ABSTRACT

INTRODUCTION. Aphasia is observed in 30-40% of patients who have suffered a stroke, and the prognosis for the restoration of speech functions in severe aphasia is unfavorable. To date, there has been no assessment of the severity of cognitive impairment in various clinical forms of aphasia. The aim is analysis of cognitive impairment in various forms of aphasia. 
MATERIAL AND METHODS. 572 patients with severe and moderate post-stroke aphasia, 103 with dynamic aphasia, 89 with afferent motor aphasia, 100 with efferent motor aphasia, 98 with acoustic-gnostic aphasia, 94 with acoustic-mnestic aphasia, 88 patients — with semantic aphasia.
RESULTS AND DISCUSSION. The presence of violations of non-verbal cognitive domains was revealed, and the specificity of pathology was different for each form of aphasia. All examined patients showed a decrease in mental activity, fatigue, exhaustion, most pronounced with dynamic aphasia and acoustic-gnostic aphasia. Memory loss was noted in all, most pronounced in acoustic-mnestic aphasia (p < 0,001), slightly in patients with dynamic aphasia (p = 0,08). The decrease in level of attention was most pronounced in patients with acoustic–gnostic aphasia (p < 0,001), insignificant — with efferent motor aphasia (p = 0,15). Intellectual disabilities and decreased executive functions were most pronounced in dynamic aphasia and semantic aphasia (p < 0,001). Violations of praxis were characteristic of dynamic aphasia, afferent motor aphasia and efferent motor aphasia (p < 0,001), and gnosis, including visual–spatial, for acoustic-mnestic aphasia and semantic aphasia (p = 0,001–0,002). 
CONCLUSION. It can be assumed that rehabilitation of patients with aphasia should include, along with speech exercises, practice aimed at restoring non-speech cognitive functions, which will increase the effectiveness of rehabilitation. 

KEYWORDS: aphasia, cognitive impairment, executive functions, visual-spatial functions, praxis, gnosis

For citation: Kotov S.V., Shcherbakova M.M., Kotov A.S., Isakova E.V., Zenina V.A. Concomitant Cognitive Impairment in Aphasia. Comorbidity Neurology. 2024; 1(1): 14–22. https://doi.org/10.62505/3034-185x-2024-1-14-22 (In Russ.)

*For correspondence: Alexey S. Kotov, Dr. Sci. (Med.), Leading Researcher, Neurological Department, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia, e-mail: alex-013@yandex.ru.

 REFERENCES

1. Alferova V.V., Shklovskiĭ V.M., Ivanova E.G., et al. The prognosis for post-stroke aphasia. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2018; 118 (4): 20–29. https://doi.org/10.17116/jnevro20181184120-29 (In Russ)

2. Parfenov V.A. Posts troke cognitive impairment. Neurology, Neuropsychiatry, Psychosomatics. 2019; 11 (4): 22–27. https://doi.org/10.14412/2074-2711-2019-4-22-27 (In Russ)

3. Laska A.C., Hellblom A., Murray V. et al. Aphasia in acute stroke and relation to outcome. J Intern Med. 2001; 249 (5): 413–22. https://doi.org/10.1046/j.1365-2796.2001.00812.x

4. El Hachioui H., Visch-Brink E.G., Lingsma H.F. et al. Nonlinguistic cognitive impairment in poststroke aphasia: a prospective study. Neurorehabil Neural Repair. 2014; 28 (3): 273–81. https://doi.org/10.1177/1545968313508467

5. Park Y.H., Jang J.W., Park S.Y., et al. Executive function as a strong predictor of recovery from disability in patients with acute stroke: a pre-liminary study. J Stroke Cerebrovasc Dis. 2015 Mar; 24 (3): 554–61. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.033

6. Wong W.S.W., Law S.P. Relationship Between Cognitive Functions and Multilevel Language Processing: Data From Chinese Speakers With Aphasia and Implications. J Speech Lang Hear Res. 2022; 65 (3): 1128–1144. https://doi.org/10.1044/2021_JSLHR-21-00381

7. Diedrichs V.A., Jewell C., Harnish S.M. A scoping review of the relationship between nonlinguistic cognitive factors and aphasia treatment response. Top Lang Disord. 2022; 42 (3): 212–235. https://doi.org/10.1097/tld.0000000000000290

8. Luria A.R. Writing and speech: Neurolinguistic studies. M.: Academy, 2002: 352 (In Russ)

9. Ardila A., Akhutina T.V., Mikadze Yu.V. A.R. Luria’s contribution to studies of the brain organization of language. Neurology, Neuropsychiatry, Psychosomatics. 2020; 12 (1): 4–12. https://doi.org/10.14412/2074-2711-2020-1-4-12 

