The Case of the Cookie Jar: Differences in Typical Language Use in Dementia.

Background: Findings from language sample analyses can provide efficient and effective indicators of cognitive impairment in older adults. Objective: This study used newly automated core lexicon analyses of Cookie Theft picture descriptions to assess differences in typical use across three groups. Methods: Participants included adults without diagnosed cognitive impairments (Control), adults diagnosed with Alzheimer's disease (ProbableAD), and adults diagnosed with mild cognitive impairment (MCI). Cookie Theft picture descriptions were transcribed and analyzed using CLAN. Results: Results showed that the ProbableAD group used significantly fewer core lexicon words overall than the MCI and Control groups. For core lexicon content words (nouns, verbs), however, both the MCI and ProbableAD groups produced significantly fewer words than the Control group. The groups did not differ in their use of core lexicon function words. The ProbableAD group was also slower to produce most of the core lexicon words than the MCI and Control groups. The MCI group was slower than the Control group for only two of the core lexicon content words. All groups mentioned a core lexicon word in the top left quadrant of the picture early in the description. The ProbableAD group was then significantly slower than the other groups to mention a core lexicon word in the other quadrants. Conclusions: This standard and simple-to-administer task reveals group differences in overall core lexicon scores and the amount of time until the speaker produces the key items. Clinicians and researchers can use these tools for both early assessment and measurement of change over time.

A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research.

BACKGROUND: It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians' and researchers' desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation. AIMS: To use scoping review methodology to identify transcription-less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: 'What transcription-less tools and analysis procedures are available to assess discourse in people with aphasia?' and included several sub-questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties. METHODS: The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer-reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. 'Transcription-less' analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review. MAIN CONTRIBUTION: An overview of the state of transcription-less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings. CONCLUSION: Transcription-less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings. WHAT THIS PAPER ADDS: What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech-language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription-less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients' desired outcomes. However, little is known about the current state of transcription-less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription-less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription-less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro-structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription-less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription-less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription-less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription-less discourse analysis to better monitor clients' desired treatment outcomes.

Validation of an Automated Procedure for Calculating Core Lexicon From Transcripts.

PURPOSE: The aim of this study was to advance the use of structured, monologic discourse analysis by validating an automated scoring procedure for core lexicon (CoreLex) using transcripts. METHOD: Forty-nine transcripts from persons with aphasia and 48 transcripts from persons with no brain injury were retrieved from the AphasiaBank database. Five structured monologic discourse tasks were scored manually by trained scorers and via automation using a newly developed CLAN command based upon previously published lists for CoreLex. Point-to-point (or word-by-word) accuracy and reliability of the two methods were calculated. Scoring discrepancies were examined to identify errors. Time estimates for each method were calculated to determine if automated scoring improved efficiency. RESULTS: Intraclass correlation coefficients for the tasks ranged from .998 to .978, indicating excellent intermethod reliability. Automated scoring using CLAN represented a significant time savings for an experienced CLAN user and for inexperienced CLAN users following step-by-step instructions. CONCLUSIONS: Automated scoring of CoreLex is a valid and reliable alternative to the current gold standard of manually scoring CoreLex from transcribed monologic discourse samples. The downstream time saving of this automated analysis may allow for more efficient and broader utilization of this discourse measure in aphasia research. To further encourage the use of this method, go to https://aphasia.talkbank.org/discourse/CoreLexicon/ for materials and the step-by-step instructions utilized in this project. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20399304.

Assessment of language impairment and function.

This chapter is written for the qualified neurologist or related professional working with persons who have had a stroke or other sudden brain injury. It is critical that the presence of aphasia is detected, no matter how mild the presentation, and to support that assertion, this chapter highlights the plight of persons with latent aphasia. At the individual level, the impact of aphasia is devastating, with overwhelming evidence that aphasia negatively impacts psychosocial outcomes. At the global level, sensitive detection and accurate diagnosis of aphasia are critical for accurate characterization and quantification of the global burden of aphasia. The word "LANGUAGE" is leveraged as an acronym to create a useful and memorable checklist to guide navigation of aphasia screening and assessment: it begins with the definition of language (L), followed by the definition and diagnostic criteria for aphasia (A). Then language abilities and characteristics to be considered in assessment are presented: naming (N); grammar and syntax (G); unintelligible words, jargon, and paraphasias (U); auditory comprehension and repetition (A); graphemic abilities-reading and writing (G); and everyday communication and discourse (E). Recommendations for improving procedural adherence are provided, and a list of potential brief assessment measures are introduced.

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia.

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG's six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity.

Main concepts for two picture description tasks: An addition to.

