The development of the Life Participation Approach to Aphasia knowledge scale and contribution to its validation.

PURPOSE: The Life Participation Approach to Aphasia (LPAA) supports the notion of personalized intervention for individuals who are affected by aphasia. However, knowledge about LPAA among speech-language therapists (SLTs), professionals who support the communication rehabilitation of people with aphasia, is unknown. SLTs with an established understanding of LPAA may be more likely to apply the approach in their practices. However, there is a lack of valid and reliable tools to measure SLTs' knowledge about LPAA. We developed and evaluated the validity and reliability of a new tool to assess SLTs' knowledge of the LPAA. MATERIALS AND METHODS: An initial scale was constructed and validated by a panel of LPAA experts. The scale was revised based on the recommendations from the panel. A total of 59 SLT participants completed the revised version on the Qualtrics Online Survey Platform. RESULTS: The scale achieved a Cronbach's alpha value of 0.73. The deletion of two items increased the alpha value to 0.80 and raised the total accuracy score. CONCLUSIONS: The LPAA Knowledge Scale is a valid tool with good internal consistency to measure the knowledge of SLTs about the LPAA. This scale may be used to evaluate the effectiveness of LPAA training for SLTs, as well as a self-assessment tool for SLTs to reflect on the application of LPAA in their practices.

The Life Participation Approach to Aphasia (LPAA) highlights the need to focus aphasia intervention on the life experiences of individuals who are affected by aphasia.A solid understanding of the LPAA concepts may encourage speech-language therapists (SLTs) to apply its values when working with individuals who are affected by aphasia.The LPAA Knowledge Scale is a valid tool to evaluate the level of understanding about LPAA among SLTs.

Cultural adaptation and psychometric analysis of Communication Activities of Daily Living third edition in Spanish and Catalan for people with aphasia.

BACKGROUND: In the Spanish and Catalan context, there is currently a lack of standardized, linguistically adapted tools to assess people with communication disorders. This lack is especially evident when it comes to instruments designed to assess functional communication. AIMS: The main objective of this study is to adapt the instrument entitled Communication Activities of Daily Living 3rd edition (CADL-3) into European Spanish (CADL-3VE) and Catalan (CADL-3VC), thus providing a new tool to assess the functional communication of patients with aphasia in the Spanish and Catalan populations. METHODS & PROCEDURES: A total of 152 people, all residents of Catalonia, took part in the study. The CADL-3VE test was administered to 125 Spanish-speaking participants, who were divided into two groups, one consisting of patients with aphasia and the other a control group. The CADL-3VC test was administered to 27 Catalan-speaking patients with aphasia. Other tests and assessment scales were used for the external validation of the test. OUTCOMES & RESULTS: Reliability scores were recorded for both new versions of the test. There was a very strong correlation between the CADL-3VE test and external criteria. The scores for both of the new versions showed significant differences in terms of performance between the aphasia and control groups. Both versions displayed similarities with the original test with respect to most of the psychometric analyses carried out. CONCLUSION & IMPLICATIONS: The test makes it possible to assess everyday communicative functioning and participation in real-world contexts. As such, it helps inform the creation of personalized, interdisciplinary treatment plans aimed at functional objectives that consider the patient's context. WHAT THIS PAPER ADDS: What is already known on the subject In order to effectively assess aphasia based on a bio-psycho-social perspective, it is necessary to examine functional communication. In other words, there is a need to explore the kinds of communication difficulties that people face in their everyday lives. Communication Activities of Daily Living (CADL-3) is an English-language test that was developed to assess functional communication by simulating certain everyday activities. What this study adds This paper offers an analysis of the items, reliability and validity of the Spanish and Catalan versions of the CADL-3 test. What are the clinical implications of this work? This new instrument has the potential to play an essential role in assessing the everyday functional communication of people with aphasia in Spain.

Expanding the scope: multimodal dimensions in aphasia discourse analysis-preliminary findings.

Background: Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals' social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population. Objective: This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations. Methods: Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task-the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses. Results: Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia. Conclusion: Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.

EEG synchronization patterns during a Go/No-Go task in individuals with aphasia in subacute and chronic phases of stroke.

