Update on the psychometric properties for the Italian version of the Aachen Aphasia Test (IT-AAT)

Abstract

Background:The Aachen Aphasia Test (AAT) is still the main test in use for the evaluation of aphasic deficits in German-speaking individuals (Huber et al., 1983(Huber et al., , 1984. The test has also been adapted to the Italian language (Luzzatti et al., 1996) and was administered to 384 people with aphasia (PWA) almost exclusively after lefthemisphere brain damage (plus 24 individuals with residual symptoms and 8 without aphasia) and 88 control individuals. The study of construct validity and reliability, as well as norm data, were based on those 343 PWA who passed the preliminary examination for applicability of the Token Test. Aims: Motivated by current calls for improving the quality of outcome measures in aphasiology, we re-analyzed the psychometric properties of the Italian version of the AAT (IT-AAT) in an enlarged participant sample, and, for key analyses, with more recent psychometric methods. The overall sample comprised 674 PWA (plus 89 individuals with left-brain damage, including 60 individuals with residual aphasic symptoms and 29 individuals without aphasia). The investigation of construct validity, reliability, and extended norm data was based on the subset of 598 PWA who passed the AAT Token Test inclusion criterion. Main Contributions: Assessment of construct validity, differential validity, and reliability aspects corroborated the earlier test properties. The extended norm data applied to the performance of an exemplary PWA yielded unanimous assignment to a Wernicke-type aphasia at initial assessment, which evolved, after speech-language therapy, to an impairment pattern consistent with conduction aphasia, characterized by disproportionately poorer performance in subtest Repetition than in subtest Comprehension. Significant improvement could be demonstrated for all subtests, which remained reliable even after taking into account the average expected increase in scores due to spontaneous recovery. Conclusions: The psychometric properties and the enlarged normative sample size are well suited for a valid application of diagnostic psychometric single-case analysis procedures to individual patients' AAT performance profiles and their comparison to detect changes in performance over time.

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7. Since the time intervals between AAT assessments were longer in the spontaneous recovery study (3 months) than in the actual study (two consecutive two-week periods), we followed the approach developed by Peitz and coworkers to compute the expected change for intervals within the range of month 1 to month 7 per aphasic syndrome.…”

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7.…”

“…More informative for the research questions of this study are the analyses of the post-minus pretherapy period difference scores tested one-sided against zero (no effect of therapy) separately with a t -test for both periods and the direct comparison of the difference score for P2 minus the difference score for P1, tested one-sided against zero (no difference in effect of therapy for SLT + tDCS vs. SLT alone) with a t -test as well (see Table 3 and Figure 2 and Figure 3 ). For the AAT group, it was possible to test these differences more adequately not against zero but against the expected estimated difference attributable to spontaneous recovery, as computed from the historical spontaneous recovery data available for the AAT [ 43 , 44 ] (see Appendix C for details of the estimation procedure). Since spontaneous recovery data are not available for the BIAS-R, the information for tests against a difference of zero is provided for the AAT group (see Appendix A Table A2 ).…”

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7. Since the time intervals between AAT assessments were longer in the spontaneous recovery study (3 months) than in the actual study (two consecutive two-week periods), we followed the approach developed by Peitz and coworkers to compute the expected change for intervals within the range of month 1 to month 7 per aphasic syndrome.…”

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7.…”

“…More informative for the research questions of this study are the analyses of the post-minus pretherapy period difference scores tested one-sided against zero (no effect of therapy) separately with a t -test for both periods and the direct comparison of the difference score for P2 minus the difference score for P1, tested one-sided against zero (no difference in effect of therapy for SLT + tDCS vs. SLT alone) with a t -test as well (see Table 3 and Figure 2 and Figure 3 ). For the AAT group, it was possible to test these differences more adequately not against zero but against the expected estimated difference attributable to spontaneous recovery, as computed from the historical spontaneous recovery data available for the AAT [ 43 , 44 ] (see Appendix C for details of the estimation procedure). Since spontaneous recovery data are not available for the BIAS-R, the information for tests against a difference of zero is provided for the AAT group (see Appendix A Table A2 ).…”

Access, referral, service provision and management of individuals with primary progressive aphasia: A survey of speech‐language therapists in Italy

