Idea selection for propositional language production

The brief executive language screen: sensitivity and specificity in acute to early sub-acute stroke

INTRODUCTION

Propositional language and underlying executive functions can be impaired post-stroke and affect communication and quality of life. Current stroke screening tools are largely tailored to patients with aphasia, being either non-verbal or focussed on core language skills such as naming and repetition. The Brief Executive Language Screening Test (BELS) is a newly developed cognitive screening tool that assesses memory, oral apraxia, core language, as well as propositional language and associated executive functions that can be impacted and overlooked in stroke patients without aphasia. This study examines BELS sensitivity and specificity, and performance in acute to early sub-acute stroke relative to controls.

METHOD

Cross-sectional BELS data from 88 acute left and right hemisphere stroke patients (within 7 weeks of stroke) and 116 age-matched healthy controls were compared using independent samples t-tests. ROC Curve Analysis was performed to determine a cutoff score for the BELS.

RESULTS

Left and right stroke patients were reduced on all propositional language subtests, and executive function subtests of inhibition, strategy, and selection. Differences were also observed for Oral Apraxia, Naming, and Memory. By contrast, Word Comprehension and Repetition, and Sentence Completion Initiation (after corrections applied) did not differ between groups. A total BELS score of 79.25/100 was highly sensitive (.89) and specific (.89) when classifying stroke patients and healthy controls.

CONCLUSION

The BELS is brief, sensitive, suitable for bedside administration, and can aid in detection and rehabilitation of subtle executive language impairments. This in turn will help improve relationships and quality of life post-stroke.

Role of cognitive control in resolving two types of conflict during spoken word production

A theoretically- and clinically-important issue for understanding word retrieval is how speakers resolve conflict during linguistic tasks. This study investigated two types of conflict resolution: prepotent conflict, when one dominant incorrect response must be suppressed; and underdetermined conflict, when multiple reasonable responses compete. The congruency sequence effect paradigm was used to assess trial-to-trial changes in reaction time and accuracy during word production tasks with either prepotent or underdetermined conflict. Pictures were named faster on trials with low-conflict as compared to high-conflict regardless of conflict type. This effect was modulated by the amount of conflict experienced on the previous trial for both tasks. These results suggest that resolution of underdetermined and prepotent conflict may engage the same general cognitive mechanism. This work expands our understanding of the relationship between cognitive control and word production and can inform clinical approaches for people with anomia.

Neural sensitivity to semantic neighbors is stable across the adult lifespan

As we age, language reflects patterns of both stability and change. On the one hand, vocabulary and semantic abilities are largely stable across the adult lifespan, yet lexical retrieval is often slower and less successful (i.e., slower picture naming times, increased tip of the tongue incidents). Although the behavioral bases of these effects have been well established, less is known about the brain regions that support these age-related differences. We used functional Magnetic Resonance Imaging (fMRI) to examine the neural basis of picture naming. Specifically, we were interested in whether older adults would be equally sensitive to semantic characteristics, specifically the number of semantic near neighbors. Near neighbors, defined here as items with a high degree of semantic feature overlap, were of interest as these are thought to elicit competition among potential candidates and increase naming difficulty. Consistent with prior reports, pictures with more semantic near neighbors were named more slowly and less accurately for all adults. Additionally, this interference for naming times was larger as age increased, starting around 30 years old. In contrast to the age-related behavioral slowing, the neural basis of these effects was stable across adulthood. Across all adults, a number of language-relevant regions including left posterior middle temporal gyrus and left inferior frontal gyrus, pars triangularis were sensitive to the number of near neighbors. Our results suggest that although middle-aged and older adults' picture naming is more slowed by increased semantic competition, the brain regions supporting semantic processes remain stable across the adult lifespan.

A Brief Executive Language Screen for Frontal Aphasia

Aphasia assessment tools have primarily focused on classical aphasia type and severity, with minimal incorporation of recent findings that suggest a significant role of executive control operations in language generation. Assessment of the interface between language and executive functions is needed to improve detection of spontaneous speech difficulties. In this study we develop a new Brief Executive Language Screen (BELS), a brief tool specifically designed to assess core language and executive functions shown to be involved in spontaneous generation of language. Similar to other measures of aphasia, the BELS assesses articulation and core language skills (repetition, naming and comprehension). Unique additions to the BELS include assessments of spontaneous connected speech, word fluency (phonemic/semantic) and sentence completion (verbal initiation, inhibition and selection). One-hundred and eight healthy controls and 136 stroke patients were recruited. Confirmatory factor analysis was used to determine construct validity and logistic regression was used to evaluate the discriminative validity, informing the final version of the BELS. The results showed that the BELS is sensitive for articulation and nominal language deficits, and it measures executive aspects of spontaneous language generation, which is a hallmark of frontal dynamic aphasia. The results have encouraging theoretical and practical implications.

Verbal Adynamia and Conceptualization in Partial Rhombencephalosynapsis and Corpus Callosum Dysgenesis

Verbal adynamia is characterized by markedly reduced spontaneous speech that is not attributable to a core language deficit such as impaired naming, reading, repetition, or comprehension. In some cases, verbal adynamia is severe enough to be considered dynamic aphasia. We report the case of a 40-year-old, left-handed, male native English speaker who presented with partial rhombencephalosynapsis, corpus callosum dysgenesis, and a language profile that is consistent with verbal adynamia, or subclinical dynamic aphasia, possibly underpinned by difficulties selecting and generating ideas for expression. This case is only the second investigation of dynamic aphasia in an individual with a congenital brain malformation. It is also the first detailed neuropsychological report of an adult with partial rhombencephalosynapsis and corpus callosum dysgenesis, and the only known case of superior intellectual abilities in this context.