and 50items = 0.690. Conclusions Lexical and semantic categories differentially affect VNT detection of MCI in older veterans. Object words, especially those without associated action components, provide the best measurement scale. Although still clinically relevant in detecting MCI, the poor reliability of verbs/action words suggests revising the VNT may improve its psychometric properties. Future research should replicate these results in a clinical sample.

A mixed-methods study of cognitive performance in persons with multiple sclerosis: Association between neuropsychological test performance and interviews about daily cognitive functioning

BackgroundCognitive difficulties are commonly reported in persons with multiple sclerosis (MS), however, self-reports of cognition often do not correspond well to objective neuropsychological test performance. The use of qualitative interviews can allow for persons with MS to describe in more detail how their cognitive function is impacted in daily life while also taking into consideration personal and environmental influences. No study to our knowledge has examined the association between objective neuropsychological test performance and qualitative interview reports of daily cognitive function. Such information could help explain the reported lack of correspondence between these two methods of evaluating cognitive function in MS. ObjectiveTo investigate the relationship between objective neuropsychological test performance and qualitative interview reported daily cognitive function in persons with MS . MethodsConvergent parallel mixed-methods design whereby 12 persons with MS (mean age= 47, 9 female, 7 relapsing-remitting MS) took part in a 2-hour neuropsychological assessment [including the Brief International Cognitive Assessment for MS (BICAMS)] followed by a semi-structured qualitative interview probing daily cognitive functioning. Interview data were analysed using thematic analysis. Interview codes and themes were compared with neuropsychological performance on respective cognitive domains and between those with and without cognitive impairment on the BICAMS. ResultsBased on the qualitative interview data, the most commonly reported difficulties were related to memory, word finding, and processing speed but only 43%, 0%, and 33% of the individuals reporting these deficits actually demonstrated impairment on the respective/ corresponding neuropsychological measures. Eleven of the twelve participants reported the use of strategies to manage cognitive difficulties. The most frequently reported strategies used were related to fatigue management. Personal (age, fatigue) and environmental factors (pressure of daily responsibilities, availability of support) were reported as influencers of daily cognitive function. Three of the 12 participants were classified as cognitively impaired on the BICAMS but they did not differ from those who were non-impaired with respect to use of strategies, and influence of personal and environmental factors on daily cognitive functioning. ConclusionsInterview-reported daily cognitive difficulties did not correspond well to objective neuropsychological performance. Greater emphasis should be placed on utilizing and developing objective neuropsychological measures that have greater sensitivity, particularly to word finding difficulties in MS, and to the incorporation of personal and environmental factors into the interpretation of neuropsychological test results. As almost all participants reported the use of cognitive strategies, we feel greater emphasis needs to be placed on patient education of evidence-based strategies, particularly focused on highly reported impacted word finding and processing speed abilities.

Validity of the Verbal Naming Test and Boston Naming Test in a sample of older Veterans

Objective The Verbal Naming Test (VNT) assesses word-finding ability, or naming, through the use of a naming-to-definition paradigm and has been shown to effectively detect naming deficits in older adults. This study evaluated the convergent and discriminant validity of the VNT, assessed how well it detects Mild Cognitive Impairment (MCI), and provided descriptive data stratified by three levels of age (60–69, 70–79, 80–89). Method The sample included 151 healthy older Veterans who were found to be cognitively intact and free of neurological and acute psychiatric disorders (mean age = 74.23, SD = 6.67; range: 60–89) and 39 older Veterans with MCI (mean age = 72.97, SD = 8.24; range 60-88). Correlations were calculated between the VNT, Boston Naming Test (BNT), and several other neuropsychological measures. ROC analyses determined how well the VNT detected MCI. Results The VNT correlated with the Rey Auditory Verbal Learning Test and the Logical Memory test. The BNT did not correlate with any measure with the exception of Judgment of Line Orientation (JLO). The Area Under the Curve (AUC) for the detection of MCI was 0.69. Normative data for the VNT are presented and stratified by ages. Conclusions This study provides evidence of the convergent and discriminant validity of the Verbal Naming Test in a sample of cognitively normal older adults, as well as its validity in the detection of MCI. It also provides descriptive data on the Verbal Naming Test that can be used in the neuropsychological assessment of older adults.

