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Cognitive deficit and aphasia – A challenging diagnosis

Georg Thieme Verlag KG
Arquivos de Neuro-Psiquiatria
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Sonia Brucki at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Sonia Brucki
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821
DOI: 10.1590/0004-282X20150159
editorial
Cognitive deficit and aphasia – a challenging
diagnosis
Déficit cognitivo e afasia – um diagnóstico desafiador
Sonia M. D. Brucki
Universidade de São Paulo, Hospital
Santa Marcelina, Faculdade de
Medicina, Grupo de Neurologia
Cognitiva e Comportamental, São
Paulo SP, Brazil.
Correspondence:
Sonia M. D. Brucki; R. Rio Grande
180 /61; 04018-000 São Paulo, SP,
Brasil; E-mail: sbrucki@uol.com.br
Conflict of Interest:
There is no conflict of interest to
declare.
Received 31 August 2015
Accepted 08 September 2015
One of the greatest challenges in cognitive neurology is to determine severity of
cognitive impairment in patients with aphasia. Most of the cognitive evalua-
tion is performed through language assessment; lesions causing aphasia can be
spread in some dierent brain areas by committing dierent networks and, con-
sequently, dierent cognitive domains. Otherwise, verbal based evaluations could show a false
positive impairment.
One of the vascular cognitive impairment (VCI) criteria classied it into vascular mild
cognitive impairment and vascular dementia, based on functional impairment and number
of evaluated cognitive domains. e neuropsychological evaluation must include memory, vi-
suospatial, language, and executive domains1. e most recent diagnostic criteria divides VCI
into mild cognitive disorder and dementia or major cognitive disorder; there is a recommen-
dation to evaluate praxis-gnosis-body schema, and social cognition, besides previous cogni-
tive domains2. In both of them there are no concerns about cognitive evaluation in aphasic
patients, which could be unsuitable in most studies.
Stud ies in tertiary outpatient clinics report a prevalence of vascular dementia between
24.9 and 32.25%; and among presenile dementia there was a prevalence of 36.9%3,4,5. ere are
a few considerations regarding aphasia in these studies. In a prospective study, that have also
included aphasics, frequency of VCI was 16.8% in 12-month follow-up6.
In the majority of the studies, aphasic patients have shown poor performance in attention,
executive functions, working memory, and short-term memory7,8,9.
e study published in this number of Arq Neuropsiquiatr tries to fulll a gap in this is-
sue in Brazil, characterizing cognitive decit in a sample of rst-stroke patients. Bonini and
Radanovic have evaluated 47 stroke patients without depression (non-aphasics: left hemi-
sphere lesion: 17, right hemisphere lesion: 9; and 21 aphasics) with a comprehensive neuro-
psychological battery; functional activities and quality of life were measured, as well. Aphasics
presented a poorer performance on digit span, verbal and visual memory, constructional prax-
is recall, clock design test, and phonemic verbal uency. Quality of life was better in right hemi-
sphere lesion and non-aphasic patients10.
Aphasia severity correlated with scores in the Trail Making Test (TMT) part B, Digit Span
forwards and backwards, and Gesture Praxis in this study. In another report, only attention
was correlated with aphasia severity9.
Although this study has limitations as a small number of patients with heterogeneous vas-
cular lesions, it is needed to highlight the importance of the development of specic batteries
for evaluating cognition in aphasic patients.
Diculties on interpretation of cognitive decit in aphasics are relatively common, ac-
cording to dierent lesioned topographies, involvement of cortical and subcortical areas, and
white matter tracts, near common language areas11.
More studies must be performed in Brazil to evaluate cognition in aphasics, using more
suitable tests for this type of patients.
822 Arq Neuropsiquiatr 2015;73(10):821-822
References
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Piccolo AC. Preva lence of presenile dementia in a tertiary
outpatient clinic. Arq Neuropsiquiatr. 2004;62(3A):592-5.
doi:10.1590/S0004-282X2004000400005
6. Brucki SMD, Machado MF, Rocha MSG. Vascular Cognitive
Impairment (VCI) after non-embolic ischemic stroke during a
12-month follow-up in Brazil. Dement Nuropsychol. 2012;6(3):164-9.
