Presentation
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Executive functions and propositional language: Verbal initiation, selection, strategy, and inhibition in acute stroke
Poster E108 in Poster Session E, Thursday, October 26, 10:15 am - 12:00 pm CEST, Espace Vieux-Port
Gail A Robinson1,2, Jessica Byrne1, Jessica Chow1, Lucy Ford1,2, Emily Gibson1, Georgia Marsh1, Mia Phillips1,2; 1The University of Queensland, 2Queensland Brain Institute
Stroke frequently results in cognitive difficulties including executive dysfunction, which can persist longer-term. Currently, brief screening measures that can detect subtle and focal cognitive changes, especially in executive functions, are lacking. The Brief Executive Language Screening Tool (BELS) is a recently developed executive function and language measure. First, we examined the reliability and validity of the BELS sentence completion (SC) subtest (BELS-SC), which measures executive function components within a semantic context in an acute stroke population. Second, we investigated acute stroke performance on Propositional Language and Executive Function subtests (Spontaneous Speech and SC), relative to healthy controls. Eighty-seven left and right hemisphere stroke patients completed the BELS and other neuropsychological measures within seven weeks of a stroke (acute phase). Ninety-two age- and gender-matched healthy control participants completed the same neuropsychological battery. The BELS-SC showed good construct validity and inter-rater reliability. The acute stroke patients were significantly more impaired on the BELS-SC measures (initiation, suppression, selection, strategy use) and Spontaneous Speech subtests compared to the healthy controls. Specifically, acute stroke patients were selectively impaired on Low (compared to High) Constraint SC Initiation Items (number correct), which place higher demands on selection processes. Stroke patients were also significantly slower on SC Initiation items, impaired on SC Inhibition items, and they employed fewer strategies than healthy controls. Further, 30-44% of patients were impaired (<5th percentile) on Spontaneous Speech subtests, demonstrating significantly reduced connected speech. Stroke patients were intact on Single Word Comprehension and Repetition, and largely unimpaired on Articulation (26% <5th percentile) and Nominal Language (29% <5th percentile) subsections; however, 72% of patients were impaired (<5th percentile) on the Propositional Language and Executive Function subsection. Findings highlight that acute stroke patients can have largely well-preserved nominal language functions, with impaired propositional language and executive functions (i.e., initiation, selection, inhibition and strategy). This study provides new insight into the assessment of executive functioning and propositional language in acute stroke and a novel finding in strategy generation. The BELS-SC subtest in particular is a valid and clinically useful tool for assessing executive functions in acute stroke, with implications for long-term functional outcomes post-stroke.
Topic Areas: Control, Selection, and Executive Processes, Language Production