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Front. Psychol. | doi: 10.3389/fpsyg.2019.00678

Language as a threat: Multimodal evaluation and interventions for overwhelming linguistic anxiety in severe aphasia

  • 1University of Málaga, Spain
  • 2Centro de Investigaciones Médico-Sanitarias, Spain
  • 3Área de Psicobiología, Universidad de Málaga, Spain
  • 4University of Santiago de Compostela, Spain
  • 5Unidad de Neurofisiología del Sistema Nervioso Autónomo, Centro de Investigaciones Medico Sanitarias (CIMES), Spain

Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behaviour, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal haemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A’s husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analysed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.

Keywords: Linguistic anxiety, stress, Aphasia, Language assessment, autonomic response, NeuroImage, rotigotine

Received: 19 Jun 2018; Accepted: 11 Mar 2019.

Edited by:

Agustin Ibanez, Institute of Cognitive and Translational Neuroscience (INCYT), Argentina

Reviewed by:

Adolfo M. García, Laboratory of Experimental Psychology and Neuroscience, Argentina
Alfredo Ardila, Florida International University, United States  

Copyright: © 2019 Torres-Prioris, López-Barroso, Pacheco, Roé Vellvé, Dawid-Milner and Berthier. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Miss. María José Torres-Prioris, University of Málaga, Málaga, 29071, Andalusia, Spain,
PhD. Diana López-Barroso, University of Málaga, Málaga, 29071, Andalusia, Spain,