Nick Miller1, William K Gray2, Suzanne C Howitt2, Ahmed Jusabani3, Mark Swai3, Ferdinand Mugusi4, Matthew P Jones2, Richard W Walker2. 1. Institute of Health and Society, Speech Language Sciences, Newcastle University, Newcastle upon Tyne, UK. 2. Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Tyne and Wear, UK. 3. Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro Region, Tanzania. 4. Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
Abstract
OBJECTIVES: This study was carried out to quantify the degree of cognitive impairment and the extent of speech, language, and swallowing problems in a representative cohort of Swahili-speaking people with stroke in Tanzania. METHODS: A case-control design was used, comparing people with and without stroke on a screening test for aphasia (spoken comprehension and expression), a water swallow test, and the Community Screening Instrument for Dementia (CSI-D). RESULTS: Fifty-eight persons between 6 and 60 months (median 36) post stroke and 58 age- and gender-matched control subjects were assessed. Twenty-eight strokes were left hemisphere; 25, right; 2, posterior circulation; and 3, undetermined. Forty-nine of 58 (84%) control subjects scored 19 to 20 (maximum) on the language screen compared with 26 of 56 (46%) persons with stroke who completed the assessment. Higher age and lower educational attainment, but not gender or time since stroke, were associated with poorer performance on language and swallow assessments. Poorer CSI-D score was significantly correlated with all items. Greater disability (Barthel Index score) was significantly correlated with poorer performance in all items except rate of drinking water. Those with a left hemisphere stroke performed less well on understanding and expression items but better than other subjects with stroke on the water swallow task. CONCLUSIONS: This is the first attempt to describe aphasia incidence in a sub-Saharan African language. Further work on the psychometric properties of the screening instrument is warranted. Given that it delivers a relatively coarse indication of language disturbance, it is likely that incidence of aphasia in the current cohort is underestimated.
OBJECTIVES: This study was carried out to quantify the degree of cognitive impairment and the extent of speech, language, and swallowing problems in a representative cohort of Swahili-speaking people with stroke in Tanzania. METHODS: A case-control design was used, comparing people with and without stroke on a screening test for aphasia (spoken comprehension and expression), a water swallow test, and the Community Screening Instrument for Dementia (CSI-D). RESULTS: Fifty-eight persons between 6 and 60 months (median 36) post stroke and 58 age- and gender-matched control subjects were assessed. Twenty-eight strokes were left hemisphere; 25, right; 2, posterior circulation; and 3, undetermined. Forty-nine of 58 (84%) control subjects scored 19 to 20 (maximum) on the language screen compared with 26 of 56 (46%) persons with stroke who completed the assessment. Higher age and lower educational attainment, but not gender or time since stroke, were associated with poorer performance on language and swallow assessments. Poorer CSI-D score was significantly correlated with all items. Greater disability (Barthel Index score) was significantly correlated with poorer performance in all items except rate of drinking water. Those with a left hemisphere stroke performed less well on understanding and expression items but better than other subjects with stroke on the water swallow task. CONCLUSIONS: This is the first attempt to describe aphasia incidence in a sub-Saharan African language. Further work on the psychometric properties of the screening instrument is warranted. Given that it delivers a relatively coarse indication of language disturbance, it is likely that incidence of aphasia in the current cohort is underestimated.
Authors: Rajesh N Kalaria; Mayowa O Owolabi; Rufus O Akinyemi; Bruce Ovbiagele; Olaleye A Adeniji; Fred S Sarfo; Foad Abd-Allah; Thierry Adoukonou; Okechukwu S Ogah; Pamela Naidoo; Albertino Damasceno; Richard W Walker; Adesola Ogunniyi Journal: Nat Rev Neurol Date: 2021-09-15 Impact factor: 42.937