7. Helm-Estabrooks N. Cognition and aphasia: a discussion and a
study. J Commun Disord. 2002;35:171-86.
8. Majerus S, Attout L, Artielle MA , Van der Kaa MA. The heterogeneity of
verbal short-term memory impairment in aphasia. Neuropsychologia;
2015;11:NSYD1500380. doi:10.1016/j.neuropsychologia.2015.08.010
9. Lee B, Pyun SB. Characteristics of cognitive impairment in patients
with post-stroke aphasia. Ann Rehabil Med. 2014;38(6):759-65.
doi:10.5535/arm.2014.38.6.759
10. Bonini MV, Radanovic M. Cognitive deficits in post-stroke aphasia. Arq
Neuropsiquiatr, 2015;73(10): 840-47 doi:10.1590/0004-282X20150133
11. Catani M, Dell’Acqua F, Bizzi A, Forkel SJ, Wiliams SC, Simmons A
et al. Beyond cortical localization in clinic-anatomical correlation.
Cortex. 2012;48(10):1262-87. doi:10.1016/j.cortex.2012.07.001
... Due to the overlap in anatomical structures of functional networks(Bonini & Radanovic, 2015;Brucki, 2015), some individuals with aphasia may present with concomitant impairments in other cognitive domains, such as attention(Villard & Kiran, 2015), memory(Lang & Quitz, 2012;Seniów et al., 2009), and/or executive function(Kertesz & McCabe, 1975;Purdy, 2002). ...
Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation
Article
Full-text available
  • Jun 2021
Purpose The purpose of this study is to summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and, in particular, for young adults. Method This review article reviews a range of ABI-associated topics including (a) mechanisms of injury; (b) biological, individual-specific, and behavioral drivers of recovery; and (c) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The review article concludes by providing (a) suggestions for key components of cognitive rehabilitation for young adults with ABI, (b) an example from our own research providing intensive academically focused cognitive rehabilitation for young adults with ABI pursuing college, and (c) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity—naturally embedded within many cognitive rehabilitation approaches—could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Afazili Olan ve Olmayan Yetişkinlerin Bilişsel Becerilerinin Kapsamli Afazi Testi Bilişsel Tarama Bölümü Uyarlamasi Kullanilarak Değerlendirilmesi
Thesis
  • Nov 2017
Introduction: The questions of how language and cognition affect each other, of how and to what extent cognitive skills of individuals with aphasia are impaired are controversial. Some studies explained cognitive impairment in aphasia with shared neural representations (Hamsher, 1991). Whereas, others showed that due to acquired language impairment, performance on cognitive tasks such as executive functions, arithmetic, and memory is decreased (Caspari et al. 1998; Tatemichi et al. 1994). Thus, neuropsychological and cognitive screening tests designed for aphasic individuals are rather limited and most of them depend on linguistic abilities. We investigated the relationship between language and cognition and provided descriptive and comparative analyses about this relationship based on test results of Turkish speaking individuals with and without aphasia by using Cognitive Screening (CS) part of Comprehensive Aphasia Test (CAT; Swinburn, Porter, and Howard, 2004), which is currently being adapted to Turkish. Methods: 14 individuals with aphasia and 14 controls were tested using CS, which consists of 6 subtests (Line Bisection, Semantic Associations, Word Fluency, Recognition Memory, Gesture-Object Use, Arithmetic). The subtests demand on the non-verbal abilities except the Word Fluency task. Non-parametric analyses are used to compare the results of the participants. The scores of CS are compared to the scores of Aphasia Language Assessment in Turkish (ADD), which is a comprehensive language battery (Mavis & Togram, 2009), in order to see the relation between language and cognition. As the aim of the study was to compare cognitive abilities to language abilities, we used Ardila’s classification, which proposes to group aphasia according to the degree of impairment in the language abilities: Primary (Broca’s (2), Global (3)), Secondary (Supplemental Motor (4), Conduction (1)), and Executive Functional Disorder Aphasias (Transcortical Motor (4)). Results: The scores of the control group were higher than the aphasia group. There was a significant correlation (p=,021*) between the results of Cognitive Screening and the ADD; and between the results of the Word Fluency subtest and the Naming subtest of ADD (p=,001*). Primary Aphasia group (the group with impairment on lexical/semantic and grammatical systems of language such as