Int J Disabil Hum Dev 2016; aop *Corresponding author: José Fonseca, Language Research Laboratory, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; and UNIC – Instituto de Medicina Molecular, Lisbon, Portugal, E-mail: jfonseca@medicina.ulisboa.pt Joaquim J. Ferreira: Clinical Pharmacology Unit, Instituto de Medicina Molecular (IMM), Faculty of Medicine, University of Lisbon, Lisbon, Portugal Isabel Pavão Martins: Language Research Laboratory, Faculty of Medicine, University of Lisbon, Lisbon, Portugal; and UNIC – Instituto de Medicina Molecular, Lisbon, Portugal José Fonseca*, Joaquim J. Ferreira and Isabel Pavão Martins Cognitive performance in aphasia due to stroke: a systematic review DOI 10.1515/ijdhd-2016-0011 Received February 15, 2016; accepted March 8, 2016 Abstract Introduction: Aphasia persists in about one third of the patients with left hemisphere stroke, yet it is not known if it enhances the risk of dementia, beyond what results from any focal brain lesion. This lack of knowledge is mostly related to the difficulty of cognitive evaluation in people with aphasia. The development of tools aiming to assess cognitive functioning in people with aphasia could overcome this limitation. The aim of this system- atic review was to evaluate the frequency and the profile of cognitive impairment in stroke patients with aphasia, to assemble existing non-verbal instruments to be used in patients with language disorders. Methods: We conducted a systematic review, through Web of Science, Medline and PsycINFO electronic databases, of articles published between January 1995 and October 31, 2015 related to aphasia due to stroke and non-verbal neurobehavioral tests. Results: The electronic search identified 2487 citations. After screening 38 were included in this review. Addi- tionally 53 articles were selected among the references of analyzed publications of which nine were included producing a total of 47 articles. The cognitive tests more frequently used in persons with aphasia are the Figures Memory Tests, Visual Memory Span, Progressive Matrices, Wisconsin Card Sorting Test and some measures of the Test of Everyday Attention, covering a reasonable range of cognitive domains. The majority of studies across cog- nitive domains reported lower scores for patients with aphasia compared with controls. No specific difficulties were reported regarding tests applicability. Conclusion: There are several tools available to assess cog- nitive functions in aphasia. Although there is some vari- ability, patients with aphasia tend to present lower scores than those with left hemisphere stroke without aphasia or healthy subjects. A consensus tool should be developed to screen or evaluate cognition and dementia in individuals with language impairment. Keywords: aphasia; cognition; neuropsychological assessment; stroke; systematic review. Introduction Aphasia is the loss or impairment of language func- tions caused by brain damage. It may occur alone or in association with other cognitive disorders depending on affected brain areas, the rate of lesion progression and the mechanisms of cerebral reorganization [1, 2]. The degree of interdependence between language and other aspects of cognition could theoretically be evaluated in individu- als with aphasia but, so far, it has not been well studied. Beyond its theoretical interest this relation has important practical implications on what concerns the prognosis of aphasia, the planning of language rehabilitation, the autonomy of persons with aphasia and medico-legal issues. In fact, although the diagnosis and characterization of aphasia constitutes the first step towards a well-founded language therapy, it may be insufficient to establish an effective therapeutic intervention, as other cognitive abili- ties need to be intact for maximum therapeutic benefit. Attention, for instance, is essential to almost all activities of daily life and its impairment can compromise patients’ participation in rehabilitation and the benefit of therapy. Furthermore, aphasia therapy is a learning experience that requires the integrity of memory systems. Besides, most therapeutic methods in aphasia require visuospatial pro- cessing, such as the identification and production based on images, gestures or written material. If the ultimate goal of aphasia therapy is to improve daily communication skills, it is essential, that subjects maintain the ability to solve problems since communication occurs in unpredict- able ways. However, mnestic [3–7], attentional [8, 9] and Unauthenticated Download Date | 6/3/16 1:11 PM