“…The second most commonly used tool, informal assessment of communication, was rated as never used by six (4.3%) respondents and as always used by 86 (61.4%) of respondents. Commonly used formal published tests and batteries included the Aachener Aphasia Test (AAT, Luzzatti et al., 1994), always used by 28 (20.0%) respondents and never used by 37 (26.4%) respondents; the Esame Neuropsicologico per l'Afasia (ENPA, Miceli et al., 1994), always used by 25 (17.9%), often used by 51 (36.4%) respondents, and never used by 25 (17.9%) respondents; the Screening for Aphasia in Neurodegeneration (SAND; Battista et al., 2018), always used by 33 (23.6%), often used by 24 (17.1%), and never used by 65 (46.4%) respondents; the Boston Naming Test (Vestito et al., 2021), always used by 7 (5.0%), often used by 20 (14.3%), and never used by 54 (38.6%) respondents; the Esame Neuropsicologico Breve (Mondini et al., 2011), always used by 5 (3.6%), often used by 20 (14.3%) and never used by 76 (54.3%) respondents. The least used instrument in clinical practice was reported to be the Pyramid and Palm Tree Test (Gamboz et al., 2009) rated as never used by 81 (57.9%) respondents and always used only by 3 (2.1%) respondents.…”

“…Historically, the only speech and language tests available for the assessment of PPA in the Italian clinical context were borrowed from the post-stroke aphasia literature ( Battista et al, 2017 ). Among the traditional aphasia instruments, respondents reported using the AAT ( Luzzatti et al, 1994 ), or the ENPA ( Capasso & Miceli, 2001 ), which are standardised on post-stroke aphasia patients. Selecting tests that were not designed to identify the core clinical features of PPA may diminish clinicians’ ability to identify the correct PPA variant, given that these features may be neglected when using tools not developed ad hoc ( Henry & Grasso, 2018 ).…”

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7. Since the time intervals between AAT assessments were longer in the spontaneous recovery study (3 months) than in the actual study (two consecutive two-week periods), we followed the approach developed by Peitz and coworkers to compute the expected change for intervals within the range of month 1 to month 7 per aphasic syndrome.…”

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7.…”

“…More informative for the research questions of this study are the analyses of the post-minus pretherapy period difference scores tested one-sided against zero (no effect of therapy) separately with a t -test for both periods and the direct comparison of the difference score for P2 minus the difference score for P1, tested one-sided against zero (no difference in effect of therapy for SLT + tDCS vs. SLT alone) with a t -test as well (see Table 3 and Figure 2 and Figure 3 ). For the AAT group, it was possible to test these differences more adequately not against zero but against the expected estimated difference attributable to spontaneous recovery, as computed from the historical spontaneous recovery data available for the AAT [ 43 , 44 ] (see Appendix C for details of the estimation procedure). Since spontaneous recovery data are not available for the BIAS-R, the information for tests against a difference of zero is provided for the AAT group (see Appendix A Table A2 ).…”

Access, referral, service provision and management of individuals with primary progressive aphasia: A survey of speech‐language therapists in Italy

“…The second most commonly used tool, informal assessment of communication, was rated as never used by six (4.3%) respondents and as always used by 86 (61.4%) of respondents. Commonly used formal published tests and batteries included the Aachener Aphasia Test (AAT, Luzzatti et al., 1994), always used by 28 (20.0%) respondents and never used by 37 (26.4%) respondents; the Esame Neuropsicologico per l'Afasia (ENPA, Miceli et al., 1994), always used by 25 (17.9%), often used by 51 (36.4%) respondents, and never used by 25 (17.9%) respondents; the Screening for Aphasia in Neurodegeneration (SAND; Battista et al., 2018), always used by 33 (23.6%), often used by 24 (17.1%), and never used by 65 (46.4%) respondents; the Boston Naming Test (Vestito et al., 2021), always used by 7 (5.0%), often used by 20 (14.3%), and never used by 54 (38.6%) respondents; the Esame Neuropsicologico Breve (Mondini et al., 2011), always used by 5 (3.6%), often used by 20 (14.3%) and never used by 76 (54.3%) respondents. The least used instrument in clinical practice was reported to be the Pyramid and Palm Tree Test (Gamboz et al., 2009) rated as never used by 81 (57.9%) respondents and always used only by 3 (2.1%) respondents.…”