Wernicke, Broca’s, and in our case Global aphasia) got the lowest scores in CS. Descriptive analysis showed that the aphasia group achieved the highest scores in the Semantic Associations and Recognition Memory subtests, which do not require motor planning and verbal production. Discussion: Cognitive impairments have an effect on aphasia and this effect may vary within and between individuals. Findings in this study showed that there is a relationship between linguistic and cognitive skills. While impaired language competences may have an impact on individuals’ cognitive abilities, impairments in attention, executive functions, and memory would also affect language skills, as language and cognitive functions are thought to have shared neural representations. The idea of language not being a solitary but one of the five domains of cognition and cannot be separated from the whole is supported. Assessment of related cognitive skills prior to a language test can provide a healthy basis for the intervention method. The CAT provides a useful screening tool for both clinicians and aphasic individuals in order to assess cognitive skills in the shortest possible and most useful way.
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A study of associations between Cognition and Language: What can Cognitive Screening Section of the Comprehensive Aphasia Test (CAT) provide?
Article
Full-text available
Introduction: The questions of how language and cognition affect each other, and of how and to what extent cognitive skills of individuals with aphasia are impaired are controversial (Hamsher, 1991; Tatemichi et al.,1994). These issues are important for the speech and language therapist (SLT), in order to be able to formulate working hypotheses and to determine the most effective therapy/intervention. The Comprehensive Aphasia Test (CAT; Swinburn, Porter & Howard, 2004) includes a Cognitive Screen (CAT-CS) and should, therefore, be a useful tool for SLTs. We report the results of descriptive and comparative analyses on the cognitive skills of Turkish-speaking people with aphasia (PWA) and their association with the participants’ language skills using data from a validation study of the Turkish adaptation of the CAT. Methods: 14 people with aphasia (PWA) and matched controls were tested using CAT-CS, which consists of 6 subtests: Line Bisection (LB), Semantic Association (SA), Word Fluency (WF), Recognition Memory (RM), Gesture-Object Use (GOU), Arithmetic. Only word-fluency requires linguistic skills. To examine the relationship between language and cognition, scores were compared to the scores on a comprehensive language battery, the Aphasia Language Assessment in Turkish (ADD) (Maviş & Toğram, 2009). The participants were classified according to the Boston classification (see Table 1). Results: The total score of the aphasia group on the CAT-CS (mean: 28) was significantly lower than that of the control group (mean: 35) but not every participant scored lower than their matched control (See Table.1). Significant differences between the two groups were observed in subtests that require motor planning and production (LB, GOU), in WF, and in Arithmetic which is known to be sensitive to language problems especially in cultures, like Turkish, where mathematics is based on oral coding. PWA achieved the highest scores in the SA and RM subtests, which require only non-verbal skills. In SA, the least successful items were those that were not common in Turkish lexicon (i.e., Eskimo, nun); whereas these same items were the most successful for RM subtest, which could be associated with preserved attention. Despite the significant difference between controls and PWA’s scores of GOU subtest, ten PWA scored at/above the level of the poorest control (9). For the PWA, the correlation between the total CAT-CS and total ADD score was significant (p=.021*; r=.607); as well as between the CAT-CS WF subtest and ADD Naming subtest (p=.001*; r=.803**). Discussion: This study supports the relationship between cognitive and language impairment. Importantly, the evaluation of cognitive skills prior to language assessment can provide the necessary conditions for successful assessment and prognosis. Findings in this study showed that CAT-CS could detect cognitive impairments and that there was a relationship between linguistic and cognitive skills. The use of CAT-CS reduces the reliance on linguistic skills and is recommended to SLTs for evaluating associated cognitive skills of PWA, particularly for those with short attention span and high fatigue sensitivity who could not complete with more comprehensive testing.
