Impact of Aphasia on Consciousness Assessment

Author:

Schnakers Caroline12,Bessou Helene1,Rubi-Fessen Ilona3,Hartmann Alexander3,Fink Gereon R.45,Meister Ingo4,Giacino Joseph T.6,Laureys Steven12,Majerus Steve1

Affiliation:

1. University of Liège, Liege, Belgium

2. University Hospital of Liege, Liege, Belgium

3. Rehanova Neurorehabilitation Center, Cologne-Merheim, Germany

4. University Hospital of Cologne, Cologne, Germany

5. Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich, Germany

6. Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA

Abstract

Background. Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However, no study investigated to what extent language impairment could affect patients’ behavioral responses. Objective. To estimate the impact of receptive and/or productive language impairments on consciousness assessment. Methods. Twenty-four acute and subacute stroke patients with different types of aphasia (global, n = 11; Broca, n = 4; Wernicke, n = 3; anomic, n = 4; mixed, n = 2) were recruited in neurology and neurosurgery units as well as in rehabilitation centers. The Coma Recovery Scale–Revised (CRS-R) was administered. Results. We observed that 25% (6 out of 24) of stroke patients with a diagnosis of aphasia and 54% (6 out of 11) of patients with a diagnosis of global aphasia did not reach the maximal CRS-R total score of 23. An underestimation of the consciousness level was observed in 3 patients with global aphasia who could have been misdiagnosed as being in a minimally conscious state, even in the absence of any documented period of coma. More precisely, lower subscores were observed on the communication, motor, oromotor, and arousal subscales. Conclusion. Consciousness assessment may be complicated by the co-occurrence of severe language deficits. This stresses the importance of developing new tools or identifying items in existing scales, which may allow the detection of language impairment in severely brain-injured patients.

Publisher

SAGE Publications

Subject

General Medicine

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