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PubMed1995

A randomized, double-blind, placebo-controlled study of bromocriptine in nonfluent aphasia.

We carried out a double-blind and placebo-controlled study of the efficacy of bromocriptine in the treatment of nonfluent aphasia. Seven patients received bromocriptine (up to 60 mg/d) and an identical placebo in a randomized order. End points were the number of content words, content units, and pauses > 3 seconds during the description of a figure; verbal naming; and verbal fluency. There were no significant benefits of bromocriptine over placebo in any of the variables examined.

Adult↗
PubMed1997

Apolipoprotein E genotypes in primary progressive aphasia.

We obtained apolipoprotein E genotyping in a population of 12 consecutive patients who fulfilled rigorous criteria for the clinical diagnosis of primary progressive aphasia (PPA). The allele frequencies were 4% for E2, 83% for E3, and 13% for E4. This pattern of allele distribution was significantly different from the pattern seen in groups of patients either with the clinical diagnosis of probable Alzheimer's disease (PRAD) or the histopathologic diagnosis of Alzheimer's disease (AD). The E4 allele frequency in the group of patients with PPA was in the range seen in control populations and was much lower than the one reported in populations of patients with PRAD or AD. The E4 allele is therefore not a significant risk factor for developing PPA. These results provide neurobiological support for the syndromic distinction of PPA from PRAD and are in keeping with neuropathologic evidence showing that the vast majority of patients with PPA do not have the histopathology of AD. Although we do not yet have neuropathologic information on our patients, these results indicate that the clinical diagnosis of PPA has biological validity in that it identifies a population that is genetically different from the population of patients with a clinical diagnosis of PRAD.

Adult↗
PubMed2000

MR perfusion imaging reveals regions of hypoperfusion associated with aphasia and neglect.

OBJECTIVE: To evaluate diffusion-weighted imaging (DWI) and MR perfusion imaging (MRPI) as tools for identifying regions of infarct and hypoperfusion associated with aphasia and neglect in hyperacute stroke. Secondary goal: to establish a functional correlate of a radiologically defined "ischemic penumbra." METHODS: Forty subjects underwent DWI, MRPI, and standardized tests for lexical deficits or hemispatial neglect within 24 hours of stroke onset or progression. Ten patients had repeat DWI, MRPI, and cognitive testing after 3 days (in some cases after reperfusion therapy). Pearson correlations between error rate on cognitive testing and volume of abnormality on DWI versus MRPI were determined at each time period, and regions of hypoperfusion corresponding to specific cognitive deficits were identified. RESULTS: Error rate was more strongly correlated with volume of hypoperfused tissue on MRPI (r = 0.65 to 0.93; p < 0.01 to p < 0.0003) than with volume of lesion on DWI (r = 0.54 to 0.75; p = 0.14 to p < 0.01) for dominant and nondominant hemisphere stroke, at each time point. Forty-eight percent of aphasic patients and 67% of those with hemispatial neglect had either no infarct or only small subcortical infarct on DWI, but had focal cortical hypoperfusion. Patients who had successful reperfusion therapy showed resolution of the hypoperfused territory beyond the infarction on repeat MRPI and showed resolution of corresponding deficits. CONCLUSIONS: MRPI shows regions of hypoperfused cortex associated with lexical deficits or hemispatial neglect, even when DWI shows no infarct or only small subcortical infarct. MRPI-DWI mismatch indicates regions of functionally salvageable tissue.

Aphasia↗
PubMed1994

Language-activated single-photon emission tomography imaging in the evaluation of language lateralization--evidence from a case of crossed aphasia: case report.

We report a right-handed patient who developed a nonfluent aphasia after surgery for a right parietal arteriovenous malformation. Resting brain single-photon emission tomography displayed decreased regional cerebral blood flow only in the right hemisphere, with spared regional cerebral blood flow in the left hemisphere. Single-photon emission tomography performed after a language activation task (Boston Naming Task) showed a consistent area of increased regional cerebral blood flow in the right inferior and posterior frontal lobe, supporting a right hemisphere dominance for language. These results suggest a potential role for this noninvasive study in the evaluation of language lateralization.