“…Historically, the only speech and language tests available for the assessment of PPA in the Italian clinical context were borrowed from the post-stroke aphasia literature ( Battista et al, 2017 ). Among the traditional aphasia instruments, respondents reported using the AAT ( Luzzatti et al, 1994 ), or the ENPA ( Capasso & Miceli, 2001 ), which are standardised on post-stroke aphasia patients. Selecting tests that were not designed to identify the core clinical features of PPA may diminish clinicians’ ability to identify the correct PPA variant, given that these features may be neglected when using tools not developed ad hoc ( Henry & Grasso, 2018 ).…”

Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7. Since the time intervals between AAT assessments were longer in the spontaneous recovery study (3 months) than in the actual study (two consecutive two-week periods), we followed the approach developed by Peitz and coworkers to compute the expected change for intervals within the range of month 1 to month 7 per aphasic syndrome.…”

“…The sample comprised global ( n = 21), Wernicke ( n = 19), Broca ( n = 12), anomic ( n = 32), and non-classifiable ( n = 12) PwA examined 1, 4, and 7 months postonset. The average (rounded) raw score increases in AAT subtest performance were reported in Luzzatti et al ([ 44 ]; Table 10b) and in Peitz et al ([ 38 ]; Supplementary Table S1) with the expected change profile level T-score added with D 12 or D 23 labeling the differences between month 1 and month 4 or between month 4 and 7.…”

“…More informative for the research questions of this study are the analyses of the post-minus pretherapy period difference scores tested one-sided against zero (no effect of therapy) separately with a t -test for both periods and the direct comparison of the difference score for P2 minus the difference score for P1, tested one-sided against zero (no difference in effect of therapy for SLT + tDCS vs. SLT alone) with a t -test as well (see Table 3 and Figure 2 and Figure 3 ). For the AAT group, it was possible to test these differences more adequately not against zero but against the expected estimated difference attributable to spontaneous recovery, as computed from the historical spontaneous recovery data available for the AAT [ 43 , 44 ] (see Appendix C for details of the estimation procedure). Since spontaneous recovery data are not available for the BIAS-R, the information for tests against a difference of zero is provided for the AAT group (see Appendix A Table A2 ).…”

Access, referral, service provision and management of individuals with primary progressive aphasia: A survey of speech‐language therapists in Italy

“…The second most commonly used tool, informal assessment of communication, was rated as never used by six (4.3%) respondents and as always used by 86 (61.4%) of respondents. Commonly used formal published tests and batteries included the Aachener Aphasia Test (AAT, Luzzatti et al., 1994), always used by 28 (20.0%) respondents and never used by 37 (26.4%) respondents; the Esame Neuropsicologico per l'Afasia (ENPA, Miceli et al., 1994), always used by 25 (17.9%), often used by 51 (36.4%) respondents, and never used by 25 (17.9%) respondents; the Screening for Aphasia in Neurodegeneration (SAND; Battista et al., 2018), always used by 33 (23.6%), often used by 24 (17.1%), and never used by 65 (46.4%) respondents; the Boston Naming Test (Vestito et al., 2021), always used by 7 (5.0%), often used by 20 (14.3%), and never used by 54 (38.6%) respondents; the Esame Neuropsicologico Breve (Mondini et al., 2011), always used by 5 (3.6%), often used by 20 (14.3%) and never used by 76 (54.3%) respondents. The least used instrument in clinical practice was reported to be the Pyramid and Palm Tree Test (Gamboz et al., 2009) rated as never used by 81 (57.9%) respondents and always used only by 3 (2.1%) respondents.…”

“…Historically, the only speech and language tests available for the assessment of PPA in the Italian clinical context were borrowed from the post-stroke aphasia literature ( Battista et al, 2017 ). Among the traditional aphasia instruments, respondents reported using the AAT ( Luzzatti et al, 1994 ), or the ENPA ( Capasso & Miceli, 2001 ), which are standardised on post-stroke aphasia patients. Selecting tests that were not designed to identify the core clinical features of PPA may diminish clinicians’ ability to identify the correct PPA variant, given that these features may be neglected when using tools not developed ad hoc ( Henry & Grasso, 2018 ).…”