Impact of post-stroke aphasia on functional communication, quality of life, perception of health and depression: A case-control study

BACKGROUND AND PURPOSE

Post-stroke aphasia is associated with a reduced quality of life (QoL) and higher risk of depression. Few studies have addressed the effect of coping with aphasia. Our aim is to evaluate the impact of post-stroke aphasia on self-reported QoL and symptoms of depression.

METHODS

This was a cross-sectional prospective case-control study. Cases involved patients with post-stroke aphasia included in the DULCINEA trial (NCT04289493). Healthy controls were recruited using snowball sampling. All subjects completed the following questionnaires: General Health Questionnaire (GHQ-12), Stroke Aphasia Quality of Life Scale (SAQOL-39), Communicative Activity Log (CAL) and Stroke Aphasic Depression Questionnaire (SADQ-10).

RESULTS

Twenty-three patients (eight women; mean age 62.9 years) and 73 controls (42 women; mean age 53.7 years) were included. Cases scored lower than controls in perception of health (GHQ-12: median 3 [IQR 1; 6] vs. 0 [IQR 0; 2]) and perception of QoL (SAQOL-39: median 3.6 [IQR 3.3; 40] vs. 4.6 [IQR 4.2; 4.8]). Functional communication (CAL: median 135 [IQR 122; 148] vs. 94 [IQR 74; 103]) and SAQOL-39 communication subscale (median 2.7 [IQR 2.1; 3.2] vs. 4.8 [IQR 4.6; 5.0]) were also significantly lower in the case group. Notably, cases reported fewer depressive symptoms than controls (SADQ-10: median 11 [IQR 9; 15] vs. 13 [IQR 11; 16]; p = 0.016). A mediational analysis revealed that the relationship between post-stroke aphasia and depression was not mediated by functional communication.

CONCLUSIONS

Although communication difficulties impact the QoL of patients with post-stroke aphasia, such patients report fewer depressive symptoms on the SADQ-10 scale than healthy people, with no differences in scores related to social participation.

DUbbing Language-therapy CINEma-based in Aphasia post-Stroke (DULCINEA): study protocol for a randomized crossover pilot trial

BACKGROUND

Communication is one of the most important predictors of social reintegration after stroke. Approximately 15-42% of stroke survivors experience post-stroke aphasia. Helping people recover from aphasia is one of the research priorities after a stroke. Our aim is to develop and validate a new therapy integrating dubbing techniques to improve functional communication.

METHODS

The research project is structured as three work packages (WP). WP1: development of the dubbed language cinema-based therapy: Two research assistants (a speech therapist and a dubbing actor) will select the clips, mute specific words/sentences in progressive speech difficulty, and guide patients to dub them across sessions. Words to be dubbed will be those considered to be functionally meaningful by a representative sample of aphasic patients and relatives through an online survey. WP2: a randomized, crossover, interventional pilot study with the inclusion of 54 patients with post-stroke non-fluent aphasia. Patients will be treated individually in 40-min sessions twice per week for 8 weeks. Primary outcomes will be significant pre/post differences in scores in the Communicative Activity Log (CAL) questionnaire and Boston Diagnostic Aphasia Examination (BDAE) administered by a psychologist blinded to the patients' clinical characteristics.

SECONDARY OUTCOMES

General Health Questionnaire (GHQ)-12, Stroke Aphasia Quality of Life Scale (SAQOL-39), Western Aphasia Battery Revised (WAB-R), and the Stroke Aphasic Depression Questionnaire (SADQ10). WP3: educational activities and dissemination of results. WP3 includes educational activities to improve public knowledge of aphasia and dissemination of the results, with the participation of the Spanish patients' association Afasia Activa.

DISCUSSION

This pilot clinical trial will explore the efficacy of a new therapeutic tool based on dubbing techniques and computer technology to improve functional communication of patients suffering from post-stroke aphasia with the use of standardized test assessment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04289493 . Registered on 28 February 2020.