Adult↗
PubMed2006

Success stories in aphasia.

Success in living with aphasia is discussed in the context of two couples who describe themselves as leading successful poststroke lives. Excerpts of interviews with the couples highlight some of the more salient issues and how each couple has come to accept and even appreciate "aphasic life."

Adaptation, Psychological↗
PubMed1997

The relevance of patient individuality in the evaluation and treatment of aphasia. Case report.

The usual approach to language disorders relies on standardised evaluations in which pattern-tests characterise the subject's status according to the classical aphasiological typology. Those data are then analysed to support a traditional prevalent criterion for the distinction between "normal" and "pathological" linguistic performance, which is strictly focused on a quantitative approach. In the present study a method for evaluation and treatment of aphasia is proposed in which socio-cultural conditions are emphasised, in order to expand this conventional criterion as to encompass a qualitative (individualised) one. Although the methodology draws the attention, the results here obtained also point to the importance of re-evaluating what is presently considered as the most appropriate criterion for "normal" cognitive processes, particularly those related to language.

Aphasia, Conduction↗
PubMed1999

[Migraine with aphasia. Report of a family].

We describe a Brazilian family in which one female patient and her three daughters present a clinical course compatible with migraine, preceded by language disorders (aphasia), without paresis. Several aspects related to genetics of migraine are reviewed. We conclude that further genetical studies are necessary to establish if these cases are different sources of well-known migraine subtypes as the familial hemiplegic migraine.

Adolescent↗
PubMed2000

[Global aphasia without hemiparesis: case report].

Symptoms and signs of a stroke indicate which areas of the brain are affected and may also suggest the pathophysiology. We report herein a case of global aphasia without hemiparesis due to embolic infarct. Our case suggests that this situation may be an important sign for embolic cerebral infarction, as reported in literature.

Aphasia↗
PubMed2001

Primary progressive aphasia: analisys of 16 cases.

Primary progressive aphasia (PPA) is an intriguing syndrome, showing some peculiar aspects that differentiate it from classical aphasic pictures caused by focal cerebral lesions or dementia. The slow and progressive deterioration of language occurring in these cases provides an interesting model to better understand the mechanisms involved in the linguistic process. We describe clinical and neuroimaging aspects found in 16 cases of PPA. Our patients underwent language and neuropsychological evaluation, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT). We observed a clear distinction in oral expression patterns; patients were classified as fluent and nonfluent. Anomia was the earliest and most evident symptom in both groups. Neuroimaging pointed to SPECT as a valuable instrument in guiding the differential diagnosis, as well as in making useful clinical and anatomical correlations. This report and a comparison to literature are an attempt to contribute to a better understanding of PPA.

Adult↗
PubMed2002

Performance of a Brazilian population sample in the Boston Diagnostic Aphasia Examination: a pilot study.

Brazilian researchers and health professionals often face the challenge of having to use tests developed in foreign languages and standardized for populations of other countries, especially in the fields of Neuropsychology and Neurolinguistics. This fact promotes a feeling that some scoring systems may be inadequate for our sociocultural reality. In the present study, we describe the performance of a Brazilian population sample submitted to a translated and adapted version of the Boston Diagnostic Aphasia Examination (BDAE). Sixty normal volunteers (21 men and 39 women), all Portuguese native speakers, ranging in age from 15 to 78 years (average 43.7) and with an educational level of 2 to 16 years (average 9.9), were tested using a translated and adapted Portuguese version of the BDAE. Cut-off scores are suggested for our population and the performance of the Brazilian sample is compared to that of American and Colombian samples, with the results being closely similar in all tasks. We also performed a correlation analysis between age, gender and educational level and the influence of these variables on the performance of the subjects. We found no statistically significant differences between genders. Educational level correlated positively with performance, especially in the subtests involving reading and writing. There was a negative correlation between age and performance in two subtests (Visual Confrontation Naming and Sentences to Dictation), but a coexisting effect of educational level could not be ruled out.

Achievement↗
PubMed2004

Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling.

