The provision of health information to stroke patients within an acute hospital setting: What actually happens and how do patients feel about it?

This preliminary study describes how health information is provided to stroke patients in an acute hospital and describes their perceptions of health information provision. A further aim was to determine if patients with aphasia were disadvantaged in their receipt of information. Seven stroke patients were observed in hospital for an average of 102 minutes each and then interviewed using a semi-structured interview. When communication occurred, only 17.5% of communication time was spent providing information. Patients with aphasia received information for less time and on fewer topics. Implications regarding approaches to information provision for patients with and without aphasia are discussed.

Progressive loss of expressive language in a journalist: What news for dementia?

A 77-year-old man with 8 year progressive language deterioration in the face of grossly intact memory was followed. No acute or chronic physiological or psychological event was associated with symptom onset. CT revealed small left basal ganglia infarct. Mild atrophy, no lacunar infarcts, mild diffuse periventricular changes registered on MRI. Gait normal but slow. Speech hesitant and sparse. Affect euthymic; neurobehavioral disturbance absent. MMSE 26/30; clock incorrect, concrete. Neuropsychological testing revealed simple attention intact; complex attention, processing speed impaired. Visuospatial copying and delayed recall of copy average with some perseveration. Apraxia absent. Recall mildly impaired. Mild deficits in planning, organization apparent. Patient severely aphasic, dysarthric without paraphasias. Repetition of automatic speech, recitation moderately impaired; prosody intact. Understanding of written language, nonverbal communication abilities, intact. Frontal release signs developed over last 12 months. Repeated cognitive testing revealed mild deterioration across all domains with significant further decrease in expressive, receptive language. Neurobehavioral changes remain absent to date; he remains interested, engaged and independent in basic ADLs. Speech completely deteriorated; gait and movements appreciably slowed. Although signs of frontal/executive dysfunction present, lack of behavioral abnormalities, psychiatric disturbance, personality change argue against focal or progressive frontal impairment or dementia. Relative intactness of memory and comprehension argue against Alzheimer’s disease. Lack of findings on neuroimaging argue against CVA or tumor. It is possible that the small basal ganglia infarct has resulted in a mild lateral prefrontal syndrome. However, the absence of depression as well as the relatively circumscribed language problem suggests otherwise. The progressive, severe nature of language impairments, with relatively minor impairments in attention and memory, argues for a possible diagnosis of primary progressive aphasia.

Localizing the deficit in a case of jargonaphasia

We report the case of a neologistic jargonaphasic and ask whether her target-related and abstruse neologisms are the result of a single deficit, which affects some items more severely than others, or two deficits: one to lexical access and the other to phonological encoding. We analyse both correct/incorrect performance and errors and apply both traditional and formal methods (maximum-likelihood estimation and model selection). All evidence points to a single deficit at the level of phonological encoding. Further characteristics are used to constrain the locus still further. V.S. does not show the type of length effect expected of a memory component, nor the pattern of errors associated with an articulatory deficit. We conclude that her neologistic errors can result from a single deficit at a level of phonological encoding that immediately follows lexical access where segments are represented in terms of their features. We do not conclude, however, that this is the only possible locus that will produce phonological errors in aphasia, or, indeed, jargonaphasia.

Effects of syllabic complexity in predicting accuracy of repetition and direction of errors in patients with articulatory and phonological difficulties

The purpose of this paper is to demonstrate the existence of a strong and significant effect of complexity in aphasia independent from other variables including length. Complexity was found to be a strong and significant predictor of accurate repetition in a group of 13 Italian aphasic patients when it was entered in a regression equation either simultaneously or after a large number of other variables. Significant effects were found both when complexity was measured in terms of number of complex onsets (as in a recent paper by Nickels & Howard, 2004) and when it was measured in a more comprehensive way. Significant complexity effects were also found with matched lists contrasting simple and complex words and in analyses of errors. Effects of complexity, however, were restricted to patients with articulatory difficulties. Reasons for this association and for the lack of significant results in Nickels and Howard (2004) are discussed. © 2005 Psychology Press Ltd.

Brain, mind and medicine:essays in eighteenth Century neuroscience

There have been no books published on neuroscience in the eighteenth century. Yet this was an important time, with science and medicine in transition. On the one hand, there were wildly speculative theories about the nervous system, many based on Newtonian mechanics and fanciful chemistry. But on the other, this was also a time when empirical research with quantification and experimentation was coming of age. This volume examines the eighteenth-century neuroscience milieu and looks at developments in anatomy, physiology, and medicine that highlight this era, which some people have called the Age of Reason and others the Enlightenment. The book covers such things as the aims of the scientific and medical Enlightenment, how neuroscience adopted electricity as the nerve force, how disorders such as aphasia and hysteria were treated, Mesmerism, and how some of the latest ideas made their way into the culture of the day.

