Predictors of Poststroke Aphasia Recovery

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia as crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke.

The extreme capsule and aphasia: proof-of-concept of a new way relating structure to neurological symptoms

We present anatomy-based symptom-lesion mapping to assess the association between lesions of tracts in the extreme capsule and aphasia. The study cohort consisted of 123 patients with acute left-hemispheric stroke without a lesion of language-related cortical areas of the Stanford atlas of functional regions of interest. On templates generated through global fibre tractography, lesions of the extreme capsule and of the arcuate fascicle were quantified and correlated with the occurrence of aphasia (n = 18) as defined by the Token Test. More than 15% damage of the slice plane through the extreme capsule was a strong independent predictor of aphasia in stroke patients, odds ratio 16.37, 95% confidence interval: 3.11–86.16, P &lt; 0.01. In contrast, stroke lesions of &gt;15% in the arcuate fascicle were not associated with aphasia. Our results support the relevance of a ventral pathway in the language network running through the extreme capsule.

Sensibilidad y especificidad del Test ScreeLing en usuarios afásicos en etapa aguda: un análisis preliminar

En Chile, entre un 20% y un 38% de los usuarios que sufren un ataque cerebro-vascular (ACV) presentan afasia. Pese a su alta prevalencia no existen herramientas validadas que permitan realizar una caracterización lingüística temprana de la afasia. Por lo anterior, el objetivo del presente trabajo es analizar la sensibilidad y especificidad de la versión en español del ScreeLing en una muestra de usuarios afásicos después de producido un ACV. Se trata de un estudio transversal analítico en el cual se aplicó el test ScreeLing a 13 usuarios afásicos tras primer evento de ACV en etapa aguda (< 6 semanas tras ACV) y a 56 adultos neurológicamente sanos. Adicionalmente, se evaluó el nivel comprensivo y el lenguaje espontáneo de usuarios con afasia, con la versión abreviada del Token Test y Escala de Severidad de la Afasia (ASRS). Se construyeron modelos mediante regresiones logísticas, obteniendo sus respectivas áreas bajo la curva ROC. Los resultados muestran que el equilibrio entre sensibilidad y especificidad para el puntaje global del test ScreeLing se estableció en 67 puntos, obteniendo una sensibilidad del 94,6% y especificidad del 100%. El área bajo la curva ROC alcanzó 0,99 (IC 95%: 0,97-1,00). En las subpruebas sintáctica y fonológica se alcanzó un puntaje de corte de 21 puntos, mientras que en la subprueba semántica se lograron 22 puntos. Se concluye que el ScreeLing en español posee una alta sensibilidad y especificidad para la detección de déficits lingüísticos post ACV similar a los resultados encontrados en la versión original del test en holandés. Esfuerzos futuros deben concentrarse en ampliar la muestra de usuarios afásicos con distintos perfiles de severidad.

Development of the English Listening and Reading Computerized Revised Token Test Into Cantonese: Validity, Reliability, and Sensitivity/Specificity in People With Aphasia and Healthy Controls

Purpose This study reports the psychometric development of the Cantonese versions of the English Computerized Revised Token Test (CRTT) for persons with aphasia (PWAs) and healthy controls (HCs). Method The English CRTT was translated into standard Chinese for the Reading–Word Fade version (CRTT-R- WF -Cantonese) and into formal Cantonese for the Listening version (CRTT-L-Cantonese). Thirty-two adult native Cantonese PWAs and 42 HCs were tested on both versions of CRTT-Cantonese tests and on the Cantonese Aphasia Battery to measure the construct and concurrent validity of CRTT-Cantonese tests. The HCs were retested on both versions of the CRTT-Cantonese tests, whereas the PWAs were randomly assigned for retesting on either version to measure the test–retest reliability. Results A two-way, Group × Modality, repeated-measures analysis of variance revealed significantly lower scores for the PWA group than the HC group for both reading and listening. Other comparisons were not significant. A high and significant correlation was found between the CRTT-R- WF -Cantonese and the CRTT-L-Cantonese in PWAs, and 87% of the PWAs showed nonsignificantly different performance across the CRTT-Cantonese tests based on the Revised Standardized Difference Test. The CRTT-R- WF -Cantonese provided better aphasia diagnostic sensitivity (100%) and specificity (83.30%) values than the CRTT-L-Cantonese. Pearson correlation coefficients revealed significant moderate correlations between the Cantonese Aphasia Battery scores and the CRTT-Cantonese tests in PWAs, supporting adequate concurrent validity. Intraclass correlation coefficient showed high test–retest reliability (between .82 and .96, p < .001) for both CRTT-Cantonese tests for both groups. Conclusions Results support that the validly translated CRTT-R- WF -Cantonese and CRTT-L-Cantonese tests significantly differentiate the reading and listening comprehension of PWAs from HCs and provides acceptable concurrent validity and high test–retest reliability for both tests. Furthermore, favorable PWA versus HC sensitivity and specificity cutoff scores are presented for both CRTT-Cantonese listening and reading tests.