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Vascular Cognitive Impairment (VCI) after non-embolic ischemic stroke during a 12-month follow-up in Brazil
Article
Full-text available
  • Sep 2012
Objective: To determine the prevalence rates of VCI and associated risk factors in a sample of ischemic stroke patients. Methods: We evaluated 172 patients with ischemic stroke for cognitive impairment one year after ictus. Results: Patients comprised 81 women (47.1%) and had a mean age of 67.77 (7.86) years, schooling of 3.52 (2.99) years, and MMSE score of 24.94 (3.59) points. After cognitive evaluation, 4.6% were diagnosed as CIND (cognitive impairment no dementia) and 12.2% had a diagnosis of dementia (probable vascular dementia in 20 patients and one subject with cerebrovascular disease and Alzheimer's disease). Conclusion: The prevalence of dementia was lower than previous reports but our sample had a lower age than others, while a 12 month-period of follow-up prevented interference from associated neurodegenerative disorders.
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Cognitive deficits in post-stroke aphasia
Article
Full-text available
The assessment of aphasics’ cognitive performance is challenging and such patients are generally excluded from studies that describe cognitive deficits after stroke. We evaluated aphasics’ performance in cognitive tasks compared to non-aphasic subjects. A sample of 47 patients (21 aphasics, 17 non-aphasics with left hemisphere lesions and 9 non-aphasics with right hemisphere lesions) performed cognitive tasks (attention, verbal and visual memory, executive functions, visuospatial skills and praxis). Aphasic patients performed poorer than all non-aphasics in Digit Span (p < 0.001), Clock-Drawing Test (p = 0.006), Verbal memory (p = 0.002), Visual Memory (p < 0.01), Verbal Fluency (p < 0.001), and Gesture Praxis (p < 0.001). Aphasia severity correlated with performance in Trail Making test part B (p = 0.004), Digit Span forward (p < 0.001) and backwards (p = 0.011), and Gesture Praxis (p = 0.002). Aphasia is accompanied by deficits not always easy to be evaluated by cognitive tests due to speech production and motor impairments. Assessment of cognitive functions in aphasics might contribute to optimize therapeutic intervention. © 2015, Associacao Arquivos de Neuro-Psiquiatria. All rights reserved.
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Characteristics of Cognitive Impairment in Patients With Post-stroke Aphasia
Article
Full-text available
  • Dec 2014
To analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity. Thirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity. Right hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests. Cognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.
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Demência na população de pacientes do Hospital das Clínicas da Unicamp
Article
Full-text available
  • Dec 2002
OBJECTIVE: To report the relative frequencies of the causes of dementia in patients seen at UNICAMP Hospital. METHOD: From 1989 to 1998, 261 dementia patients were admitted (89.7% studied retrospectively, and 10.3%, prospectively); mean age 63.5 years (±13.2), and education 3.6 years (±3.9; 25% illiterate). Diagnosis of dementia and its subtypes was based on DSM-IV criteria, CAMDEX, NINCDS-ADRDA, NINDS AIREN/ADDTC, Lund-Manchester, besides tap-test, including laboratory and neuroimaging examinations. RESULTS: Sixty five patients (24.9%) had vascular dementia, 62 ( 23.7%) Alzheimer's, 29 (11.1%) depressive pseudodementia, 28 (10.9%) normal pressure hydrocephalus, 14(5.4%) mixed, 12 (4.6%) post-traumatic, 9 (3.4%) frontotemporal and 38 (14.5%) had diverse or unknown causes. Dementia was minimal or mild in 123 (47.1%), moderate in 95 (36.4%), and severe in 43 (16.5%). CONCLUSION: Frequency of vascular dementia was 24.9%, Alzheimer's 23.7%, and normal pressure hydrocephalus 10.7%, in disagreement with that found in the neurological literature (20-30%, 50%, and 1-4%, respectively), probably because we are dealing with cases admitted to a tertiary university hospital. Epidemiological studies are needed to disclose the true proportion of these dementia syndromes in the population.
