The first aphasia screening test in Hungarian: A preliminary study on validity and diagnostic accuracy

PLOS ONE RESEARCH ARTICLE The first aphasia screening test in Hungarian: A preliminary study on validity and diagnostic accuracy Lilla Zakariás ID1,2,3*, Ágnes Lukács4,5 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Bárczi Gusztáv Faculty of Special Needs Education, Eötvös Loránd University, Budapest, Hungary, 2 Faculty of Humanities, Eötvös Loránd University, Budapest, Hungary, 3 National Institute of Locomotor Diseases and Disabilities/National Institute for Medical Rehabilitation, Budapest, Hungary, 4 Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary, 5 MTA-BME Momentum Language Acquisition Research Group, Eötvös Loránd Research Network (ELKH), Budapest, Hungary * Abstract OPEN ACCESS Citation: Zakariás L, Lukács Á (2023) The first aphasia screening test in Hungarian: A preliminary study on validity and diagnostic accuracy. PLoS ONE 18(8): e0290153. https://doi.org/10.1371/ journal.pone.0290153 Editor: Garumma Tolu Feyissa, Drexel University, UNITED STATES Received: June 4, 2022 Accepted: August 2, 2023 Published: August 17, 2023 Copyright: © 2023 Zakariás, Lukács. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting information files. Funding: LZ was supported by the Hungarian National Research, Development and Innovation Office (FK 131828; principal investigator: LZ, https://nkfih.gov.hu/about-the-office) and by the ÚNKP-21-4 New National Excellence Program of the Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation Fund (https://2015-2019.kormany. hu/en/ministry-for-innovation-and-technology). ÁL The Hungarian Aphasia Screening Test (HAST) is a newly developed diagnostic tool for detecting post-stroke aphasia in clinical settings, and for differentiating between stroke patients with and without aphasia. The HAST was developed by our team and has not been published in English yet. In Hungarian, to date, there is no aphasia screening test with reported psychometric properties available. This study aims to present the main characteristics of the HAST and to evaluate its validity, internal consistency, and diagnostic accuracy. The HAST comprises five subtests (maximum score: 20) and takes 5–10 minutes to administer. We administered the HAST to 40 stroke patients with aphasia, 26 stroke patients without aphasia, and 51 healthy control participants to evaluate the test’s construct validity, convergent validity, and internal consistency, as well as its sensitivity and specificity. We used the Western Aphasia Battery (WAB) as a reference test. With a cut-off score of 17, the HAST showed high diagnostic accuracy (sensitivity: 92.5%, specificity: 88.5%). Its construct validity was good; we identified one component in the test, and moderate-to-strong positive correlations across most of its subtests (mean Spearman r = 0.56). Convergent validity of the HAST was satisfying, reflected by the moderate-to-strong positive correlations between subtests of the HAST and subtests of the WAB (Spearman r = 0.50–0.86). The correlation between the HAST total score and the WAB aphasia quotient was high (Spearman r = 0.86). Despite the small number of items within tasks, all subtests showed acceptable internal consistency (mean Cronbach’s α = 0.74). Our preliminary results suggest that the HAST is a valid, accurate, and clinically feasible test to detect post-stroke aphasia and to identify patients who require a more detailed assessment of their language skills. In addition, it reliably identifies not only the presence but also the severity of aphasia, thus, it might be a good candidate for monitoring patient progress. PLOS ONE | https://doi.org/10.1371/journal.pone.0290153 August 17, 2023 1 / 18 PLOS ONE was supported by the Momentum research grant of the Hungarian Academy of Sciences (96233; principal investigator: ÁL, https://mta.hu/english). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. The Hungarian aphasia screening test (HAST) Introduction Hungarian is spoken by 13 to 14 million people [1]; by 9,690,000 people in Hungary [2] and, as a minority language, by around three million people in the neighbouring countries, namely Slovakia, Ukraine, Romania, Serbia, Croatia, Slovenia, and Austria [1]. There are around 40,000 incident strokes and 28,000 stroke survivors each year in Hungary [3]. Around one-third of these patients present with an acquired language disorder due to stroke, namely aphasia [4, 5]. Aphasia has a negative impact on quality of life both personally and socially [6, 7]. It may negatively impact employment, education, leisure activities, finances, personal relationships, and identity of people with aphasia [8]. Families experience negative consequences of aphasia, including increased stress, more responsibilities in domestic life, decreased time for leisure, and withdrawal from social life [9]. Since aphasia significantly affects the individual, their families, and communities, its early recognition and treatment are vital [6]. The main goals of language assessment in the acute phase of stroke are to identify aphasia and determine its severity, to monitor changes in the early stage of recovery, and to facilitate the early referral to the speech-language pathologist (SLP) for further examination and early treatment of aphasia [10, 11]. In order to achieve these goals, assessment tools that can be administered in a few minutes, even at bedside, can prove to be pivotal. Ideally, such screening tests do not require specific competencies of SLPs, allowing for a use also by non-SLP health care professionals such as neurologists, psychologists, neuropsychologists, nurses, physical and occupational therapists etc. [10, 12]. Although screening tests are primarily used in the acute care of stroke, they can be useful in any clinical setting allowing for quick test administration and diagnostics. These typically include follow-up assessments to monitor change over time, assess maintenance of language skills, and decide about referral to SLPs. Some of these are often performed only by physicians in later stages of stroke care in Hungary with little time available. El Hachioui and colleagues [10] identified eight aphasia screening tests that had been designed to determine the presence and/or severity of aphasia, had been validated in stroke patients with and without aphasia, and had data on their diagnostic accuracy (i.e., sensitivity and specificity) reported. These tests include the Frenchay Aphasia Scree (...truncated)