Demographic, Clinical and Language Characteristics of Malaysian Patients with Aphasia: A Retrospective Study

Aziz MAA; Razak AR; Farid AHM; Hamid BA; Taha NA; Garraffa M; Alisaputri ML

Original Article Published on 14 Mar, 2024

Demographic, Clinical and Language Characteristics of Malaysian Patients with Aphasia: A Retrospective Study

Antiplatelet Therapy for Stroke Secondary Prevention

Vol. 19 No. 1 : 2024 (82-98)

Aziz MAA

Razak AR

Farid AHM

Hamid BA

Taha NA

Garraffa M

Alisaputri ML

Abstract

Limited research has been conducted in Malaysia on the characteristics of patients with aphasia. To address this gap, a retrospective study was conducted at Hospital Rehabilitasi Cheras (HRC). The study aimed to profile the demographic, clinical, and language characteristics of patients who underwent speech therapy for aphasia. Medical records from 2014 to 2017 were reviewed, focusing on 1,259 adult patients who were referred to the Speech Therapy Unit. Analysis included demographics, clinical aspects, and linguistic features. The Western Battery of Aphasia-Revised (WAB-R), a comprehensive assessment tool, was used to evaluate the language abilities. Among the patients' files analysed, a total of 211 contained WAB-R test results. The demographic profile revealed a higher proportion of male patients compared to females, with Malay patients comprising the majority, followed by Chinese and Indians. Age distribution included 41.7% older adults (aged 55 and above), 37.9% middle-aged (aged 36-55), and 20.4% younger adults (aged 18-35). Notably, 44.5% had completed high school education. Clinically, right- sided hemiparesis was prevalent as noted with 67.8% of patients, while 14.7% had left-sided hemiparesis. The primary cause of aphasia was stroke, accounting for 71.1% of cases, with ischemic stroke being the dominant subtype (56.9%). Fluent aphasia was presented in 50.2% of the cases, compared to 49.3% of non-fluent aphasia. Anomic aphasia was the most common subtype (35.5%), followed by global aphasia (27.5%) and Broca’s aphasia (17.5%). The language profile provided a detailed description, encompassing linguistic aspects relevant to different aphasia types. These preliminary findings yielded valuable insights and hold significant implications for the clinical management of aphasia patients in Malaysia.

Keywords : Aphasia, clinical characteristics, demographic, language profile, Malaysia,

Abstrak

Kajian yang telah dilakukan di Malaysia tentang ciri-ciri pesakit afasia adalah terhad. Bagi mengatasi jurang ini, kajian retrospektif telah dijalankan di Hospital Rehabilitasi Cheras (HRC). Kajian ini bertujuan untuk memprofilkan ciri-ciri demografi, klinikal dan bahasa bagi pesakit yang menjalani terapi pertuturan untuk afasia. Rekod perubatan dari tahun 2014 hingga 2017 telah disemak, memfokuskan pada 1,259 pesakit dewasa yang dirujuk ke Unit Terapi Pertuturan. Analisis yang dijalankan termasuklah demografi, aspek klinikal dan ciri-ciri linguistik. Western Battery of Aphasia- Revised (WAB-R), alat penilaian yang komprehensif digunakan untuk menilai kebolehan bahasa. Antara fail pesakit yang dianalisis, sebanyak 211 mengandungi keputusan ujian WAB-R. Profil demografi menunjukkan nisbah pesakit lelaki lebih tinggi berbanding dengan wanita, di mana majoritinya adalah pesakit Melayu, diikuti oleh Cina dan India. Taburan umur termasuk 41.7% orang dewasa yang lebih tua (berumur lebih dari 55 tahun), 37.9% pertengahan umur (berumur 36-55 tahun) dan 20.4% orang dewasa yang lebih muda (berumur 15-35 tahun). Sebanyak 44.5% telah menamatkan pendidikan sekolah menengah. Secara klinikal, hemiparesis sebelah kanan adalah lazim iaitu 67.8% daripada pesakit, manakala 14.7% mempunyai hemiparesis sebelah kiri. Penyebab utama afasia ialah strok, menyumbang kepada 71.1% kes, dengan kebanyakannya adalah strok iskemia (56.9%). Terdapat 50.2% kes afasia lancar, berbanding dengan 49.3% afasia tidak lancar. Afasia jenis anomik ialah yang paling banyak (35.5%), diikuti oleh afasia global (27.5%) dan afasia jenis Broca (17.5%). Profil bahasa memberikan penerangan terperinci, merangkumi aspek linguistik yang berkaitan dengan jenis afasia yang berbeza. Penemuan awal ini menghasilkan pandangan yang berharga dan mempunyai implikasi yang signifikan terhadap pengurusan klinikal pesakit afasia di Malaysia.

