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Prevalence, impairment patterns, and response to cholinergic modulation of visual attention deficits in post-stroke aphasia
Poster Session A, Wednesday, September 30, 11:00 am - 1:00 pm, Wangari Maathai
Guadalupe Davila1, Africa Y. Gomez-Perez1, Marcelo L. Berthier1, Maria Jose Torres-Prioris1, Agustina Birba2, Adolfo M. Garcia2,3,4; 1Unidad de Neurociencia Cognitiva y Afasia (UNCA), Centro de Investigaciones Médico-Sanitarias, IBIMA-Plataforma Bionand, Universidad de Málaga, Málaga, España, 2Cognitive Neuroscience Center, Department of Life and Behavioral Sciences, Universidad de San Andrés, Buenos Aires, Argentina, 3Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States; and Trinity College Dublin, Dublin, Ireland, 4Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
Background: Non-linguistic deficits in post-stroke aphasia (PSA) have received limited attention, largely due to assessment challenges arising from language impairments. Accumulating evidence indicates that visual attention deficits (VADs) significantly affect language outcomes in people with aphasia (PWA). Despite advances in attention rehabilitation, no pharmacological clinical trials have specifically targeted attention in this population. Aims: This study evaluated (i) the prevalence and patterns of VADs in PWA following chronic left hemisphere strokes and (ii) the effect of cholinergic modulation with donepezil in a proof-of-concept randomized, placebo-controlled clinical trial. Methods & Procedures: Attention was assessed using the abbreviated California Computerized Attention Package (CalCAP), which includes four continuous performance tasks of increasing attentional demand: Simple RT, Choice RT, Sequential RT1, and Sequential RT2. To ensure comprehension, participants completed three practice trials for each task. The outcomes analyzed were reaction time (RT) and accuracy. Study 1 compared attention performance between 55 PWA and 25 age- and education-matched healthy controls, as well as with the normative dataset. Study 2 examined VADs in an independent sample of 26 PWA within a 16-week, double-blind, parallel, randomized, placebo-controlled clinical trial of donepezil. All participants had previously received speech-language therapy, reached a plateau, and continued therapy during the study at a rate of 2 hours per week. Aphasia severity was evaluated with the Western Aphasia Battery in both studies. Results: In Study 1, PWA demonstrated significantly slower and less accurate responses than controls on CalCAP tests; 69% met VAD criteria: 33% exhibited both speed and accuracy deficits, 27% accuracy deficits alone, and 9% speed deficits alone. Baseline performance on Sequential RT2, the most demanding task, significantly correlated with aphasia severity (r = .413, p < .05) among PWA with VADs. In Study 2, donepezil was superior to placebo (F(1,19) = 6.337; p = .021; η²ₚ = .25) in enhancing performance on Sequential RT1, a visual attention task with an executive component. Aphasia severity significantly correlated with improvements in Sequential RT2 speed (r = .503; p = .02). Conclusions: VADs are highly prevalent in PWA and are associated with aphasia severity. Individuals with more severe language impairments may be at greater risk of VADs during demanding tasks, even when instructions are understood. Cholinergic stimulation appears to partially address VADs. These findings suggest new treatment pathways for non-verbal deficits in aphasia.
Topic Areas: Control, Selection, and Executive Processes, Speech-Language Treatment