Stroke and subsequent neuroregenerative processes cause changes in neural organization of attentional functions. In this study, we attempted to identify differences in neural synchronization patterns during a visual Go/No-Go task in people with post-stroke aphasia in both subacute and chronic stroke phases. To identify neuronal underpinnings of the behavioral differences we investigated pairwise connectivity patterns using corrected imaginary phase locking value and graph-theoretic measures (efficiency, modularity and clustering coefficient) at global and local level in subacute (n = 13) and chronic stroke phases (n = 14) during a Go/No-Go task. We observed significantly lower phase synchronization in the Subacute Group in the alpha band in the connections spanning frontal and central areas of both hemispheres alongside lower local efficiency and clustering coefficient in the left frontal region. Additionally, we observed higher modularity in the beta band in the unaffected right parietal region in the Subacute Group which may denote inhibition of motor and attention functions. Those mechanisms could serve to align cognitive abilities between the damaged and healthy hemispheres, harmonizing the activity of the neuronal networks of both hemispheres disrupted by the effects of the stroke. Our findings have potential implications for rehabilitation therapies, which should take into account the pattern of connectivity changes during different phases of reovery.

Mind Language Disturbances and PET-Signs of Depression vs Alzheimer's Disease: Are There Any Common Patterns Identified?

BACKGROUND: There is a broad appreciation that a diagnosis of depression (D) in the elderly is a strong risk factor for incident dementia, particularly Alzheimer's disease (AD). Indeed, the two disorders might constitute a dyad, although their causal relationship is uncertain, given the likely bidirectional and compounding effects of social withdrawal and loss of previous activities, and the manifestation of language disturbances, cognitive dysfunction, and social disruption that are typical of both conditions. We argue that language declines in D and AD share common patterns and biological underpinnings, and that D/AD patients might benefit from intensive language remediation training aiming to improve the functioning of neural networks that are linked to similar cognitive impairments. METHODS: A literature search in PubMed database included topics of language disturbances, cognitive impairments, and molecular brain imaging by positron emission tomography (PET) to identify common patterns in D and AD regarding language decline and its neurobiological underpinnings. RESULTS: Language disturbances show a particular commonality in the two disorders, manifesting in simplified language and particular speech markers (e.g., lexical and semantic repetitions, arguably due to ruminations in D and memory deficits in AD). PET can reveal abnormal protein deposits that are practically diagnostic of AD, but cerebrometabolic deficits to PET with the glucose tracer FDG show a certain commonality in D and AD. Typical findings of hypometabolism in the frontal lobes doubtless underlie the executive function deficits, where frontal hypometabolism in prodromal D increases with AD progression. This may reflect overlapping changes in noradrenaline and other neurotransmitter (e.g. serotonin) changes. Cerebrometabolic deficits associated with language dysfunction may inform targeted language remediation treatments in the D/AD progression. CONCLUSIONS: Language remediation techniques targeting specific language disturbances might present an important complimentary treatment strategy along with an adjusted pharmacotherapy approach and standard psychosocial rehabilitation interventions. We see a need for investigations of language remediation informed by the overlapping pathologies and language disturbances in D and AD.

Is semantic dementia an outdated entity?

Does it still make clinical sense to talk about semantic dementia? For more than 10 years, some researchers and clinicians have highlighted the need for new diagnostic criteria, arguing for this entity either to be redefined or, more recently, to be divided into two partially distinct entities, each with its own supposed characteristics, namely the semantic variant primary progressive aphasia and the semantic behavioral variant frontotemporal dementia. Why such a shift? Is it no longer appropriate to talk about semantic dementia? Is it really useful to divide the concept of semantic dementia into verbal and socioemotional semantic subcomponents? Does this proposal have any clinical merit or does it solely reflect theoretical considerations? To shed light on these questions, the purpose of the present review was to explore theoretical considerations on the nature of the knowledge that is disturbed in this disease which might justify such terminological changes.

Apraxia phenotypes and frontotemporal lobar degeneration.