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Dementia in patients of UNICAMP University Hospital
Article
  • Dec 2002
Objective: To report the relative frequencies of the causes of dementia in patients seen at UNICAMP Hospital. Method: From 1989 to 1998, 261 dementia patients were admitted (89.7% studied retrospectively, and 10.3%, prospectively); mean age 63.5 years (±13.2), and education 3.6 years (±3.9; 25% illiterate). Diagnosis of dementia and its subtypes was based on DSM-IV criteria, CAMDEX, NINCDS-ADRDA, NINDS AIREN/ADDTC, Lund-Manchester, besides tap-test, including laboratory and neuroimaging examinations. Results: Sixty five patients (24.9%) had vascular dementia, 62 (23.7%) Alzheimer's, 29 (11.1%) depressive pseudodementia, 28 (10.9%) normal pressure hydrocephalus, 14(5.4%) mixed, 12 (4.6%) post-traumatic, 9 (3.4%) frontotemporal and 38 (14.5%) had diverse or unknown causes. Dementia was minimal or mild in 123 (47.1%), moderate in 95 (36.4%), and severe in 43 (16.5%). Conclusion: Frequency of vascular dementia was 24.9%, Alzheimer's 23.7%, and normal pressure hydrocephalus 10.7%, in disagreement with that found in the neurological literature (20-30%, 50%, and 1-4%, respectively), probably because we are dealing with cases admitted to a tertiary university hospital. Epidemiological studies are needed to disclose the true proportion of these dementia syndromes in the population.
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Diagnostic Criteria for Vascular Cognitive Disorders A VASCOG Statement
Article
  • Mar 2014
Several sets of diagnostic criteria have been published for vascular dementia since the 1960s. The continuing ambiguity in vascular dementia definition warrants a critical reexamination. Participants at a special symposium of the International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2009 critiqued the current criteria. They drafted a proposal for a new set of criteria, later reviewed through multiple drafts by the group, including additional experts and the members of the Neurocognitive Disorders Work Group of the fifth revision of Diagnostic and Statistical Manual (DSM-5) Task Force. Cognitive disorders of vascular etiology are a heterogeneous group of disorders with diverse pathologies and clinical manifestations, discussed broadly under the rubric of vascular cognitive disorders (VCD). The continuum of vascular cognitive impairment is recognized by the categories of Mild Vascular Cognitive Disorder, and Vascular Dementia or Major Vascular Cognitive Disorder. Diagnostic thresholds are defined. Clinical and neuroimaging criteria are proposed for establishing vascular etiology. Subtypes of VCD are described, and the frequent cooccurrence of Alzheimer disease pathology emphasized. The proposed criteria for VCD provide a coherent approach to the diagnosis of this diverse group of disorders, with a view to stimulating clinical and pathologic validation studies. These criteria can be harmonized with the DSM-5 criteria such that an international consensus on the criteria for VCD may be achieved.
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Beyond cortical localization in clinico-anatomical correlation
Article
  • Aug 2012
Last year was the 150th anniversary of Paul Broca's landmark case report on speech disorder that paved the way for subsequent studies of cortical localization of higher cognitive functions. However, many complex functions rely on the activity of distributed networks rather than single cortical areas. Hence, it is important to understand how brain regions are linked within large-scale networks and to map lesions onto connecting white matter tracts. To facilitate this network approach we provide a synopsis of classical neurological syndromes associated with frontal, parietal, occipital, temporal and limbic lesions. A review of tractography studies in a variety of neuropsychiatric disorders is also included. The synopsis is accompanied by a new atlas of the human white matter connections based on diffusion tensor tractography freely downloadable on http://www.natbrainlab.com. Clinicians can use the maps to accurately identify the tract affected by lesions visible on conventional CT or MRI. The atlas will also assist researchers to interpret their group analysis results. We hope that the synopsis and the atlas by allowing a precise localization of white matter lesions and associated symptoms will facilitate future work on the functional correlates of human neural networks as derived from the study of clinical populations. Our goal is to stimulate clinicians to develop a critical approach to clinico-anatomical correlative studies and broaden their view of clinical anatomy beyond the cortical surface in order to encompass the dysfunction related to connecting pathways.
