Presence and laterality of brain damage predicted from responses to a short aphasia screening test

Complex Behavioral Indices Weighted by Linear Discriminant Functions for the Prediction of Cerebral Damage

Linear discriminant functions were applied to seven dichotomized measures from each of 224 patients who were divided into control, left cerebral damage, right cerebral damage, and diffuse or bilateral damage groups. The measures were: Wechsler Verbal Weighted Score, Wechsler Performance Weighted Score, Halstead Impairment Index, Trail Making Test A, Trail Making Test B, Aphasia 4-rule Prediction, and age of patient. Four comparisons were made, one for each criterion group vs all remaining groups. The discriminant function in each comparison produced a single weighted score per S, and an optimum, least-squares type of separation between the two sets of scores. The resulting distributions of summed, weighted scores in each comparison were inspected for the point of minimum overlap, and an individual's weighted score, falling above or below this point, categorized him as belonging either in the single criterion group or in any one of the remaining three groups. These assignments, when compared with the actual criterion classes of the patients, were expressed as percentages of correct prediction: control vs non-control, 83.0%; left damage vs non-left, 87.5%; right damage vs non-right, 85.7%; diffuse (or bilateral) damage vs non-diffuse, 84.4%. Each measure was examined individually for percentages of correct prediction, but the discriminant function was superior in all instances, being approached only by the Halstead Impairment Index (one comparison) and by the Aphasia 4-rule Prediction (two comparisons). The seven-variable discriminant function was approximately as efficient as either of two previous functions that included more than 20 variables each.

Discriminant Functions Applied to the Problem of Predicting Cerebral Damage from Behavioral Tests: A Cross-Validation Study

Linear discriminant functions were applied to 23 behavioral test scores from each of 304 patients who were divided into control, left cerebral damage, right damage, and diffuse or bilateral damage groups. Random-half and temporal-half (early versus late test period) cross-validations were performed by generating weights from the scores of each of the foregoing halves and applying them to the appropriate counter-halves. The reduction in accuracy of criterion prediction attributable to cross-validating, i.e., the “noise” in the system, varied between 10% and 20% of the uncrossed accuracy. Validated accuracy was about 80% for comparisons between controls and (a) all the damaged groups together, (b) diffuse or bilateral damage groups, (c) left damage groups, (d) right damage groups, and (e) between left and right damage groups; it was about 70% between the left damage and diffuse or bilateral damage groups; about 60–65% (essentially no better than chance) between the right damage and diffuse or bilateral damage groups. It was concluded that when greater validated accuracies of correct prediction are obtained, for situations like those of this study, they must rest at least partially upon the basis of nonlinear relationships that exist in the data. The obtained accuracies (except for lateralized damage versus non-lateralized damage groups) were considered to be high enough to indicate that the discriminant function has practical value.

Predictions of Brain Damage from an Aphasia Screening Test; An Application of Discriminant Functions and a Comparison with a Non-Linear Method of Analysis

Under linear discriminant function analysis of four cerebral-damage criterion groups (including non-damage), arranged in seven two-way comparisons, the aphasia screening test gave over-all percentages of correct prediction of 262 Ss' actual brain-damage classifications, ranging between 77.5% and 93.4%. An earlier analysis of the same Ss' responses to the aphasia test, organized in terms of four mutually exclusive and exhaustive, non-linear rules for classifying each S to a single damage category (control, left, right, and diffuse or bilateral), produced percentages of correct prediction within virtually the same range as did the discriminant function analysis, but with a different pattern of accuracy of prediction. The results of the aphasia test discriminant function analysis were almost completely congruent with those obtained from the same kind of analysis applied to 23 entirely different test variables from the Wechsler, Halstead, and Trail Making tests. The implications of such methods as the discriminant function, for the production of new understanding of the effects of brain damage on human behavior, are discussed.

Methodological Note on the Relationship between Ability to Copy a Simple Configuration and Wechsler Verbal and Performance IQS

Free-hand reproductions of a Greek cross by 100 retarded Ss were significantly related to the Wechsler-Bellevue Performance IQ but not to Verbal IQ. The reproductions could be reliably classified into three categories of adequacy.

