Search Results (114)

Background/Objectives: Stroke-related aphasia significantly impairs communication and quality of life (QoL). Constraint-induced aphasia therapy (CIAT) and repetitive transcranial magnetic stimulation (rTMS) are evidence-based approaches targeting language recovery. No combined protocol exists for Greek, a morphologically complex language. The present study was designed as a feasibility pilot, with the primary objective of determining if a modified CIAT (mCIAT) protocol, with or without continuous theta burst stimulation (cTBS), could be delivered safely and acceptably in a Cypriot clinical context, while also reporting the first mCIAT protocol adapted for Greek. Methods: A single-subject experimental design (SSED) was employed. Two participants (PAs) with chronic anomic aphasia underwent a 10-day treatment protocol. PA1 received sham cTBS plus mCIAT-GR; PA2 received real cTBS (to the right inferior frontal gyrus) plus mCIAT. Multiple language, cognitive, and QoL measures were administered across three baselines and two follow-up time points. Results: Both PAs completed the full protocol with 100% session adherence and no adverse effects, establishing the feasibility of delivery. Neither participant showed improvements in standardized expressive language measures following mCIAT with or without cTBS; Standard Error of Measurement (SEM) analysis confirmed that observed score fluctuations on most measures fell within expected measurement noise. PA2 showed improvement in QoL (SAQOL-39g) domains at the two-year follow-up, though this finding requires cautious interpretation given the follow-up interval and regression-to-mean considerations. Conclusions: The Greek mCIAT protocol is feasible and safe to deliver in a Cypriot clinical setting. The absence of clear language improvements may reflect several factors, including ceiling effects, limited assessment sensitivity, insufficient treatment dosage, or limited intervention effects. These findings should be interpreted cautiously and require confirmation in larger, adequately powered studies. Full article

The assessment of consciousness has been shaped largely by research on acquired disorders of consciousness after acute or chronic brain injury, but similar problems of unreliable behavioral expression increasingly arise in neurodegenerative disease. This translational overlap is especially relevant when preserved cognition, awareness, or intentionality cannot be reliably expressed because of severe motor impairment, fluctuating arousal, cognitive decline, aphasia, apraxia, or impaired cooperation. In neurodegenerative disease, degeneration of arousal systems, large-scale brain networks, cognition, and motor pathways may similarly make observable behavior an unreliable measure of awareness. The challenge is not only to determine if a patient responds, but also to ask if residual awareness, intentionality, or covert cognition can still be detected through physiological signals. This review discusses how contemporary modalities reshape this assessment. Electroencephalography has moved from a descriptive measure of background activity to a bedside tool capable of probing event-related responses, network organization, and cortical complexity. Magnetic resonance methods reveal altered connectivity within thalamocortical and default mode network systems, while functional near-infrared spectroscopy adds a portable hemodynamic approach that may be repeated at the bedside and integrated with active paradigms. Brain–computer interfaces provide a translational step by converting neural responses into evidence of command following or, in selected patients, into communication, and artificial intelligence strengthens these approaches by extracting clinically meaningful patterns from complex neural and hemodynamic data. Additionally, autonomic measures, including heart rate variability and baroreflex indices, are considered as auxiliary physiological context for arousal and engagement, and not as direct markers of awareness. Because the most mature evidence for covert awareness and cognitive-motor dissociation comes from acquired disorders of consciousness, this review treats brain injury literature as a methodological foundation instead of as directly interchangeable evidence for neurodegenerative disease. It then examines how these approaches may be adapted to neurodegenerative contexts, especially ALS, severe dementia, Lewy body disease with fluctuating cognition, and conditions in which communication or motor output becomes unreliable. Full article

