Verbal Function

Disturbances in language function are one of the most noticeable impairments in cognitive abilities. They can be the result of generalized cognitive deterioration, as in dementing conditions (see Chapter 33 ), or confusional states (see Chapters.3.8 , 39 , 40 , and 55 ). Likewise, they may be due to specific lesions, as in transcortical aphasia (see Chapter 6) or psychiatric conditions (see Chapters ), as in psychotic word salad or neologisms. Most assessments of verbal function include testing of expressive abilities (spontaneous speech, naming, repetition of words and phrases, writing) and receptive abilities (comprehension of speech, comprehension of written material).

APHASIA BATTERIES (see Chapters )

Boston Diagnostic Aphasia Examination (BDAE). y This battery is a comprehensive assessment of verbal function. It provides information on 12 areas of language abilities using 34 subscales. Assessments include verbal comprehension, written comprehension, writing to dictation, naming, articulation, spontaneous speech, repetition, reading, following simple and complex commands, speech fluency, and prosody. The test provides an overall severity rating score and a profile of subtest performance. This test is very useful in providing a comprehensive assessment of verbal function, but because of the number of items, testing time is quite long. Therefore, this battery is mostly used for specific diagnosis and rehabilitative planning of aphasic patients. Because of scoring and normative information, separate subtests can be given independently for a more focused (and shorter) examination of specific areas of verbal function.

Multilingual Aphasia Examination (MAE).y This test is similar to the BDAE in that it provides a comprehensive assessment of language function. The administration time is shorter, however. MAE tests were taken from the Neurosensory Center Comprehensive Examination for Aphasia. An advantage to the MAE is that alternate forms are provided, so repeated testing can be conducted without contamination of practice effects. Subtests of the MAE can also be given independently of the complete battery.

Neurosensory Center Comprehensive Examination for Aphasia (NCCEA).y This battery provides detailed assessments of reading, writing, articulation, visual abilities, and tactile abilities. The battery has 20 subtests measuring visual naming, description of use of objects, tactile naming, digit repetition forward and backward, sentence construction, identification of objects, oral reading for single words and sentences, visual naming of objects, written naming of objects, writing to dictation, writing from copy, and articulation. In addition, four "control tests" are provided. These tests are given if the patient makes errors on the tactile naming, visual naming, or reading tests. Extensive norms are provided for each subtest, so they may be used independently. Administration time is usually under 2 hours, which makes this battery practical in everyday clinical use.

APHASIA SCREENING TESTS

Because most aphasia batteries require extensive time for administration, screening measures have been developed. These screening tests have variable reliability, sensitivity, and specificity to language impairments.

Aphasia Screening Test.y This test is part of the Halstead-Reitan Battery and is composed of 32 items testing reading, articulation, spelling, repetition, naming, calculations, and construction. Administration time is brief (approximately 15 to 30 minutes). Each ability is tested with one or two items, so the range of abilities is not great. In addition, studies of the diagnostic utility of this test have been disappointing. y

The Token Test.y This test is extremely sensitive to impairments in verbal functions. It does not provide specific information as to type of verbal disturbance, however. The patient is presented with tokens of different shapes (i.e., circles, squares, triangles), sizes, and colors. The patient is required to perform certain acts with the tokens, such as point to selected tokens, touch them, pick them up, and place one token on top of another. Administration and scoring are very simple and the testing time is brief (approximately 15 minutes). Because this test requires comprehension of detailed information, it is sensitive to patients with disturbances of attention and vigilance. This test is particularly useful in identifying the presence of verbal function disturbances and whether additional, more detailed testing is required.

INDIVIDUAL TESTS OF VERBAL SKILLS

The most commonly used individual tests of verbal skills come from the batteries discussed above. Because of the common use of these individual tests, a few will be presented below.

Naming Test.y This test comes from the MAE. Patients are required to name common and uncommon objects depicted in line drawings.

Boston Naming Test. y This naming test is not part of any battery, but is often added to the BDAE. Patients are required to name 60 objects depicted in line drawings. The objects range from simple and common objects such as a tree to complex and uncommon objects such as an abacus. If a patient is unable to name an object, he or she is given a phonemic cue and a semantic cue.

Controlled Oral Word Association Test.y This test measures verbal fluency and comes from the MAE. Patients are required to generate as many words as possible, as quickly as possible, to a given letter. Proper nouns, numbers, and the plural form of a produced word are not allowed. The patient is given three 1-minute trials using three different letters. A variant of this test also requires the patient to generate exemplars from different categories (e.g, four-legged animals, things found in a grocery store, parts of a building).

Sentence Repetition.y This test is part of the MAE and requires the patient to repeat spoken sentences. The first item is simple, composed of three syllables, and the last item is complex, composed of 24 syllables. In addition to testing repetition, this test assesses verbal memory.

CLINICAL SITUATIONS FOR TESTS OF VERBAL FUNCTION

Assessment of language function is necessary for all neuropsychological examinations. Not only do these tests provide information about verbal function, they also assess basic skills needed to complete other neuropsychological tests. Usually, requests for administration of aphasia batteries are limited to patients with documented verbal impairments. Screening tests or individual tests of naming, comprehension, verbal fluency, repetition, reading, and writing should be requested for all referrals. In the assessment of patients with vascular disease (see Chapter.^, and Chapter.45 ), cortical developmental (see Chapter.2.8. and Chapter..30 ), or degenerative processes (see Ch§pie.Ls.,..3.1 32 33 34 35 ), language testing can help in identifying deficits and tracking verbal decline or improvement.

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