BACKGROUND: Proposition analysis of the discourse of persons with aphasia has a long history, yielding important advancements in our understanding of communication impairments in this population. Recently, discourse measures have been considered primary outcome measures, and multiple calls have been made for improved psychometric properties of discourse measures. AIMS: To advance the use of discourse analysis in persons with aphasia by providing Main Concept Analysis checklists and descriptive statistics for healthy control performance on the analysis for the Cat in the Tree and Refused Umbrella narrative tasks utilized in the AphasiaBank database protocol. METHODS & PROCEDURES: Ninety-two control transcripts, stratified into four age groups (20-39 years; 40-59; 60-79; 80+), were downloaded from the AphasiaBank database. Relevant concepts were identified, and those spoken by at least one-third of the control sample were considered to be a main concept. A multi-level coding system was used to determine the accuracy and completeness of the main concepts produced by control speakers. OUTCOMES & RESULTS: Main concept checklists for two discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data. CONCLUSIONS: These checklists provide clinicians and researchers with a tool to reliably assess the discourse of persons with aphasia. They also help address the gap in available psychometric data with which to compare persons with aphasia to healthy controls.

Macrostructural Analyses of Cinderella Narratives in a Large Nonclinical Sample.

Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with MC accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%-100%) revealed highly reliable scoring. Results Descriptive statistics for the typically aging sample are presented for sequencing, MC + sequencing, total episodic components, and episodic complexity. Scores for participants over 60 years of age were lower (poorer) than scores for those 20-59 years of age, supporting the construct validity of score use for identifying age-related declines in performance. Conclusions This study's novel MSSG analyses of narrative production efficiently assess the logical sequencing and story grammar organization of content in healthy controls. Preliminary reliability and validity evidence support the use of all scores to measure age-related changes in narrative macrostructure. Data from this typically aging sample provide a foundation for future research and clinical assessment aimed at quantifying narrative deficits in adults with communication disorders. Supplemental Material https://doi.org/10.23641/asha.12683495.

Moving Toward Non-transcription based Discourse Analysis in Stable and Progressive Aphasia.

Measurement of communication ability at the discourse level holds promise for predicting how well persons with stable (e.g., stroke-induced), or progressive aphasia navigate everyday communicative interactions. However, barriers to the clinical utilization of discourse measures have persisted. Recent advancements in the standardization of elicitation protocols and the existence of large databases for development of normative references have begun to address some of these barriers. Still, time remains a consistently reported barrier by clinicians. Non-transcription based discourse measurement would reduce the time required for discourse analysis, making clinical utilization a reality. The purpose of this article is to present evidence regarding discourse measures (main concept analysis, core lexicon, and derived efficiency scores) that are well suited to non-transcription based analysis. Combined with previous research, our results suggest that these measures are sensitive to changes following stroke or neurodegenerative disease. Given the evidence, further research specifically assessing the reliability of these measures in clinical implementation is warranted.

A Compendium of Core Lexicon Checklists.

Core Lexicon (CoreLex) is a relatively new approach assessing lexical use in discourse. CoreLex examines the specific lexical items used to tell a story, or how typical lexical items are compared with a normative sample. This method has great potential for clinical utilization because CoreLex measures are fast, easy to administer, and correlate with microlinguistic and macrolinguistic discourse measures. The purpose of this article is to provide clinicians with a centralized resource for currently available CoreLex checklists, including information regarding development, norms, and guidelines for use.

A Large-Scale Comparison of Main Concept Production Between Persons With Aphasia and Persons Without Brain Injury.

Purpose The purposes of this study are to provide clinicians and researchers with introductory psychometric data for the main concept analysis (MCA), a measure of discourse informativeness, and specifically, to provide descriptive and comparative statistical information about the performance of a large sample of persons not brain injured (PNBIs) and persons with aphasia (PWAs) on AphasiaBank discourse tasks. Method Transcripts of 5 semi-spontaneous discourse tasks were retrieved from the AphasiaBank database and scored according to detailed checklists and scoring procedures. Transcripts from 145 PNBIs and 238 PWAs were scored; descriptive statistics, median tests, and effect sizes are reported. Results PWAs demonstrated overall lower informativeness scores and more frequent production of statements that were inaccurate and/or incomplete. Differences between PNBIs and PWAs were observed for all main concept measures and stories. Comparisons of PNBIs and aphasia subtypes revealed significant differences for all groups, although the pattern of differences and strength of effect sizes varied by group and discourse task. Conclusions These results may improve the investigative and clinical utility of the MCA by providing descriptive and comparative information for PNBIs and PWAs for standardized discourse tasks that can be reliably scored. The results indicate that the MCA is sensitive to differences in discourse as a result of aphasia. Supplemental Material https://doi.org/10.23641/asha.7485647.

