A Brief Executive Language Screen for Frontal Aphasia

Abstract

Aphasia assessment tools have primarily focused on classical aphasia type and severity, with minimal incorporation of recent findings that suggest a significant role of executive control operations in language generation. Assessment of the interface between language and executive functions is needed to improve detection of spontaneous speech difficulties. In this study we develop a new Brief Executive Language Screen (BELS), a brief tool specifically designed to assess core language and executive functions shown to be involved in spontaneous generation of language. Similar to other measures of aphasia, the BELS assesses articulation and core language skills (repetition, naming and comprehension). Unique additions to the BELS include assessments of spontaneous connected speech, word fluency (phonemic/semantic) and sentence completion (verbal initiation, inhibition and selection). One-hundred and eight healthy controls and 136 stroke patients were recruited. Confirmatory factor analysis was used to determine construct validity and logistic regression was used to evaluate the discriminative validity, informing the final version of the BELS. The results showed that the BELS is sensitive for articulation and nominal language deficits, and it measures executive aspects of spontaneous language generation, which is a hallmark of frontal dynamic aphasia. The results have encouraging theoretical and practical implications.

Validation of a Novel Cognitive Screen in Acute Stroke: The Brief Executive Language Screen

“…Post-stroke cognitive impairments occur in up to 70% of patients and frequently persist long-term (> 1 year), which contributes to disability and reduced quality of life (Barker-Collo & Feign, 2006;Hackett & Anderson, 2000;Nys et al, 2007;Wagle et al, 2011;Warlow, 1998). Domains commonly affected during the acute stage (within three weeks of stroke) include executive functions language, attention, and memory (Chahal et al, 2011;Nys et al, 2007;Law et al, 2015;Robinson et al, 2021). Acute executive, language and attention deficits are predictors of long-term functional, neuropsychological, and emotional outcomes (Chahal et al, 2011;Nys et al, 2005;Nys et al, 2007;Lesniak et al, 2008;Robertson et al, 1997).…”

“…It is also the strongest predictor of functional and cognitive outcomes one-year post-stroke (Lesniak et al, 2008;Nys et al, 2005;Nys et al, 2007). Stroke patients also often demonstrate impaired propositional language; which is voluntary, spontaneous, and connected speech that is novel to a context, and crucial for communicating ideas, thoughts, instructions, and feelings (Barker et al, 2020;Law et al, 2015;Levelt, 1999;Robinson et al, 2021;Sherratt, 2007). Impairment presents as diminished quantity and quality of connected speech, and consequently individuals can experience less meaningful communication and strained relationships with others (Law et al, 2015).…”

“…Propositional language impairment highlights the interface of language and executive functions (Alexander, 2006;Barker et al, 2017;Barker et al, 2022;Robinson et al, 2006;Robinson et al, 2015;Robinson et al, 2021). Models of spoken language production (e.g., Dell, 1986;Dell et al, 1999;Levelt, 1989;Levelt, 1999;Sherratt, 2007) typically posit three stages: conceptualisation (i.e., broader formulation and structure of intended message, resulting in a 'pre-verbal' message); linguistic formulation (i.e., words encoded with syntax and sounds retrieved and available to speaker); and articulation (i.e., overt speech).…”

“…Further, poor cohesion and coherence of spontaneous speech in RHS patients is linked to executive and attentional dysfunction, as opposed to linguistic deficits (Barker et al, 2017;Blake, 2021;Sherratt & Bryan, 2012). However, impairments to propositional language have also been associated with left frontal lobe damage (Costello & Warrington, 1989;Kiran, 2012;Price et al, 2010;Robinson et al, 1998;Robinson et al, 2005;Robinson et al, 2021) or left basal ganglia damage (e.g., Crescentini et al, 2008). Acute left hemisphere stroke (LHS) patients have shown greater impairment in executive functions, memory, core language, and abstract reasoning than RHS patients (Nys et al, 2007).…”

Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia

“…In line with these studies, Robinson et al’s paper, “A Brief Executive Language Screen for Frontal Aphasia” [ 4 ], focuses on the development of an abbreviated aphasia screening tool designed to assess the executive components of language generation in a cohort of one hundred and thirty-eight stroke patients matched with one hundred and eight controls. Based on contemporary theoretical models which posit that different cognitive processes contribute to spoken language generation, the Brief Executive Language Screen (BELS) assesses propositional language (spontaneous speech), nominal language functions (repetition, comprehension, naming, and reading), and the role of executive components in the conceptualization phase of language generation.…”