Kata Kunci : Afasia, demografi, ciri-ciri klinikal, Malaysia, profil bahasa,

Correspondance Address

Mohd Azmarul A Aziz. Speech Pathology Programme, School of Health Sciences Universiti Sains Malaysia (Health Campus), 16150 Kubang Kerian, Kelantan, Malaysia. Tel: +609-7677662 Email: azmarul@usm.my

References

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Australian Aphasia Rehabilitation Pathway. Screening tools. National Stroke Foundation. [Australia Aphasia Rehabilitation Pathway website]. https://www.aphasiapathway.com.au/?name=aphasia-screening-tools [24 January, 2020].

Aziz, M.A.A., Abd Aziz, A., A Razak, R., Hamid, B. 2013. Word retrieval deficits in Malay- speaking adults with non-fluent aphasia. Pro Soc Behav Sci 94: 69-70.

Aziz, M.A.A., Chern, P.M. 2016. Paediatric speech and language disorders in Malaysia: A preliminary study. J Rehabil Med 48 (suppl. 55): 290.

Aziz, M.A.A., Mukhtar, F., Onwi, N., Mohd Marzuki, N.H. 2016. Demographic and clinical profiles of patients with aphasia: a preliminary data. [abstract]. J Rehabil Med 48(suppl 55): 290.

Aziz, M.A.A., Razak, R.A., Garraffa, M. 2020. Targeting complex orthography in the treatment of a bilingual aphasia with acquired dysgraphia: The case of a Malay/English speaker with conduction aphasia. Behav Sci 10(7): 109.

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Bakheit, A.M., Shaw, S., Carrington, S., Griffiths, S. 2008. The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke. Clin Rehabil 21(10): 941-9.

Connor, L.T., Obler, L.K., Tocco, M., Fitzpatrick, P.M., Albert, M.L. 2001. Effect of socioeconomic status on aphasia severity and recovery. Brain Lang 78(2): 254- 7.

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Dickey, L., Kagan, A., Lindsay, M.P., Fang J., Rowland, A., Black, S. 2010. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil 91(2): 196-202.

Donkor, E.S. 2018. Stroke in the 21st Century: A snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat 2018: 3238165.

El Hachioui, H., Visch-Brink, E.G., de Lau, L.M., van de Sandt-Koenderman, M.W., Nouwens, F., Koudstaal, P.J., Dippel, D.W. 2017. Screening tests for aphasia in patients with stroke: A systematic review. J Neurol 264(2): 211-20.

Engelter, S.T., Gostynski, M., Papa, S., Frei, M., Born, C., Ajdacic-Gross, V., Gutzwiller, F., Lyrer, P.A. 2006. Epidemiology of aphasia attributable to first ischemic stroke: Incidence, severity, fluency, etiology, and thrombolysis. Stroke 37(6): 1379-84.

Fridriksson, J., Hillis, A.E. 2021. Current approaches to the treatment of post-stroke aphasia. J Stroke 23(2): 183-201.

Gonzalez, M.F., Lavados, G.P., Olavarria, I.V. 2017. Incidence of aphasia in patients experiencing an ischemic stroke. Rev Med Chil 145(2): 194-200.

Gronberg, A., Henriksson, I., Lindgren, A. 2020. Aphasia recovery after ischemic stroke. Stroke 51(suppl1): 149.

Hallowell, B., Chapey, R. 2008. Delivering language intervention services to adults with neurogenic communication disorders. In Language intervention strategies in adult aphasia. Edited by Chapey R. 5th edition. Philadelphia: Williams & Wilkins; 203-27.

Hamid, B., Hashim, F., Mohd Yassin, S. 2018. Interacting with discourse: Foregrounding social matters- Links between discourse practice, culture and society. UKM Publisher: Bangi.

Hassan, M., Lee, G.Z.H., Razak, R.A., Aziz, M.A., Singh, S.J. 2023. The management of multilingual adults with aphasia in Malaysia: Current practices, needs, and challenges. Aphasiology 2023: 1-23

Hilari, K. 2011. The impact of stroke: Are people with aphasia different to those without? Disabil Rehabil 33(3): 211-8.

Jin, L., A Razak, R., Wright, J., Song, J. 2014. Issues in Developing Grammatical Assessment Tools in Chinese and Malay for Speech and Language Therapy. In South and Southeast Asian Psycholinguistics. Edited by Winskel, H. & Padakannaya.Cambridge University Press: London; 145-58.

