aphasia

This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status.

This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used.

Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P<0.05), but the difference between scores before and after the intervention follows a normal distribution (P<0.05). Both the AQ1 and MMSE variables significantly differ before and after the intervention, according to the Wilcoxon test. The non-fluent aphasia group has a higher increase in MMSE scores than the fluent aphasia group.

Neuropsychological rehabilitation interventions can effectively improve AQ1 and MMSE. In addition, further research on neuropsychological rehabilitation interventions with two intervention and control groups and the treatment methods used during this study can be suggested for the treatment of stroke patients.

There is still disagreement about the prevalence and incidence of dysphagia in Parkinson’s Disease (PD). Since the prevalence of dysphagia has been reported very differently in the related literature, it is imperative to estimate pooled prevalence in PD patients. Thus, we conducted a systematic review and meta-analysis to estimate the pooled prevalence of dysphagia in PD overall and separately for each assessment method (subjective and objective). 

These databases were searched: ScopusPubMed Web of Science ,and Google Scholar, January 1990 to October 2021. A random-effects model was used to pool the prevalence rates reported in the included studies by the Comprehensive Meta-Analysis (CMA( software .All designs of the studies were included. 

Thirty-nine articles entered the current meta-analysis. The global estimation of the overall prevalence of dysphagia in PD patients was 50.4% )95%CI:42.2-58.6) in all the 39 studies, which proved statistically heterogeneous (p<0.001). Moreover, the pooled prevalence by the subjective (30 studies) and objective (19 studies) methods of assessment were estimated to be 39.5 and 68.8%, respectively. There was also a significant relationship between the prevalence of dysphagia and age of Parkinson’s patients )r=0.44, p=0.011) and also between the prevalence of dysphagia and the duration of PD (r=0.55, p=0.006). 

Based on the results, one in two patients with PD has dysphagia. This is proven that dysphagia is common in PD. The prevalence of objective dysphagia and subjective dysphasia were very different. It suggests that all Parkinson’s patients should be evaluated for swallowing disorders regularly with objective tools.

Aphasia is a language disorder caused by damage to a specific region of the brain that regulates the expression and comprehension of language. For many years, attempts to rehabilitate aphasic patients have been made. In this study, the efficacy of low-resolution electromagnetic tomography analysis (LORETA) z-score neurofeedback (LZNFB) training for enhancing language, working memory, and attention in a group of 13 non-fluent aphasic patients was investigated. 

The quantitative electroencephalography (QEEG)/LORETA and behavioral tests were administered at baseline and after 15 LZNFB treatment sessions. Using the NeuroGuide software, version 3.0.9, the LORETA analysis was conducted

The LORETA metrics revealed an increased high beta at the orbital frontal, beta at the medial frontal, and Alpha at the superior frontal, as well as decreased delta and theta at the cingulate gyrus. The behavioral tests revealed improved scores for language, working memory, and attention. 

These results are extremely encouraging, as they suggest that LZNFB training could provide a range of improvements and offer new hopes to individuals with aphasia who were unable to achieve satisfactory improvements with conventional therapies.

Broca and Wernicke’s patients perform satisfactorily regarding the processing of canonical syntactic structures, as maintained by previous studies; however, there has been a gap in the literature because no particular research has yet investigated the performance of these patients in the Persian circumstances once they were required to analyze sentences which would demand extra-semantic processing. This study clarifies the role of two critical semantic operations demanding extra-semantic processing at the sentential level: Aspectual coercion. It complements to provide some evidence on the localist view of the brain. Our rationale for selecting these operations was their pure semantic nature, not relying on morphosyntactic properties.

Having recruited two age- and education-matched Broca, two Wernicke, and four healthy controls, we conducted a semantic judgment task in which the participants were asked to express their correct semantic judgment in the two coercion and two normal conditions.

Our results showed an approximately above-chance performance of the Broca group for all conditions; however, in the Wernicke group, the same result was not observed due to their poor performance in coercion conditions, though in ordinary sentences, they performed much better.

Our findings, along with similar off-line and imaging studies, corroborate the view of localism, based on which Wernicke’s area is mainly responsible for the primary semantic operations while Broca’s area predominantly takes over syntactic parsing.

