Holistic Assessment of Stroke Patients with Aphasia

Primary Assessment Tools

The Western Aphasia Battery (WAB) should be used as the primary comprehensive assessment tool for patients with aphasia as it evaluates spoken and written language production and comprehension, calculation, drawing, and visuoconstruction skills 1
The Boston Naming Test should be included to assess word retrieval abilities, which is a common deficit in post-stroke aphasia 1
For reading assessment, include the Reading Comprehension Battery, which has acceptable psychometric qualities and is appropriate for patients with aphasia 1
The Assessment of Language-Related Functional Activities should be used to evaluate practical communication skills in everyday activities such as check writing and telephone tasks 1
The ASHA Functional Assessment of Communication Skills for Adults should be included to assess social communication, basic needs communication, reading, writing, and number concepts 1
The Quality of Communication Life Scale should be administered to evaluate the impact of communication deficits on quality of life and social participation 1
The Cognitive Linguistic Quick Test can be used to assess attention, memory, executive function, language, and visuospatial perception in patients with diverse neurological diagnoses 1

The Behavioral Assessment of the Dysexecutive Functioning Syndrome should be used to evaluate executive skills in everyday activities and includes a questionnaire that can be completed by both patient and caregiver 1
The Color Trails Test is recommended for assessing sustained attention and attention switching with minimal language or cultural bias 1
The Rivermead Behavioral Memory Test is recommended to evaluate everyday memory abilities with parallel versions allowing for reliable repeated administrations 1
The Location Learning Test should be used to assess visuospatial learning and recall in older adults 1
The Stroop Test should be included to evaluate executive functions, including psychomotor speed, cognitive flexibility, and response inhibition in patients with suspected vascular cognitive impairment 2

All stroke patients should be screened for communication disorders using simple, reliable, validated tools 3, 4
Patients with any suspected communication deficits should be referred to a Speech-Language Pathologist (SLP) for comprehensive assessment 3, 4
Consider the validity and standardization of selected tools with regards to factors such as age, culture, language fluency, physical function, and education levels 5
Be aware of the potential impact of multiple assessments on both validity of test results and patient fatigue; use different equivalent assessment forms when available to avoid practice effects 5
When assessing patients with significant language impairments, use alternative means of communication such as gesture, drawing, writing, and augmentative and alternative communication devices 6, 7

All patients with suspected vascular cognitive impairment should undergo MRI (preferred) or CT to evaluate cerebrovascular disease 5
Laboratory testing should include CBC, TSH, B12, calcium, electrolytes, creatinine, ALT, lipid panel, and HbA1c to assess stroke risk factors and possible contributing factors to cognitive impairment 5

The presence of non-cognitive neurological deficits (visual field deficits, motor deficits) must be considered when performing cognitive assessments 5
Assessing non-language cognitive domains is challenging when aphasia is present; in complex cases, formal evaluation by a neuropsychologist and/or repeated assessments may be required 5
The Stroop test should be interpreted within a comprehensive assessment battery, considering potential confounding factors such as educational level, language proficiency, visual impairments, and cultural background 2