Clinical impression and Western Aphasia Battery classification of aphasia in acute ischemic stroke: Is there a discrepancy?
BACKGROUND
Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear.


OBJECTIVE
The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them.


METHODS
Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB.


RESULTS
Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patient's bedside clinical impression and WAB classification of aphasia, with aP< 0.001.


CONCLUSIONS
Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
Aju Abraham
AA
John
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
Mahendra
M
Javali
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
Rohan
R
Mahale
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
Anish
A
Mehta
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
P T
PT
Acharya
Department of Neurology, M.S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India.
R
R
Srinivasa
Aphasia; clinical impression; ischemic stroke