Utility of the WHO-Five Well-being Index as a screening tool for depression in Parkinson's disease.

Beck depression inventory (BDI-1A) is the gold standard screening tool for Parkinson's disease (PD) depression, but as a result of its complexity, it is of limited suitability as a quick and easy screening device. We, therefore, validate the 5-item WHO-Five Well-being Index (WHO-5) as a screening tool for PD depression. Two hundred thirteen of 215 recruited PD patients (99.1%) completed the WHO-5. Receiver operating characteristic plots were used to calculate sensitivity/specificity for all cut-off scores for the detection of depression and combined depression/dysthymia as assessed by an independent investigator using the Mini International Neuropsychiatric Interview (MINI). Internal consistency of the WHO-5 was good (Cronbach's alpha = 0.83). WHO-5 showed high validity with adequate detection of depression without differences in the validity indices compared to BDI-1A (P = 0.234). The optimal cut-off value for detection of depression was 12 of 13 points. WHO-5 is a useful, brief, and easy instrument for identifying PD subjects with depression in daily practice.

Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia.

Constraint-Induced Movement Therapy (CIMT) is a powerful and well evaluated therapeutic tool for the treatment of post-stroke paresis. CIMT is based on an intensive training (massed practice) principle and a gradual rebuilding of movement functions (shaping principle). In this article we will review how CIMT principles can be adapted to treat post-stroke aphasia, thereby establishing a Constraint-Induced Aphasia Therapy (CIAT). First results of this new approach suggest success and feasibility for the treatment of chronic aphasia. The observation of reorganizational changes in brain activity following intensive language training add to previous evidence that CIMT-based therapy may lead to macroscopic remodelling of cortical network architecture.

Brain regions essential for improved lexical access in an aged aphasic patient: a case report.

BACKGROUND: The relationship between functional recovery after brain injury and concomitant neuroplastic changes is emphasized in recent research. In the present study we aimed to delineate brain regions essential for language performance in aphasia using functional magnetic resonance imaging and acquisition in a temporal sparse sampling procedure, which allows monitoring of overt verbal responses during scanning. CASE PRESENTATION: An 80-year old patient with chronic aphasia (2 years post-onset) was investigated before and after intensive language training using an overt picture naming task. Differential brain activation in the right inferior frontal gyrus for correct word retrieval and errors was found. Improved language performance following therapy was mirrored by increased fronto-thalamic activation while stability in more general measures of attention/concentration and working memory was assured. Three healthy age-matched control subjects did not show behavioral changes or increased activation when tested repeatedly within the same 2-week time interval. CONCLUSION: The results bear significance in that the changes in brain activation reported can unequivocally be attributed to the short-term training program and a language domain-specific plasticity process. Moreover, it further challenges the claim of a limited recovery potential in chronic aphasia, even at very old age. Delineation of brain regions essential for performance on a single case basis might have major implications for treatment using transcranial magnetic stimulation.

Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy.

BACKGROUND AND PURPOSE: In response to the established notion that improvement of language functions in chronic aphasia only can be achieved through long-term treatment, we examined the efficacy of a short-term, intensive language training, constraint-induced aphasia therapy (CIAT). This program is founded on the learning principles of prevention of compensatory communication (constraint), massed practice, and shaping (induced). METHODS: Twenty-seven patients with chronic aphasia received 30 hours of training over 10 days. Twelve patients were trained with the CIAT program. For 15 patients the training included a module of written language and an additional training in everyday communication, which involved the assistance of family members (CIATplus). Outcome measures included standardized neurolinguistic testing and ratings of the quality and the amount of daily communication. RESULTS: Language functions improved significantly after training for both groups and remained stable over a 6-month follow-up period. Single case analyses revealed statistically significant improvements in 85% of the patients. Patients and relatives of both groups rated the quality and amount of communication as improved after therapy. This increase was more pronounced for patients of the group CIATplus in the follow-up. CONCLUSIONS: Results confirm that a short-term intense language training, based on learning principles, can lead to substantial and lasting improvements in language functions in chronic aphasia. The use of family and friends in the training provides an additional valuable element. This effective intervention can be successfully used in the rehabilitation of chronic aphasia patients. Additionally, its short-term design makes it economically attractive for service providers.

Intensive language training enhances brain plasticity in chronic aphasia.

BACKGROUND: Focal clusters of slow wave activity in the delta frequency range (1-4 Hz), as measured by magnetencephalography (MEG), are usually located in the vicinity of structural damage in the brain. Such oscillations are usually considered pathological and indicative of areas incapable of normal functioning owing to deafferentation from relevant input sources. In the present study we investigated the change in Delta Dipole Density in 28 patients with chronic aphasia (>12 months post onset) following cerebrovascular stroke of the left hemisphere before and after intensive speech and language therapy (3 hours/day over 2 weeks). RESULTS: Neuropsychologically assessed language functions improved significantly after training. Perilesional delta activity decreased after therapy in 16 of the 28 patients, while an increase was evident in 12 patients. The magnitude of change of delta activity in these areas correlated with the amount of change in language functions as measured by standardized language tests. CONCLUSIONS: These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.