Anomia is a language disorder that negatively affects communication abilities in people with aphasia (PWA). We aimed to compare the effect of transcranial direct current stimulation (tDCS) over the left and right inferior frontal gyrus (IFG) and superior temporal gyrus (STG) on the picture-naming accuracy and reaction time in PWA. A randomized, single-blind, sham-controlled crossover trial was conducted in 2021 at Mobasher Kashani Clinic, Hamadan, Iran. Sixteen patients received both five days of real-tDCS (1 mA for 20 minutes) and five days of sham-tDCS with a seven-day washout period in between. Using the Persian aphasia naming test, picture-naming accuracy and reaction time on 50 images were assessed at baseline, real-tDCS, and sham-tDCS stages. The data were analyzed using STATA software, version 11.0. P<0.05 was considered statistically significant. Sixteen non-fluent PWA participated in the study. Of all patients, 64% benefited from tDCS over the STG and 18% over the IFG. The results showed that real-tDCS had a significant effect on the picture-naming accuracy (P=0.003) and the Persian-Western aphasia battery-one score (P=0.01), whereas sham-tDCS had no noticeable effects. Both the real- and sham-tDCS had no significant effect on the reaction time (P=0.28). Five sessions of individualized tDCS protocol (1 mA for 20 minutes) were adequate to improve picture-naming accuracy in patients with chronic aphasia.

The Aphasia Check List (ACL) is a comprehensive, time-saving tool for language evaluation in aphasia, including a cognitive assessment part. This cross-sectional study aimed to translate ACL into Persian and analyze the psychometric features of the translated version. The original version of the ACL was translated and adapted from German; its psychometric features were then determined. 

Twenty People With Aphasia (PWA) and 50 age- and education-matched, cognitively healthy controls participated in this research. Possible floor and ceiling effects, discriminant validity, test-retest reliability, and internal consistency of the test were analyzed in addition to the evaluation of internal correlations between the test parts (language & cognition).

Regarding the performance of PWAs in the language section and the cognitive subtests assessing attention, memory, and reasoning, there were no floor and ceiling effects. Adequate discriminant validities for the language section of the test [i.e., total score: (Mann-Whitney U= 6.000, P<0.001); diagnostic subtests scores: (Mann-Whitney U= 3.000, P<0.001), and each subtest individually. Besides, the attention subtest of the cognition section (Mann-Whitney U= 16.500, P<0.001) was also observed. There was no difference between the control and patient groups in the subtests of memory (Mann-Whitney U= 497.500, P=0.973) and reasoning (Mann-Whitney U= 3.000, P= 308). The test-retest reliability was acceptable in all subtests (ICC agreement= 0.573-0.984). The ACL-P suggested appropriate internal consistency (Cronbach’s alpha coefficient= 0.761 for test & retest scores). There were also significant correlations between language and cognition in the control and patient groups.

The ACL-P test indicated sufficient reliability and validity for the evaluation of Persian-speaking PWAs and is suggested to be used in studies on this population.

Neurolinguists are increasingly inclined to study the language behavior of patients with aphasia (PWAs) to discover more about the relationship between the brain and language.

This study investigated the production of synthetic and root compound nouns in the PWAs to discover how these lexemes were processed.

Using a confrontation naming task, four PWAs (two patients with Broca aphasia and two patients with transcortical motor aphasia) named 80 random black and white drawings of simple and compound nouns. They also repeated the nouns through an auditory repetition task. Compound nouns were of two root and synthetic types. Root nouns belonged to the noun-noun, and synthetic compounds belonged to the noun-verb category.

There was a significant difference between the affected components in naming and repetition of compound nouns. Moreover, there was a significant difference between naming and repetition of simple and compound nouns. There was no significant difference between naming and repetition of root and synthetic nouns.

PWAs process compound nouns through the dual-route model. They cannot retrieve the phonological forms of compound nouns, but they retain their knowledge of word-formation, indicating the modularity of linguistic ability. Morphological structure plays a role in word processing.

So far, many studies have investigated the extent and nature of the grammatical deficit in aphasia. However, to the best of our knowledge, this research is the first in the Persian language to inspect the comprehension of patients with Broca’s aphasia on diverse syntactically complex structures.

To scrutinize the impact of task on aphasics’ performance, four age-, education- and gender-matched Persian-speaking patients with Broca’s aphasia were compared with their healthy matched controls regarding the two different tasks of grammatical judgment and figurine act-out task. The structures used to examine the subjects’ performance included agentive passive, subject cleft, object cleft, object relative clause, and object experiencer psychological verbs.