Background/Objectives: While a growing number of studies have demonstrated positive effects of adjuvant anodal transcranial direct current stimulation (tDCS) on linguistic performance in aphasia, evidence for corresponding effects on verbal and—in particular—nonverbal functional communication remains absent. This is a critical gap, given that restoring everyday communicative competence is the ultimate goal of speech and language therapy (SLT). In the present observational study, we investigated the add-on effect of anodal tDCS over language-relevant left-hemispheric areas on verbal and nonverbal functional communication in n = 34 individuals with subacute aphasia and examined the relationship between communicative and linguistic change. Methods: Participants underwent two consecutive two-week therapy phases (P1, P2), each consisting of 10 SLT sessions. Severity-specific linguistic and communicative assessments were administered before, between, and after both phases: the Aachen Aphasia Test (AAT; n = 26) combined with the Amsterdam–Nijmegen Everyday Language Test (ANELT, A-scale), and the Bielefeld Aphasia Screening Rehabilitation (BIAS-R; n = 8) combined with the Scenario Test. During P2, SLT was supplemented by online anodal tDCS. Results: Overall test performance improved significantly more in tDCS-supported P2 compared to P1 (AAT profile level, p < 0.001; BIAS-R mean percentage value (MPW), p = 0.027; ANELT A-scale raw score Version 1, p = 0.081, and version 2, p = 0.038; and Scenario Test total score, p = 0.003). Significant correlations between AAT profile level and ANELT total scores were found across all time points. Between the MPV and subtests of the BIAS-R and the Scenario total score, there was a tendency toward decreasing correlation levels from T1 to T3. Conclusions: To our knowledge, this is the first study demonstrating that adjuvant tDCS in subacute aphasia enhances not only linguistic performance but also verbal and nonverbal functional communication beyond SLT alone—assessed with standardized, performance-based, ecologically valid instruments. Full article

Background: Prosodic cues play a critical role in marking syntactic boundaries and guiding sentence interpretation. However, Turkish clinical language batteries lack dedicated measures targeting linguistic prosody and the syntax–prosody interface. Consequently, subtle auditory–prosodic comprehension difficulties may go undetected in stroke populations who perform within normal limits on standard aphasia assessments. This study presents the development and initial psychometric evaluation of the Prosodic Comprehension Test (PCT), a Turkish sentence–picture matching tool designed to isolate prosodic contributions to meaning under controlled syntactic conditions. Methods: A total of 440 neurologically healthy native Turkish-speaking adults participated. An initial pool of 80 sentences (40 minimal pairs), identical in segmental and syntactic structure but differing in interpretation through prosodic boundary placement, was created. Audio stimuli were recorded by a professional actor, and corresponding visual stimuli represented alternative interpretations. Following expert review, 32 sentences (16 pairs) were retained and organized into three subcomponents: In situ Prosody, Focus–Topic Marking, and Pragmatic Disambiguation. Administration included fixed-intensity auditory presentation and a structured learning phase. Results: Internal consistency was acceptable (Cronbach’s α = 0.73). Principal component analysis was consistent with the theoretically proposed three-component structure (KMO = 0.74; Bartlett’s test significant, p < 0.001), with the three components collectively accounting for 28.2% of the total variance. Convergent validity was supported by a significant positive correlation with MoCA-TR (r = 0.23, p < 0.001, 95% CI [0.14, 0.32]). Conclusions: The PCT appears to be a linguistically grounded and psychometrically promising tool for assessing prosodic comprehension in Turkish. The present findings are based on a healthy adult sample and should be interpreted as preliminary normative evidence. Further research should address test–retest reliability, confirmatory factor analyses, and validation in clinical populations. Full article

Background/Objectives: Verb anomia is a common symptom of primary progressive aphasia (PPA), particularly in the logopenic variant (lvPPA). Despite the central role of verbs in sentence construction, interventions specifically targeting verb anomia remain scarce. This study examined the effects of Personalized Observation, Execution and Mental Imagery (POEM) therapy, grounded in evidence that sensorimotor systems are recruited during action verb processing and may support verb retrieval. Methods: A 74-year-old woman with lvPPA completed pre- and post-POEM assessments (linguistic, cognitive, thymic, and motor). POEM consisted of 15 telepractice sessions delivered three times weekly using a systematic procedure with three sensorimotor strategies: action observation, gesture execution, and mental imagery. Results: No significant gains were observed in verb production across naming tasks, spontaneous speech, or functional communication contexts. However, co-verbal gesture use increased in frequency and quality, particularly during the naming of untrained verbs, suggesting that the gesture execution strategy was generalized. A delayed treatment effect was also noted, raising questions regarding the optimal duration of POEM in neurodegenerative conditions. Conclusions: While no statistically significant improvements in verb production were observed, qualitative analyses revealed increased use and quality of co-verbal gestures, suggesting that POEM had a compensatory effect. Future research involving larger cohorts and longer periods could help clarify the benefits of POEM therapy. It would also be relevant to compare in-person and remote delivery formats to evaluate POEM therapy’s robustness and adaptability in different clinical contexts. To conclude, these findings remain preliminary and should be interpreted with caution, particularly given the lack of significant improvement in primary verb production outcomes. Full article