Extending a misallocation model to children's choice behavior

Nonhuman animal models show that reinforcers control behavior through what they signal about the likelihood of future events, but such control is generally imperfect. Imperfect control by the relation between past and likely future events may result from imperfect detection of those events as they occur, which result in imperfect detection of the relation between events. Such an approach would suggest the involvement of more complex psychological processes like memory in simple operant learning. We extended a research paradigm previously examined with nonhuman animals to test the ability of a quantitative model that assumes imperfect control by the relation between events arises because of (a) occasional misallocation of reinforcers to the wrong response, causing imperfect control by the relation between events; and (b) a tendency to explore or exploit which is independent of the relation between events. Children played a game in which one of two different responses could produce a reinforcer. The likelihood of a reinforcer for the same response that produced the last one varied across three conditions (.1, .5, .9). As with nonhuman animal models, children's choices followed these probabilities closely but not perfectly, suggesting strong control by what one reinforcer signals about subsequent reinforcers. Choice was well described by the quantitative model. This same model also provides a good description of nonhuman animal-model data, suggesting fundamentally similar mechanisms of control across species. These findings suggest reinforcers control behavior to the extent the relation between reinforcers can be detected-that is, simple operant learning may be more complex than is typically assumed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Advances in the indirect, descriptive, and experimental approaches to the functional analysis of problem behavior

BACKGROUND

Experimental functional analysis is an assessment methodology to identify the environmental factors that maintain problem behavior in individuals with developmental disabilities and in other populations. Functional analysis provides the basis for the development of reinforcement-based approaches to treatment.

METHODS

This article reviews the procedures, validity, and clinical implementation of the methodological variations of functional analysis and function-based interventions.

RESULTS

We present six variations of functional analysis methodology in addition to the typical functional analysis: brief functional analysis, single-function tests, latency-based functional analysis, functional analysis of precursors, and trial-based functional analysis. We also present the three general categories of function-based interventions: extinction, antecedent manipulation, and differential reinforcement.

CONCLUSIONS

Functional analysis methodology is a valid and efficient approach to the assessment of problem behavior and the selection of treatment strategies.

Clinical decision making and preference assessment for individuals with intellectual and developmental disabilities

Individuals with intellectual or developmental disabilities are able to reliably express their likes and dislikes through direct preference assessment. Preferred items tend to function as rewards and can therefore be used to facilitate the acquisition of new skills and promote task engagement. A number of preference assessment methods are available and selecting the appropriate method is crucial to provide reliable and meaningful results. The authors conducted a systematic review of the preference assessment literature, and developed an evidence-informed, decision-making model to guide practitioners in the selection of preference assessment methods for a given assessment scenario. The proposed decision-making model could be a useful tool to increase the usability and uptake of preference assessment methodology in applied settings.

The Case Against B. F. Skinner 45 years Later: An Encounter with N. Chomsky

Chomsky's (1959) review of Verbal Behavior (Skinner, 1957) has been hailed as the most influential document in the history of psychology. Although many rejoinders to Chomsky's review have been published, their impact has been minimal. Moreover, Chomsky has not answered them in detail. To invite Chomsky to revisit a number of matters concerning the review, he was interviewed. The principal topics addressed by Chomsky were (a) historical factors associated with behaviorism after World War II; (b) circumstances surrounding the preparation of the review; (c) likely compatibility between formal and functional analyses of language; and (d) Chomsky's current point of view on aspects of the content of his review and on the evolution of behavior analysis.

Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning

OBJECTIVES

The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability.

METHODS

Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses.

RESULTS

The sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74).

CONCLUSIONS

Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.

Changing patterns of neuropsychological functioning in children living at high altitude above and below 4000 m: a report from the Bolivian Children Living at Altitude (BoCLA) study

The brain is highly sensitive to environmental hypoxia. Little is known, however, about the neuropsychological effects of high altitude residence in the developing brain. We recently described only minor changes in processing speed in native Bolivian children and adolescents living at approximately 3700 m. However, evidence for loss of cerebral autoregulation above this altitude (4000 m) suggests a potential threshold of hypoxia severity over which neuropsychological functioning may be compromised. We conducted physiological and neuropsychological assessments in 62 Bolivian children and adolescents living at La Paz (∼3700 m) and El Alto (∼4100 m) in order to address this issue. Groups were equivalent in terms of age, gender, social class, schooling, parental education and genetic admixture. Apart from percentage of hemoglobin saturated with oxygen in arterial blood (%SpO(2)), participants did not differ in their basal cardiac and cerebrovascular performance as explored by heart rate, mean arterial pressure, end-tidal carbon dioxide, and cerebral blood flow velocity at the basilar, anterior, middle and posterior cerebral arteries. A comprehensive neuropsychological assessment was administered, including tests of executive functions, attention, memory and psychomotor performance. Participants living at extreme altitude showed lower levels of performance in all executive tests (Cohen effect size = -0.91), whereas all other domains remained unaffected by altitude of residence. These results are compatible with earlier physiological evidence of a transitional zone for cerebral autoregulation at an altitude of 4000 m. We now show that above this threshold, the developing brain is apparently increasingly vulnerable to neuropsychological deficit.

