Development, Cross-Cultural Adaptation, and Psychometric Characteristics of the Persian Progressive Aphasia Language Scale in Patients With Primary Progressive Aphasia: A Pilot Study.

Basic and Clinical January, February 2018, Volume 9, Number 1 Research Paper: Development, Cross-Cultural Adaptation, and Psychometric Characteristics of the Persian Progressive Aphasia Language Scale in Patients With Primary Progressive Aphasia: A Pilot Study Salime Jafari1, Amin Modarresszadeh1, Ahmad Reza Khatoonabadi1*, John Hodges2, Noureddin Nakhostin Ansari3,4, Cristian Leyton5 , Maryam Noroozian6 1. Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. 2. Brain & Mind Centre, The University of Sydney, Sydney, Australia. 3. Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. 4. Neuro-Musculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran. 5. Faculty of Health Sciences, The University of Sydney, Sydney, Australia. 6. Memory and Behavioral Neurology Division, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Use your device to scan and read the article online Citation: Jafari, S., Modarresszadeh, A., Khatoonabadi, A. R., Hodges, J., Nakhostin Ansari, N., Leyton, C., et al. (2018). Development, Cross-Cultural Adaptation, and Psychometric Characteristics of the Persian Progressive Aphasia Language Scale in Patients With Primary Progressive Aphasia: A Pilot Study. Basic and Clinical Neuroscience, 9(1), 35-42. https://doi. org/10.29252/NIRP.BCN.9.1.35 : Article info: : https://doi.org/10.29252/NIRP.BCN.9.1.35 Received: 12 December 2016 First Revision: 02 January 2017 Accepted: 05 July 2017 AB STRACT Introduction: Primary Progressive Aphasia (PPA) is a neurological condition characterized by progressive dissolution of language capabilities. The Progressive Aphasia Language Scale (PALS) is an easy-to-apply bedside clinical scale capable of capturing and grading the key language features essential for the classification of PPA. The objective of the present study was to develop and validate the Persian version of the PALS (PALS-P) as a clinical language assessment test. Methods: In this cross-sectional study, PALS was translated and adapted into Persian according to the international guidelines. A total of 30 subjects (10 subjects with PPA and 20 control subjects without dementia) were recruited to evaluate the intra-rater reliability and discriminant validity of PALS-P. Key Words: Aphasia, Neurodegenerative disorders, Primary progressive aphasia, Language test Results: The intra-rater reliability of the PALS-P within a 14-day interval was excellent for each subtest (ICC agreement range=0.81-1.0). PALS-P results were statistically significant among groups, suggesting its discriminative validity. Conclusion: This preliminary study indicates that PALS-P was successfully developed and translated. It seems to be a valid and reliable screening tool to assess language skills in Persianspeaking subjects with progressive aphasia. * Corresponding Author: Ahmad Reza Khatoonabadi, PhD Address: Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98 (21) 77636042 E-mail: 35 Basic and Clinical January, February 2018, Volume 9, Number 1 P 1. Introduction rimary Progressive Aphasia (PPA) refers to a group of neurodegenerative disorders that slowly and progressively impair language function while sparing other aspects of cognitive processing such as memory, attention, visuospatial skills, and executive functions in the initial stages of the condition (Mesulam, 1982). According to a recently published framework for the diagnosis and classification of PPA, three clinical variants of PPA have been described: semantic dementia, progressive nonfluent aphasia, and progressive logopenic aphasia (Gorno Tempini et al., 2011). Although a vast majority of cases fit in this tripartite classification, some cases with mild or mixed deficits make this classification clinically challenging. Therefore, researchers suggest an unclassified or mixed PPA variant as a fourth category for those patients with overlapping deficits (Leyton & Hodges, 2014; Mesulam et al., 2012). These three variants differently affect cortical regions responsible for the language network functions, which subsequently results in various clinical profiles (Gorno-Tempini et al., 2011; Mesulam et al., 2017). Each variant of primary progressive aphasia is associated with a different anatomical site of peak atrophy in the left-hemisphere language network: the inferior frontal gyrus (Boca’s area) in the agrammatic variant, the temporoparietal junction (Wernicke’s area) in the logopenic variant, and the anterior temporal lobe in the semantic variant. In semantic dementia, preferential atrophy of the anterior temporal lobe also occurs but usually in a more symmetric pattern that involves both hemispheres (Mesulam et al., 2017). Therefore, the cardinal feature of all PPA types is the deterioration of language functions while preserving other cognitive functions; the diagnosis of its variants must be based on the presence or absence of key speech/ language features. Table 1 presents those language features considered by the International Consensus Group on PPA to be of cardinal importance for diagnosing the disorder and defining each of its variants. Despite the importance of considering speech and language criteria in the diagnosis of PPA and its variants, the assessment process may not be so straightforward in real clinical situations due to the potential inconsistency of signs and diagnostic biases. This is especially the case when a clinician is not well versed in the assessment of affected patients (Leyton et al., 2011). The problem may be partially resolved by using standardized tests that are able to quantify speech and language deficits (e.g. Western Aphasia Battery [WAB], Boston Diagnostic Aphasia Examination [BDEA]) (Goodglass, Kaplan & Barresi, 2000; Kertesz, 1982). WAB and BDEA are based on speech/language profiles of aphasic patients affected by cerebrovascular events and may not directly target the deficits caused by PPA. In addition, complete administration of these tests and the interpretation of their results require considerable time and skill. The Clinical Dementia Rating (CDR) is another widely used scale for the cognitive-linguistic assessment of patients with various degenerative syndromes that determines the severity of their cognitive deficits and performance in activities of daily living. The language assessment included in this scale cannot provide a com- Table 1. Summary of the core language features of PPA and its variants recommended by Gorno-Tempin et al. (2011) (adapted from Leyton et al., 2011) 36 Core Language Features Variants Primary progressive aphasia 1. Deficient language ability (i.e. word-finding deficits, effortful speech, paraphasias, grammatical and/or comprehension deficits) is the most prominent clinical feature of the disorder. 2. Aphasia must be the m (...truncated)