A standardization study of the Czech version of the Mississippi Aphasia Screening Test (MASTcz) in stroke patients and control subjects

The first aphasia screening test in Hungarian: A preliminary study on validity and diagnostic accuracy

The Hungarian Aphasia Screening Test (HAST) is a newly developed diagnostic tool for detecting post-stroke aphasia in clinical settings, and for differentiating between stroke patients with and without aphasia. The HAST was developed by our team and has not been published in English yet. In Hungarian, to date, there is no aphasia screening test with reported psychometric properties available. This study aims to present the main characteristics of the HAST and to evaluate its validity, internal consistency, and diagnostic accuracy. The HAST comprises five subtests (maximum score: 20) and takes 5-10 minutes to administer. We administered the HAST to 40 stroke patients with aphasia, 26 stroke patients without aphasia, and 51 healthy control participants to evaluate the test's construct validity, convergent validity, and internal consistency, as well as its sensitivity and specificity. We used the Western Aphasia Battery (WAB) as a reference test. With a cut-off score of 17, the HAST showed high diagnostic accuracy (sensitivity: 92.5%, specificity: 88.5%). Its construct validity was good; we identified one component in the test, and moderate-to-strong positive correlations across most of its subtests (mean Spearman r = 0.56). Convergent validity of the HAST was satisfying, reflected by the moderate-to-strong positive correlations between subtests of the HAST and subtests of the WAB (Spearman r = 0.50-0.86). The correlation between the HAST total score and the WAB aphasia quotient was high (Spearman r = 0.86). Despite the small number of items within tasks, all subtests showed acceptable internal consistency (mean Cronbach's α = 0.74). Our preliminary results suggest that the HAST is a valid, accurate, and clinically feasible test to detect post-stroke aphasia and to identify patients who require a more detailed assessment of their language skills. In addition, it reliably identifies not only the presence but also the severity of aphasia, thus, it might be a good candidate for monitoring patient progress.

Psychometric Testing of the CEECCA Questionnaire to Assess Ability to Communicate among Individuals with Aphasia

(1) Background: The CEECCA questionnaire assesses the ability to communicate among individuals with aphasia. It was designed using the NANDA-I and NOC standardised nursing languages (SNLs), reaching high content validity index and representativeness index values. The questionnaire was pilot-tested, demonstrating its feasibility for use by nurses in any healthcare setting. This study aims to identify the psychometric properties of this instrument. (2) Methods: 47 individuals with aphasia were recruited from primary and specialist care facilities. The instrument was tested for construct validity and criterion validity, reliability, internal consistency, and responsiveness. The NANDA-I and NOC SNLs and the Boston test were used for criterion validity testing. (3) Results: five language dimensions explained 78.6% of the total variance. Convergent criterion validity tests showed concordances of up to 94% (Cohen's κ: 0.9; p < 0.001) using the Boston test, concordances of up to 81% using DCs of NANDA-I diagnoses (Cohen's κ: 0.6; p < 0.001), and concordances of up to 96% (Cohen's κ: 0.9; p < 0.001) using NOC indicators. The internal consistency (Cronbach's alpha) was 0.98. Reliability tests revealed test-retest concordances of 76-100% (p < 0.001). (4) Conclusions: the CEECCA is an easy-to-use, valid, and reliable instrument to assess the ability to communicate among individuals with aphasia.

The Screening Test for Aphasia and Dysarthria (STAD) for Patients with Neurological Communicative Disorders: A Large-Scale, Multicenter Validation Study in Japan

INTRODUCTION

Evaluation of multiple domains, such as language, articulation, and cognitive function, is frequently required in neurological communicative disorders. The purpose of this study was to investigate the performance of a 10-min screening scale for estimating aphasia, dysarthria, and cognitive dysfunction using a multicenter, large-sized consecutive series.

METHODS

We conducted a multicenter validation study that included 314 patients with brain injury between February 1 and June 31, 2018, from 20 medical centers across Japan. The Screening Test for Aphasia and Dysarthria (STAD) was developed in Japan in 2009, and a previous smaller-scale retrospective study established its high to moderate validity. All patients had undergone the STAD, and 212 of them underwent the Western Aphasia Battery or Assessment of Motor Speech for Dysarthria. The effect size on all 29 items and receiver operating curves of 3 sections of the STAD were analyzed based on external criteria, which were decided considering the clinical diagnosis of aphasia, dysarthria, and cognitive dysfunction. Correlations between the STAD and reference tests were calculated.

RESULTS

The phi coefficients of 23 out of 29 items exceeded the moderate effect size of 0.3 toward the targeted disorder. Overall, there was a good balance between sensitivity (82-92%) and specificity (77-78%), with moderate to large positive and negative likelihood ratios (3.7-4.19 and 0.1-0.23). The Pearson's r between the verbal section and Western Aphasia Battery Aphasia Quotient, the articulation section and Assessment of Motor Speech for Dysarthria, and the nonverbal section and Western Aphasia Battery Nonlinguistic Skills were 0.89, 0.70, and 0.79, respectively.

