Comparison of Aphasia Severity in Dementia and Stroke Using MASTcz, and Aphasia in Relation to Severity of Cognitive Deficit

Czech version

Authors: M. Košťálová ¹; J. Bednařík ¹; S. Skutilová ¹; A. Mitášová ¹; E. Bártková ¹; K. Šajgalíková ¹; A. Demovičová ^1,3; L. Dušek ²
Authors‘ workplace: Neurologická klinika LF MU a FN Brno ¹; Institut biostatistiky a analýz MU, Brno ²; Interní hematoonkologická klinika LF MU a FN Brno ³
Published in: Cesk Slov Neurol N 2010; 73/106(3): 246-252
Category: Original Paper

Overview

Aim:

To assess the prevalence and severity of aphasia in dementia using the Czech version of the Mississippi Aphasia Screening Test (MASTcz) for the detection of aphasia in relation to the severity of global cognitive deficit, and to compare this with aphasia severity arising out of focal vascular lesion of a dominant brain hemisphere.

Patients and methods:
Group A comprised 149 patients, 74 women and 75 men, aged 19– 95 years, median 68, with aphasia due to acute stroke in the dominant hemisphere (verified by speech therapist examination). Group B consisted of 52 patients, 26 women and 26 men, aged 41– 84, median 74, who complied with the diagnostic criteria for dementia according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition, revised version) and scored in the “abnormal” range of the Addenbrook Cognitive Examination (ACE) (≤82 points); 43 demented patients had an ACE score of 30– 82 (mild‑ to‑ moderate dementia). Alzheimer’s disease was the cause of dementia in 22 cases, while other causes of dementia were identified in the remaining 30 patients. Aphasia severity was scored with MASTcz.

Results:
A subgroup of mild‑ to‑ moderate dementia patients exhibited a significantly lower degree of language deficit expressed as MASTcz indexes in comparison with stroke patients with aphasia. Using a cut‑off value of total index (TI) <85 points as a criterion for the presence of aphasia, receiver operating curve analysis showed high discrimination power between group A (stroke patients with aphasia – 131 out of 149 patients complied with the chosen criterion for aphasia) and subgroup Ba with mild‑ to‑ moderate dementia (6 out of 43 complied with the criterion for aphasia. The lowest TI value was 68 points); the sensitivity and specificity of the test were 88.6% and 81.4%, respectively (p <0.001).

Conclusion:
The severity of language deficit in patients with dementia remains significantly lower compared with that in aphasia due to focal vascular lesion of a dominant brain hemisphere until severe cognitive deficit develops.

Key words:
aphasia – dementia – Alzheimer’s disease – cognitive deficit – communication disorder

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