BACKGROUND: Apraxia has been identified in all clinical forms of frontotemporal lobar degeneration (FTLD). The characteristics of apraxia symptoms and their underlying cognitive/motor basis are not fully understood. This study investigated apraxia in pathological subtypes of FTLD. METHODS: The study constituted a retrospective review of 115 pathologically confirmed cases of FTLD from a single cognitive neurology centre. Patients in whom apraxia had been documented as a notable clinical characteristic were identified. Apraxia features, demographic, cognitive, neurological, and imaging findings were recorded. RESULTS: Eighteen patients were identified: 12 with FTLD-tau pathology (7 corticobasal degeneration (CBD), four Pick type and one progressive supranuclear palsy (PSP)) and six with FTLD-TDP pathology, all type A and four linked to progranulin gene mutations. Apraxia as a dominant presenting feature was typically associated with tau pathologies, whereas it emerged in the context of aphasia in TDP pathology. Apraxia typically predominated in one body part (face or limb) in tau but not TDP pathology. Relatively preserved activities in daily life were associated with TDP. Apraxia of speech was associated with tau pathology. Pick-type pathology was linked to symmetrical atrophy and late development of limb rigidity. CONCLUSION: Apraxia in FTLD subtypes has variable characteristics. Apraxia associated with CBD pathology conformed to criteria for probable corticobasal syndrome (CBS), whereas apraxia with Pick-type pathology did not. Apraxia in patients with TDP-A pathology was interpreted as one manifestation of their generalised communication disorder. Apraxia in FTLD may have distinct cognitive and motor substrates that require prospective investigation.

Task-State Functional MRI of Brain Regions with Reduced Activation in Aphasia Patients: A Meta-analysis.

OBJECTIVE: Language is one of the most celebrated hallmarks of human cognition. With the continuous improvement of medical technology, functional MRI (fMRI) has been used in aphasia. Although many related studies have been carried out, most studies have not extensively focused on brain regions with reduced activation in aphasic patients. The aim of this study was to identify brain regions normally activated in healthy controls but with reduced activation in aphasic patients during fMRI language tasks. METHODS: We collected all previous task-state fMRI studies of secondary aphasia. The brain regions showed normal activation in healthy controls and reduced activation in aphasic patients were conducted activation likelihood estimation (ALE) meta-analysis to obtain the brain regions with consistently reduced activation in aphasic patients. RESULTS: The ALE meta-analysis revealed that the left inferior frontal gyrus, left middle temporal gyrus, left superior temporal gyrus, left fusiform gyrus, left lentiform nucleus and the culmen of the cerebellum were the brain regions with reduced activation in aphasic patients. DISCUSSION: These findings from the ALE meta-analysis have significant implications for understanding the language network and the potential for recovery of language functions in individuals with aphasia.

Animal-assisted services for adults with acquired neurogenic communication disorders: A scoping review.

BACKGROUND: There is increasing interest in the incorporation of animal-assisted services (AAS) in therapy for adults with acquired neurogenic communication disorders. AAS have the potential to enhance speech and language therapy engagement and outcomes. However, a greater understanding of the nature and potential benefits of these interventions is needed. AIMS: To describe the existing evidence for the incorporation of AAS in therapy with adults with acquired neurogenic communication disorders and to identify areas for future research. METHODS & PROCEDURES: A scoping review was conducted and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist extension for scoping reviews (PRISMA-ScR). Seven databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane, Scopus, Web of Science) and grey literature (Google) were searched. Two reviewers independently screened titles, abstracts and full texts against eligibility criteria using Covidence software. The Template for Intervention Description and Replication (TIDieR) checklist guided extraction of intervention data. MAIN CONTRIBUTIONS: A total of 17 studies with adults with aphasia, apraxia of speech and cognitive-communication disorders were included. While terminology varied, most interventions met the definition of animal-assisted therapy or animal-assisted activity and used therapy dogs. Across studies, a range of outcomes were targeted, and positive benefits were reported for participant mood, emotions, motivation and satisfaction. There were mixed, but mostly positive, benefits on social behaviour, communication and participation. CONCLUSIONS & IMPLICATIONS: AAS has been incorporated in therapy for adults with acquired neurogenic communication disorders, predominately with people with dementia. Across studies, communication impairments and AAS interventions were insufficiently or inconsistently described. Improved reporting would assist understanding of the potential benefits of AAS as an adjunct therapy. A quality appraisal of existing studies, and meta-analysis of findings, is needed to draw conclusions about the effectiveness of AAS as a complementary therapy for people with acquired neurogenic communication disorders. WHAT THIS PAPER ADDS: What is already known on this subject There is increasing interest and research in AAS as an adjunct to traditional speech and language therapy. Several clinical populations have been shown to benefit from the incorporation of AAS as a complementary therapy approach, including adults with acquired neurogenic communication disorders. To date there has not been a comprehensive review of literature in the area. What this paper adds to the existing knowledge This review aimed to describe what is known about AAS as an adjunct intervention for adults with acquired neurogenic communication disorders. A total of 17 studies were identified, the majority conducted with people living with dementia. Overall, consistent positive benefits of AAS were reported on participant mood, positive emotions, motivation, and satisfaction. There were mixed, but mostly positive, benefits of AAS on social behaviour, including both verbal and non-verbal communication outcomes, and participation. What are the practical and clinical implications of this work? These results suggest a potential therapeutic benefit for the inclusion of AAS into traditional modalities used by speech-language therapists with people with acquired neurogenic communication disorders. However, clinicians should view these findings with caution. Studies were often insufficiently or inconsistently reported, and a quality appraisal and meta-analysis of existing studies would be needed to draw clear conclusions on the effectiveness of AAS as a complementary approach for people with acquired neurogenic communication disorders.

