Comparison of Aphasia Severity in Dementia and Stroke Using MASTcz, and Aphasia in Relation to Severity of Cognitive Deficit

Authors: M. Košťálová 1;  J. Bednařík 1;  S. Skutilová 1;  A. Mitášová 1;  E. Bártková 1;  K. Šajgalíková 1;  A. Demovičová 1,3;  L. Dušek 2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  Institut biostatistiky a analýz MU, Brno 2;  Interní hematoonkologická klinika LF MU a FN Brno 3
Published in: Cesk Slov Neurol N 2010; 73/106(3): 246-252
Category: Original Paper



To assess the prevalence and severity of aphasia in dementia using the Czech version of the Mississippi Aphasia Screening Test (MASTcz) for the detection of aphasia in relation to the severity of global cognitive deficit, and to compare this with aphasia severity arising out of focal vascular lesion of a dominant brain hemisphere.

Patients and methods:
Group A comprised 149 patients, 74 women and 75 men, aged 19– 95 years, median 68, with aphasia due to acute stroke in the dominant hemisphere (verified by speech therapist examination). Group B consisted of 52 patients, 26 women and 26 men, aged 41– 84, median 74, who complied with the diagnostic criteria for dementia according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition, revised version) and scored in the “abnormal” range of the Addenbrook Cognitive Examination (ACE) (≤82 points); 43 demented patients had an ACE score of 30– 82 (mild‑ to‑ moderate dementia). Alzheimer’s disease was the cause of dementia in 22 cases, while other causes of dementia were identified in the remaining 30 patients. Aphasia severity was scored with MASTcz.

A subgroup of mild‑ to‑ moderate dementia patients exhibited a significantly lower degree of language deficit expressed as MASTcz indexes in comparison with stroke patients with aphasia. Using a cut‑off value of total index (TI) <85 points as a criterion for the presence of aphasia, receiver operating curve analysis showed high discrimination power between group A (stroke patients with aphasia –  131 out of 149 patients complied with the chosen criterion for aphasia) and subgroup Ba with mild‑ to‑ moderate dementia (6 out of 43 complied with the criterion for aphasia. The lowest TI value was 68 points); the sensitivity and specificity of the test were 88.6% and 81.4%, respectively (p <0.001).

The severity of language deficit in patients with dementia remains significantly lower compared with that in aphasia due to focal vascular lesion of a dominant brain hemisphere until severe cognitive deficit develops.

Key words:
aphasia – dementia – Alzheimer’s disease – cognitive deficit – communication disorder


1. Glosser G, Kaplan E. Linguistic and nonlinguistic impairments in writing: a comparison of patients with focal and multifocal CNS disorders. Brain Lang 1989; 37(3): 357– 380.

2. Chapey R, Patterson PJ. Assesment of Language Disorders in Adults. In: Chapey R (ed). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2008: 64– 160.

3. Hopper T, Bayles KA. Management of neurogenic communication disorders associated with dementia. In: Chapey R (ed). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2008: 988– 1008.

4. Rektorová I. Neurodegenerativní demence. Cesk Slov Neurol N 2009; 72/ 105(2): 97– 109.

5. Appell J, Kertesz A, Fisman M. A study of language functioning in Alzheimer patients. Brain Lang 1982; 17(1): 73– 91.

6. Nickels L, Croot K. Progressive language impairments: Intervention and management. Editorial. Aphasiology 2009; 23: 123– 124.

7. Horner J, Dawson DV, Heyman A, Fish AM. The usefullness of the Western Aphasia Battery for dif­ferential diagnosis of Alzheimer dementia and focal stroke syndromes: preliminary evidence. Brain Lang 1992; 42(1): 77– 88.

8. Kostálová M, Bártková E, Sajgalíková K, Dolenská A,Dusek L, Bednarík J. A standardization study of the Czech version of the Mississippi Aphasia Screening Test (MASTcz) in stroke patients and control subjects. Brain Injury 2008; 22(10): 793– 801.

9. Nakase‑ Thompson R, Manning E, Sherer M, Yablon SA, Vickery C, Harris C et al. Bedside screen of language disturbance among acute care admissions: Initial psychometrics of the Mississippi Aphasia Screening Test. Arch Clin Neuropsychol 2002; 17(8): 848.

10. Nakase‑ Thompson R, Manning E, Sherer M, Yablon SA, Gontkovsky SLT, Vickery C. Brief assessment of severe language impairments: Initial validation of the Mississippi aphasia screening test. Brain Injury 2005; 19(9): 685– 691.

11. Košťálová M, Bednařík J. Screening afázie: MASTcz. Dostupné z URL: http:/ / Article.asp?nDepartmentID=1355&nArticleID=2298&nLanguageID=1.

12. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968; 114(512): 797– 811.

13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Association 2000.

14. McKhann G, Drachman D, Folstein M, Katzman R,Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS‑ ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34(7): 939– 944.

15. Ressner P, Hort J, Rektorová I, Bartoš A, Rusina R, Línek V et al. Doporučené postupy pro diagnostiku Alzheimerovy nemoci a dalších onemocnění spojených s demencí. Cesk Slov Neurol N 2008; 71/ 104(4): 494– 501.

16. Hummelová- Fanfrdlová Z, Rektorová I, Sheardová K,Bartoš A, Línek V, Ressner P, Zapletalová J, Vyhnálek M, Hort J. Česká adaptace Addenbrookského kognitivního testu. Cesk psychol 2009; 53(4): 376– 388.

17. Eng J. ROC analysis: web‑based calculator for ROC curves. Baltimore: Johns Hopkins University [updated 2006 May 17; cited 2008 February 20]. Dostupné z URL: http:/ /

18. Rousseaux M, Sève A, Vallet M, Pasquier F, Mackowiak Cordoliani MA. An analysis of communication in patients with dementia. J Neurol 2008; 255 (Suppl 2): 46– 47.

19. Kertesz A, Appell J, Fisman M. The dissolution of language in Alzheimer’s disease. Can J Neurol Sci 1986; 13 (Suppl 4): 415– 418.

20. Faber‑ Langendoen K, Morris JC, Knesevich JW, LaBarbe E, Miller JP, Berg L. Aphasia in senile dementia of the Alzheimer type. Ann Neurol 1988; 23(4): 365– 370.

21. Alzheimer A. On a peculiar disease of the cerebral cortex. Allgemeine Zeitschrift fur Psychiatrie 1907; 64: 146.

22. Pick A. Über die Beziehungen der senilen Hirnatrophie zur Aphasie. Prager Medizinische Wogenschrift 1892; 17: 165– 167.

23. Kertesz A. Western Aphasia Battery. New York: Grune & Stratton 1982.

24. Blair M, Kertesz A, McMonagle P, Davidson W, Bodi N. Quantitative and qualitative analyse of clock drawing in FTD and AD. J Int Neuropsychol Soc 2006; 12(2):159– 165.

25. Kramer JH, Duffy JM. Aphasia, apraxia, and agnosia in the diagnosis of dementia. Dementia 1996; 7(1): 23– 26.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2010 Issue 3

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account