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Cognitive and language processing among Cantonese speakers with aphasia: A multi-level investigation

Winsy W. Wong1*, Kwan Yin Lee1 and SamPo Law1
  • 1 The University of Hong Kong, Division of Speech and Hearing Sciences, Hong Kong, SAR China

Background. Cognitive deficits are common among people with aphasia (PWA). A recent systematic review reported that PWA performed poorer than healthy individuals on various cognitive domains (Fonseca et al., 2017). Studies investigating various cognitive components including short-term and working memory (see Cahana-amitay & Albert, 2015 for a review), attention (e.g., Murray, 2012), and executive functions (e.g., Frankel, Penn, & Ormond‐Brown, 2007) suggested that cognitive deficits do not only co-exist with language impairments; they form an explanatory basis for language performance. Yet, no previous reports have examined in detail the relationship in performance between various cognitive domains and different linguistic levels among PWA. This study aimed to fill this gap. It was expected that the integrity of attention and executive functions would more strongly predict higher level linguistic performance compared with lower level, namely sentence and discourse versus single-word levels. Method. Twenty-three Cantonese-speaking PWA (mean age= 56.7 years) were assessed. Cognitive assessment included the Test of Nonverbal Intelligence-third edition (TONI-3; Brown, Sherbenou, & Johnsen, 1997), the Wisconsin Card Sort Test (WCST; Grant & Berg, 1993), the Attention Network Task (ANT; Fan, McCandliss, Sommer, Raz & Posner, 2002), digit span forward and backward (Wechsler, 1987), and subtests 1 to 4 of the Test of Everyday Attention (TEA; Robertson, Ward, Ridgeway, & Nimmo-Smith; 1994). Multi-level linguistic measures included: (a) object and action verb naming (Law, 2004), and verbal fluency test (Chan & Poon, 1999) for word-level production, (b) spoken-word-picture matching task (Law, 2004) and synonym judgment task (Law, as cited in Kong, et al., 2017) for word comprehension, (c) spoken-sentence-picture matching task (Law & Leung, 1998), and (d) Main Concept Analysis (Kong, 2011) and procedural description for discourse production. Composite scores of two cognitive measures (TONI and WCST) and all linguistic levels except sentence comprehension were calculated. A correlational matrix across all cognitive and linguistic composite scores was constructed prior to step-wise multiple regressions for selecting relevant cognitive measures as variables predicting linguistic performance at each of the four levels. Results. All PWA participants suffered cognitive deficits to various degrees. None them scored within normal range in all TEA sub-tests. Nine participants performed similarly to healthy controls in both short-term and working memory tasks. In executive functions tasks, only four participants scored similarly to heathy controls in ANT. On the contrary, 22 of the PWA had normal performances in TONI-3. Table 1 reports the final multiple regression models. Attentional measures significantly predicted word level expression and comprehension. However, digit span backward and composite TONI-3 and WCST were significant predictors for sentence comprehension and discourse production. Conclusion. The current results from regression analyses are generally consistent with previous findings of the association between cognitive functions and language performance of PWA. More importantly, they further delineate the differential effects of various cognitive functions on performance at each linguistic aspect. The findings call for routine and thorough cognitive assessment of PWA in the management process. Moreover, incorporating cognitive rehabilitation in advanced language training to maximize treatment effectiveness should be considered.

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Acknowledgements

This work was supported by the Seed Fund for Basic Research of the University of Hong Kong under Grant # 201611159051. Special thanks are given to the Aberdeen Kai-fong Welfare Association, Community Rehabilitation Network of the Rehabilitation Society of Hong Kong, and Neighbourhood Advice-Action Council. The authors would like to sincerely thank the participants, care-takers, volunteering communication partners, speech therapists and student speech therapists for their involvement.

References

Brown, L., Sherbenou, R., & Johnsen, S. (1997). Test of Nonverbal Intelligence: A Language-free Measure of Cognitive Ability (3rd ed.). Austin, TX: Pro-Ed. Cahana-Amitay, D., & Albert, M. L. (2015). Redefining Recovery from Aphasia. New York: Oxford University Press. Chan, A. S., & Poon, M. W. (1999). Performance of 7-to 95-year-old individuals in a Chinese version of the category fluency test. Journal of the International Neuropsychological Society, 5(6), 525-533. Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14, 340–347. Frankel, T., Penn, C., & Ormond‐Brown, D. (2007). Executive dysfunction as an explanatory basis for conversation symptoms of aphasia: A pilot study. Aphasiology, 21, 814–828. http://doi.org/10.1080/02687030701192448 Fonseca, J., Ferreira, J. J., & Martins, I. P. (2017). Cognitive performance in aphasia due to stroke: A systematic review. International Journal of Disability and Human Development, 16, 127-139. Grant, D. A., & Berg, E. A. (1993). Wisconsin Card Sorting Test. San Antonio, TX: Psychological Assessment Resources. Key-DeLyria, S. E., & Altmann, L. J. (2016). Executive function and ambiguous sentence comprehension. American Journal of Speech and Language Pathology, 25, 252-267. Kong, A. P. H., Law, S. P., & Chak, G. W. C. (2017). A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia. Journal of Speech, Language, and Hearing Research, 60(7), 2031-2046. Law, S. P. (2004). Case Study Impairment to phonological processes in a Cantonese‐speaking brain‐damaged patient. Aphasiology, 18(4), 373-388. Law, S.-P., & Leung, M.-T. (1998). Sentence comprehension in Chinese aphasic patients. Aphasiology, 12, 49-63. Murray, L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. American Journal of Speech-Language Pathology, 21, S51-S64. http://doi.org/10.1044/1058-0360(2012/11-0067) Robertson, I. H., Ward, T., Ridgeway, V., & Nimmo-Smith, I. (1994). The Test of Everyday Attention. London, England: Harcourt Assessment. Wechsler, D. (2008). Wechsler Adult Intelligence Scale - Fourth Edition. San Antonio, TX: Pearson.

Keywords: Aphasia, multi-level analysis, cognitive and language processing, executive functions, Attention, Short-term (working) memory

Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019.

Presentation Type: Poster presentation

Topic: Eligible for student award

Citation: Wong WW, Lee K and Law S (2019). Cognitive and language processing among Cantonese speakers with aphasia: A multi-level investigation. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00016

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Received: 27 Apr 2019; Published Online: 09 Oct 2019.

* Correspondence: Mx. Winsy W Wong, The University of Hong Kong, Division of Speech and Hearing Sciences, Pokfulam, Hong Kong, SAR China, winsywg@gmail.com