How well can simple clinical features predict long-term language recovery after left-hemisphere glioma surgery?

PURPOSE: Long-term language recovery after left-hemisphere glioma surgery varies substantially across patients. We investigated how well it can be predicted using clinical variables such as the postoperative decline in language processing, tumor grade, resection volume and location, extent of resection, and intraoperative language mapping. Beyond predicting the overall recovery, we examined which domains of language processing are most prone to persistent deficits. METHODS: Fifty-nine patients with left-hemisphere gliomas completed the Russian Aphasia Test (RAT) before surgery, immediately after surgery, and at follow-up three to seventeen months after surgery. We modeled their average language score (Generalized Aphasia Quotient, GAQ) at follow-up using a cross-validated multiple linear regression and calculated the number of patients showing persistent deficits in each subtest of the RAT. RESULTS: The difference between GAQ scores at follow-up and before surgery was not significant at the group level but varied substantially across patients (mean -1.3%, range -34.2 - 9.2%). Our best-performing model predicted the follow-up GAQ scores with the mean absolute error of 3.5% (cross-validated R2 = 0.15). A greater decline in language processing immediately after surgery predicted worse recovery, whereas intraoperative language mapping predicted better recovery. Deficits in sentence repetition, verb production, verb and sentence comprehension, and object naming most often persisted at follow-up. CONCLUSION: The postoperative decline in language processing and intraoperative language mapping explain a substantial amount of variability in long-term language recovery. Verbal working memory and lexical retrieval, particularly that of verbs, are most prone to persistent deficits.

Non-fluent Primary Progressive Aphasia and Its Association to Motor Neuron Disease.

Frontotemporal dementia (FTD) is among the most common forms of dementia, with an average symptom onset in the fifth decade of life. Neuropathologic changes in FTD demonstrate degeneration in the frontal and/or temporal lobes, which is defined as frontotemporal lobar degeneration (FTLD). FTD is categorized into a subset of variants by symptomatic presentation and corresponding clinical workup. Primary progressive aphasia (PPA) is among these variants of FTD and is distinguished by its primary clinical presentation of language impairment with correlating neuropathology in the aforementioned areas of the brain. More specifically, the classification of PPA is further subdivided into three clinical variants, which has allowed for appropriate diagnostic and prognostic considerations within this patient population. Among these variants in PPA are the semantic (svPPA), non-fluent (navPPA), and logopenic (lvPPA) forms. Motor neuron disease (MND) is a progressive and irreversible process of neuronal degeneration that can lead to an upper motor neuron, a lower motor neuron, or a combination of these two symptomologies. FTD and its association with MND is a well-established spectrum, although more rarely among the PPA variant of FTD. Comparatively, there is a significant body of clinical knowledge on the association between the behavioral variant of FTD (bvFTD) and MND. This is the case of a 69-year-old female with navPPA who later presented with clinical symptoms of MND. Although the two clinical diagnoses, PPA and MND, are irreversible and progressive, this case serves to elucidate diagnostic and prognostic considerations in this rare patient population.