Neuropsychological findings with pseudoxanthoma elasticum

It has been reported that the disease pseudoxanthoma elasticum (PXE) is associated with a high incidence of neurologic and psychiatric symptoms, which are possibly due to cerebrovascular ischemia. These reports are based mainly upon clinical observations made without reference to control group data. We have compared the results of 27 PXE patients with results of a control group on a battery of objective neuropsychological and personality tests. The PXE group showed only very mild deficits on extensive neuropsychological testing, a finding which argues against any marked involvement of cerebral vessels in these patients. Similarly, the personality test results did not reveal significant psychiatric disturbances which could be attributed to PXE. Possible reasons for the descrepancy with previous reports include the subjective data and much older PXE patients on which those reports are based. The need for systematic neuropsychological research with older PXE patients and control groups is suggested.

Normal pressure hydrocephalus in patients with myelomeningocele

Although the syndrome of normal pressure hydrocephalus (NPH) was described in the adult as early as 1964, it has only recently been recognized in the child. In this preliminary report, eight myelomeningocele patients with presumed NPH were evaluated before and after ventricular shunting procedures. Cranial computed tomography and serial psychological testing have proved to be particularly valuable both in the pre-operative and post-operative assessment of these patients and have the distinct advantage of being simple, non-invasive diagnostic measures. Continuous intra-ventricular pressure monitoring has shown what promises to be characteristic elevated pressure plateaux imposed on normal baseline cerebrospinal fluid (CSF) pressures in so-called NPH but is a more difficult clinical procedure, necessarily associated with potential complications. Although decreasing response to growth-stimulating hormone can be demonstrated in patients with long-standing hydrocephalus, this endocrine malfunction cannot be considered an early indicator of intracranial pathology. Single IQ scores are inadequate measures of intellectural function in children with NPH and serial examinations should be carried out. Detailed neuropsychological testing will document performance IQ scores well below verbal IQ scores and will generally show failure of psychomotor development to keep pace with chronological ageing. Initial studies indicate that improved performance scores can be expected within 1 1/2 to 3 months following successful ventricular shunting operations, and that any downward trend in pre-operative test scoring can at least be reversed. Statistically significant improvements in full-scale IQ scores have not been seen, however, before the end of the first post-operative year. Clinically, improved attentiveness and sociability, and decreased spasticity (if present prior to surgery) can be expected following shunting. Over-all, ventriculomegaly, normal CSF pressure, stable head size, and non-progressive neurological symptoms cannot be regarded as sufficient criteria for the diagnosis of an arrested state of hydrocephalus, and should suggest NPH, especially in those children who demonstrate a discrepancy between performance and verbal IQ scores and who fail to exhibit continuing psychomotor development with advancing age.

Identification of aphasia post stroke: a review of screening assessment tools

INTRODUCTION

Aphasia is one of the most common consequences of stroke. Early identification, diagnosis and treatment of language deficits are important steps in maximizing rehabilitation gains. A routine screening test is an invaluable tool in the identification and appropriate referral of patients with potential communication problems. The present study presents an evaluation of the measurement properties of screening tools for aphasia found within the stroke research literature.

METHODS

Screening tools were identified following searches of the published research literature in stroke. Instruments were reviewed on the basis of reliability, validity, classification sensitivity and practical utility.

RESULTS

Six aphasia screening tools were identified. For most tools, information pertaining to measurement properties and clinical utility was limited.

CONCLUSIONS

The Frenchay Aphasia Screening Test (FAST) appears to be the most widely used and thoroughly evaluated tool found within the stroke research literature. Further evaluation of the measurement properties and clinical utility of screening tools is recommended.

A selective and critical review of neuropsychological deficits and the frontal lobes

Presumptions about the functions of the frontal lobes, and the sensitivity and specificity of certain tests to measure frontal lobe functions, are having a substantial influence on both clinical and research conclusions. In this paper the authors examine the details of the studies that have contributed to these presumptions, and find that the evidence to support these conclusions is weak. A detailed evaluation of the evidence relating to the Wisconsin Card Sorting Test and the Thurstone Word Fluency Test is also presented. Finally, the development of the belief that frontal lobe functions can be specifically measured is reviewed. The authors of this paper conclude that the "bewildering array" of deficits attributed to frontal lesions still seems to prevail.

Ward Halstead's contributions to neuropsychology and the Halstead-Reitan Neuropsychological Test Battery

This paper reviews the roots from which Halstead began his investigations, the significance of his original collaboration with neurological surgeons, and the long-term implications of his practical approach of observing brain-damaged patients in their everyday living situations in order to identify the problems and limitations they experienced. This work led to development of the Halstead-Reitan Battery (HRB), which has proved to be sensitive to a broad range of neurological variables including location, type, and status of brain lesion. The HRB, in turn, has laid the groundwork for a rehabilitation program (REHABIT) that integrates neuropsychological evaluation with cognitive retraining, using an approach that can be designed to restore the individual's functional ability structure (as contrasted with approaches oriented toward highly specific deficits or toward a general, nonspecific notion of "brain damage."