Long-term neurocognitive and educational outcomes of neonatal insults in Kilifi, Kenya

BackgroundThere is little data on the long-term neurocognitive and educational outcomes among school-aged survivors of neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) in Africa.This study investigates the long-term neurocognitive and educational outcomes and the correlates of these outcomes in school-aged survivors of NNJ or HIE in Kilifi, Kenya.MethodsWe conducted a cross-sectional study on neurocognitive and educational outcomes among school-aged survivors (6–12 years) of NNJ (n = 134) and HIE (n = 107) and compared them to a community comparison group (n = 134). We assessed nonverbal intelligence, planning, working memory, attention, syntax, pragmatics, word-finding, memory, perceptual-motor, mathematical, and reading abilities. We also collected information on medical history, caregivers’ mental health, and family environment.ResultsThe survivors of NNJ had lower mean total scores in word-finding [F (1, 250) = 3.89, p = 0.050] and memory [F (1, 248) = 6.74, p = 0.010] than the comparison group. The survivors of HIE had lower mean scores in pragmatics [F (1, 230) = 6.61, p = 0.011] and higher scores higher scores in non-verbal reasoning [F (1, 225) =4.10, p = 0.044] than the comparison group. Stunted growth was associated with almost all the outcomes in HIE.ConclusionSurvivors of NNJ and HIE present with impairment in the multiple domains, which need to be taken into consideration in the planning of educational and rehabilitative services.

Understanding differing outcomes from semantic and phonological interventions with children with word-finding difficulties: A group and case series study

Developmental Language Disorder occurs in up to 10% of children and many of these children have difficulty retrieving words in their receptive vocabulary. Such word-finding difficulties (WFD) can impact social development and educational outcomes. This research aims to develop the evidence-base for supporting children with WFD and inform the design and analysis of intervention studies.We included 20 children (age 6 to 8) with WFD each of whom participated in two interventions one targeting semantic attributes and the other phonological attributes of target words. The interventions, employing word-webs, were carefully constructed to facilitate direct comparison of outcome which was analysed at both group and case-series level.The study used a robust crossover design with pre-intervention baseline, between–intervention wash-out and post-intervention follow-up testing. We incorporated: matching of item sets on individual performance at baseline, independent randomisation of order of intervention and items to condition, blinding of assessor, evaluation of fidelity and control items. The interventions were clinically feasible, with weekly sessions over six weeks.Intervention improved children's word-finding abilities with statistically significant change only during treatment phases of the study and not over baseline, wash-out or follow-up phases. For the group the semantic intervention resulted in a gain of almost twice as many items as the phonological intervention, a significant difference.However, children differed in their response to intervention. Importantly, case-series analysis revealed outcomes predictable on the basis of children's theoretically driven language profiles. Taking account of individual profiles in determining choice of intervention would enable more children to benefit.The study provides new evidence to inform and refine clinical practice with this population. Future studies should be designed such that results can be analysed at both group and case series levels to extend theoretical understanding and optimise use of appropriate interventions.

Does Working-Memory Training Given to Reception-Class Children Improve the Speech of Children at Risk of Fluency Difficulty?

Procedures were designed to test for the effects of working-memory training on children at risk of fluency difficulty that apply to English and to many of the languages spoken by children with English as an Additional Language (EAL) in UK schools. Working-memory training should: (1) improve speech fluency in high-risk children; (2) enhance non-word repetition (NWR) (phonological) skills for all children; (3) not affect word-finding abilities. Children starting general education (N = 232) were screened to identify those at risk of fluency difficulty. Children were selected who were at high-risk (12), or low-risk (27) of fluency difficulty. For the low-risk children 10 received, and 17 did not receive, the working-memory training. All children in the treatment groups received working-memory training over a 2-week period. For the high-risk group, fluency improved and lasted for at least a week after the end of the study. Phonological skills improved in this group and in the low-risk group who received the training and the improvements continued for at least a week. The low-risk group who did not receive working-memory training showed no improvements, and no group improved word-finding ability.

