Relationship between discourse and Western Aphasia Battery performance in African Americans with aphasia

Background: There is a need for discourse research with African Americans who have aphasia, highlighted by ethnic group differences in stroke prevalence, and potential ethnic group differences in dialect. Identification of ethnic dialect is critical to differentiate communication changes associated with pathology from normal communicative differences associated with ethnicity. Also, preliminary research on adults with aphasia indicates an uncertain relationship between discourse performance and standardised test performance. Aims: This study was designed to assess: (1) the relationship between performance on a standardised language measure and discourse performance, and (2) the use of ethnic dialect and discourse features, in the narrative productions of African-American adults with moderate aphasia on a variety of discourse tasks. Methods & Procedures: We investigated the discourse of 12 African Americans with scores in the moderate severity range on the Western Aphasia Battery, Aphasia Quotient (WAB-AQ). Each subject produced a fable retell, a story derived from a picture sequence, two stories derived from single pictures, and a topic-elicited personal narrative of a frightening experience. Analysis consisted of ratings of discourse quality (coherence, reference, and emplotment); a measure of discourse quantity (number of propositions); and a tally of the presence or absence of ethnic dialect and discourse features. Outcomes & Results: The correlation between WAB-AQ and discourse quality was statistically significant on the picture sequence task and one single-picture task, but not on the other discourse tasks. There was a significant relationship between WAB-AQ and overall quality ratings of coherence, reference, and emplotment. The correlation between WAB-AQ and discourse quantity was not significant for any task, and discourse quality was not significantly correlated with discourse quantity. Ethnic features appeared most often on one single-picture task and the personal narrative. No ethnic dialect features occurred on the fable retell. Conclusions : These findings suggest the need to supplement standardised assessment of aphasia with assessment of discourse performance, using less structured discourse tasks, such as a personal narrative task. Less structured discourse tasks may also be optimal for eliciting natural ethnic patterns of communication. The lack of relationship between narrative quantity and narrative quality may not generalise to individuals with aphasia that is severe or mild. This study contributes towards development of a discourse assessment tool for culturally and linguistically diverse populations that may supplement information provided by standardised testing.     

Social and behavioral predictors of insufficient sleep among African Americans and Caucasians

BackgroundFew studies have examined the social and behavioral predictors of insufficient sleep.ObjectiveTo assess the social and behavioral predictors of insufficient sleep in the U.S. population.MethodsData from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Telephone interviews were conducted in six representative states that completed the optional sleep module. A total of 31,059 respondents were included in the present analysis. BRFSS-provided weights were applied to analyses to adjust for the use of complex design.ResultsThe mean age for the sample was 56 ± 16 years, with 63% of the sample being female; 88% identified as non-Hispanic white and 12% identified as non-Hispanic black; 42% were not married and 8% did not have a high school degree. The prevalence of insufficient sleep (<7 hours) was 37%. Multivariate-adjusted logistic regression revealed associations of four important factors with insufficient sleep, which were: working more than 40 hours per week [OR = 1.65, p < 0.001, 95% CI = 1.65–1.66], black race/ethnicity [OR = 1.37, p < 0.001, 95% CI = 1.37–1.38], history of heart disease [OR = 1.26, p < 0.001, 95% CI = 1.25–1.28], care-giving to family/friends [OR = 1.50, p < 0.001, 95% CI = 1.49–1.51], and lack of social and emotional support [OR = 1.24, p < 0.001, 95% CI = 1. 23–1.25].ConclusionSocial and behavioral predictors of health uniquely contribute to the report of insufficient sleep and should be considered when developing programs to increase awareness of the adverse effects of insufficient sleep.     

Stereotype confirmation concern and fear of negative evaluation among African Americans and Caucasians with Social Anxiety Disorder

Fear of negative evaluation is a central component of social anxiety. The current study examines the relation between fear of negative evaluation and fears of confirming stereotypes about social groups to which one belongs among people diagnosed with social anxiety disorder. Participants (N = 94) with a primary diagnosis of social anxiety disorder who self-identified as either African American (n = 41) or Caucasian (n = 53) completed standardized self-report measures of stereotype confirmation concerns and fear of negative evaluation. Results from hierarchical logistical regression showed that stereotype confirmation concerns predicted fear of negative evaluation for both racial groups, with greater concern predicting greater fear. This association was moderated by race, B = −.24, t = −2.67, p < .01, such that stereotype confirmation concerns had a stronger association with fear of negative evaluation for Caucasians (b = .38, p < .01) than for African Americans (b = .14, p < .05). This study is the first to directly examine the relation between stereotypes and fear of negative evaluation within a socially anxious sample. Although we cannot identify the specific social group to which each participant's stereotype confirmation concerns apply, this study provides quantitative evidence that the social context within which socially anxious individuals view themselves impacts their fear of negative evaluation and highlights the need for further research in this area.     

