Decision Making by People With Aphasia: A Comparison of Linguistic and Nonlinguistic Measures

Abstract

Purpose Decision making involves multiple cognitive and linguistic processes. The extent to which these processes are involved depends, in part, on the conditions under which decision making is assessed. Because people with aphasia (PWA) have impaired language abilities and may also present with cognitive deficits, they may have difficulty during decision-making tasks. Yet little research exists on the decision-making abilities of PWA. Thus, the purposes of this study were to investigate the performance of PWA on linguistic and nonlinguistic decision-making measures and to explore the relationship between decision making and cognitive test performance. Method A quasi-experimental design was used to compare the performance of PWA ( n = 16) and age- and education-matched control participants ( n = 16) on three decision-making tasks: Making a Decision subtest from the Functional Assessment of Verbal Reasoning and Executive Strategies (linguistic decision-making task), Iowa Gambling Task (nonlinguistic decision-making task with ambiguity), and Game of Dice Task (nonlinguistic decision-making task without ambiguity). Participants also completed assessments of language, working memory, and executive functions. Scores on the three decision-making tasks were compared between groups, and cognitive influences on decision-making performance were examined using correlation analyses. Results PWA differed significantly from control participants on linguistic decision making, particularly when required to verbalize their rationale for making their decision. PWA and control participants did not differ significantly on measures of nonlinguistic decision making. Performance on multiple cognitive measures was correlated with performance on the linguistic reasoning task, as well as one of the nonlinguistic tasks (Game of Dice Task). Conclusions Decision-making tasks that are heavily dependent on language, such as those used in capacity assessments, may disadvantage PWA. Assessments of decision-making capacity should include communication supports for people with acquired communication disorders; further investigation in the areas of decision making and aphasia is needed.

A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties

“…The distinction between capacity and lack of capacity is far from straightforward [ 24 , 25 ]. Furthermore, the presence of communication and cognitive impairments may complicate the informed consent process [ 26 – 30 ] by masking true competence in people with, for example, early stage dementia, moderate intellectual disability [ 31 , 32 ], aphasia following stroke [ 33 , 34 ] and autistic spectrum disorder [ 35 ]. To circumnavigate some of these difficulties, researchers have developed person-centred approaches [ 24 ] characterised by flexibility and support from family and friends [ 36 ].…”

Communication strategies to support decision‐making by persons with aphasia: A scoping review

“…The quantitative study compares the performance of PWA on linguistic and non‐linguistic decision‐making tasks (Kim et al., 2020). The two mixed methods design studies examine the decision‐making process between PWA and their SLPs regarding therapy goals (Isaksen, 2018) and the effectiveness of a tool in establishing capacity to give informed consent (Jayes & Palmer, 2014), respectively.…”

“…In addition to acknowledging the competence of the PWA, SCA focuses on revealing the competence of the PWA using techniques to aid comprehension and expression, and to verify understanding of what has been communicated (Kagan, 1998). As decision‐making requires multiple linguistic and cognitive skills, strategies to support decision‐making by PWA are required to not only compensate for language difficulties, but also reduce cognitive load (Kim et al., 2020). SCA techniques compensate for limited working memory capacity, attention related deficits and impaired inhibition, all of which may impact decision‐making by PWA (Suleman & Kim, 2015).…”

Assessment of quality of life in patients with aphasia

“…Irrespective of the reason, it has serious impact on the quality of life of patients with aphasia. 16 This study also addressed that how people with aphasia feel about their ability to speak for themselves.52.6% participants stated that they are not very confident about their ability to speak for themselves this is major hallmark that represents that quality of life in aphasia is very low as people with aphasia are in constant need of someone who can understand them, their needs and also can convey their intended message. As the results indicate that people with aphasia are not very confident about their decision making abilities thus the results reflect that person with aphasia live a low quality of life as they are deprived of the elements that can contribute to improved life quality but unfortunately their quality of life is below average.…”