CONCLUSION

We demonstrated that the STAD has acceptable content and concurrent validity for the assessment of communicative function in patients with brain injury. This short screening tool can be useful in specific contexts, such as in early bedside investigations, to obtain a quick summary of communicative function prior to the administration of other tests, and in cases where more in-depth testing is not feasible.

Adaption and validation of the Mississippi Aphasia Screening Test to Estonian speakers with aphasia

OBJECTIVES

The Mississippi Aphasia Screening Test (MAST) is a brief screening tool for assessing the expressive and receptive language abilities of patients with aphasia. The goal of this study was to adapt and validate the MAST into the Estonian language. The discriminant validity and internal consistency of the test were examined, as well as its sensitivity and specificity.

METHODS

The MASTest was administered in 50 left hemisphere stroke patients with aphasia (LHA+ group) in the acute phase after the stroke and 126 healthy volunteers in a control group (CG), stratified by age and level of education. Nonparametric tests were used to get normative values, compare the values of the MASTest scores between the LHA+ group and the CG, and to assess the discriminant validity, internal consistency, sensitivity, and specificity of the MASTest.

RESULTS

The summary scores: total score (MASTest-T), expressive score (MASTest-E), and receptive score (MASTest-R) correlated with age and educational level, and the normative values were adjusted accordingly. The LHA+ group showed more impairment than the CG in all subtests and summary scores. The internal reliability of the MASTest was high for the whole sample and LHA+ group. The sensitivity and specificity of the MASTest using the 5th percentile were 74% and 94%, respectively, but using receiver operating characteristic (ROC) analysis, it was 89% and 80%.

CONCLUSION

The MASTest is a valid screening tool for evaluating expressive and receptive language abilities in Estonian patients with aphasia in early stroke. The MASTest is the first validated aphasia screening test for Estonian-speaking people, who number less than one million worldwide.

Transient aphasia after right-unilateral ultrabrief electroconvulsive therapy: A case report

A brief period of aphasia is an extremely rare and likely underreported adverse effect of electroconvulsive therapy. Clinical studies that have described this phenomenon are scarce and its prevalence is unknown. We present a unique case of a 35-year old woman, who underwent an outpatient ECT session at our department, followed by a short span of aphasic symptoms, the extent of which were monitored clinically and via the czech version of the Minnesota aphasia screening test.

A Chinese version of the Language Screening Test (CLAST) for early-stage stroke patients

There is a severe lack of aphasia screening tools for bedside use in Chinese. A number of aphasia assessment tools have recently been developed abroad, but some of these scales were not suitable for patients with acute stroke. The Language Screening Test (which includes two parallel versions [a/b]) in French has been proven to be an effective and time-saving aphasia screening scale for early-stage stroke patients. Therefore, we worked out a Chinese version of the LAST taking into consideration Chinese language and culture. Two preliminary parallel versions (a/b) were tested on 154 patients with stroke at acute phase and 107 patients with stroke at non-acute phase, with the Western Aphasia Battery serving as a gold standard. The equivalence between the two parallel versions and the reliability/validity of each version were assessed. The median time to complete one preliminary Chinese version (each had some item redundancy) was 98 seconds. Two final parallel versions were established after adjustment/elimination of the redundant items and were found to be equivalent (intra-class correlation coefficient: 0.991). Internal consistency is(Cronbach α for each version [a/b] was 0.956 and 0.965, respectively) good. Internal validity was fine: (a) no floor or ceiling effect/item redundancy; (b) construct validity revealed a 1-dimension structure, just like the French version. The higher educated subjects scored higher than their lower educated counterparts (p<0.01). The external validity: at the optimum cut-off point where the score of version a/b <14 in higher educated group(<13 in lower): the specificity of each version was 0.878/0.902(1/1 in lower) and sensitivity was 0.972/0.944(0.944/0.944 in lower). Inter-rater equivalence (intra-class correlation coefficient) was 1. The Chinese version of the Language Screening Test was proved to be an efficient and time-saving bedside aphasia screening tool for stroke patients at acute phase and can be used by an average medical physician.

Screening tests for aphasia in patients with stroke: a systematic review

Aphasia has a large impact on the quality of life and adds significantly to the costs of stroke care. Early recognition of aphasia in stroke patients is important for prognostication and well-timed treatment planning. We aimed to identify available screening tests for differentiating between aphasic and non-aphasic stroke patients, and to evaluate test accuracy, reliability, and feasibility. We searched PubMed, EMbase, Web of Science, and PsycINFO for published studies on screening tests aimed at assessing aphasia in stroke patients. The reference lists of the selected articles were scanned, and several experts were contacted to detect additional references. Of each screening test, we estimated the sensitivity, specificity, likelihood ratio of a positive test, likelihood ratio of a negative test, and diagnostic odds ratio (DOR), and rated the degree of bias of the validation method. We included ten studies evaluating eight screening tests. There was a large variation across studies regarding sample size, patient characteristics, and reference tests used for validation. Many papers failed to report on the consecutiveness of patient inclusion, time between aphasia onset and administration of the screening test, and blinding. Of the three studies that were rated as having an intermediate or low risk of bias, the DOR was highest for the Language Screening Test and ScreeLing. Several screening tools for aphasia in stroke are available, but many tests have not been verified properly. Methodologically sound validation studies of aphasia screening tests are needed to determine their usefulness in clinical practice.