Left cerebral dominance for bilateral simultaneous sensory stimulation?

Hom and Reitan (1982) reported findings with respect to sensorimotor deficits in groups with lateralized cerebral lesions, but evaluated the results only within a framework that related cerebral dominance to deficits that resulted from lateralized lesions. Some of the variables they studied, however, depend upon evidence of retention of functions by one hemisphere under conditions of distracting input. While the right cerebral hemisphere appears to be dominant for tactile-perceptual abilities in terms of resulting deficits, the present study suggests that the left cerebral hemisphere is dominant for certain non-language functions that reflect maintenance of sensory-perceptual abilities under conditions of distracting stimuli.

Self-report of indifference and anxiety among persons with right hemisphere stroke

A sample of persons with a single ischemic cerebral stroke was used to elucidate and quantify the indifference associated with right hemisphere stroke. Seven persons with right hemisphere stroke were compared with 10 persons with left hemisphere stroke on two aspects of indifference (social indifference and lack of anxiety). Persons with right hemisphere stroke reported themselves as being substantially less anxious (p = .025) and somewhat more socially indifferent (p = .081) than did those with left hemisphere stroke. Lack of appropriate anxiety may contribute to the clinical descriptions of indifference, failure to make expected recovery, and difficulty in relationships with others.

Mirror phenomena in language and nonverbal activities--a case report

A case is described of a 38-year-old, left-handed female who demonstrated mirror phenomena for both language and non-motor, nonverbal material. She mirror-wrote with her left hand with normal right-hand writing. Mirror-reading as well as object and spatial reversals were revealed. These data are consistent with bilateral representation of visual engrams, with one hemisphere containing a mirror-reversed representation of the other.

A comparison of language deficits in learning-disabled, head-injured, and nondisabled young adults: results from an abbreviated Aphasia Screening Test

This study used an Aphasia Screening Test (AST) abbreviated to its naming, pronunciation, and sentence interpretation items to compare groups of 60 learning-disabled (LD), 30 head-injured (HI), and 30 nondisabled (ND) young adults matched for FISQ and balanced for gender composition. The LD and HI, who did not differ, made significantly more AST errors than the ND. One-quarter to one-third of the LD and HI subjects exhibited language deficits. For the clinical groups only, AST errors, particularly pronunciation errors, were related negatively to WRAT reading and spelling scores. The Reitan and Wolfson (1988) severity ratings for AST items did not improve group discrimination.

Selected cognitive losses after stroke. Frequency, recovery and prognostic importance

Data collected in a population-based study on 976 patients suffering an acute stroke have been analysed to discover the frequency of disturbance of selected cognitive functions, particularly orientation, non-verbal reasoning, and copying. Further analysis investigated how these deficits related to other impairments, their prognostic importance, and their recovery. Considering patients assessed within the first week, only 45% were orientated, only 44% could be assessed for IQ and their average score was 94 (SD 16), and only 36% could copy a cross satisfactorily. Seventeen per cent of patients had a reduced level of consciousness preventing assessment, and the other unassessable patients had other impairments such as aphasia preventing assessment. In general failure to pass these tests was associated with evidence of a more severe stroke; the patients had other impairments such as a more severe paralysis. No independent effect of cognitive dysfunction upon recovery could be demonstrated. By 6 months most surviving patients passed all the tests used.

Verbal processing by the brain

Reitan and Wolfson (1985) have proposed a model of brain-behavior relationships which postulates a three-part organization of higher-level aspects of central processing: Verbal and related language functions (mainly left hemisphere), visual-spatial and related abilities (mainly right hemisphere), and conceptual abilities (both hemispheres). Three groups of subjects (controls, left cerebral lesions, and right cerebral lesions) and two strictly verbal tests (the Word Finding Test and the Vocabulary subtest from the Wechsler Scale) were used as a partial test of this model. Left cerebral lesions impaired Vocabulary scores but right cerebral lesions had little if any impairing effect. However, on the Word Finding Test, which has a strong conceptual requirement in addition to the verbal requirement, the group with left cerebral lesions continued to show striking impairment but the group with right cerebral lesions also showed significant impairment as compared to the control group. Additional studies are needed to test the proposed model in more detail.

