Event Abstract

Cookie Theft Picture Description: Linguistic and Neural Correlates

  • 1 Johns Hopkins Medicine, Neurology, United States
  • 2 Johns Hopkins University, The Russell H Morgan Department of Radiology and Radiological Science, United States
  • 3 Johns Hopkins Medicine, Department of Physical Medicine and Rehabilitation, United States
  • 4 Johns Hopkins University, Department of Cognitive Science, United States

Problem/Hypothesis: Expressive language deficits, such as word finding, are common following a stroke and inhibit effective communication, as well as quality of life. Clinically, there is a paucity of sensitive and efficient tools for acute bedside administration to determine aphasia severity. We hypothesized that performance on a picture description task correlates with confrontational naming and analysis of this description contributes valuable information about lesion size, location, and percent damage to specific areas of the brain. Procedures/Analyses: 60 left hemisphere (LH) ischemic stroke patients aged 28-87 years (M=58.42; SD=13.24) were included (19 (32%) women; mean education=13.74±2.54). This cohort was tested acutely (48 hours following stroke) and a subset of participants (n=17) were tested chronically (6-12 months post stroke) with the Boston Naming Test, short form (BNT; Mack et al., 1992) and Cookie Theft Picture Description (BDAE; Goodglass & Kaplan, 1972). Cookie Theft Picture Descriptions were scored for number of words, syllables, correct content units (CU), syllables/content units (syll/CU) and ratio of left/right content units (L:R Ratio). Results were compared with published norms and standardized scoring for the Cookie Theft Picture Description (Yorkston & Beukelman, 1980; Agis et al., 2016) and BNT (Williams et al., 1989). Imaging: All participants received an acute MRI scan, including diffusion weighted-imaging. Acute ischemia was traced on DWI scans. A radiologist identified percent damage to cortical lobes, thalamus, basal ganglia, and each vascular territory on DWI, after co-registration to the respective anatomical atlas (divided by lobes, and nuclei, or vascular territories). Results: Acutely, mean scores were: BNT =19.38 ±10.07 (of 30; normal=27.5±2.4); cookie theft total CU = 6.82±4.36 (mean for controls=16.0±3.7), syll/CU M=11.55±18.02 (mean for controls=6.2±1.9), L:R Ratio M=.911±.691. Chronically, mean scores were: BNT M=24.17±4.58; cookie theft total CU M=11.12±4.9; syllables/CU M=6.74±3.32, L:R Ratio M=1.319±.639, indicating participants improved in naming, content, and efficiency of narrative speech. BNT scores correlated positively with total CU (r=.65, p<.05) and negatively with syll/CU (r=-.34, p<.05). Chronically, BNT scores correlated with CUs (r=.58, p<.05), but not syll/CU; however, this may reflect inadequate power to detect association at follow up (n=17). As hypothesized, total CU negatively correlated with percent damage to total LH (r=-0.38, p<.05), and percent damage across language areas; LH frontal (r=-.2970, p<.05), parietal (r=-.30, p<.05), and temporal (r=-.38, p<.05). Percent damage to LH MCA and PCA territories negatively correlated with total CU (r=-.43, p<.05 and r=-.27, p<.05, respectively). Final Conclusions: The Cookie Theft Picture Description which requires only two minutes to administer at bedside, captures an overall aphasia severity measure that correlates with percent damage to language cortex in acute stroke. This is important because other batteries are cumbersome at bedside. This analysis provides an efficient acute stroke assessment and measurement of change over time. Future studies will examine a larger cohort of participants longitudinally to determine additional neural correlates that predict language recovery.


This work was made possible by NIH grants ROI DC 011317 from NIDCD. We gratefully acknowledge this support.


Agis, D., Goggins, M. B., Oishi, K., Davis, C., Wright, A., & Hillis, A. E. (2016). Picturing the size and site of stroke with an expanded National Institutes of Health Stroke Scale. Stroke, 47(6), 1459-1465.

Goodglass, H., Kaplan, E., Barresi, B.. Boston Diagnostic Aphasia Examination-Third Edition (BDAE-3) San Antonio: Pearson; 2000.

Mack, W.J., Freed, D.M., Williams, B.W., & Henderson, V.W. (1992). Boston naming test:
Shortened versions for use in Alzheimer’s disease. Journal of Gerontology, 47, 154-158.

Yorkston, K. M., & Beukelman, D. R. (1980). An analysis of connected speech samples of aphasic and normal speakers. Journal of speech and hearing disorders, 45(1), 27-36.
doi: 10.1044/jshd.4501.27.

Keywords: Neuroimaging, Stroke, Aphasia, assessment, Language

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: not eligible for a student prize

Citation: Keator LM, Sheppard SM, Faria AV, Kim K, Saxena S, Wright A and Hillis AE (2019). Cookie Theft Picture Description: Linguistic and Neural Correlates. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00097

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Received: 30 Apr 2018; Published Online: 22 Jan 2019.

* Correspondence: Ms. Lynsey M Keator, Johns Hopkins Medicine, Neurology, Baltimore, Maryland, 21287, United States, lkeator@jhmi.edu