Prevalence and European comparison of dementia in a ≥75-year-old composite population in Spain

OBJECTIVES

To estimate dementia prevalence in Spain.

MATERIALS AND METHODS

Nine probabilistic and geographically defined samples participated. A screening design based on the MMSE was implemented. Positively screened individuals underwent clinical evaluation. The total number of cases in Spain was estimated. Prevalence was confronted to that of other European countries.

RESULTS

Five hundred and forty-six persons aged ≥75 participated, 49 had dementia (35 with Alzheimer's disease [AD], 10 with vascular dementia [VD], 4 other; 25 first diagnosed in the study). Age- and sex-adjusted prevalence and estimated nationwide cases were 7.5% (95% CI 5.4-9.7), 5.6 (95% CI 3.7-7.5) and 1.4 (95% CI 0.5-2.3), and 290,000 (95% CI 208,000-372,000), 214,000 (95% CI 141,000-288,000) and 54,000 (95% CI 20,000-88,000) for dementia, AD and VD, respectively.

CONCLUSIONS

Dementia prevalence in Spain is comparable to other European populations, while a high number of undiagnosed cases live in the community. The potential impact of Mediterranean diet, hypertension control and decreasing vascular risk factors is discussed.

Prevalence of disability in a composite ≥75 year-old population in Spain: a screening survey based on the International Classification of Functioning

Background

The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.

Methods

Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2^nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).

Results

The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).

Conclusions

Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

A systematic archival inquiry on Juan Huarte de San Juan (1529–88)

[[Examen de Ingenios historyJuan HuarteTrial of Men’s Wits psychiatrypsychology ]] Juan Huarte de San Juan (1529–88) was a physician of the Spanish Renaissance. He wrote the Examen de Ingenios para las Ciencias, translated as The Trial of Men’s Wits (1989[1575–94]), a book that has been acknowledged as a precursor of educational psychology, organizational psychology, behaviorism, neuropsychology and psychiatry. Huarte suggested that before beginning a course of study, students’ intellectual capabilities (i.e. ingenio) should be matched up with the professional studies that best suit their aptitudes. His book had a great impact in Europe from the late 16th century to the mid-18th century. The influence of the Trial spread throughout many areas including philosophy, politics, linguistics and literature. Although there has been a growing interest in Huarte’s work in recent years, biographical studies have been rare; as a result, the information about Huarte’s life is currently incomplete, scattered and sometimes inaccurate. This study presents a systematic archival research on Spanish original sources. We present a reconstruction of Huarte’s life-story based on 32 original documents (1549–c.1650), some of them first discovered during the present survey. Documents are described according to the General International Standard of Archival Description, ISAD(G). The documents uncovered allow for a reappraisal of Huarte’s biography.

Cross-cultural evaluation of the modified Parkinson Psychosis Rating Scale across disease stages