In Neurolinguistics, the use of diagnostic tests developed in other countries can create difficulties in the interpretation of results due to cultural, demographic and linguistic differences. In a country such as Brazil, with great social contrasts, schooling exerts a powerful influence on the abilities of normal individuals. The objective of the present study was to identify the influence of schooling on the performance of normal Brazilian individuals in the Boston Diagnostic Aphasia Examination (BDAE), in order to obtain reference values for the Brazilian population. We studied 107 normal subjects ranging in age from 15 to 84 years (mean +/- SD = 47.2 +/- 17.6 years), with educational level ranging from 1 to 24 years (9.9 +/- 4.8 years). Subjects were compared for scores obtained in the 28 subtests of the BDAE after being divided into groups according to age (15 to 30, N = 24, 31 to 50, N = 33 and 51 years or more, N = 50) and education (1 to 4, N = 26, 5 to 8, N = 17 and 9 years or more, N = 61). Subjects with 4 years or less of education performed poorer in Word Discrimination, Visual Confrontation Naming, Reading of Sentences and Paragraphs, and Primer-Level Dictation (P < 0.05). When breakdown by schooling was 8 years or less, subjects performed poorer in all subtests (P < 0.05), except Responsive Naming, Word Recognition and Word-Picture Matching. The elderly performed poorer (P < 0.05) in Complex Ideational Material, Visual Confrontation Naming, Comprehension of Oral Spelling, Written Confrontation Naming, and Sentences to Dictation. We present the reference values for the cut-off scores according to educational level.

Adolescent↗
PubMed2005

A study of the abilities in oral language comprehension of the Boston Diagnostic Aphasia Examination -- Portuguese version: a reference guide for the Brazilian population.

We analyzed the performance of 162 normal subjects, subdivided into groups according to age and schooling, in the oral comprehension tasks of the Boston Diagnostic Aphasia Examination translated and adapted to Brazilian Portuguese to obtain a profile of performance for the Brazilian population, as well as cut-off scores for each task, and to determine the best combination of tasks that distinguish normal from aphasic subjects, as a guide for clinicians. The normal subjects were compared to 69 aphasics. Age alone influenced the performance in the designation of actions (subjects above 70 years showing the worst performance); schooling alone influenced the comprehension of forms, colors and numbers (subjects with less than four years of education showing a poorer performance). Both age and schooling influenced the performance in Body Part Identification (BPI) and Complex Ideational Material (CIM) with mean values of 70.5 +/- 3.3 (Word Discrimination, WD), 18.9 +/- 1.4 (BPI), 14.7 +/- 0.9 (Commands), and 10.3 +/- 1.7 (CIM) for the whole sample; the cut-off scores obtained were 65 (WD), 17.5 (BPI), 14 (Commands), and 9.5 (CIM) for the whole sample. Logistic regression showed that the combination of BPI + Commands + CIM was the most efficient in differentiating normal subjects from aphasics, with 72.5% sensitivity and 97.6% specificity. However, for low-education subjects, BPI and Commands were sufficient for this differentiation (75.7% sensitivity and 84.7% specificity). The main contribution of this study was to provide reference values that are far more representative of our population to be used by health professionals in Brazil, taking into account cultural differences.

Adolescent↗
PubMed1976

Multivariate comparison of Howes' and Weisenburg and McBride's models of aphasia on the neurosensory center comprehensive examination.

The verbal production of 57 aphasic patients was rated and used to assign these patients into two sets of groups reflecting Howes' and Weisenburg and McBride's models of aphasia. Test scores covering a broad range of communication skills and modalities were compared between these groups to examine the assumption that salient features of verbal production could be used to establish groups which would show significant differences on other important linguistic variables. Neither Howes' nor Weisenburg and McBride's model provided groups showing significant multivariate differences. It was suggested that these models be improved by expanding them to include other important psycholinguistic components of language skills. Since these models did not account for significant between group differences, caution was suggested in using these models for assessment or treatment purposes.

Adolescent↗
PubMed1983

Effects of intensity variations on auditory processing in aphasia. I. Equal intensities at each ear.

