Validity and features of spontaneous speech in acute aphasia as evaluated with the Brief Aphasia Evaluation: is fluent aphasia more severe than nonfluent aphasia? / Validez y características del habla espontánea en la afasia aguda evaluada con la Evaluación Breve de la Afasia: ¿Es la afasia fluente más severa que la no fluente?

ABSTRACT Purpose To explore the relationship between the two components of spontaneous speech in the Brief Aphasia Evaluation (BAE) and the rest of the scale represented by its three main factors: The Expression, Comprehension, and Complementary factors. Methods BAE has proven validity and reliability. The evaluation of spontaneous speech in this scale comprises two components: Performance Rank (score: 0-3) and Type of Disorder (Fluency [F], Content [C], or Mixed [FC]) when rank < 3. Sixty-seven patients with left brain damage and 30 demographically matched healthy participants (HP) were studied. It was analyzed the correlation between Performance Rank and the three BAE factors and, recoding 3 as 0 and < 3 as 1, the sensitivity/specificity of this component for each factor. The effect of Type of Disorder on the three factors was analyzed. Results 1) Performance Rank: Correlations of 0.84 (Expression), 0.81 (Comprehension), and 0.76 (Complementary) were observed, with a sensitivity and specificity ≥ 78% for any factor; 2) Type of Disorder: The performance significantly decreased from FC to C and from C to F in Expression (FC < C < F), from FC to C and from FC to F also in Comprehension and Complementary, from patients with any type of disorder to HP. Conclusion Performance Rank was a relevant indicator of aphasia by its consistency with valid and comprehensive dimensions of acute language impairments. A degree difference between F and C was observed, being F a milder disorder; i.e., fluency problems were less severe than retrieval or anomia ones.

RESUMEN Objetivo Explorar la relación entre los dos componentes del habla espontánea en la Evaluación Breve de la Afasia (EBA) y el resto de la escala, representada por sus tres factores principales: Expresión, Comprensión y Complementario. Método EBA ha demostrado validez y confiabilidad. La evaluación del habla espontánea consta de dos componentes: Grado de Desempeño (puntuación: 0-3) y Tipo de Trastorno (Fluidez (F), Contenido (C), o Mixto (FC)) cuando grado<3. Se estudiaron 67 pacientes con lesión cerebral izquierda y 30 participantes sanos (PS), emparejados demográficamente. Se analizó la correlación entre Grado de Desempeño y los tres factores de EBA y, recodificando 3 como 0 y <3 como 1, la sensibilidad/especificidad del componente para cada factor. Se analizó el efecto de Tipo de Trastorno sobre los tres factores. Resultados 1) Grado de Desempeño: Se observaron correlaciones de 0,84 (Expresión), 0,81 (Comprensión), y 0,76 (Complementario), con una sensibilidad y especificidad ≥ 78% para cualquier factor; 2) Tipo de Trastorno: El desempeño disminuyó significativamente desde FC a C y desde C a F en Expresión (FC<C<F); desde FC a C y desde FC a F también en Comprensión y Complementario; desde los pacientes con cualquier tipo de trastorno a PS. Conclusión Grado de Desempeño fue un indicador relevante de la afasia por su consistencia con dimensiones válidas y comprensivas de trastornos agudos del lenguaje. Se observó una diferencia de grado entre F y C, siendo F un trastorno más leve, vale decir, los problemas de fluidez fueron menos severos que los de evocación o anomia.

[Comparison of picture naming ability in fluent and non-fluent aphasics: an analysis of 4 cases]

Impairment of noun retrieval is common among aphasic patients, but some of previous studies represent differences between noun retrieval ability of various aphasia syndromes. Current study investigates and compares the picture naming ability of 4 patients with fluent and non-fluent aphasia. Present study investigated the naming ability of 2 fluent and 2 non-fluent aphasic patients with oral picture naming test. This test contains line drawing of 109 nouns. Patients were asked to name each picture with a single word. Responses were classified according to Philadelphia Naming Test scoring system as correct and semantic, formal, mixed, non-word, unrelated and others error [no response, description/circumlocution, miscellaneous error]. Then, the data were investigated in terms of descriptive statistics and analyzed by Mann-Whitney U test. The score of non-fluent aphasics was more than fluent ones. The percentage of semantic errors in fluent group and no responses among non-fluent patients were more than the other types. Despite of personal differences, all error types were found in responses of patients. The difference between score and error types in fluent and non-fluent patients was not significant [p>.05]. This scoring system can define a variety of word retrieval errors. The fluent aphasics have more noun retrieval problems than non-fluent patients. Although, there are differences between two groups, but error type in picture naming is not a precise factor for distinguish between various aphasia syndromes and there is similarity in impaired underling mechanisms and naming behavior of them