Phonological simplifications, apraxia of speech and the interaction between phonological and phonetic processing

Research on aphasia has struggled to identify apraxia of speech (AoS) as an independent deficit affecting a processing level separate from phonological assembly and motor implementation. This is because AoS is characterized by both phonological and phonetic errors and, therefore, can be interpreted as a combination of deficits at the phonological and the motoric level rather than as an independent impairment. We apply novel psycholinguistic analyses to the perceptually phonological errors made by 24 Italian aphasic patients. We show that only patients with relative high rate (>10%) of phonetic errors make sound errors which simplify the phonology of the target. Moreover, simplifications are strongly associated with other variables indicative of articulatory difficulties - such as a predominance of errors on consonants rather than vowels -but not with other measures - such as rate of words reproduced correctly or rates of lexical errors. These results indicate that sound errors cannot arise at a single phonological level because they are different in different patients. Instead, different patterns: (1) provide evidence for separate impairments and the existence of a level of articulatory planning/programming intermediate between phonological selection and motor implementation; (2) validate AoS as an independent impairment at this level, characterized by phonetic errors and phonological simplifications; (3) support the claim that linguistic principles of complexity have an articulatory basis since they only apply in patients with associated articulatory difficulties.

Survival in the pre-senile dementia frontotemporal lobar degeneration with TDP-43 proteinopathy:effects of genetic, demographic and neuropathological variables

Factors associated with survival were studied in 84 neuropathologically documented cases of the pre-senile dementia frontotemporal dementia lobar degeneration (FTLD) with transactive response (TAR) DNA-binding protein of 43 kDa (TDP-43) proteinopathy (FTLD-TDP). Kaplan-Meier survival analysis estimated mean survival as 7.9 years (range: 1-19 years, SD = 4.64). Familial and sporadic cases exhibited similar survival, including progranulin (GRN) gene mutation cases. No significant differences in survival were associated with sex, disease onset, Braak disease stage, or disease subtype, but higher survival was associated with lower post-mortem brain weight. Survival was significantly reduced in cases with associated motor neuron disease (FTLD-MND) but increased with Alzheimer's disease (AD) or hippocampal sclerosis (HS) co-morbidity. Cox regression analysis suggested that reduced survival was associated with increased densities of neuronal cytoplasmic inclusions (NCI) while increased survival was associated with greater densities of enlarged neurons (EN) in the frontal and temporal lobes. The data suggest that: (1) survival in FTLD-TDP is more prolonged than typical in pre-senile dementia but shorter than some clinical subtypes such as the semantic variant of primary progressive aphasia (svPPA), (2) MND co-morbidity predicts poor survival, and (3) NCI may develop early and EN later in the disease. The data have implications for both neuropathological characterization and subtyping of FTLD-TDP.

Upplevelsen av kommunikation när en person diagnosticerats med afasi ur ett närståendeperspektiv : En litteraturstudie

Introduktion: Var sjätte person världen över drabbas av stroke någon gång under sin livstid. Av alla strokepatienter drabbas cirka 38% av någon form av språkdefekt, så kallad afasi. När en person får afasi drabbas även närstående såsom partners, barn, syskon, föräldrar och nära vänner. Syfte: Syftet med litteraturstudien var att belysa närståendes upplevelse av kommunikation när en person diagnosticerats med afasi till följd av stroke. Metod: Metoden som användes var en litteraturstudie. 10 vetenskapliga artiklar hämtades ur databaserna CINAHL och PubMed, som efter kvalitetsgranskning utgjorde grunden för resultatet i litteraturstudien. Resultat: I resultatet framkom ett huvudtema: Begränsningar, och tre underteman: Frustration, Skyddande beteende och Anpassning av kommunikation. Närstående upplevde att kommunikationen begränsats sedan afasidiagnosen; något som manifesterades genom att närstående upplevde frustration, att de föll in i ett skyddande beteende samt en anpassning av kommunikationen. Slutsats: Kommunikationen, och bristen av densamma, har fått konsekvenser på sättet närstående anpassar sin vardag till personen med afasi. Därför är det av största relevans att sjuksköterskan genom forskning på området, kan ge närstående de nycklar som krävs för att underlätta vardagen med en person med afasi.

Langage et cerveau : vingt ans d’imagerie fonctionnelle

International audience

Polvo de lavar o Irex: incidencia de estímulos fonológicos y semánticos en la producción de palabras habladas de una paciente afásica

Se estudia la incidencia de los estímulos fonológicos y semánticos en los procesos de producción léxica, a partir de los datos obtenidos en pruebas de denominación con paciente afásica con características anómicas. Arroja datos en relación con la naturaleza del lexicón, el debate entre procesos seriales y de acceso directo y su papel en la recuperación léxica la longitud fonológica y silábica de la palabra.The incidence of semantic and phonological stimuli in word production processes is addressed. This research analyzes the results obtained from different denomination tasks with an anomic speaker with aphasia. The basis of research was a lexicon theory, the debate between connectionist or serial levels in language production, and the incidence of syllabical and phonological length in word recovery.

Crisis afásica simulando un ataque cerebrovascular isquémico agudo en el Servicio de Neurología del Hospital de San José de Bogotá DC

Se ha demostrado que la afasia como fenómeno ictal o postictal, se observa en cerca del 17% de los pacientes. Los casos en que es el único síntoma ictal, como en el estado epiléptico afásico, podría presentar un reto diagnóstico, y dependen de la sospecha diagnóstica del clínico. Presentamos el caso de un adulto mayor, que llega a urgencias por una alteración del lenguaje. Fue enfocado como un ataque cerebrovascular isquémico, pero después de evaluar la imagen de resonancia magnética cerebral simple se solicitó videotelemetría, que mostró descargas epileptiformes lateralizadas en región temporal izquierda, por lo que el paciente fue manejado como un estatus de afasia, con mejoría.