Cognitive impairment patterns in schizophrenia and affective disorder

A battery of neuropsychological tasks was used to study 62 schizophrenics, 67 melancholics, and 30 manics satisfying specific research diagnostic criteria, and 42 normal subjects. Two patterns of neuropsychological impairment among patients were identified by factor analysis. The first pattern of bifrontal, non-dominant hemisphere dysfunction was shared by schizophrenics and affectively ill patients, whereas the second pattern of dominant temporo-parietal-occipital impairment was most frequent in a subgroup of schizophrenics. These relationships remained after accounting for the effects of age, gender, handedness and drugs received at time of testing.

Aphasia Screening Test performance in patients with lateralized brain damage

Patients with lateralized stroke (N = 36) or tumor (N = 14) were compared in the frequency of errors on specific test items of the Aphasia Screening Test (Reitan, 1984). Right- and left-hemisphere damaged patients showed a statistically significant difference on only 1 of the 33 items of this measure. When items were categorized according to task type (e.g., spelling, reading, calculation, etc.) only 1 of 9 comparisons was significant. Several possible explanations for the lack of differences are discussed and suggestions offered for potential modifications to this measure.

The Reitan-Indiana Aphasia Screening Test: scoring and factor analysis

This article presents a scoring system and factor analysis for the Reitan-Indiana Aphasia Screening Test. Eight content categories were clinically identified and scored (N = 197). Also, the interrelationships of these content areas were explored by factor analysis. The analysis revealed two major factors, a general language abilities factor and a sensorimotor coordination factor. The pattern of loadings was interpreted with reference to hypothesized relationships and previous research on the test. The findings also have implications for the clinical interpretation of test results.

Language and visuospatial abilities in learning-disabled, brain-damaged, and nondisabled young adults

This study confirmed the construct validity of dysphasic errors but not of Block Design or dyscopia for 88 male and 22 female young adults, aged 17 to 29 yr. Right-hand sensorimotor deficits correlated with dysphasic errors but not with Block Design. Brain-damaged and learning-disabled with Halstead Impairment Index (HII) greater than or equal to 0.4 differed from nondisabled on both dysphasic errors and Block Design. Learning-disabled with HII less than 0.4 differed from nondisabled only for dysphasic errors. As a group, young learning-disabled adults had impaired language abilities. Learning-disabled with HII greater than or equal to 0.4 and brain-damaged had generalized neuropsychological deficits characterized by less adequate language and visuospatial abilities.

Incidence and doubtful significance of nonstandard orientations in reproduction of the key from the Aphasia Screening Test

Nonstandard key orientations (reversed, vertical, diagonal, indeterminant) were studied for 138 normal control subjects and in 1,235 patients obtained from three sources. Keys in nonstandard orientations were slightly but not significantly more frequent in the patient groups. The vast majority of nonstandard keys were reversed. Comparisons with persons having normal key orientations on biodata, neuropsychological, intellectual, and personality variables gave negative results. Retesting a portion of the sample showed that the tendency to reproduce the key in irregular orientations was consistent over time in only about half the cases. In contrast to occasional reports in the literature, it appears that nonstandard orientations in the drawing of the key in the Aphasia Screening Test are infrequent, somewhat inconsistent in appearance, and likely of little or no demonstrable clinical significance.

Short-term cognitive effects of unilateral and bilateral ECT

We administered an extensive battery of primarily non-memory neuropsychological tasks to 37 patients with endogenous depression, randomly assigned to either bilateral (B/ECT) or unilateral (U/ECT) electroconvulsive therapy. Testing was done prior to therapy and again shortly after the sixth induced seizure. The two groups did not significantly differ in cognitive impairment, either before or after treatment, and within-group cognitive changes following treatment were small. We conclude that neither B/ECT nor U/ECT substantially worsen non-memory cognitive performance in depressed patients, yet both result in significant clinical improvement.

A brief clinical neuropsychologic battery: clinical classification trials

Based upon non-neuropsychological evaluative data, 150 neuropsychiatric referrals were classified independently into Definite (DBD), Suspected (SBD), or No Brain Damage (NBD) groups. Each S was examined with a brief, 2-hour neuropsychologic battery and the test data clinically rated by two neuropsychologists, blind to group membership. Clinical classifications were compared with criteria for NBD vs. SBD + DBD, NDB vs. SBD, and SBD vs. DBD groupings. Hit rates ranged from 83.3% for the former to 64.3% for the latter. These results compared favorably with hit rates derived from statistical classification trials. Clinicians also classified SBD and DBD cases into one of eight different diagnostic categories. The overall hit rate was 61.3%.