Severity of Post-stroke Aphasia According to Aphasia Type and Lesion Location in Koreans

To determine the relations between post-stroke aphasia severity and aphasia type and lesion location, a retrospective review was undertaken using the medical records of 97 Korean patients, treated within 90 days of onset, for aphasia caused by unilateral left hemispheric stroke. Types of aphasia were classified according to the validated Korean version of the Western Aphasia Battery (K-WAB), and severities of aphasia were quantified using WAB Aphasia Quotients (AQ). Lesion locations were classified as cortical or subcortical, and were determined by magnetic resonance imaging. Two-step cluster analysis was performed using AQ values to classify aphasia severity by aphasia type and lesion location. Cluster analysis resulted in four severity clusters: 1) mild; anomic type, 2) moderate; Wernicke's, transcortical motor, transcortical sensory, conduction, and mixed transcortical types, 3) moderately severe; Broca's aphasia, and 4) severe; global aphasia, and also in three lesion location clusters: 1) mild; subcortical 2) moderate; cortical lesions involving Broca's and/or Wernicke's areas, and 3) severe; insular and cortical lesions not in Broca's or Wernicke's areas. These results revealed that within 3 months of stroke, global aphasia was the more severely affected type and cortical lesions were more likely to affect language function than subcortical lesions.

Non-convulsive status epilepticus presenting with wernick's aphasia

Ictal aphasia in adults is a rare phenomenon. Most reported cases manifest with non-fluent [Broca] aphasia. Ictal fluent [Wernicke] aphasia is less common. We report a 47-year-old, right-handed woman that presented with recurrent episodes of non-convulsive seizures in the form of Wernickes aphasia for 2 weeks. An MRI of the brain showed an old cerebral infarction in the left parieto-occipital area. Scalp EEG revealed continuous periodic sharp waves at the left temporal regions with diffusion to the whole left hemisphere and at occasions to the right. This is followed by variable periods of post ictal slowing. Recurrence of the described ictal pattern was noted. Management of status epilepticus was started in the form of intravenous diazepam and a loading dose of phenytoin and phenobarbitone. After treatment, she improved clinically and the EEG improved with disappearance of the left temporal ictal rhythm and normalization of the EEG background. Thus, establishing the diagnosis of non-convulsive partial status epilepticus manifesting as ictal aphasia

Estudio de las funciones musicales en los pacientes afásicos / A study of musical function in aphasics

Las capacidades musicales fueron evaluadas en 20 pacientes afásicos, con lesiones únicas en hemisferio cerebral izquierdo. Las alteraciones musicales fueron raras en afasias de Broca (n=7), solo el 14% tenía trastornos rítmicos y el 28% melódicos. La mitad de los pacientes con afasias de Wernicke (n=4) mostraron compromiso en los aspectos rítmicos y de discriminación auditiva. Las mayores alteraciones neurosonoromusicales aparecieron en afasias globales (n=6), estando comprometidos los aspectos rítmicos en el 83% de los casos. Estas lesiones en hemisferio izquierdo mostraron que la función más alterada fue la rítmica (55%) cuyas superposiciones lesionales se encontraron sistemáticamente en el área postrolándica parietotemporal medial. Sólo el 20% tenía falla en los aspectos melódicos y el 25% en la discriminación auditiva

Agnosia auditiva surdez pura para palavras afasia de Wernicke sem alexia: aspectos clínicos e conceituais / Auditory agnosia, pure word deafness, Wernicke's aphasia without alexia: clinical and concepetial aspects

A agnosia auditiva e sindromes correlatas podem ter seu diagnóstico confundido com o das afasias. Descrevemos o caso de uma mulher de 32 anos que subitamente perdeu a capacidade de compreender a palavra falada e sons näo verbais,, embora a leitura e a escrita estivessem intactas e a fala espontânea fosse apenas muito discretamente disfásica. A investigaçäo mostrou isquemia extensa e bilateral do córtex temporal, secundária a anticoagulaçäo inadequada, após colocaçäo de prótese aórtica. O segundo paciente é um homem de 43 anos com súbita dificuldade para compreender a palavra falada, estando preservadas a compreensäo de sons näo verbais, leitura e escrita. A nosso ver, o primeiro caso corresponde à agnosia auditiva e o segundo à afasia de Wernicke sem alexia. Säo discutidos aspectos do diagnóstico diferencial e prognóstico das diferentes síndromes