Comparative Efficacy of Cognitive Training for Post-Stroke Aphasia: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Although cognitive training has shown potential for treating post-stroke aphasia (PSA), its efficacy varies across studies, and the optimal training approaches remain unclear. OBJECTIVE: To evaluate and compare the effects of distinct cognitive training interventions, either combined with or independent of speech and language therapy (SLT), on language function in individuals with PSA. METHODS: A systematic search encompassing PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and Chinese Biomedical Databases was conducted for randomized controlled trials (RCTs). A network meta-analysis evaluated interventions, including computer-assisted cognitive training (CCT), conventional cognitive training (CT), virtual reality (VR)-based cognitive training (vrCT), telerehabilitation computer-assisted cognitive training (tCCT), working memory (WM) training, and attention training (AT). RESULTS: Eleven RCTs comprising 501 participants were included. Individuals with PSA who underwent combined WM training with SLT led to significantly enhanced Western Aphasia Battery (WAB) Aphasia Quotient (AQ), as well as in spontaneous speech, auditory comprehension, repetition, and naming, compared to those receiving SLT alone. This combination was more effective than both CCT with SLT and tCCT with SLT in improving WAB AQ. Similarly, it outperformed both CCT with SLT and vrCT with SLT in enhancing WAB spontaneous speech. Additionally, both AT and CT combined with SLT were more effective than SLT alone in enhancing WAB spontaneous speech. Specifically, AT combined with SLT proved more effective than vrCT with SLT in this area. Moreover, vrCT combined with SLT significantly improved auditory comprehension compared with SLT alone. CONCLUSIONS: Combining WM training and SLT and integrating vrCT with SLT both significantly enhance language function in individuals with PSA, compared with SLT alone. Our findings advocate for the use of these cognitive training approaches as promising strategies for language rehabilitation in this population. PROSPERO registration number: CRD42023462361.

Validity and reliability of the Pain Assessment in Impaired Cognition 15 (PAIC15) observation scale in persons with aphasia.

BACKGROUND: The use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3-4):190-201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia. METHODS: Persons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement. RESULTS: PAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35-0.50; transfer: 0.38-0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer. CONCLUSIONS: Recognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results.

Sentence comprehension deficits in aphasia disorders: A systematic review of mapping therapy.

Patients with aphasia (PWA), particularly those with agrammatic aphasia, experience problems in sentence comprehension. Studies have found that Mapping Therapy (MT) can improve sentence processing in PWA. This paper aims to review the literature on therapeutic studies using MT for the treatment of sentence processing in PWA. All studies on the treatment of sentence comprehension using MT were found by searching Cochrane Library, ISI Web of Knowledge, Google Scholar, Pubmed, and Scopus from 1986 until December 2023, with the combination of these search keywords: 'aphasia, sentence, comprehension, mapping therapy, treatment, rehabilitation'. All studies (single-subject or group design) on the treatment of sentence comprehension using MT in PWA were reviewed. An adaptation of the Cochrane Collaboration's risk of bias (RoB) tool was used to assess the risk of bias (RoB) in the reviewed studies. A total of 14 studies on 81 participants were selected and reviewed. All studies (13 studies) had employed a single-subject design, except for one study that had used a group design. Twelve studies (86%) showed that MT is effective in the remediation of sentence comprehension in PWA. Generalization to untrained sentences similar to the trained structure was also observed in 12 studies (86%). Generalization to untrained structures (usually passive sentences) was limited. In addition, cross-modal improvement in sentence production was observed in 8 studies (57%). This review highlights the need for a more detailed investigation of the effect of MT on cross-modal generalization using elicited production of the sentence types trained during comprehension treatment.

Evidence from aphasia suggests a bidirectional relationship between inner speech and executive function.

Research over the past several decades has revealed that non-linguistic cognitive impairments can appear alongside language deficits in individuals with aphasia. One vulnerable cognitive domain is executive function, an umbrella term for the higher-level cognitive processes that allow us to direct our behavior towards a goal. Studies in healthy adults reveal that executive function abilities are supported by inner speech, the ability to use language silently in one's head. Therefore, inner speech may mediate the connection between language and executive function deficits in individuals with aphasia. Here, we investigated whether inner speech ability may link language and cognitive impairments in 59 adults with chronic, post-stroke aphasia. We used two approaches to measure inner speech: one based on internal retrieval of words and one based on internal retrieval plus silent manipulation of the retrieved phonological forms. Then, we examined relationships between these two approaches to measuring inner speech and five aspects of executive function ability: response inhibition, conflict monitoring/resolution, general task-switching ability, phonological control, and semantic control. We also looked for dissociations between inner speech ability and executive function ability. Our results show tentative relationships between inner speech (across multiple measurement approaches) and all aspects of executive function except for response inhibition. We also found evidence for a double dissociation: many participants show intact executive function despite poor inner speech, and vice versa, so neither process is strictly reliant on the other. We suggest that this work provides preliminary evidence of a bidirectional relationship between inner speech and executive function: inner speech supports some aspects of executive function via internal self-cueing and certain aspects of executive function support performance on complex inner speech tasks.