Informed consent is a core ethical and legal requirement in clinical practice. For individuals with aphasia, language impairments can hinder communication during consent processes. However, aphasia is primarily a language disorder and does not inherently imply cognitive impairment, a distinction frequently overlooked in clinical and legal settings. This scoping review examines how decision-making capacity (DMC) is assessed and supported in adults with aphasia, and outlines the clinical, ethical, and medico-legal implications for consent procedures. The review followed PRISMA-ScR guidelines. A systematic search of biomedical and legal databases was conducted without time restrictions. Studies addressing informed consent or DMC in adults with aphasia were included and analyzed using a qualitative thematic approach. Out of 519 records, 9 studies (2010–2024) from Australia, Canada, the United Kingdom, and Ireland met inclusion criteria. These studies often referenced national legislation and rights-based frameworks to define clinical responsibilities. Three main themes emerged: (1) DMC assessments rely heavily on language, with limited involvement of speech–language pathologists (SLPs), despite their role in reducing bias; (2) supported communication strategies—such as simplified language, visual aids, alternative response formats, and structured tools—can uncover “hidden competence”; and (3) structural barriers, including time constraints, insufficient training, and limited access to aphasia services, restrict implementation. Current evidence remains limited, largely qualitative, and insufficient to support definitive clinical recommendations. Incorporating supported communication, multidisciplinary assessment, and thorough documentation may enhance fairness and legal robustness. Future research should focus on validating aphasia-sensitive tools and evaluating their impact on outcomes and medico-legal risk. Full article

Aphasia is a complex neurological syndrome that includes a multitude of signs and symptoms that describe a patient’s inability to use language (understanding and producing spoken and/or written language) after it has already been acquired, which is caused by cerebral lesions situated in the dominant (left) cerebral hemisphere in right-handed people. Aphasia has a prevalence of 25–30% in acute ischemic stroke (especially in arterial infarcts). In patients who suffered cerebral venous and dural sinuses thrombosis (CVST), aphasia has been noticed in almost 20% of cases, its presence being considered a negative predictive factor. We report the case of a 22-year-old right-handed woman with obesity and active smoking (10 cigarettes/day), undergoing treatment with oral contraceptives who presented to the Emergency Department with an intense headache, resistant to usual analgesic treatment, accompanied by language disorders onset within 24 h. The neurological examination was normal, except for language assessment, which revealed the severe impairment of the repetition domain (she was unable to repeat simple words), and difficulty in naming objects with some hesitations and mild comprehension difficulties (especially in complex orders). She underwent neuroimaging examinations at admission. Native Head Computed Tomography revealed spontaneous hyperdensity (parenchymatous hematoma) in the left temporal lobe. Cranial magnetic resonance imaging (MRI) confirmed venous infarction in the left temporal area and a hypointense signal on MRI T2*SW (susceptibility-weighted) in the region of the left lateral sinus and left jugular vein bulb, which confirmed the thrombosis at this level. Associated cortical vein thrombosis was diagnosed on indirect radiological grounds, since hemorrhagic transformation obscured the direct visualization of the adjacent cortical veins. MR venography was not performed at that time, but instead at the 1-month follow-up, MR venography confirmed the chronic, partial thrombosis of the left lateral sinus and left jugular vein bulb. Laboratory data demonstrated an elevated D-dimer and the presence of homozygosity for MTHFR C677T and PAI-1 4G/4G. Anticoagulation in the form of low-molecular-weight heparin was immediately started, followed by chronic treatment with oral anticoagulant (apixaban) and folic acid. The headaches resolved within three days, and her neurological examination was almost normal: the repetition continued being altered for complex phrases. We did not observe any left lateral sinus thrombosis recurrence, or other extra-cerebral embolic events (deep vein thrombosis or pulmonary embolism) during the follow-up year. The immediate anticoagulation since the admission resulted in a favorable outcome. Taking into consideration our interest in monitoring patients with aphasia secondary to CVST, we also analyzed data from the literature regarding the incidence of conduction aphasia and other aphasic syndromes in this CVST. Due to the limited number of articles identified in the last 21 years (2005–2026) in the literature, we concluded that conduction aphasia is an extremely rare clinical presentation in this kind of pathology and further studies should be conducted in order to identify significant statistical data. Full article