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Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Article
  • Jul 2011
  • STROKE
This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic literature reviews (primarily covering publications from 1990 to May 1, 2010), previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. After peer review by the American Heart Association, as well as review by the Stroke Council leadership, Council on Epidemiology and Prevention Council, and Scientific Statements Oversight Committee, the statement was approved by the American Heart Association Science Advisory and Coordinating Committee. The construct of VCI has been introduced to capture the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury-not solely stroke-ranging from mild cognitive impairment through fully developed dementia. Dysfunction of the neurovascular unit and mechanisms regulating cerebral blood flow are likely to be important components of the pathophysiological processes underlying VCI. Cerebral amyloid angiopathy is emerging as an important marker of risk for Alzheimer disease, microinfarction, microhemorrhage and macrohemorrhage of the brain, and VCI. The neuropathology of cognitive impairment in later life is often a mixture of Alzheimer disease and microvascular brain damage, which may overlap and synergize to heighten the risk of cognitive impairment. In this regard, magnetic resonance imaging and other neuroimaging techniques play an important role in the definition and detection of VCI and provide evidence that subcortical forms of VCI with white matter hyperintensities and small deep infarcts are common. In many cases, risk markers for VCI are the same as traditional risk factors for stroke. These risks may include but are not limited to atrial fibrillation, hypertension, diabetes mellitus, and hypercholesterolemia. Furthermore, these same vascular risk factors may be risk markers for Alzheimer disease. Carotid intimal-medial thickness and arterial stiffness are emerging as markers of arterial aging and may serve as risk markers for VCI. Currently, no specific treatments for VCI have been approved by the US Food and Drug Administration. However, detection and control of the traditional risk factors for stroke and cardiovascular disease may be effective in the prevention of VCI, even in older people. Vascular contributions to cognitive impairment and dementia are important. Understanding of VCI has evolved substantially in recent years, based on preclinical, neuropathologic, neuroimaging, physiological, and epidemiological studies. Transdisciplinary, translational, and transactional approaches are recommended to further our understanding of this entity and to better characterize its neuropsychological profile. There is a need for prospective, quantitative, clinical-pathological-neuroimaging studies to improve knowledge of the pathological basis of neuroimaging change and the complex interplay between vascular and Alzheimer disease pathologies in the evolution of clinical VCI and Alzheimer disease. Long-term vascular risk marker interventional studies beginning as early as midlife may be required to prevent or postpone the onset of VCI and Alzheimer disease. Studies of intensive reduction of vascular risk factors in high-risk groups are another important avenue of research.
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Cognition and aphasia: A discussion and a study
Article
  • Mar 2002
  • J COMMUN DISORD
Unlabelled: The relation between other aspects of cognition and language status of individuals with aphasia is not well-established, although there is some evidence that integrity of non-linguistic skills of attention, memory, executive function and visuospatial skills can not be predicted on the basis of aphasia severity. At the same time, there is a growing realization among rehabilitation specialists, based on clinical experience and preliminary studies, that all domains of cognition are important to aphasia therapy outcomes. This paper describes a new study of the relation between linguistic and nonlinguistic skill in a group of individuals with aphasia. No significant relationship was found between linguistic and nonlinguistic skills, and between nonlinguistic skills and age, education or time post onset. Instead, individual profiles of strengths and weaknesses were found. The implications of these findings for management of aphasia patients is discussed. Learning outcomes: Readers of this papers will be able to: list five primary domains of cognition and relate each to an aspect of aphasia therapy; describe at least three studies that examined the relation between cognition and aphasia; describe four nonlinguistic tasks of cognition that can be used with a wide range of aphasia patients.
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