A brief clinical neuropsychologic screening battery: statistical classification trials

Classified independently 150 neuropsychiatric referrals into Definite (DBD), Suspected (SBD) or No Brain Damage (NBD) groups on the basis of nonneuropsychological evaluative data. Each S was examined with a brief, 2-hour neuropsychologic screening battery, and the test data were analyzed by a stepwise linear discriminant function program. Statistical classifications were compared with criteria for NBD vs. SBD + DBD and for SBD vs. DBD groupings. Hit rates ranged from 95% for the former to 81.7% for the latter, with the low false positives and negatives. Hit and miss rates were not as strong in a validation step, but exceeded chance levels.

Abbreviating the Halstead-Reitan neuropsychological test battery

Describes a brief and relatively data-rich abbreviated form of the Reitan. By employing the Trail Making Test, the Aphasia Screening Test, and Block Design and Digit Symbol from the WAIS, one can predict the presence and severity of organic impairment and comment on lateralization and localization. Findings are cross-validated.

Capgras' syndrome and cerebral dysfunction

Two cases of Capgras' syndrome in association with coarse brain disease are presented. The authors suggest that prosopagnosia (face nonrecognition) may be the primary expression of a specific cerebral dysfunction which forms the basis for a delusional elaboration resulting in Capgras' syndrome.

Handedness in relation to measures of motor and tactile-perceptual functions in normal children

10 boys and 10 girls were tested at each of six age levels (6, 7, 8, 12, 13, and 14 yr). All of the children were right-handed, and at each age level the groups did not differ in age, WISC Full Scale IQ, or educational attainment. The groups were compared on motor tasks (strength and speed) and tactile-perceptual tasks (finger localization and symbol recognition). The performances of the right and left hands were compared. The results indicated clear right-hand motor superiority, but no "sidedness" effect for the tactile-perceptual measures. The implication of these results for brain-behaviour relationships was discussed.

Chronic cerebral effects of alcohol and drug abuse

A minority of alcohol abusers develop severe cerebral dysfunction in the form of Wernicke-Korsakoff syndrome. There is also evidence to suggest that cerebral dysfunction, particularly impaired abstracting ability, occurs in that larger population of heavy drinkers who do not go on to develop the Wernicke-Korsakoff syndrome. There is no consistent evidence that long-term marijuana, hallucinogen, or sedative use causes lasting neuropsychological disturbance. The deficits in abstract thinking reported by some LSD studies are similar to deficits others have reported among alcoholics. Since the LSD studies were not controlled for alcohol use, their interpretation is difficult. It appears that cerebrovascular accidents occur more frequently and at a younger age among amphetamine abusers. There is no reliable information about possible other long-term effects of stimulants on the brain per se (i.e., nonvascular complications). Abuse of intravenous narcotics has been associated with case reports of transverse myelitis and encephalitis. It is not known whether this pathology is a direct or hypersensitivity effect of narcotic drugs, of adulterants, or of infection.

Verbal problem solving as related to cerebral damage

An instrument, called the Word Finding Test, was devised to evaluate ability in discerning the meaning of a nonsense word through appreciation of its verbal context. This test consisted of 20 items and each item was made up of five sentences. In each sentence a nonsense word was used in place of an actual word which fit the context of all sentences for that item. S's task was to guess the meaning of the nonsense word, if possible, in each item. The test was administered to groups (males and females) of control Ss as well as to a group of normally functioning control Ss. Ss with cerebral lesions, who had also taken the test, were matched individually with Ss in each of the control groups on the basis of age, sex, and education. The results indicated that groups with cerebral damage consistently performed worse than their matched control groups. In total, 66 (94%) of the 70 brain-damaged Ss earned lower scores than did their matched controls. These findings indicated that the Word Finding Test appears to be especially sensitive to cerebral damage in adult Ss and suggest that problem-solving abilities, even in a verbal context, may be seriously deficient in persons with cerebral lesions.

Geometric form reproduction: relationship to chronological and mental age

195 children from Grades 1, 4, and 6 of middle-class suburban schools were given SRA Primary Mental Abilities tests, a developmental sequence of geometric forms to be copied, and a pencil-and-paper test of eye-hand dexterity. Correlations among form-reproduction scores and those of the PMA subtests and totals, eye-hand dexterity and chronological age suggested that form reproduction was related primarily to MA rather than CA within the age groups. MA and CA appear to be highly related to form reproduction among the younger children.