Diagnostic Instrument for Mild Aphasia (DIMA): standardization and clinical application
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1
Erasmus MC University Medical Center, Neurosurgery, Netherlands
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2
Vrije Universiteit Brussel, Clinical and Experimental Neurolinguistics, Center for Linguistics, Belgium
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3
University of Groningen, Center for Language and Cognition Groningen, Netherlands
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4
ZNA Middelheim, Neurology and Memory Clinic, Belgium
Introduction: Just as severe and moderate aphasia, a mild language disorder has negative effects on daily communication and quality of life (Cruice et al. 2006). For instance, patients with brain tumors (low-grade gliomas) suffer from mild language deficits due to slow growth rate which facilitates neural plasticity (Duffau, 2014). Classical aphasia tests such as the Token Test or the Boston Naming Test (BNT), usually administered in stroke patients, are not always sensitive to detect mild language disorders (Satoer et al. 2013). In this patient group, there exists a need for a new test-battery: The Diagnostic Instrument for Mild Aphasia (DIMA) which is based on the Dutch Linguistic Intraoperative Protocol (De Witte et al. 2015). Complex tests (e.g. with reaction time) at the different linguistic levels phonology, semantics and syntax were selected for language production and comprehension. Standardization with parallel tests (version A and B) of DIMA in a healthy population was conducted in the Netherlands and Flanders. Clinical application and validation is ongoing.
Methods: DIMA consists of 4 subtests: repetition (words, compounds, non-words, sentences), odd-picture-out (nouns, verbs), sentence completion and sentence judgment (see Table 1 for examples). We included 529 healthy participants divided by nationality (Netherlands, Belgium), gender (male, female), handedness (right, left, ambidexter), age (18-34, 35-54, 55-74, >75 years) and education (≤12, >12 years). Participants were tested in a quit environment (private setting). Duration was 10-15 minutes. Parametric (t-test, ANOVA) or non-parametric (Mann-Whitney U, Kruskal-Wallis) tests were used to examine the effects of gender, handedness, age, and education on the test-scores. Cut-off z-scores were defined: mild impairment z=≥-1.5, severe impairment z=≥-2. Clinical application of DIMA is demonstrated in a right-handed patient (F.E.) with a left fronto-parietal glioma, age 35, education >12 years. In addition, classical aphasia tests including the Token Test, BNT and verbal fluency (category and letter) were also administered.
Results: There was no effect of gender and handedness on all test-scores on both DIMA versions (p>0.05). There was an effect of age (the higher the age the lower the scores), except between the groups 18-34 and 35-54 years in version A, and of education (the higher the education, the higher the scores) (p<0.05). Apart from semantic-odd-picture-out verbs, accuracy rate was >80% on all sub-tests in both versions. Patient F.E. showed severe impairments in all repetition sub-tests (z=>-2) and a mild impairment in the sentence completion test (z=>-1.5) of DIMA. No impairments were found on Token Test, BNT and verbal fluency tests (z=<-1.5).
Discussion: For the first time a standardized Dutch test was developed to detect mild aphasia within a short time-frame (10-15 minutes). A normative study was carried out in a large group of native Dutch-speaking healthy adults. Clinical application was demonstrated in a glioma patient. Our preliminary analyses indicate that DIMA has the potential to become a valuable addition to the standard clinical procedure concerning language assessment in patients suffering from mild language disorders of a different etiology.
References
Cruice, M., Worral, L. & Flickson L. (2006). Perspectives of quality of life by people with aphasia and their family: Suggestions for succesful living. Topics in Stroke Rehabilitation 13, 14-24.
De Witte, E., Satoer, D., Robert, E., Colle, H., Verheyen, S., Visch-Brink, E., Mariën, P. (2015). The Dutch Linguistic Intraoperative Protocol (DuLIP): A valid linguistic approach to awake brain surgery. Brain and Language 140, 5-48.
Duffau H. (2014). The huge plastic potential of adult brain and the role of connectomics: New insights provided by serial mappings in glioma surgery. Cortex 58, 325-337.
Satoer, D., Vincent, A., Smits, M., Dirven, C., Visch-Brink, E. (2013). Spontaneous speech of patients with gliomas in eloquent areas before and early after surgery. Acta Neurochirurgica 155, 685-692.
Keywords:
Mild aphasia,
Linguistic test-battery,
Norm study,
diagnostic instrument,
Glioma
Conference:
Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.
Presentation Type:
poster presentation
Topic:
General Submission
Citation:
Satoer
D,
De Witte
E,
Bastiaanse
R,
Vincent
A,
Mariën
P and
Visch-Brink
E
(2019). Diagnostic Instrument for Mild Aphasia (DIMA): standardization and clinical application.
Conference Abstract:
Academy of Aphasia 55th Annual Meeting .
doi: 10.3389/conf.fnhum.2017.223.00103
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Received:
02 May 2017;
Published Online:
25 Jan 2019.
*
Correspondence:
Dr. Djaina Satoer, Erasmus MC University Medical Center, Neurosurgery, Rotterdam, Netherlands, d.satoer@erasmusmc.nl