Kang, E.K., Sohn, H.M., Han, M.K., Kim, W, Han, T.R., Paik, N.J. 2010. Severity of post- stroke aphasia according to aphasia type and lesion location in Koreans. J Korean Med Sci 25(1): 123-7.

Kertesz, A. 2006. Western Aphasia Battery-Revisited. Pearson Clinical.

Kim, W.J., Paik, N.J. 2014. Lesion localization of global aphasia without hemiparesis by overlapping of the brain magnetic resonance images. Neural Regen Res 9(23): 2081-6.

Kuriakose, D., Xiao, Z. 2020. Pathophysiology and treatment of stroke: Present status and future perspectives. Int J Mol Sci 21(20): 7609.

National Aphasia Association. National Survey of Aphasia Awareness. 2016. https://www.aphasia.org/2016-aphasia-awareness-survey/naasurveyresults-2016report/. 17 April, 2019.

Ocklenburg, S., Friedrich, P., Fraenz, C., Schlüter, C., Beste, C., Güntürkün, O., Genç, E. 2018. Neurite architecture of the planum temporale predicts neurophysiological processing of auditory speech. Sci Adv 4(7): eaar6830.

O’Neill, P.A., Cheadle, B., Wyatt, R., McGuffog, J., Fullerton, K.J. 1990. The value of the frenchay aphasia screening test in screening for dysphasia: Better than the clinician? Clin Rehabil 4: 123-8.

Owens, A. 2016. National Aphasia Awareness month: 5 things you should know. https://www.mageerehab.org/blog_post/national-aphasia-awareness-month-5-things- you-should-know/ [30 June, 2021].

Pedersen, P.M., Vinter, K, Olsen, T.S. 2004. Aphasia after stroke: Type, severity, and prognosis.Cerebrovasc Dis 17(1): 35-43.

Salter, K., Jutai, J., Foley, N., Hellings, C., Teasell, R. 2006. Identification of aphasia post stroke: A review of screening assessment tools. Brain Inj 20(6): 559-68

Shin, Y.C., Khoong, E.S., Mohamed Ismail, F., Al Taher, A.M., A Razak, R. 2019. Speech- language pathology in Malaysia. Perspect ASHA Spec Interest Groups 4(5): 1162-6.

Vidović, M., Sinanović, O., Šabaškić, L., Hatičić, A., Brkić, E. 2011. Incidence and types of speech disorders in stroke patients. Acta Clin Croat 50(4): 491-4.

Worral, T. 2017. Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia. Centre for Clinical Research Excellence in Aphasia Rehabilitation. https://www.aph.gov.au/DocumentStore [5 March, 2019].

Yourganov, G., Smith, K.G., Fridriksson, J., Rorden, C. 2015. Predicting aphasia type from brain damage measured with structural MRI. Cortex 73: 203-15.

Correspondance Address

Al-Khawaja, I., Wade, D.T., Collin, C.F. 1996. Bedside screening for aphasia: A comparison of two methods. J Neurol 243(2): 201-4.

Australian Aphasia Rehabilitation Pathway. Screening tools. National Stroke Foundation. [Australia Aphasia Rehabilitation Pathway website]. https://www.aphasiapathway.com.au/?name=aphasia-screening-tools [24 January, 2020].

Aziz, M.A.A., Abd Aziz, A., A Razak, R., Hamid, B. 2013. Word retrieval deficits in Malay- speaking adults with non-fluent aphasia. Pro Soc Behav Sci 94: 69-70.

Aziz, M.A.A., Chern, P.M. 2016. Paediatric speech and language disorders in Malaysia: A preliminary study. J Rehabil Med 48 (suppl. 55): 290.

Aziz, M.A.A., Mukhtar, F., Onwi, N., Mohd Marzuki, N.H. 2016. Demographic and clinical profiles of patients with aphasia: a preliminary data. [abstract]. J Rehabil Med 48(suppl 55): 290.

Aziz, M.A.A., Razak, R.A., Garraffa, M. 2020. Targeting complex orthography in the treatment of a bilingual aphasia with acquired dysgraphia: The case of a Malay/English speaker with conduction aphasia. Behav Sci 10(7): 109.

Aziz, Z.A., Sidek, N.N. 2017. Annual Report of the Malaysian Stroke Registry 2009-2016. https://www.macr.org.my/nneur [30 February, 2019]

Bakheit, A.M., Shaw, S., Carrington, S., Griffiths, S. 2008. The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke. Clin Rehabil 21(10): 941-9.

Connor, L.T., Obler, L.K., Tocco, M., Fitzpatrick, P.M., Albert, M.L. 2001. Effect of socioeconomic status on aphasia severity and recovery. Brain Lang 78(2): 254- 7.