Our results which supported the trade-off hypothesis, showed that our subjects generally performed better in grammatical judgment task than in figurine act-out task (P≤0.05). Particularly in the second task, as our inner task comparison, the patients’ problems were more severe in object cleft, object experiencer, and object relative clauses: all structures whose interpretations need more cognitive load.

Our findings put more weight on the interactive or constraint-based model of language processing.

The present study is a case report of a 50-year-old man (SM) with aphasia whose word retrieval was severely impaired. The aim of the study was to compare the effect of a combined treatment program (attention training and language treatment) and a single program (language treatment alone) on the naming picture materials.

This case was affected by a hemorrhagic cerebrovascular accident in the territory of Middle Cerebral Artery branches of the left hemisphere. Two naming treatments, i.e. the single and combined treatments sequentially, were provided for SM; during each of them a 50-item wordlist was practiced (Lists A and B). 12 treatment sessions were implemented for him during each treatment program. These two lists along with another list (List C), left for assessment of generalization of treatments to untrained items, were probed 6 times during and after each program. The whole picture set was normalized in another study described in the text.

Our patient’s naming ability progressed during the treatment programs. However, this progression was more salient in combined treatment program. More specifically, List B had the mean score of 34.25 in combined treatment program that was higher than mean of List A in single treatment program (14.5). The slope of List B scores was also higher than that of List A (3.7 vs 1.2). List C showed more generalization of combined treatment to untrained items than single treatment based on its mean scores (27 vs 18.5).

the observed improvements of naming ability were felt to be the result of combining attention training into the language treatment which is lead to sustained attention, less distraction and more concentration.

In the current study, we report a patient of crossed aphasia in dextrals (CAD) that presented with aphasia and typical neuropsychological deficits following right hemisphere brain damage. To the best of the authors’ knowledge, it is the first Persian language patient of CAD reported internationally.

The patient was a 59-year-old right-handed female with no history of left-handedness or ambidexterity in her family. Right handedness was measured in the current patient by the Edinburgh right-handedness inventory. Speech and language functions were measured by the Persian Western-Aphasia Battery (P-WAB) and the Bilingual Aphasia test (BAT). Also, the bedside version of Persian WAB (P-WAB-1) was used. Hemianopia/neglect was investigated by line bisection, painting, and cancellation tasks that confirmed left visuospatial neglect. Telegraphic speech was her dominant output feature. She had a problem with sentence construction; also, her morphological derivation skills were impaired. The syntactic structures of utterances were very simple. In writing tasks, her sample was unintelligible semantically. The auditory comprehension of the patient was impaired at the level of semi-complex and complex commands. It should be mentioned that difficulty in topic maintenance was observed in storytelling. Left visuospatial neglect was confirmed in the patient by assessments. The results confirmed the presence of neglect and language disorder, typologically consistent with Broca’s aphasia.

The current study patient represented the typical symptoms of language dominant left hemisphere damage and a range of deficits indicating right hemisphere pathology. Analysis of patient symptoms confirmed the right hemisphere language dominance.

Background &

Aphasia is an acquired language disorder that affects daily communication and quality of life. Early diagnosis and the treatment of aphasia are important. In this regard, one of the screening tests is the Aphasia Rapid Test (ART). This study aimed to investigate the validity and reliability of this test and extend the use of ART in the acute phase for patients with aphasia.

The original version of ART was translated to Persian and 100 acute stroke patients were evaluated by ART. Besides, all the patients were assessed again after eight days by two independent raters to evaluate inter-rater reliability. Also, 70 patients were chosen to examine ART’s predictive ability; they were assessed using the Persian version of Western Aphasia Battery, after three months.

On day eight of the study, the Mean±SD ART was 11.26±2.03 for rater 1 and 11.44±2.04 for rater 2. Inter-rater reliability was good with the concordance correlation coefficient of 0.959 (95% CI: 0.939-0.972). Also, the Bland-Altman plot showed good agreement between raters without any significant trend/bias. 

The ART is a test that includes features, such as reproducibility, predictability, and inter-rater reliability. This test is short and can be used in the acute phase of aphasia in patients with stroke.