This study assessed the psychometric attributes of the modified Parkinson Psychosis Rating Scale (mPPRS). In an attempt to improve scale's scaling assumptions and content validity, all types of hallucinations were rated and all items were scored based on intensity. The scale was cross-culturally adapted to four Latin American countries (Argentina, Brazil, Ecuador, and Paraguay). Acceptability, internal consistency, factor structure, convergent and known-groups validity, and precision (standard error of measurement, SEM) were explored. A total of 388 patients with PD were included in the study (age, 64.5 +/- 10.7 years; 59.8% males; PD duration, 8.2 +/- 4.9 years). The mPPRS was highly usable in terms of missing values generated and scores distribution (total computable scores, 99.7%, ceiling effect, <15%). Scaling assumptions were acceptable as noted by the range of item-total correlations (0.14-0.55, only one coefficient below 0.2). Internal consistency was adequate for research use (Cronbach alpha, 0.7). Factor analysis identified two factors that accounted for 58.5% of the variance. Low correlation coefficients were found with cognitive function (SCOPA-Cog) and disease severity (CISI-PD) (r(S) <or= 0.30), whereas correlation with psychosis were high (r(S) = 0.56). Known-groups validity analyses indicated a significant increase in mPPRS scores by Hoehn and Yahr stage (P < 0.001). The SEM value was 1.06. Overall, the results suggest that the mPPRS is a useful tool for evaluation of psychosis in PD. The results show that some psychometric properties of the mPPRS are satisfactory albeit there is room for the improvement of scale's content validity and internal consistency. (c) 2010 Movement Disorder Society.

Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes

A number of clinical trials and single-subject studies have been published measuring the effectiveness of long-term, comprehensive applied behavior analytic (ABA) intervention for young children with autism. However, the overall appreciation of this literature through standardized measures has been hampered by the varying methods, designs, treatment features and quality standards of published studies. In an attempt to fill this gap in the literature, state-of-the-art meta-analytical methods were implemented, including quality assessment, sensitivity analysis, meta-regression, dose-response meta-analysis and meta-analysis of studies of different metrics. Results suggested that long-term, comprehensive ABA intervention leads to (positive) medium to large effects in terms of intellectual functioning, language development, acquisition of daily living skills and social functioning in children with autism. Although favorable effects were apparent across all outcomes, language-related outcomes (IQ, receptive and expressive language, communication) were superior to non-verbal IQ, social functioning and daily living skills, with effect sizes approaching 1.5 for receptive and expressive language and communication skills. Dose-dependant effect sizes were apparent by levels of total treatment hours for language and adaptation composite scores. Methodological issues relating ABA clinical trials for autism are discussed.

Prevalence of dementia and major dementia subtypes in Spanish populations: a reanalysis of dementia prevalence surveys, 1990-2008

Background

This study describes the prevalence of dementia and major dementia subtypes in Spanish elderly.

Methods

We identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008). Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression.

Results

The reanalyzed study population (aged 70 year and above) was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimer's disease, 238 of vascular dementia). Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimer's disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists.

Conclusion

Prevalence of dementia and Alzheimer's disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimer's disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted.

Cross-cultural validation of the Scales for Outcomes in Parkinson's Disease-Psychosocial questionnaire (SCOPA-PS) in four Latin American countries

OBJECTIVE

To conduct a cross-national validation of the Scales for Outcomes in Parkinson's Disease-PsychoSocial questionnaire (SCOPA-PS) in four Latin American Countries.

METHODS

Data quality (missing items), scale assumptions (item-test correlation), internal consistency (Cronbach's alpha, item homogeneity), factor structure, content validity, and precision (standard error of measurement, SEM) of the scale were explored, as was convergent validity with motor symptoms (Clinical Impression of Severity Index [CISI-PD], Scales for Outcomes in Parkinson's Disease-Motor Scale), emotional status (Hospital Anxiety and Depression Scale) and health-related quality of life (Parkinson Disease Questionnaire-39). Known-groups validity was studied by category of severity, based on Hoehn and Yahr staging (HY), CISI-PD, and disease duration.

RESULTS

Three hundred thirty-one Parkinson's disease (PD) patients with usable data participated (mean age 64.7 years; 42.3% female; mean PD duration 8.5 years; HY, 1 to 5). Data quality (missing items <10%), scale assumptions (item-total correlation = 0.43 - 0.71) and internal consistency of SCOPA-PS (Cronbach's alpha = 0.87; item homogeneity = 0.38) were satisfactory. Factor analysis suggested a unifactorial structure. High convergent validity was found for depression (r(S) = 0.61), anxiety (r(S) = 0.62), and health-related quality of life (r(S) = 0.82). Known-groups validity analyses indicated a gradual influence of severity category and disease duration on SCOPA-PS scores (P < 0.0001). SEM value was 8.24 (7 to 12 in previous studies). These magnitudes may be indicative of the threshold for a real change and a minimum important difference.

