Aphasia: No Age Discrimination Here

1
Aphasia No Age Discrimination Here? Amy D.
Rodriguez 1,2, Diane L. Kendall 1,2, John C.
Rosenbek 1,2, Alonso Riestra 3, Kyle Womack 4,
Leslie J. Gonzalez Rothi 1,2 1Malcom Randall VA
RRD Brain Rehabilitation Research Center,
Gainesville, FL 2University of Florida,
Gainesville, FL 3Instituto Mexicano de
Neurociencias Hospital Ángeles Lomas,
Huixquilucan Estado de México 4University of
Texas Southwestern Medical Center, Dallas, TX
BACKGROUND AND PURPOSE Previous studies
investigating the relationship between age and
type of aphasia (anterior/nonfluent and
posterior/fluent) have shown equivocal
results1-9. Some reports suggest that younger
individuals demonstrate nonfluent aphasia while
older individuals demonstrate fluent aphasia1-6.
Two hypotheses for this phenomenon are continuing
differentiation within the left hemispheric
language zones1 and a posterior shift in stroke
distribution with age6. There are some studies,
however, that are incompatible with these
findings7-8. The purpose of this study is to
further investigate the relationship between age
and type of aphasia in a sample of 181
individuals with cerebral vascular accident (CVA)
and subsequent aphasia Our primary research
question asked if there was a significant
difference between age (youngerbelow 70,
older70) and aphasia type (nonfluent/anterior,
fluent/posterior).

• METHODS
• A clinical database of individuals referred to
  the VA Speech Pathology Service in Gainesville,
  FL (1980- 1998) was queried for patients that fit
  the following criteria
• right-handedness
• single, unilateral left hemisphere infarction
• The query resulted in 181 chronic and acute
  patients between the ages of 27 and 91 years
• Aphasia subtype was determined using criteria for
  classification outlined by Kertesz (Western
  Aphasia Battery)9.
• Aphasia types were further collapsed into two
  groups using the fluency score from the
  Spontaneous Speech subtest
• Nonfluent Global, Brocas, Isolation, TC Motor
• Fluent Wernickes, TC Sensory, Conduction,
  Anomic
• RESULTS
• PRIMARY RESEARCH QUESTION Chi-square analysis
  showed no significant difference between age
  group (youngerbelow70, older70) and type of
  aphasia (nonfluent/anterior, fluent/posterior).
  See Table 1.
• THREE POST HOC ANALYSES were performed

• DISCUSSION
• The primary purpose of this study was to
  investigate the potential relationship between
  age and type of aphasia.
• In our sample of 181 patients, results of the
  group analysis (nonfluent, fluent) showed there
  was no significant difference in age, which is
  consistent with two studies that used similar
  methods of classification7,8.
• However, results of the aphasia subtype analyses
  showed that individuals with Brocas subtype
  (nonfluent) were significantly younger and
  individuals with TC Sensory subtype (fluent) were
  significantly older than individuals with all
  other aphasia subtypes.
• These findings are consistent with previous
  studies1-6 and lend support to the notion that
  younger individuals may be more likely to acquire
  nonfluent aphasia while older individuals acquire
  fluent aphasia.
• Incidentally, individuals with Isolation subtype
  were significantly older than individuals with
  all other aphasia subtypes, despite the small
  size of the group (n3). This finding is
  inconsistent given that isolation aphasia is
  considered to be nonfluent and therefore should
  be seen in the younger group. However, when
  considering the criteria used to classify
  isolation aphasia it is apparent that anterior as
  well as posterior mechanisms are degraded.
• Future directions Imaging data to determine
  lesion location could be used to corroborate
  behavioral findings.

Table 1. Primary Research Question Aphasia
Type by Age
Table 2. Post Hoc Analysis 2 Aphasia Type by
Age
Figure 1. Post Hoc Analysis 3 Distribution of
aphasia type by decade
LITERATURE CITED 1 Brown, J. Jaffe, J. (1975).
Hypothesis in cerebral dominance.
Neuropsychologia, 13, 107-110. 2 Brown, J.W.
Grober, E. (1983). Age, sex, and aphasia type
Evidence for a regional cerebral growth process
underlying lateralization. The Journal of Nervous
and Mental Disease, 171(7), 431-434. 3
Eslinger, P.J. Damasio, J.R. (1981). Age and
type of aphasia in patients with stroke. Journal
of Neurology, Neurosurgery, and Psychiatry, 44,
377-381. 4 Harasymiw, S.J., Halper, A.,
Sutherland, B. (1981). Sex, age, and aphasia
type. Brain and Language, 12, 190-198. 5 Miceli,
G. et al (1981). Influence of age, sex, literacy,
and pathologic lesion on incidence, severity,
and type of aphasia. Acta Neurologica
Scandinavia, 64, 370-382. 6 Obler, L.K., Albert,
M.L., Goodglass, H. Benson, F.D. (1978).
Aphasia type and aging. Brain and Language, 6,
318-322. 7 Pedersen, P.M., Vinter, K., Olsen,
T.S. (2004). Aphasia after stroke Type, severity
and prognosis. The Copenhagen Aphasia Study.
Cerebrovascular Diseases, 17, 35-43. 8 Womack,K.
et al (2005). Effects of age and race on aphasia.
Journal of the International Neuropscyhologica
Society. 9 Kertesz, A. (1982). Western Aphasia
Battery. Test manual. San Antonio, TX The
Psychological Corporation. ACKNOWLEDGMENTS This
study was supported by the VARRD Brain
Rehabilitation Research Center.