There are several tests to determine the type and severity of aphasia, but they take a long time to administer when assessing aphasic patients. In recent years, the analysis of spontaneous speech has gained great attention because it is important to diagnose and follow post-treatment improvement in aphasic patients. 
This study was done to assess some parameters of connected speech in aphasic patients. In addition, the correlation between connected speech parameters and the type and severity of aphasia was measured.

We compared the connected speech parameters of 27 aphasics (10 fluent and 17 non-fluent), Persian speakers, compared with the control group. There were two groups matched by age, sex, and education. Nest’s bird story pictures were used to elicit a speech sample. In the next step, the connected speech was analyzed to define speech parameters, including speech rate, mean length of utterance, number of utterances, total words, content words, function words, nouns, and verbs. Moreover, the severity of aphasia was measured using a Persian Western Aphasia Battery (WAB). 

The findings showed significant differences between groups in all parameters of the connected speech (P<0.01). The correlation coefficient between speech parameters and severity of aphasia demonstrated that all parameters were highly correlated (r >0.71) with the severity of aphasia (P<0.01) except for speech rate and the number of function words. There were some typical differences between linguistics grammatical and pragmatical characters of different types of aphasia.

Connected speech is one of the most sensitive parts of language in all types of aphasic patients. There are some clinical signs for differential diagnosis of aphasia based on speech measures. According to the findings, the type and severity of aphasia and connected speech were highly correlated. Thus, the use of the connected speech analysis is necessary as an assessment tool for the diagnosis of aphasia.

Aphasia is one of the most common consequences of a stroke; thus, screening tests for early diagnosis of the problem are necessary when dealing with aphasia patients. One of these screening tests is the Language Screening Test (LAST). The purpose of this study was to translate, validate, and utilize this test in the Persian language for patients after stroke.

The original version of LAST was translated into Persian, and then administrated on 100 patients in the acute phase by two examiners at the patient’s bedside in order to check the inter-rater reliability. To assess the agreement between the two forms (a and b) of the LAST, Concordance Correlation Coefficient (CCC), weighted Kappa, and Intraclass Correlation Coefficient (ICC) were used. Also, the Persian version of LAST and the Western Aphasia Battery (WAB) were performed at the chronic phase with two independent examiners with blind scoring.

Inter-rater reliability between Rater 1 and Rater 2 on LAST-a and LAST-b score were very good for both phases. The CCC for LAST-a and LAST-b, respectively, were 0.874 and 0.865 for the acute phase and 0.923 and 0.927 for the chronic phase. The weighted Kappa for LAST-a and LAST-b, respectively, were 0.750 and 0.740 for the acute phase, and 0.822 and 0.846 for the chronic phase.

The obtained results showed that LAST is a very simple, fast, and valid test and can be used as a reliable tool in stroke patients. Lack of cultural and language dependency are the advantages of using this test.

Post-stroke persons with aphasia (PWA) may suffer from deficits in executive function (EF). Cognitive flexibility, as an important element of EF, may be affected by PWA. As a task of cognitive flexibility, set-shifting can be measured by the Wisconsin Card Sorting Test (WCST). Assessing these EF basics may have important implications for cognitive-communicative rehabilitation of PWA. The aim of the current study was to examine set-shifting skills and their correlation with language components of Persian-speaking PWA. Nineteen Persian-speaking, non-fluent PWA (13 males and six females; mean age was 54.26  8.88 years, and age range was 32 to 69 years old) participated in this study. The bedside version of the PersianWestern Aphasia Battery (P-WAB-1) and the WCST were performed to assess language and set-shifting abilities, respectively. The Spearman’s rank correlation coefficient test was used to examine the correlation between the variables. Statistical analyses were performed using the SPSS 18.0 software. The results showed that the P-WAB-1 score was inversely correlated with perseverative errors index of WCST (r = -0.48, P < 0.05). Also, there was a significant correlation between the “fluency of spontaneous speech” subtest of P-WAB-1 and WCST indices, including number of categories completed (r = 0.54, P < 0.05), total number of correct responses (r = 0.61, P < 0.05), total number of errors (r = -0.60, P < 0.05), and non-perseverative errors (r = - 0.44, P < 0.05). Based on these results, it appears that decreased cognitive flexibility of PWA may coincide with decreased language ability. This study broadens current understanding of the complex relationship between language and EF by measuring set-shifting in a sample of non-fluent PWA. These results may be beneficial to cognitive-communicative rehabilitation programs for PWA.