Background/Objectives: Spontaneous intracranial hypotension (SIH) is a rare pathology that arises in the context of a known or suspected cerebral spinal fluid (CSF) leak. A key symptom of SIH is an orthostatic headache; however, additional neurological complications are common. This case study not only highlights the co-existence of Menière’s disease and SIH but describes a subsequent complication of benign paroxysmal positional vertigo (BPPV) and management thereof. Case Description: The patient is a 61-year-old female who presented to the emergency department due to an intractable headache, right sided weakness and aphasia. CT/MRI revealed a subdural hematoma overlying the left cerebral hemisphere measuring up to 8 mm with 4 mm left to right midline shift. Fluoro-guided total spine myelogram, cisternogram, and lumbar epidural blood patch were performed for suspected SIH. As headache, right sided weakness and aphasia resolved, the patient began reporting onset of constant “spinning” dizziness, tinnitus and aural fullness mimicking symptoms of a Menière’s attack. The vestibular examination was consistent with compensated bilateral Menière’s disease (left > right) and right horizontal canalithiasis BPPV. The patient was treated with Gufoni and Lempert maneuvers with complete resolution of positional dizziness and associated nystagmus along with improved balance and gait. Discussion/Conclusions: This case study highlights the importance of multidisciplinary assessment in complex neurological cases and specifically recommends that patients with Menière’s disease accompanied by intractable headaches undergo extended neuroradiological examination of the brain to exclude underlying spontaneous intracranial hypotension syndrome. Full article

The nonfluent/agrammatic variant of primary progressive aphasia (nfav-PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes that raise diagnostic challenges related to several issues. First, there are two divergent conceptions, one stipulating that (i) nfav-APP and PPAOS are distinct entities, and the other (ii) that PPAOS has to be integrated into the nfav-APP spectrum. A second related issue concerns the consideration of phonological dimensions, lying at the language interface with speech, which could potentially help overcome the nfva-PPA/PPAOS controversy. Third, there is a lack of internationally validated clinical tests assessing apraxia of speech and syntactic abilities with sufficient specificity and sensitivity. This narrative review discusses these issues taking into account clinical, neurocognitive and neurobiological dimensions. It proposes a conceptual-integrative framework conciliating competing nfav-APP/PPAOS accounts while suggesting a graded continuum with subdivisions, related to neurodegenerative expansion throughout language/speech production systems, ranging from syntactic to phonological to phonetic-articulatory impairments. A second controversy in the field of PPA arises from divergent conceptions of semantic PPA (sv-PPA), defined by primary damage to verbal semantics, and of semantic dementia (SD) characterized by multimodal semantic impairments. The current consensus criteria of PPA have deconstructed the initial SD conception by absorbing it into sv-PPA, hence leaving mixed and some non-verbal semantic phenotypes nosologically orphaned. Again, the article proposes a conceptual and integrative model, built on findings from clinical research and cognitive neuroscience, suggesting a graded continuum with subdivisions spanning from verbal to different non-verbal semantic impairments including social-semantic/behavioral phenotypes. Full article