CONCLUSIONS

The Latin American versions of the SCOPA-PS displayed appropriate psychometric attributes.

Validación transcultural de la Escala de Sentido de Coherencia de Antonovsky (OLQ-13) en ancianos mayores de 70 años

BACKGROUND AND OBJECTIVE

Sense of Coherence (SOC) is a construct relating to coping strategies in the face of traumatic events. SOC is defined as a personal disposition towards perceiving life experiences as understandable, manageable and meaningful. The construct has shown itself to be a predictor of self-reported and objective health in a variety of contexts. Although the SOC construct has been studied, among the elderly in particular, the scale has never been validated in the Spanish aged population. This paper reports on the cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in a sample of Spanish senior citizens.

SUBJECTS AND METHOD

We studied a sample of population from 8 locations across Spain, totaling 419 subjects aged 70 years or over. The psychometric attributes of the scale were studied. These included acceptability, scale assumptions, internal consistency, factor structure, construct validity (convergent validity, differential analyses, inter-domains correlation), and precision.

RESULTS

The internal consistency of the scale was adequate (Cronbach = 0.80). SOC showed moderate correlations with self-reported indices of physical health, quality of life and depression. The scale was found valid in differential analyses conducted for gender, age groups, levels of disability and functional impact of diseases. Principal components analysis yielded four factors accounting for 65.59% of the variance. The Meaningfulness domain acted as an independent factor.

CONCLUSIONS

The OLQ-13 is a valid and reliable instrument for use on Spanish elderly populations, including those with low educational level.

Human behaviour and development under high-altitude conditions

Although we are far from a universally accepted pattern of impaired function at altitude, there is evidence indicating motor, perceptual, memory and behavioural deficits in adults. Even relatively low altitudes (2500 m) may delay reaction time, and impair motor function. Extreme altitude exposure (>5000 m) may result in more pronounced impairment that can persist after returning to the lowlands. Research into the effects of altitude exposure earlier in development is lacking by comparison. Un-acclimatized children can suffer from acute mountain sickness, and, in native populations born at altitude, subtle cognitive and behavioural deficits suggest incomplete adaptation to hypoxia. The study of neurobehavioural functioning at altitude may provide important information about the effects of clinical hypoxia on the human brain and behavioural development.

Psychophysiological effects of human-animal interaction: theoretical issues and long-term interaction effects

This paper reviews literature published on the psychophysiological effects of long-term human-animal interaction (i.e., pet ownership, pet adoption). A literature search was conducted using PsycInfo and Medline databases. Although the available evidence is far from being consistent, it can be concluded that, in some cases, long-term relationships with animals may moderate baseline physiological variables, particularly blood pressure. Results proved more coherent in studies where animals were adopted by owners as part of the procedure. This paper examines existing hypotheses seeking to account for these effects and the supporting evidence. Two major hypotheses have been suggested to explain the psychophysiological effects of long-term interaction, namely (1) stress-buffering effects of noncritical social support provided by pets; and (2) classical conditioning of relaxation. These mechanisms may partially account for the long-term health outcomes observed in a number of human-animal interaction studies.

Neuropsychological Functioning Associated with High-Altitude Exposure

This article focuses on neuropsychological functioning at moderate, high, and extreme altitude. This article summarizes the available literature on respiratory, circulatory, and brain determinants on adaptation to hypoxia that are hypothesized to be responsible for neuropsychological impairment due to altitude. Effects on sleep are also described. At central level, periventricular focal damages (leuko-araiosis) and cortical atrophy have been observed. Frontal lobe and middle temporal lobe alterations are also presumed. A review is provided regarding the effects on psychomotor performance, perception, learning, memory, language, cognitive flexibility, and metamemory. Increase of reaction time and latency of P300 are observed. Reduced thresholds of tact, smell, pain, and taste, together with somesthetic illusions and visual hallucinations have been reported. Impairment in codification and short-term memory are especially noticeable above 6,000 m. Alterations in accuracy and motor speed are identified at lower altitudes. Deficits in verbal fluency, language production, cognitive fluency, and metamemory are also detected. The moderating effects of personality variables over the above-mentioned processes are discussed. Finally, methodological flaws found in the literature are detailed and some applied proposals are suggested.