Cognitive and functional decline in African Americans with VaD, AD, and stroke without dementia.

OBJECTIVE: To compare the rates of cognitive and functional decline in African American patients diagnosed at baseline with vascular dementia (VaD) (n = 79), AD (n = 113), or stroke without dementia (SWD) (n = 56) and followed for up to 7 years with annual neuropsychological and other examinations. METHODS: Study patients were diagnosed using established criteria for dementia and were administered cognitive screening, functional screening, and neuropsychological measures. Baseline dementia severity was rated using the Clinical Dementia Rating Scale. Random effects modeling was used to examine rates of decline and to compare the rates of decline in the three groups. RESULTS: Both patients with VaD and those with AD showed significant cognitive and functional decline during follow-up; patients with VaD declined at a slower rate than patients with AD; and patients diagnosed with SWD at baseline did not show cognitive or functional decline during follow-up. CONCLUSIONS: Patients with VaD decline at a slower rate than patients with AD. Patients who do not meet criteria for dementia soon after stroke may not be at high risk for developing dementia. Future studies are needed to follow VaD patients with longitudinal, specialized MR protocols, concurrent neuropsychological examinations, and neuropathologic examination to determine possible neuroimaging predictors of progressive cognitive and functional decline and to assess the contribution of Alzheimer's pathology to decline in patients diagnosed with VaD.     

Stroke in African Americans

There is an excess burden of cerebrovascular disease in African Americans. This article will define possible reasons for excess stroke risk, review racial differences in stroke subtype and stroke prevention programs in the African American Community, and delineate sequelae of stroke. The authors provide insights about stroke prevention in African Americans and highlight challenges to reduce the burden of cerebrovascular disease in this high-risk group.     

Quality of life with and without aphasia

Background: Although the social approach to managing aphasia is designed to improve the quality of life (QOL) of the aphasic person, the influence of being aphasic on different facets of QOL is unknown. Aims: To delineate socially valid therapy targets, we examined 24 facets of QOL proposed by the World Health Organisation (WHO) to determine which facets differentiate QOL between aphasic and nonaphasic people. Methods & Procedures: A prospective, observational, non-randomised group design was employed. Two measures--the WHO QOL Instrument, Short Form (WHOQOL-BREF) and the Psychosocial Well-Being Index (PWI)--were administered to 18 adults with chronic aphasia and 18 nonaphasic adults. Indices of determination (ID) and degrees of overlap (DO) were calculated to determine which of the 24 facets were best in differentiating between the aphasic and nonaphasic groups. Outcomes & Results: Facets within three domains--level of independence, social relationships, and environment--were best in distinguishing QOL between the aphasic and nonaphasic groups. Conclusion: Therapy that focuses on situation-specific communication and societal participation appears to be most appropriate for enhancing the QOL of people with chronic aphasia.     

Production of nouns and verbs in aphasia: Effects of elicitation context

This study investigated the ability of 10 aphasic speakers and 9 normal controls to produce unambiguous, frequency-matched nouns and verbs in four elicitation conditions. Two auditory conditions included naming to definition and sentence completion; two picture conditions preceded the presentation of the picture with an auditory cue consisting of a question (what is the action shown here?) or a sentence completion (this is a picture of the action to...). Patients were grouped in terms of whether they demonstrated only word retrieval problems (anomia), or also showed difficulty with sentence comprehension and production. Contrary to expectations, there were no reliable effects of elicitation condition on performance. Although both groups of aphasic speakers found verbs more difficult than nouns to retrieve across conditions, the sentence production-impaired group showed a more severe impairment of verb production that was reliable for individual subjects. Results reinforce the importance of grammatical class as a factor in the word retrieval impairments found in aphasia.     

Sleep paralysis in African Americans with panic disorder

Studies have reported a wide range in lifetime prevalence of sleep paralysis (SP). This variation may stem from cultural factors, stressful life events and genetic differences in studied populations. We found that recurrent SP was more common among African-American participants, especially those with panic disorder. Recurrent SP was reported by 59% of African Americans with panic disorder, 7% of whites with panic disorder, 23% of African-American community volunteers and 6% of white community volunteers. Significantly more early life stressors were reported by African Americans than whites. Higher levels of psychosocial stressors, including poverty, racism and acculturation, may contribute to the higher rates of SP experienced by African Americans.     

Diagnosing Depression in African Americans

Since the 1970s, articles have noted the increased presence of psychotic symptoms among depressed African Americans, the presence of diagnostic bias identified when structured clinical interviews are used, and the identification of misdiagnosis of affective illness among chronically, mentally ill, African Americans. This paper reviews this literature and describes three alternative presentations of depressive illness among African Americans that differ from the DSM IV criteria for Major Depressive Disorder: the stoic believer, the angry, evil one with a personality change, and the John Henry doer. Clinicians are encouraged to recall these presentations of depression when evaluating African American patients.