Background: Given the central role of writing and typing in contemporary communication, integrating writing assessments into clinical practice is crucial for improving the diagnosis and management of primary progressive aphasia (PPA). This scoping review summarizes evidence on writing abilities in PPA, examining task types, their strengths and limitations, the linguistic features of stimuli, and the influence of language differences. Methods: A literature search was conducted using the Google Scholar and PubMed databases. We included papers published in peer-reviewed journals and written in English that present data from at least one PPA subject and report a quantitative score relative to a writing task. Fifty-one studies were included (forty-seven behavioral; four with neuroimaging). Results: Overall, the literature is fragmented, with marked variability in task design and the control of psycholinguistic variables. Writing to dictation is the most frequently used task but fails to capture the full spectrum of writing impairments, whereas tasks tapping lexico-semantic, morpho-syntactic, and discourse-level abilities are rarely employed. At the syndromic description level, svPPA typically shows surface dysgraphia, nfvPPA presents phonological dysgraphia and agrammatic writing, and lvPPA displays mixed error profiles. Neuroimaging findings are highly heterogeneous. Conclusions: The review underscores the need for systematic, linguistically grounded approaches to writing assessments in PPA to enhance diagnostic precision and cross-linguistic comparability. Full article

Background: Stroke is a leading cause of mortality and long-term disability, and aphasia is among its most common and debilitating sequelae. Diffusion tensor imaging (DTI) and advanced diffusion imaging techniques enable the assessment of white matter integrity and provide clinically relevant measures in post-stroke aphasia. Methods: We conducted a comprehensive review of studies applying DTI or advanced diffusion imaging to investigate structural connectivity in adults with post-stroke aphasia (PSA). PubMed, CENTRAL, Ovid MEDLINE, and Embase were searched, and eligible studies were synthesized according to their diagnostic, prognostic, or therapeutic focus. Results: Ninety-five studies were included. Of these, 59 were classified as diagnostic, 17 as prognostic, and 19 as therapeutic. Most studies employed conventional DTI (n = 77), while a growing body of research utilized advanced diffusion models, including CSD, DSI, and DKI (n = 18). Conclusions: This comprehensive synthesis demonstrates the evolution of diffusion imaging in PSA research. While conventional DTI has provided foundational insights, advanced diffusion methods offer superior characterization of complex fiber architecture and improved clinical–anatomical correlation. Diffusion-derived markers of dorsal and ventral language pathways were consistently associated with language performance, while connectome-level analyses highlighted the importance of preserved global network architecture for recovery. Continued efforts are needed to translate diffusion imaging findings into clinical applicable biomarkers to guide personalized aphasia rehabilitation, with greater use of advanced methods. Full article

Background/Objectives: The Speech-Language Pathologists (SLP) are an integral part of the multidisciplinary team approach to rehabilitation of persons with aphasia (PWA). However, the efficacy of treatment provided by SLPs can vary due to several factors related to clinicians, patients, and the availability of services. The present study was conducted with the aim of investigating current practices in aphasia rehabilitation, key challenges, and future directions as perceived by the SLPs in the Indian context. Methods: The study was conducted using a web-based survey comprising a 32-item questionnaire to gather information related to demographic and professional details, knowledge and use of aphasia rehabilitation approaches, patient education, counselling, bilingual & multilingual contexts, and challenges faced by SLPs. A total of 142 responses were analyzed after initial screening to assess the knowledge, use, and confidence of aphasia rehabilitation along with challenges faced by SLPs in the Indian context. Results: The results indicated significant challenges in the assessment of aphasia due to a lack of formal screening and diagnostic languages in several languages. Further, the results also indicated variations in the knowledge level and confidence in the use of various approaches to aphasia rehabilitation, which warrants the urgent need for organizing short-term training programs for SLPs. The participants also self-reported significant challenges in managing bilingual and multilingual patients with aphasia due to differences in their knowledge and confidence in the selection of language for treatment. On the other side, major patient-related challenges include inadequate logistics, lack of funding, unavailability of speech and language therapy services, social acceptance, and support from family members. The participants also reported the necessity of improving tele-rehabilitation services and developing materials and mobile apps for rehabilitation in Indian languages as future directions for aphasia rehabilitation. Conclusions: The present study through a self-reported questionnaire identified key challenges in aphasia rehabilitation related to the clinician and PWA in the Indian context. The results of the study warrant the need for immediate action to overcome the challenges to enhance the rehabilitation services to PWAs. Full article

