A quick aphasia battery for efficient, reliable, and multidimensional assessment of language function

Abstract

This paper describes a quick aphasia battery (QAB) that aims to provide a reliable and multidimensional assessment of language function in about a quarter of an hour, bridging the gap between comprehensive batteries that are time-consuming to administer, and rapid screening instruments that provide limited detail regarding individual profiles of deficits. The QAB is made up of eight subtests, each comprising sets of items that probe different language domains, vary in difficulty, and are scored with a graded system to maximize the informativeness of each item. From the eight subtests, eight summary measures are derived, which constitute a multidimensional profile of language function, quantifying strengths and weaknesses across core language domains. The QAB was administered to 28 individuals with acute stroke and aphasia, 25 individuals with acute stroke but no aphasia, 16 individuals with chronic post-stroke aphasia, and 14 healthy controls. The patients with chronic post-stroke aphasia were tested 3 times each and scored independently by 2 raters to establish test-retest and inter-rater reliability. The Western Aphasia Battery (WAB) was also administered to these patients to assess concurrent validity. We found that all QAB summary measures were sensitive to aphasic deficits in the two groups with aphasia. All measures showed good or excellent test-retest reliability (overall summary measure: intraclass correlation coefficient (ICC) = 0.98), and excellent inter-rater reliability (overall summary measure: ICC = 0.99). Sensitivity and specificity for diagnosis of aphasia (relative to clinical impression) were 0.91 and 0.95 respectively. All QAB measures were highly correlated with corresponding WAB measures where available. Individual patients showed distinct profiles of spared and impaired function across different language domains. In sum, the QAB efficiently and reliably characterized individual profiles of language deficits.

An adaptive semantic matching paradigm for reliable and valid language mapping in individuals with aphasia

“…In the first session, the study was explained to them and they provided written informed consent, demographic and medical history information, and were screened for MRI safety. To characterize language deficits, they completed one of three equivalent forms of Quick Aphasia Battery (QAB; Wilson, Eriksson, Schneck, & Lucanie, ), as well as the Western Aphasia Battery (WAB; Kertesz, ). Because the adaptive semantic matching task depends on comprehension and semantic processing of written words, patients then completed the written word to picture matching subtest of the Comprehensive Aphasia Test (Swinburn et al, ), written word to picture matching using the word comprehension items from another form of the QAB, and a 14‐item short version (Breining et al, ) of the Pyramids and Palm Trees Test (Howard & Patterson, ).…”

“…The patients spanned a range of aphasia severity: per WAB criteria, five had severe aphasia, four had moderate aphasia, six had mild aphasia, and one was within normal limits. The patients’ language function is described in more detail elsewhere (Wilson et al, ). Written word comprehension was excellent in all but one of the patients, the only exception being the person with the most severe Broca's aphasia, who comprehended about two thirds of written words.…”

“…In particular, four of the five individuals with conduction aphasia (A6, A7, A8, and A10) had large left posterior temporal lesions and none had normal temporal functional activation. Yet all of these participants had excellent single word comprehension and semantic processing abilities, as evidenced by their task performance, as well as language and neuropsychological data (Wilson et al, 2018). They also were fluent, could produce sentences (albeit with paragrammatic and paraphasic errors), and were able to retrieve words, repeat words and sentences, and read aloud, to varying extents (Wilson et al, 2018).…”

“…Yet all of these participants had excellent single word comprehension and semantic processing abilities, as evidenced by their task performance, as well as language and neuropsychological data (Wilson et al, 2018). They also were fluent, could produce sentences (albeit with paragrammatic and paraphasic errors), and were able to retrieve words, repeat words and sentences, and read aloud, to varying extents (Wilson et al, 2018). All of these functions normally depend on the posterior left temporal language area, but…”

The Cortical Organization of Syntax

“…In the 1970s it was discovered that Broca's aphasia is also associated with particular sentence comprehension deficits that suggested a fundamental syntactic problem (Caramazza & Zurif, 1976), kicking off decades of intense investigation of the role of Broca's area in syntactic processing, assessed primarily via comprehension tasks (Grodizinsky & Amunts, 2006;Matchin & Rogalsky, 2017). However, while some large-scale lesion-deficit mapping studies have reported an association between damage to Broca's area and comprehension of syntactically complex and/or non-canonical sentence structures (Wilson et al, 2011;Magnusdottir et al, 2013;Mesulam et al, 2015;Fridriksson et al, 2018), many others have primarily implicated the posterior temporal lobe in basic syntactic processing and not Broca's area (Dronkers et al, 2004;Wilson & Saygin, 2004;Baldo & Dronkers, 2007;Peelle et al, 2008;Pillay et al, 2017;Rogalsky, et al 2018;Wilson et al, 2018b;2018c).…”