Exploring the Neuropsychological Mechanisms in a Bilingual Individual with Aphasia and Apraxia of Speech: Evidence from a Case.
Jorge Vargas Rojas1, Jane Roitsch2, Nuria Montagut3, Crystal Hinrichs2, Gracie Lopez2, Ladan Ghazi-Saidi2
1Universidad Autónoma de Bucaramanga, 2Department of Communication Disorders, University of Nebraska at Kearney, 3Alzheimer’s disease and other cognitive disorders unit, Hospital Clínic de Barcelona
Objective:
Describe a bilingual individual with post-stroke aphasia and apraxia of speech (AoS) and explain its possible neuropsychological mechanisms.
Background:
Aphasia and AoS are neurological disorders due to focal lesions like stroke and can co-occur. In bilingual individuals, additional symptoms such as language mixing may occur. Postmorbid, bilingual individuals may demonstrate different symptoms and at different severity levels in their two languages.
Design/Methods:
This study presents a case of a 36-year-old Spanish/English bilingual male, who presented cognitive and communication impairments indicative of aphasia and AoS post stroke. A modified version of the Barcelona Scale for Buccophonatory Apraxia (BSBA) assessment was completed in both languages. Boston test Cookie theft picture was used to collect a speech sample. Mean length of utterance (MLU) was calculated in both languages for the assessment of aphasia. Executive functions were evaluated through an executive function battery including Wisconsin Card Sorting Test, Simon Says Task, Stroop Task and Symbol Substitution Test.
Results:
Post-morbidly the patient demonstrates language mixing, slower rate of speech and phonemic and semantic paraphasias. MLU of 1.30 in Spanish and 1.34 in English confirms a slightly higher severity in Spanish, the mother tongue.. BSBA demonstrated a significantly higher score in English (310.96; Moderate) than Spanish (216; Mild), reflecting different AoS profiles with more severe impairment in English. The response times and accuracy rates in the executive function battery reflect slower and less accurate cognitive control processes. Together, the results of language, motor speech and cognitive control assessment suggest an impairment of cognitive control poststroke in this bilingual individual, supporting the dynamic cognitive control model (Green & Abutalebi, 2007; Ghazi Saidi et al., 2013).
Conclusions:
Impairment of cognitive control impairment post stroke in bilingual individuals can lead to selective AoS. Co-occurrence of aphasia and AOS can complicate the diagnosis due to challenges of differentiating paraphasias from articulatory errors.
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