Aphasia Awareness Among Spiritual Healthcare Providers in the United States.

Spiritual healthcare providers (e.g., chaplains) working in healthcare settings across the United States were surveyed with the goals of (1) understanding their awareness of aphasia (a language disorder affecting reading, writing, verbal communication, and auditory comprehension); (2) determining whether they have received any training in aphasia and what type of training has been received; (3) whether they altered their approach to assessing the spiritual well-being of a person with aphasia; and, (4) what tools were used to augment communication. From a convenience sample of 203 respondents, the results indicated that 96% of respondents had previously heard of aphasia and 85% of respondents correctly identified the definition of aphasia. Seventy-three percent of respondents (N = 128) altered their approach to spiritual well-being assessment due to the aphasia diagnosis. Most respondents did not indicate receiving any formal training related to aphasia.

"Staying connected": Speech-language pathologists' perspectives on the communication needs of people with primary progressive aphasia and their family members.

PURPOSE: The research objectives were to explore the communication needs pertaining to (a) people with primary progressive aphasia (PwPPA); (b) family members of PwPPA; and (c) the different variants of primary progressive aphasia (PPA), from the perspectives of speech-language pathologists (SLPs). METHOD: This investigation used a qualitatively driven concurrent mixed methods research design. Data collection involved semi-structured interviews and mixed methods questionnaires with 14 SLPs. Qualitative content analysis of interview and questionnaire data was used to identify codes and categories related to the research objectives. Quantitative analysis of questionnaire data involved single item summaries and cross item tabulations. RESULT: Analysis revealed eight categories of communication need pertaining to PwPPA and six pertaining to their family members. Results regarding communication needs according to variant of PPA revealed limited findings. CONCLUSION: SLPs perceived several important areas of communication need for PwPPA and their family members, highlighting key clinical implications for proactive communication care across the continuum of care. Future research can build on the current findings and integrate the perspectives of PwPPA and their family members on this topic, to develop interventions and explore models of service delivery to meet their progressive and complex communication needs.

Inappropriate trusting behaviour in dementia.

Background: Inappropriate trusting behaviour may have significant social, financial and other consequences for people living with dementia. However, its clinical associations and predictors have not been clarified. Here we addressed this issue in canonical syndromes of frontotemporal dementia (FTD) and Alzheimer's disease (AD). Methods: In 34 patients with AD and 73 with FTD (27 behavioural variant (bv)FTD, 22 semantic variant primary progressive aphasia (svPPA), 24 nonfluent/agrammatic variant (nfv)PPA) we recorded inappropriate trusting and other abnormal socio-emotional behaviours using a semi-structured caregiver survey. Patients were comprehensively characterised using a general cognitive assessment and the Revised Self-Monitoring Scale (RSMS; an informant index of socioemotional awareness). Results: Inappropriate trusting was more frequent in svPPA (55%) and bvFTD (44%) than nfvPPA (17%) or AD (24%). After adjusting for age, sex, education and Mini-Mental State Examination (MMSE) score, inappropriate trusting was significantly more likely in svPPA (odds ratio 3.61; 95% confidence interval 1.41-8.75) and bvFTD (3.01, 1.23-6.65) than AD. Significant predictors of inappropriate trusting comprised apathy in svPPA, disinhibition and altered pain responsiveness in bvFTD, and lower MMSE and RSMS (self-presentation) scores in AD. Conclusion: Dementia syndromes vary in prevalence and predictors of abnormal trusting behaviour, with implications for clinical counselling and safeguarding.

Establishing Quality Indicators and Implementation Priorities for Post-Stroke Aphasia Services Through End-User Involvement.

BACKGROUND: Currently, there are no agreed quality standards for post-stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationalise and (3) prioritise best practice recommendations for post-stroke aphasia care. METHODS: Three phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation through a two-round e-Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory-based voting system. In Phase 2, shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3, priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting. FINDINGS: In Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2, people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating to assessment (n = 2), information provision (n = 3), communication partner training (n = 3), goal setting (n = 1), person and family-centred care (n = 1) and provision of treatment (n = 1). In Phase 3, people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia, provision of aphasia-friendly information and provision of therapy. INTERPRETATION: Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficient and person-centred measurement and quality improvement in post-stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities. PATIENT AND PUBLIC CONTRIBUTION: Protocol development was informed by our previous research, which explored the perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. We received support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.

Increased risk of depression and associated symptoms in poststroke aphasia.

Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.