Clinical Profiling of a Bilingual Client with Anomic Aphasia.

Background:Aphasia is an acquired condition affecting auditory comprehension, verbal expression, reading, writing and word-finding abilities along with sensory-motor impairments. Anomia refers to difficulty in word retrieval or naming which is seen irrespective of the type of aphasia. However, if a patient shows word-finding difficulty, in specific, a diagnosis of Anomic aphasia is made. There are variations within anomic aphasia on which the management and recovery depend. The article provides one such case report.Purpose:Speech and language profiling in anomic aphasia, specific treatment strategies, the effect of bilingualism on recovery.Methods:Mr S, a 38-year-old bilingual male reported 5 months post-stroke with difficulty in expressing, difficulty in writing and weakness in the right side of the body. Medical history was checked and speech and language evaluations including both formal and informal assessments were performed. After this, a diagnosis of Anomic aphasia with mild dysarthria was made. An appropriate speech–language therapeutic plan and specific activities were formulated for Mr S in his first language (L1) and he was given a therapy for a span of 3 months. A follow-up evaluation in both first and second language of the patient yielded differential recovery patterns.Results:The diagnosis was affected by different variants of anomic aphasia; treatment was specific to the clinical profiling and followed life-participation approach of aphasia. The recovery was affected by differential recovery patterns between the languages.Discussion:Factors pertaining to diagnosis, recovery, bilingualism and treatment of the client with anomic aphasia are discussed.

COCAINE-INDUCED THROMBOTIC STORM

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Cocaine is associated with a wide array of complications through a number of different mechanisms. Although majority of cocaine related morbidity has been attributed to complications in arterial vasculature, the deleterious impact of venous complications appears to be largely unrepresented in current literature as well as clinical practice despite emerging evidence of the high prevalence and annual incidence of DVT in illicit drug users CASE PRESENTATION: 27-year-old previously healthy male presented to the ED with new onset difficulty speaking and facial droop hours after using cocaine. He was afebrile with vitals 98.5 °F, BP 142/97, HR 94 and RR 16. Examination was remarkable for expressive aphasia and right facial droop with no other focal neurological finding. CT scan of head showed thrombosed left MCA with infarct in left frontal lobe and basal ganglia. Labs were significant for a troponin of 14 md/dl and CK-MB 34. CBC and metabolic panel were unremarkable. Urine toxicology was positive for cocaine and opiates. EKG showed T wave inversion with ST depression in V1-V4 II and aVF. CTA of chest revealed bilateral segmental and subsegmental PE without any acute pulmonary disease. CTA of head and neck showed complete abrupt occlusion of proximal left internal carotid artery with distal reconstitution at the segment M1 of MCA and an intraluminal thrombus in the M1 segment. A doppler of lower extremities revealed deep venous thrombosis in left peroneal and posterior tibial veins. An ECHO failed to reveal an intracardiac shunt precluding the possibility of paradoxical thrombosis. He was continued on heparin for 10 days before being switched to Xarelto. He experienced improvement in word finding ability and is currently in rehab. Hypercoagulability work-up including prothrombin gene mutation, factor V Leiden deficiency, APLA and anti-thrombin deficiency was negative. DISCUSSION: This case illustrates an uncharacteristic presentation of cocaine-related widespread thrombotic cascade involving both arterial and venous circulations causing significant morbidity. The complex pathophysiology of widespread prothrombotic state caused by cocaine includes endothelial damage promoting increase of fibrinogen and Von Willebrand factor to platelet aggregation and clot formation. It is important to identify the impact cocaine induced venous thrombosis can mount, especially in the form of potentially fatal complications like pulmonary embolism. CONCLUSIONS: Although recent studies have focused on increased incidence and prevalence of venous thrombosis in setting of cocaine abuse, ours is the first case of documented pulmonary embolism caused by cocaine related venous thrombosis. Further studies are needed to identify patients at higher risk for this complication like rare thrombotic disorders Reference #1: 1. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Reference #2: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies). The DAWN Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD, December 28, 2010. Reference #3: . Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network: Detailed Tables: National Estimates, Drug-Related Emergency Department Visits for 2004–2009. Rockville, MD, December 28, 2010. DISCLOSURES: no disclosure on file for Erika Cappelluti; No relevant relationships by Manish Kumar, source=Web Response No relevant relationships by Alain Rizkallah, source=Web Response No relevant relationships by Nihar Shah, source=Web Response No relevant relationships by Toishi Sharma, source=Web Response