T74. RECOVIWEL: AN OBSERVATIONAL STUDY, COMPARING COGNITIVE AND FUNCTIONAL OUTCOMES IN OFFENDERS AND NON-OFFENDERS PATIENTS WITH SEVERE MENTAL ILLNESS

Background Individuals with severe mental illness (SMI) may be considered violent, but in most cases they are victims. Substance abuse, a clinical history of violence and gender are among the main risk factors for aggressive behavior. To date, evidence on the mechanisms involved in violent behavior in SMI is still scarce and controversial. From a neuropsychological point of view, the deficits in executive functions, may be a key element in increasing propensity to violence. Methods Sample: 50 offender SMI patients recruited at the Residence for the Execution of Security Measures (REMS) of Castiglione d/S (case group) and 35 non-offender SMI patients recruited at the Department of Mental Health and Addictive Disorders of Brescia (control group). Match 1: 1 by gender, education and main diagnosis. An interview was given to collect the anamnestic data. All patients were assessed with clinical (CGI-S, PANSS-EC), neurocognitive (TMT, SCWT, BACS), social cognitive (FEIT), psychosocial functioning / wellness (MCH-SF, PSP), impulsiveness (BIS-11, IGT) and aggressive behaviour risk assessment (MOAS, HCR-20, PCL-R) measures. Results The two groups appeared to be significantly different as far as the total scores for both HCR-20 and PCL-R, with REMS patients have significant higher values. HCR-20 and PCL-R showed a significant predictive value independent of each other, in determining membership of the case group or control group. In particular, each additional point in the HCR-20 increased the probability of belonging to the case group of 1.8, while each additional point at the PCL-R increased this probability by 1.3. Significant differences were observed regarding the CGI-S and the PANSS-EC scores, where REMS patients had, at the same diagnosis, more severe psychopathology. PANSS-EC, BACS token test and SCWT errors showed a significant independent predictive value in HCR-20 score. In particular, for each additional point at the PANSS-EC, the HCR-20 increased 1 point, while this score is reduced by 0.16 for each additional point to the BACS token test and 0.42 for each additional point to the SCWT errors. Considering the cognitive profile, poorer performances were found in the offenders patients in the TMT-A and the BACS token exercise, indicating greater deficits in both visuomotor speed and attention. Regarding school performance (a possible proxy of cognitive reserve), the two groups appeared significantly different for the number of failures (p&lt;0.012), which is higher among REMS patients. Friend relationships were more associated with PCL-R factor 2 (p&lt;0.05). HCR-20 showed a strong association with both PCL-R factors and the total score (p&lt;0.001), as well as CGI-S (p&lt;0.005) and PSP (subscale A) (p&lt;0.001). FEIT (happiness), friend relationships, PSP (subscale A), MHC-SF (social and psychological subscales) were independently associated with the PCL-R total score. The difference regarding the use of hashish lifetime, which is greater in the group of cases, appeared significant. Discussion Results of the present study highlight that offenders patients with SMI have higher levels of clinical, cognitive and friends relationships severity, but better social cognition skills and a higher degree of perceived well-being. The greatest number of failures in REMS patients could be due to a greater impairment of cognitive function from an early stage of the disease. Even if the majority of crimes is carried out against the family members, family relationships do not present differences between the two groups. Although preliminary, these results could help clinicians to better understand offenders patients with SMI and to identify more homogeneous subgroups of patients, in order to plan more tailored care pathways.

Evaluating Part V of the German version of the Token Test as a screening of specific language impairment in preschoolers

Specific language impairment (SLI) is a very common childhood disorder that is characterized by impairments in expressive and/or receptive language regarding different modalities. Part V of the German version of the Token Test was evaluated as a potential screening tool for the early detection of SLI. Forty-five male and 16 female monolingual native German-speaking preschoolers with SLI (4–6 years) and 61 age- and gender-matched typically developing controls were examined with a German version of the Token Test and an established intelligence measure. Token Test performance was significantly worse in preschoolers with SLI including greater group differences at age 4 than at ages 5 and 6. Analyses showed a detection rate of 77% for Part V of the Token Test in the whole sample as well as 85.1% at age 4, 80.6% at age 5, and a nonsignificant detection at age 6. Correctly detected preschoolers with SLI showed significantly worse performance than typically developing controls regarding nonverbal and verbal intelligence, numeracy, problem solving, working memory, visual attention, and memory. Children with SLI show worse Token Test performance, whereas at ages 4 and 5, Part V of the Token Test could potentially serve as a screening tool for the detection of SLI.

EFFECTIVENESS OF DIFFERENT INTERGENERATIONAL LEARNING PROGRAMS FOR ELDERS WITH MILD COGNITIVE IMPAIRMENT

The purposes of this study was to investigate the efficacy of interpersonal relationships, cognition, instrumental activities of daily living, depression for elderly with cognitive impairment through intervention using the intergenerational somatosensory video game and company. The experimental design was used for this study. Eighty-nine elders with mild cognitive impairement and 180 adolescents were from nine junior and senior high school were recruited in this study. Eight day care centers were randomly assigned to the experimental group I (EGI) (5-week intergenerational somatosensory video game), the experimental group II (EGII) (8-week intergenerational somatosensory video game), the experimental group III (EGIII) (5-week intergenerational company), the experimental group IV (EGIV) (8-week intergenerational company) and control group for eight weeks of routine activities. Subjects were interviewed using structured instruments, including the Instrumental Activities of Daily Living (IADL), Token test, and Geriatric Depression Scale. Obtained data was analyzed using the Generalized Estimate Equation (GEE). The results revealed that there was no significant difference of eldsers’ characteristics among five groups. After intervention, instrumental activities of daily living scores in 8-week intergenerational somatosensory video game (EGII) and 8-week intergenerational company groups (EGIV) were significantly better than the control group. Token test score in 8-week intergenerational company (EGIV) were significant higher than that in the control group; while depression in 5-week intergenerational company (EGIII) was significantly lower thatn that in the control group. Based on the research findings, to arrange intergenerational action video game and intergenerational company to enhance elders’ attention, instrumental activities of daily living and decrease depression.