Describing Phonological Paraphasias in Three Variants of Primary Progressive Aphasia.

Purpose: The purpose of this study was to describe the linguistic environment of phonological paraphasias in 3 variants of primary progressive aphasia (semantic, logopenic, and nonfluent) and to describe the profiles of paraphasia production for each of these variants. Method: Discourse samples of 26 individuals diagnosed with primary progressive aphasia were investigated for phonological paraphasias using the criteria established for the Philadelphia Naming Test (Moss Rehabilitation Research Institute, 2013). Phonological paraphasias were coded for paraphasia type, part of speech of the target word, target word frequency, type of segment in error, word position of consonant errors, type of error, and degree of change in consonant errors. Results: Eighteen individuals across the 3 variants produced phonological paraphasias. Most paraphasias were nonword, followed by formal, and then mixed, with errors primarily occurring on nouns and verbs, with relatively few on function words. Most errors were substitutions, followed by addition and deletion errors, and few sequencing errors. Errors were evenly distributed across vowels, consonant singletons, and clusters, with more errors occurring in initial and medial positions of words than in the final position of words. Most consonant errors consisted of only a single-feature change, with few 2- or 3-feature changes. Importantly, paraphasia productions by variant differed from these aggregate results, with unique production patterns for each variant. Conclusions: These results suggest that a system where paraphasias are coded as present versus absent may be insufficient to adequately distinguish between the 3 subtypes of PPA. The 3 variants demonstrate patterns that may be used to improve phenotyping and diagnostic sensitivity. These results should be integrated with recent findings on phonological processing and speech rate. Future research should attempt to replicate these results in a larger sample of participants with longer speech samples and varied elicitation tasks. Supplemental Materials: https://doi.org/10.23641/asha.5558107.

The Relationship Between Confrontation Naming and Story Gist Production in Aphasia.

Purpose: The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. Method: Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. Results: We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. Conclusions: Picture naming may accurately predict gist production for individuals with Broca's and Wernicke's aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia. Supplemental Materials: https://doi.org/10.23641/asha.5851848.

Discourse Characteristics in Aphasia Beyond the Western Aphasia Battery Cutoff.

PURPOSE: This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. METHOD: Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. RESULTS: Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia. CONCLUSION: Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

Assessment Fidelity in Aphasia Research.

Purpose: In aphasia treatment literature, scarce attention is paid to factors that may reduce a study's validity, including adherence to assessment and treatment procedures (i.e., fidelity). Although guidelines have been established for evaluating and reporting treatment fidelity, none exist for assessment fidelity. Method: We reviewed treatment fidelity guidelines and related literature to identify assessment fidelity components. We then examined 88 aphasia treatment studies published between 2010 and 2015 and report the frequency with which researchers provide information regarding the following assessment fidelity components: assessment instruments, assessor qualifications, assessor or rater training, assessment delivery, assessor or rater reliability, and assessor blinding. Results: We found that 4.5% of studies reported information regarding assessment instruments, 35.2% reported information regarding assessor qualifications, 6.85% reported information regarding assessor or rater training, 37.5% reported information regarding assessor or rater reliability, 27.3% reported on assessor blinding, and no studies reported information regarding assessment delivery. Conclusions: There is a paucity of assessment fidelity information reported in aphasia treatment research. The authors propose a set of guidelines to ensure readers will be able to evaluate assessment fidelity, and thus study validity.

Core-Lexicon and Main-Concept Production During Picture-Sequence Description in Adults Without Brain Damage and Adults With Aphasia.

PURPOSE: We sought to identify the core lexicon of a picture-description task using transcripts from the AphasiaBank database and to determine differences in core-lexicon usage between control speakers and persons with aphasia (PWAs). We also investigated the relationship between core lexicon and an established discourse measure, main-concept analysis. METHOD: A core lexicon was developed by identifying lemmas produced by 92 control speakers. Transcripts were scored-165 control transcripts and 238 PWA transcripts-using the core lexicon and a recently developed main-concept list. Median tests examined differences between controls, PWAs, and aphasia subtypes. Spearman's correlations assessed the relationship between core-lexicon and main-concept performance. RESULTS: A 24-item core lexicon was identified. Significant differences were found between control speakers and PWAs, and between aphasia subtypes, for core-lexicon and main-concept scores. Core-lexicon and main-concept performance was significantly and positively correlated for all groups. CONCLUSIONS: We report the development of a core lexicon, differences in core-lexicon usage between speakers, and the relationship between core-lexicon and main-concept scores. Research is needed to determine the clinical utility and psychometric properties of these discourse measures and their potential contribution to multilevel discourse analysis of functional communication.