Comparing the Boston Naming Test With the Neuropsychological Assessment Battery–Naming Subtest in a Neurodegenerative Disease Clinic Population

The Boston Naming Test-Second edition (BNT-2) and the Neuropsychological Assessment Battery-Naming (NAB-N) subtest are two commonly used confrontation naming tests used to evaluate word-finding ability in individuals suspected of neurodegenerative disease. The BNT-2 and NAB-N are designed to measure the same construct; however, observations in practice suggest these two tests provide divergent estimates of naming ability. This study sought to systematically investigate the level of agreement between performance on the BNT-2 and NAB-N. Records from 105 consecutive referrals seen for neuropsychological evaluation as part of routine care in an outpatient memory disorders clinic were reviewed. Discrepancy scores, concordance correlation coefficients, and root mean squared differences were calculated between demographically adjusted T-scores on the BNT-2 and NAB-N. Results indicated that estimates of word finding ability generated by the BNT-2 and NAB-N have a strong linear relationship but systematically generate scores that are inconsistent. Despite similar task demands, the BNT-2 and NAB-N provide different information about naming ability and further research is needed to understand these differences and inform clinicians on interpreting the naming estimates provided by each test.

Higher physical fitness levels are associated with less language decline in healthy ageing

Healthy ageing is associated with decline in cognitive abilities such as language. Aerobic fitness has been shown to ameliorate decline in some cognitive domains, but the potential benefits for language have not been examined. In a cross-sectional sample, we investigated the relationship between aerobic fitness and tip-of-the-tongue states. These are among the most frequent cognitive failures in healthy older adults and occur when a speaker knows a word but is unable to produce it. We found that healthy older adults indeed experience more tip-of-the-tongue states than young adults. Importantly, higher aerobic fitness levels decrease the probability of experiencing tip-of-the-tongue states in healthy older adults. Fitness-related differences in word finding abilities are observed over and above effects of age. This is the first demonstration of a link between aerobic fitness and language functioning in healthy older adults.

Estimating risk of word-finding problems in adults undergoing epilepsy surgery.

This retrospective, observational study examined the frequency and magnitude of change in naming ability as a function of side/site of epilepsy surgery and identified predictive factors to assist clinicians in identifying patients at low, moderate, or high risk of postoperative naming decline. A total of 875 adults with pharmacoresistant epilepsy (454 left/421 right; 763 temporal/87 frontal/25 posterior quadrant) met inclusion criteria and completed the Boston Naming Test before and after surgery. Clinically meaningful change in naming ability was assessed using reliable change indices for epilepsy. Demographic, cognitive, and seizure variables were examined to determine factors most predictive of naming decline and to develop a decision tree to assist with clinical decision-making. Naming decline was rare in right-sided resections and did not exceed the level expected by chance (5% overall; 90% confidence interval [CI] ± 2%). Naming decline occurred in 41% (CI ± 5%) of patients after left temporal resection (TLR) compared to 10%-12% (CI ± 10%-19%) in other left-sided surgical groups. A sizable proportion of left TLR patients (17%; CI ± 4%) showed substantial declines in naming (>11 points). Decline following left TLR was related to later age at seizure onset, older age at surgery, and higher preoperative naming ability. These factors correctly predicted naming decline in 68% of patients and were associated with degree of decline following left TLR. A decision tree is provided to assist clinicians in identifying patients at low, moderate, or high risk for postoperative naming declines. In addition to discussions regarding risk for memory decline following left TLR, patients should be counseled about potential decline in word-finding ability.