The Neuroscience on the Web Series:
CMSD 636 Neuropathologies of Language and Cognition

CSU, Chico, Patrick McCaffrey, Ph.D

Unit 9. Aphasia: Diagnosis

The Diagnosis of Aphasia

Several standardized tests are commonly used in the diagnosis of aphasia. Some of these are the Minnesota Test for Differential Diagnosis (MTDDA), the Porch Index of Communicative Ability (PICA), and the Boston Diagnostic Aphasia Examination (BDAE).

The MTDDA was developed by Schuell in 1965. This comprehensive test assesses the patient's strengths and weakness in all language modalities.

The PICA (Porch, 1967) samples fewer language behaviors than the MTDDA. However, it is known for its elaborate scoring system, which allows the examiner to differentiate between responses elicited with different degrees of cueing, various types of errors, and also to note the immediacy of the response.

The BDAE, developed by Goodglass and Kaplan in 1972, has been revised twice, in 1983 and 2001. I was one of the reviewers for the new edition. It's good, but perhaps a bit lengthy for many patients. While much of the previous edition has been retained the new edition has significant changes/improvements. It consists of more than 40 subtests divided into the following sections: fluency, conversation/expository speech, auditory comprehension, articulation, recitation and music, repetition, naming, paraaphasia, reading, and writing. It also has extended subtests that include narrative speech/fables, auditory comprehension, repetition, naming, reading, writing and praxis. It can often make a determination whether or not the aphasic has Broca's aphasia, Wernicke's aphasia, or another.The severity of a patient's aphasia can be rated on a scale from one to seven based on speech and language characteristics as well as auditory comprehension. The Boston Naming Test, a test for anomia which was developed to be used along with the BDAE, is the supplementary instrument most often used in the evaluation of aphasia. The new edition can quantify the severity of the word finding problem and can help the clinician determine whether and to what extent the patient can recognize the picture he/she has failed to name.

The administration of any of the above standardized aphasia batteries can be time-consuming. In practice, it is best to try to quickly test all aspects of language, including auditory comprehension, oral expression, reading and writing, during an evaluation. In some facilities, patients only stay for a day or two, and it is necessary to quickly gather enough information to write any reports that may be required. Also, it is important to remember that standardized tests are just one way to sample the patient's performance. A set of tasks devised by the clinician may provide an equally valid basis for establishing therapy goals. A standardized test should be viewed as a checklist (this was suggested some years ago by Joseph Keenan, 1975, who had an excellent procedure manual that is out of print). Checklists are used to evaluate all aspects of language, and thus ensure that the examiner does not forget to evaluate any important areas of functioning. In my practice I seldom have the opportunity to administer a complete diagnostic aphasia exam. I am pleased that the authors of the Boston have developed a short form with its own set of stimulus cards.

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Other courses in the Neuroscience on the Web series:
CMSD 620 Neuroanatomy | CMSD 642 Neuropathologies of Swallowing and Speech

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