10. Shcherbakova M.M., Kotov S.V. Computer aphasia screening test. Consilium Medicum. 2017; 19 (2): 24–26. https://doi.org/10.26442/2075-1753_19.2.24-26 (In Russ)

11.  Khomskaya E.D. Neuropsychology. 4th edition. SPb.: Peter, 2005: 496 (In Russ)

12. Kotov S.V., Zenina V.A., Isakova E.V., et al. Assessment of disorders of neurodynamic processes in patients with acute ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2023; 123 (3-2): 5–12. https://doi.org/10.17116/jnevro20231230325 (In Russ)

13. Turken A.U., Dronkers N.F. The neural architecture of the language comprehension network: converging evidence from lesion and connectivity analyses. Front Syst Neurosci. 2011; 5: 1 https://doi.org/10.3389/fnsys.2011.00001

14. Shah-Basak P., Sivaratnam G., Teti S., et al. Electrophysiological connectivity markers of preserved language functions in post-stroke aphasia. Neuroimage Clin. 2022; 34: 103036. https://doi.org/10.1016/j.nicl.2022.103036

15. Howard D. Language in the human brain. In: Cognitive Neuroscience, ed. M.D. Rugg. London: Psychology Press, 1997: 277–304. https://doi.org/10.4324/9780203765401

16. Friederici A.D. The cortical language circuit: from auditory perception to sentence comprehension. Trends Cogn Sci. 2012; 16 (5): 262–8. https://doi.org/10.1016/j.tics.2012.04.001

17. Mollica F., Siegelman M., Diachek E., et al. Composition is the Core Driver of the Language-selective Network. Neurobiol Lang (Camb). 2020; 1 (1): 104–134. https://doi.org/10.1162/nol_a_00005

18. Fokin V.F., Ponomareva N.V., Konovalov R.N. et al. Resting-state neural networks in cognitive decline in patients with vascular encephalopathy. Annals of clinical and experimental neurology. 2020; 14 (4): 39–45. https://doi.org/10.25692/acen.2020.4.5

19. Fritsch M., Rangus I., Nolte C.H. Thalamic Aphasia: a Review. Curr Neurol Neurosci Rep. 2022; 22 (12): 855–865. https://doi.org/10.1007/s11910-022-01242-2

20. Crosson B. The Role of Cortico-Thalamo-Cortical Circuits in Language: Recurrent Circuits Revisited. Neuropsychol Rev. 2021; 31 (3):5 16–533. https://doi.org/10.1007/s11065-019-09421-8

ADDITIONAL INFORMATION

Sergey V. Kotov, Dr. Sci. (Med.), Professor, Head, Department of Neurology, Faculty of Postgraduate Medical Education, Chief Researcher, Neurological Department, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia.
ORCID: https://orcid.org/0000-0002-8706-7317

Maria M. Shcherbakova, Cand. Sci. (Med.), Speech Therapist, Psychologist, Neurological Department, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia.
ORCID: https://orcid.org/0000-0001-5923-5355

Alexey S. Kotov, Dr. Sci. (Med.), Leading Researcher, Neurological Department, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia.
ORCID: https://orcid.org/0000-0003-2988-5706

Elena V. Isakova, Dr. Sci. (Med.), Leading Researcher, Neurological Department, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia.
ORCID: https://orcid.org/0000-0002-0804-1128

Valentina A. Zenina, Postgraduate Student, Department of Neurology, Faculty of Postgraduate Medical Education, M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia; Resident, Stroke Unit, Ramenskoye Regional Hospital, Ramenskoe, Russia.
ORCID: https://orcid.org/0000-0002-6864-0018

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Kotov S.V. — development of the concept of t he article, editing the final text; Shcherbakova M.M. — collecting material, writing text, methodology; Kotov A.S. — preparation of an article for publication; Isakova E.V. — development of the concept of the article, editing the final text; Zenina V.A. — collecting material, writing text, statistical processing. 

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare that they have no competing interests.

Ethics Approval. The study protocol was approved by the Independent Ethics Committee of M.F. Vladimirsky Moscow Regional Research and Clinical Institute (Moscow, Russia) (Protocol No. 7 of August 5, 2018).

Informed consent for publication. All patients, and if it is impossible to review and sign, persons responsible for the patients (relatives, social workers, etc.), on behalf of the patients undergoing examination and participating in this study, signed informed consent.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Sergey V. Kotov, Maria M. Shcherbakova, Alexey S. Kotov, Elena V. Isakova, Valentina A. Zenina