Background/Objectives: Primary progressive aphasia (PPA) is a clinical syndrome associated with gradual language impairment caused by neurodegenerative disease. While people with post-stroke aphasia often depend on visual and prosodic cues to facilitate language, we hypothesized that people with PPA may have difficulty using such cues due to degeneration in the right hemisphere (albeit less than in the left hemisphere) in PPA. Methods: Eighty-eight outpatients diagnosed with PPA received the Hopkins Auditory Comprehension with Context Assessment (HACCA), a recently developed instrument that systematically titrates both acoustic (prosody) and visual (speaker image) cues in a four-item forced-choice sentence picture matching paradigm assessing comprehension. Patients were grouped based on the effects of cues on accuracy and were examined both by the PPA variant and individually. Results: There was a significant difference between performance classifications across the three cueing conditions as a function of PPA variant (p = 0.014). When individuals with distinct complementary profiles of performance across conditions were examined separately, a small number with logopenic PPA uniquely benefitted from the inclusion of video, while certain patients performed more poorly given any additional cues. HACCA performance across cueing conditions had a strong positive association with other concurrent measures of communication and cognition. Conclusions: Individual patterns of response to prosodic and visual cues provide important insights valuable in refining therapeutic approaches that target the retention of function and support a more robust understanding of the individual variability among patients with this uncommon neurodegenerative syndrome. Full article

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with PPA. This study aims to examine the effectiveness of an elaborated Semantic Feature Analysis (SFA) approach in enhancing naming abilities and semantic networks in individuals with the logopenic and semantic variants of PPA. Methods: Fourteen participants were recruited, including seven individuals with logopenic PPA and seven with semantic PPA. All participants received an elaborated SFA intervention twice weekly for four weeks. The Aphasia Language Assessment Test (ADD), the Turkish Picture Naming Test (T-RAT), and the SAQOL-39 were conducted at the following three time points: prior to treatment (pre-test), immediately after treatment (post-test), and one month post-treatment (follow-up). Results: Significant improvements were observed in ADD, T-RAT, and SAQOL-39 scores in both logopenic and semantic PPA groups following treatment (p < 0.05). Although follow-up scores declined compared to posttest performance (p < 0.05), several follow-up scores remained higher than pretest levels. Between-group comparisons indicated no significant difference in ADD scores; however, logopenic PPA participants demonstrated higher T-RAT scores (p < 0.05), while semantic PPA participants showed higher SAQOL-39 scores, except at follow-up (p < 0.05). Conclusions: Preliminary results suggest that the elaborated SFA intervention is effective in improving naming skills, language functioning, and quality of life in both logopenic and semantic variants of PPA. Although treatment gains partially decreased after one month, many improvements were maintained above baseline, supporting the clinical value of SFA in managing language decline in PPA. Full article

Background/Objectives: Aphasia screening tools help healthcare professionals detect aphasia after a stroke. To date, there is no standardized and validated aphasia screening tool available for use in Cyprus. The Cyprus Aphasia Screening Test (CAST) is a newly developed tool for detecting post-stroke aphasia. This study aims to present the main characteristics of the CAST and evaluate its psychometric properties and diagnostic accuracy. Methods: A cross-sectional study was conducted, involving 99 participants divided into three groups as follows: 43 people with stroke-aphasia, 21 with strokes but without aphasia, and 35 healthy controls. Results: The CAST demonstrated excellent internal consistency (Cronbach’s α > 0.967), high test–retest (ICC ≥ 0.983) and interrater (ICC = 0.979) reliability, and verified known-groups validity (p< 0.001). A significant correlation between the total scores of the CAST and the Greek version of the Boston Diagnostic Aphasia Examination (Short Form) confirmed a linear relationship across the two measures (p < 0.001). A ROC curve analysis (AUC = 0.97) identified 36/40 as the cut-off for detecting aphasia. Conclusions: The CAST is a reliable, clinician-administered aphasia screening tool with strong psychometric properties. It is designed to identify post-stroke aphasia and distinguish between stroke patients with and without aphasia. It consists of 10 subtests that assess both language comprehension and production. The CAST is designed for easy scoring and requires minimal equipment, making it well-suited for quick and efficient administration at the bedside. The CAST represents a step forward in aphasia screening for Greek-speaking populations in Cyprus. Full article