What screening tests should be used for a patient suspected of having global aphasia?

Screening Tests for Global Aphasia

For patients with suspected global aphasia, the Western Aphasia Battery (WAB) should be used as the primary comprehensive assessment tool, as it effectively evaluates spoken and written language production and comprehension, calculation, drawing, and visuoconstruction skills. 1

Primary Language Assessment Tools

• The Western Aphasia Battery (WAB) is the gold standard assessment tool for comprehensive evaluation of aphasia, with a shortened version available for bedside screening 2, 1
• The Quick Aphasia Battery (QAB) is recommended for efficient assessment (approximately 15 minutes) with excellent test-retest reliability (ICC = 0.98) and inter-rater reliability (ICC = 0.99) 3, 4
• The Boston Naming Test should be included to assess word retrieval abilities, which is particularly impaired in global aphasia 2, 1
• The Cognitive Linguistic Quick Test is suitable for patients with language production or comprehension impairments and assesses attention, memory, executive function, language, and visuospatial perception 2
• The Assessment of Language-Related Functional Activities should be used to evaluate practical communication skills in everyday activities 2, 1
• The ASHA Functional Assessment of Communication Skills for Adults is recommended to assess social communication, basic needs communication, reading, writing, and number concepts 2, 1
• The Quality of Communication Life Scale should be administered to evaluate the impact of communication deficits on quality of life 2, 1

Cognitive Assessment Tools for Patients with Global Aphasia

• The Color Trails Test is recommended for assessing sustained attention and attention switching with minimal language requirements (5-15 minutes to administer) 2
• The Behavioral Inattention Test can identify presence and severity of unilateral visual neglect through tasks requiring minimal verbal responses 2
• The Location Learning Test is appropriate for assessing visuospatial learning and recall with minimal language demands 2
• The Rivermead Behavioral Memory Test evaluates everyday memory abilities and is suitable for patients with significant language impairments 2, 1
• The CoBaGA (Cognitive Test Battery for Global Aphasia) is specifically designed to assess nonverbal cognitive domains in patients with severe aphasia 5

Neurological Assessment Tools

• The National Institutes of Health Stroke Scale (NIHSS) should be used to assess stroke severity, with particular attention to items 9 (language) and 11 (extinction/inattention) 2
• The Barthel Index should be used to evaluate functional status and independence in activities of daily living 2

Implementation Considerations

• Patients with global aphasia often have heterogeneous cognitive profiles that affect recovery and rehabilitation potential 5
• Assessment should include evaluation of residual linguistic abilities, particularly comprehension and reading-writing skills, which can vary significantly even within global aphasia 5
• Attention, reasoning, and executive functions should be assessed as they may improve after language rehabilitation 5
• Be aware that thalamic lesions can cause global aphasia with poor prognosis for recovery, so imaging results should be considered when interpreting assessment findings 6, 7
• When assessing patients with significant language impairments, use alternative means of communication such as gesture, drawing, and writing 1
• Consider the impact of multiple assessments on patient fatigue; prioritize the most informative tests first 1

Pitfalls and Caveats

• Standard cognitive screening tools like the Mini-Mental State Examination (MMSE) have limited utility in patients with global aphasia due to their heavy reliance on verbal abilities 2
• The presence of non-cognitive neurological deficits (visual field deficits, motor deficits) must be considered when performing cognitive assessments 1
• Assessing non-language cognitive domains is challenging when aphasia is present; in complex cases, formal evaluation by a neuropsychologist may be required 1
• Be aware of the potential impact of testing on both validity of results and patient fatigue; use different equivalent assessment forms when available to avoid practice effects 1