Addenbrooke's Cognitive Examination and Individual Domain Cut-Off Scores for Discriminating between Different Cognitive Subtypes of Parkinson's Disease

Objective. The main aim of this study was to verify the sensitivity and specificity of Addenbrooke's Cognitive Examination-Revised (ACE-R) in discriminating between Parkinson's disease (PD) with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI) and between PD-MCI and PD with dementia (PD-D). We also evaluated how ACE-R correlates with neuropsychological cognitive tests in PD. Methods. We examined three age-matched groups of PD patients diagnosed according to the Movement Disorder Society Task Force criteria: PD-NC, PD-MCI, and PD-D. ROC analysis was used to establish specific cut-off scores of ACE-R and its domains. Correlation analyses were performed between ACE-R and its subtests with relevant neuropsychological tests. Results. Statistically significant differences between groups were demonstrated in global ACE-R scores and subscores, except in the language domain. ACE-R cut-off score of 88.5 points discriminated best between PD-MCI and PD-NC (sensitivity 0.68, specificity 0.91); ACE-R of 82.5 points distinguished best between PD-MCI and PD-D (sensitivity 0.70, specificity 0.73). The verbal fluency domain of ACE-R demonstrated the best discrimination between PD-NC and PD-MCI (cut-off score 11.5; sensitivity 0.70, specificity 0.73) while the orientation/attention subscore was best between PD-MCI and PD-D (cut-off score 15.5; sensitivity 0.90, specificity 0.97). ACE-R scores except for ACE-R language correlated with specific cognitive tests of interest.

Assessment and treatment of aphasia in czech

Intervention approaches to aphasia differ in different countries. The aim of this paper is to give an overview of the situation in the Czech Republic. The following topics are summarized: (1) Czech logopedics in aphasiology; (2) the assessment of aphasia; (3) the treatment of aphasia; (4) Czech aphasiologic material; (5) the qualification of clinical logopedists, and (6) regulations of aphasiologic care. Czech is a very intricate language, both phonetically and grammatically. The prevalence of consonants appearing in long sequences (a whole sentence can be constructed purely of consonants) makes it difficult to pronounce. The strong inflecting character with hundreds of grammatical forms for each inflected word makes it difficult to use correct morphology and syntax. These facts make Czech a real challenge both for aphasics and logopedists. An overview of aphasia tests and treatment methods used in the Czech Republic, as well as conditions of logopedic care are given. The paper will allow comparison with the situation in other countries.

Towards a predictive model for post-stroke delirium

PRIMARY OBJECTIVE

To assess predisposing and precipitating risk factors and create a predictive model for post-stroke delirium.

RESEARCH DESIGN

A prospective observational study in a cohort of consecutive patients with ischemic stroke or intracerebral haematoma admitted within 24 hours of stroke onset.

METHODS

Patients were assessed daily for delirium during the first week by means of DSM-IV criteria and risk factors were recorded.

RESULTS

One hundred patients completed a 7-day evaluation (47 women and 53 men, median age 77 years). An episode of delirium was detected in 43 patients (43%). Using multivariate logistic regression, a predictive statistical model was developed that utilized independent risk factors: age (OR = 1.08; 95% CI = 1.02-1.15); intracerebral haemorrhage (OR = 6.11; 95% CI = 1.62-22.98), lesion volume > 40 ccm (OR = 3.99; 95% CI = 1.29-12.39) and either elevated gamma-glytamyl transferase (OR = 4.88; 95% CI = 1.45-16.35) and elevated serum bilirubin (OR = 3.70; 95% CI = 1.32-10.38) or maximum sequential organ failure assessment score >2 (OR = 3.33; 95% CI = 1.06-10.45) with acceptable sensitivity and specificity (69.0% and 80.7%). In ischemic strokes, total anterior circulation infarctions were more frequently associated with delirium (73.3% developed delirium) compared with the remainder of the groups combined (p = 0.004; OR = 6.66; 95% CI = 1.85-24.01).

CONCLUSION

Higher age, metabolic disturbances, intracerebral haemorrhage and larger ischemic hemispheric strokes increase the risk of post-stroke delirium.

Instrumentos de avaliação breve da comunicação: ferramentas existentes e sua aplicabilidade clínica

TEMA: a avaliação breve da comunicação é um recurso útil aos profissionais da saúde, pois fornece informações que subsidiam tanto o diagnóstico funcional, quanto o planejamento e a execução de avaliações expandidas e de medidas de reabilitação a serem realizados em cada caso. OBJETIVO: apresentar uma revisão sistemática acerca do uso de instrumentos padronizados de avaliação breve da comunicação e caracterizar as populações alvo descritas. CONCLUSÃO: encontraram-se 18 artigos, com 10 instrumentos breves, sendo a população mais examinada a de pacientes pós-acidente vascular cerebral. Os componentes lingüísticos prevalentes nas avaliações foram expressão, compreensão, leitura e escrita.