Assessing Cortisol Reactivity to a Linguistic Task as a Marker of Stress in Individuals With Left-Hemisphere Stroke and Aphasia

Laures‐Gore, Jacqueline; Heim, Christine; Hsu, Yu Sheng

doi:10.1044/1092-4388(2007/034)

Cited by 27 publications

(36 citation statements)

References 46 publications

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“…However, the availability of such attentional resources can be altered by the emotional state of the aphasic individual, who, if anxious, can show heightened psychophysiologic stress responses that would compete with the attention resources required for successful task performance [98]. Such changes may implicate biomarkers of the hypothalamic-pituitary-adrenal (HPA) axis [99], which, in turn, can influence limbic structures subserving memory-based or learning-related language performance [8••]. Taking such variables into account, it seems to us, represents a fruitful course of action promising new hope for the millions of people around the world living within the prison of aphasia.…”

Section: Discussionmentioning

confidence: 99%

Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality

Cahana-Amitay

Albert

2015

Curr Neurol Neurosci Rep

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Aphasia therapy, while demonstrably successful, has been limited by its primary focus on language, with relatively less attention paid to nonlinguistic factors (cognitive, affective, praxic) that play a major role in recovery from aphasia. Neuroscientific studies of the past 15-20 years have opened a breach in the wall of traditional clinico-anatomical teachings on aphasia. It is not an exaggeration to talk of a paradigm shift. The term "neural multifunctionality" denotes a complex web of neural networks supporting both linguistic and nonlinguistic functions in constant and dynamic interaction, creating language as we know it and contributing to recovery from aphasia following brain damage. This paper reviews scientific underpinnings of neural multifunctionality and suggests ways in which this new approach to understanding the neural basis of language can lead to meaningful, practical steps for improvements in aphasia therapy.

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Section: Discussionmentioning

confidence: 99%

Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality

Cahana-Amitay

Albert

2015

Curr Neurol Neurosci Rep

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“…An increase in cortisol levels may influence immune system modulation. Thus, increased levels of cortisol may indicate stress [25,26]. As stress increases, the production of cortisol increases via the hypothalamic-pituitary-adrenal axis [26].…”

Section: Stressmentioning

confidence: 99%

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

Sharp

Shaughnessy

Berk

et al. 2013

PTRS

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Objective: Constraint induced aphasia therapy (CIAT) is a more intensive form of language treatment for aphasia as compared to traditional treatments. This study examined whether there are differences in cortisol stress levels between the two methods of aphasia treatment as well as effects on language skills. Design: Randomized controlled trial. Methods: A total of 20 participants with expressive aphasia were randomly placed into one of the two treatment groups. The CIAT group received 10 days of intensive treatment over two weeks. The traditional therapy group received 6 days of treatment over 2 weeks. All participants in each group provided salivary cortisol samples before treatment, at the mid-point of treatment, and at the conclusion of treatment. Language skills were assessed before treatment and at the conclusion of treatment. Results: A significantly higher proportion of individuals in the CIAT treatment group had increased salivary cortisol stress levels when compared to the traditional treatment group at the mid-point of the program (80% versus 30% respectively, p<0.05). There was no significant difference in the proportion of individuals with increased cortisol stress by the end of the treatment. Language scores for word repetition and overall aphasia quotient significantly improved for the CIAT group when compared to the traditional group (p<0.05). Conclusions:The CIAT treatment appears to initially create increased psychophysiological stress as compared to the traditional treatment. In spite of the initial increases in psychophysiological stress, participants appear to become conditioned to the challenge and ultimately have enhanced benefit from CIAT treatment.

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“…The one exception that we could find is the series of studies by Laures-Gore and colleagues, which measured salivary cortisol levels in persons with aphasia and in healthy controls in relation to performance on linguistic tasks (Laures, Odell, & Coe, 2003; Laures-Gore, Heim, & Hsu, 2007; Laures-Gore, DuBay, Duff, & Buchanan, in press). Laures-Gore and colleagues (2007) hypothesized that persons with aphasia would show hypercortisolemia in response to the stressfulness of the linguistic demand, stemming from chronic HPA dysregulation. For the linguistic task, the investigators used an adaptation of the Trier Social Stress Test: A 5 minute speech, during which subjects were asked to tell an unfamiliar listener about their occupation, followed by questions.…”

Section: Anxiety In Aphasiamentioning

confidence: 56%

“…They also speculated that the non-threatening nature of the experimental design was insufficiently challenging to arouse the patients. Laures-Gore et al (2007) made similar arguments, even though the experimental methods used in the (2007) study were designed to increase threat and, so, arousal. Since the patients in this study once again failed to show cortisol reactivity, the investigators conjectured that persons with aphasia are habituated to language tasks, which are frequently administered to them while in treatment.…”

Section: Anxiety In Aphasiamentioning

confidence: 93%

“…The differences in cortisol profiles between the two groups, however, did not lend themselves to easy analysis. Laures-Gore et al (2007) proposed that patients with aphasia consistently experience language as a repetitive stressor and, as a result, suffer from chronic HPA hypoactivity, commonly found in a range of stress related disorders (e.g., Heim, Ehlert, & Hellhammer, 2000; Fries, Hesse, Hellhammer, & Hellhammer, 2005). Nonetheless, this explanation needs to be reconciled with evidence cited in Carota et al (2001), according to which patients with left hemisphere damage show increased autonomic responses which have been claimed to inhibit the arousal system modulated by the right hemisphere, leading to decreased arousal overall.…”

Section: Anxiety In Aphasiamentioning

confidence: 99%

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Language as a stressor in aphasia

et al. 2011

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Background Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. Aim The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. Main Contribution Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term “linguistic anxiety.” Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to “linguistic anxiety.” Conclusion Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer’s disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom “linguistic anxiety” might be at work when they have trouble finding words.

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Assessing Cortisol Reactivity to a Linguistic Task as a Marker of Stress in Individuals With Left-Hemisphere Stroke and Aphasia

Cited by 27 publications

References 46 publications

Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality

Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality

Stress and language recovery in individuals with aphasia: constraint induced aphasia therapy

Language as a stressor in aphasia

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