The Relation between Language, Nonverbal Cognition, and Quality of Life in People with Aphasia

Transcription

1 The Relation between Language, Nonverbal Cognition, and Quality of Life in People with Aphasia Eileen Hunsaker, MS CCC-SLP, CBIS Marjorie Nicholas, Ph.D CCC-SLP MGH Institute of Health Professions, Boston, MA

2 Disclosure statement The authors have no financial or nonfinancial information to disclose that is relevant to the topic of this presentation.

3 Background Some individuals with severe aphasia perform well on nonlinguistic measures and others perform poorly. (Helm-Estabrooks, Bayles, Ramage, and Bryant, 1995; Helm-Estabrooks, 2002.) No relation between performance on the Ravens Coloured Progressive Matrices (visual matching and reasoning) and aphasia severity. (Basso, De Renzi, Faglioni, Scotti, and Spinnler, 1973; Kertesz and McCabe, 1975; Gainotti, D Erme, Villa, and Caltagirone, 1986.) Aphasia severity accounted for only a small proportion of variance in performance on the nonverbal subtests of the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale. (Fucetola, Connor, Strube and Corbetta, 2009.)

4 Bottom Line Aphasic Language Impairments Nonverbal Cognitive Impairments

5 Attention, Working Memory and Executive Functions The additional presence of cognitive deficits in the domain of executive functions in conjunction with the language disorder may be partially responsible for unsuccessful communication in people with aphasia. (Fridriksson, Nettles, Davis, Morrow, & Montgomery, 2006; Helm-Estabrooks, 2002; Nicholas, Helm-Estabrooks, and Sinotte, 2011 ;Purdy, 2002; Purdy & Koch, 2006; Van Mourik, Verschaeve, Boon, & Paquier, 1992.) Aphasic Language Impairments Nonverbal Cognitive Impairments

6 Processing of Nonverbal Events Event processing studies provide evidence that some PWA have difficulty processing nonverbal events and have poor ability to predict the end result of the event. (Dean & Black, 2005; Cairns, Marshall, Cairns, & Dipper, 2007; Marshall, Pring, & Chiat, 1993a; Marshall, Pring, & Chiat, 1993b; Marshall, Chiat, & Pring, 1997; Nicholas and Vaughan, 2012),

7 Quality of Life (QOL) The LPAA model has also sparked interest in evaluating and helping to improve QOL in PWA How do deficits in nonverbal cognition relate to QOL in PWA?

8 Previous Research on Quality of Life in PWA Reported no correlation between aphasia severity and the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). (Williamson, Richman, & Redmond, 2008) However no data have been published relating non-linguistic cognition to QOL in PWA.

9 Purpose To investigate the relationship between aphasic language impairments, nonverbal cognitive impairments and QOL in a sample of people with chronic aphasia.

10 Questions Addressed: 1. What is the relation between measures of nonverbal cognition (executive functioning, attention, working memory, and event processing) and measures of linguistic functioning? 2. What is the relation between measures of nonverbal cognition and language and QOL as measured by the Stroke and Aphasia Quality of Life (SAQOL-39)?

11 Participant Demographics 29 people with aphasia 7 females 22 males Age range 30 to 82 years (mean = 56.5) Months post onset between 6 and 276 (mean =75.3 ) BDAE Aphasia Severity Rating 1 to 4.5 (mean =2.8)

12 Assessment Battery Included: 1. Boston Diagnostic Aphasia Examination-3 (BDAE-3) (Goodglass, Kaplan, & Barresi, 2000) Scores for: Aphasia Severity Rating (ASR) Commands Complex Ideational Material Single Word repetition Word-Picture matching Primer Level Writing to Dictation

13 2. The Cognitive Linguistic Quick Test (CLQT) (Helm-Estabrooks, 2001) Scores for: Symbol Cancellation Symbol Trails Design Memory Mazes Design Generation Clock drawing

14 3. The Role Video Assessment of Event Processing (Marshall, Pring, & Chiat, 1993)

15 4. The Stroke and Aphasia Quality of Life Scale - 39 item version (SAQOL-39) (Hilari et al., 2003) An aphasia-friendly measure of post-stroke quality of life Consists of 39 questions in four domains: 1. Physical and daily life activities 2. Communication functions 3. Psychosocial functions 4. Energy

16 Sample Items (SAQOL-39)

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19 RESULTS Significant Correlations Nonverbal Cognition x Language Cognition Language p r Role Video ASR **.53 Complex Ideational *.46 Word-picture Matching *.39 CLQT Symbol Trails ASR **.52 Complex Ideational *.47 CLQT Clock Drawing Word Discrimination *.47 Word Writing *.46 CLQT Design Memory Complex Ideational *.47 Word Writing *.44 CLQT Symbol Cancellation Word-picture Matching *.40 Word Writing *.38 CLQT Total 5 Subtests Complex Ideational *.39 Word-picture Matching *.42 *p<.05 ** p<.01

20 RESULTS Significant Correlations Nonverbal Cognition x Language Role Video: Significantly correlated with: -BDAE aphasia severity rating, complex ideational auditory comprehension score, word to picture matching task, writing words subtest. -CLQT clock drawing, symbol trails, design memory, and mazes

21 Results Relation between QOL and nonverbal cognition and language

22 Quality of Life The sum of the SAQOL-39 domain scores was not correlated with any language measures. This same measure of QOL was significantly correlated with one of the nonverbal cognition scores (CLQT symbol trails task; p <.01, r =.48). There were also some significant correlations between QOL domain sub-scores and individual language and cognition measures.

23 The SAQOL-39 domain scores x language and cognitive measures SAQOL-39 Domain Language and cognitive measures p r Physical Symbol Trails **.48 Communication ASR **.48 Word Repetition *.41 Design Memory *.40 Psychosocial Design Memory *.40 Energy Symbol Trails *.44 SAQOL Total Score Symbol Trails **.48 *p<.05 ** p<.01

24 Regression analysis Performance on symbol trails predicted 23% of the variance in the QOL total score (r 2 =.23, p <.01).

25 DISCUSSION 1. A number of language and nonverbal cognition measures were correlated with each other. 2. However, none of the language measures was correlated to the overall QOL measure.

26 DISCUSSION 3. One of the nonverbal cognitive measures (Trails) was related to QOL. 4. Our results suggest that at least some portion of QOL is related to impairment of executive function skills in people with aphasia, separate from any deficit in language processing.

27 Thank you to: Clients at MGH Institute of Health Professions, Aphasia Center Program Graduate Students at MGH IHP Aphasia Center