Clinical observations have led several authors to suggest that talking louder improves auditory comprehension for the aphasic patient, while others suggest that it does nothing to help comprehension. To clarify these observations under experimental conditions, four measures of auditory processing (cortical-evoked responses, nonverbal intensity sequencing, phoneme in word discrimination and sequencing, and a semantic-syntactic measure of comprehension) were used in diotic presentation of stimuli to 10 aphasic subjects with left temporal lobe damage. The stimuli were presented at 70, 85, and 100 dB SPL. Results suggest that a simple diotic (true binaural) increase of stimulus intensity is not a potent variable for influencing auditory processing in patients with aphasia. Although a few subjects improved their performances on selected levels when stimulus intensity was increased, the performances of others decreased. Auditory-evoked response (AER) latencies and amplitudes generally were not significantly different between the damaged and intact hemispheres. The time-intensity trading function was demonstrated with the AER, particularly for the N2 component. The ear with the greatest advantage on dichotic listening was contralateral to the lesion and was contralateral to the hemisphere that had the shorter P1 latencies, longer N2 latencies, and smaller AER amplitudes.

Adult↗
PubMed1983

Effects of intensity variations on auditory processing in aphasia. II. Different intensities at each ear.

A neurologic extinction model was applied to the auditory-processing disorders evidenced by 10 persons with aphasia. This model suggests that messages travel faster to the intact hemisphere, where they are more differentiated and articulated, than to the affected hemisphere. This leads to extinction and interference of the message. To overcome this extinction, the stimulus intensity was raised by 15 or 30 dB to one ear at a time. The stimuli were a cortical auditory-evoked response (AER) measure, a nonverbal intensity sequencing test (NVIST), a minimally varied phoneme-in-word discrimination and sequencing test (MVPT). and a semantic-syntactic level test (RTT). The results suggest that intensity can be traded for time in quantities large enough to overcome the extinction interference of auditory stimuli. Although some statistically significant results and meaningful trends toward improved performance were evident on the NVIST and the MVPT, a unilateral increase of stimulus intensity did not prove to be a potent mechanism for improving auditory comprehension. Sentence length material was not affected in either direction by selective amplification. The role of the left ear/right hemisphere as a facilitator of processing for linguistic and nonlinguistic material was suggested by the results of this study.

Adult↗
PubMedDate not supplied

Cerebrovascular complications of L-asparaginase therapy in children with leukemia: aphasia and other neuropsychological deficits.

Children with acute lymphoblastic leukemia (ALL), treated with L-asparaginase are at risk for cerebral thrombosis or hemorrhage because of coagulation protein deficiencies. The results and the importance of serial neuropsychological examinations after such complications in three children with ALL are presented. All patients showed marked aphasia and other cognitive deficits. Recovery was complete in two of three children.

Adolescent↗
PubMed1996

Accounting for handicaps in aphasia: communicative assessment from an authentic social perspective.

The ICIDH classification system has had an important effect on many areas of rehabilitation. In this article an application of the handicap category of the ICIDH system within the assessment of aphasia is described. This assessment procedure, Communicative Profiling System, provides an example of how detailed and authentic examination of complex social phenomena can be accomplished. A case study and implications of this procedural application are provided.

Aphasia↗
PubMed1996

Auditory comprehension problems in aphasia from the perspective of aphasic persons and their families and friends.

This study explored with a qualitative approach the experience of auditory comprehension problems from the perspective aphasic persons and their families and friends. Semi-structured group interviews were held with 55 persons (29 aphasic and 26 non-aphasic) who were asked to describe the consequences of aphasia on their lives. Most participants contributed some material to the topic of interest. They described problematic situations, and the behaviours they said they adopted at those times; they also provided explanations of what their problems were. Some discrepancies between aphasic persons and their families and friends were also noted. The essential elements of the experience of an auditory comprehension problem centre around speakers' rate of speech and situations in which aphasic persons feel they are incapable of understanding or of following because of an unfavourable environment.

Adaptation, Psychological↗