Department of Statistics Malaysia (DOSM). Demographic Statistics Malaysia First Quarter 2023. https://www.dosm.gov.my/uploads/release-content/. [29 May 2023]

Dickey, L., Kagan, A., Lindsay, M.P., Fang J., Rowland, A., Black, S. 2010. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch Phys Med Rehabil 91(2): 196-202.

Donkor, E.S. 2018. Stroke in the 21st Century: A snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat 2018: 3238165.

El Hachioui, H., Visch-Brink, E.G., de Lau, L.M., van de Sandt-Koenderman, M.W., Nouwens, F., Koudstaal, P.J., Dippel, D.W. 2017. Screening tests for aphasia in patients with stroke: A systematic review. J Neurol 264(2): 211-20.

Engelter, S.T., Gostynski, M., Papa, S., Frei, M., Born, C., Ajdacic-Gross, V., Gutzwiller, F., Lyrer, P.A. 2006. Epidemiology of aphasia attributable to first ischemic stroke: Incidence, severity, fluency, etiology, and thrombolysis. Stroke 37(6): 1379-84.

Fridriksson, J., Hillis, A.E. 2021. Current approaches to the treatment of post-stroke aphasia. J Stroke 23(2): 183-201.

Gonzalez, M.F., Lavados, G.P., Olavarria, I.V. 2017. Incidence of aphasia in patients experiencing an ischemic stroke. Rev Med Chil 145(2): 194-200.

Gronberg, A., Henriksson, I., Lindgren, A. 2020. Aphasia recovery after ischemic stroke. Stroke 51(suppl1): 149.

Hallowell, B., Chapey, R. 2008. Delivering language intervention services to adults with neurogenic communication disorders. In Language intervention strategies in adult aphasia. Edited by Chapey R. 5th edition. Philadelphia: Williams & Wilkins; 203-27.

Hamid, B., Hashim, F., Mohd Yassin, S. 2018. Interacting with discourse: Foregrounding social matters- Links between discourse practice, culture and society. UKM Publisher: Bangi.

Hassan, M., Lee, G.Z.H., Razak, R.A., Aziz, M.A., Singh, S.J. 2023. The management of multilingual adults with aphasia in Malaysia: Current practices, needs, and challenges. Aphasiology 2023: 1-23

Hilari, K. 2011. The impact of stroke: Are people with aphasia different to those without? Disabil Rehabil 33(3): 211-8.

Jin, L., A Razak, R., Wright, J., Song, J. 2014. Issues in Developing Grammatical Assessment Tools in Chinese and Malay for Speech and Language Therapy. In South and Southeast Asian Psycholinguistics. Edited by Winskel, H. & Padakannaya.Cambridge University Press: London; 145-58.

Kang, E.K., Sohn, H.M., Han, M.K., Kim, W, Han, T.R., Paik, N.J. 2010. Severity of post- stroke aphasia according to aphasia type and lesion location in Koreans. J Korean Med Sci 25(1): 123-7.

Kertesz, A. 2006. Western Aphasia Battery-Revisited. Pearson Clinical.

Kim, W.J., Paik, N.J. 2014. Lesion localization of global aphasia without hemiparesis by overlapping of the brain magnetic resonance images. Neural Regen Res 9(23): 2081-6.

Kuriakose, D., Xiao, Z. 2020. Pathophysiology and treatment of stroke: Present status and future perspectives. Int J Mol Sci 21(20): 7609.

National Aphasia Association. National Survey of Aphasia Awareness. 2016. https://www.aphasia.org/2016-aphasia-awareness-survey/naasurveyresults-…. 17 April, 2019.

Ocklenburg, S., Friedrich, P., Fraenz, C., Schlüter, C., Beste, C., Güntürkün, O., Genç, E. 2018. Neurite architecture of the planum temporale predicts neurophysiological processing of auditory speech. Sci Adv 4(7): eaar6830.

O’Neill, P.A., Cheadle, B., Wyatt, R., McGuffog, J., Fullerton, K.J. 1990. The value of the frenchay aphasia screening test in screening for dysphasia: Better than the clinician? Clin Rehabil 4: 123-8.

Owens, A. 2016. National Aphasia Awareness month: 5 things you should know. https://www.mageerehab.org/blog_post/national-aphasia-awareness-month-5…- you-should-know/ [30 June, 2021].

Pedersen, P.M., Vinter, K, Olsen, T.S. 2004. Aphasia after stroke: Type, severity, and prognosis.Cerebrovasc Dis 17(1): 35-43.

Salter, K., Jutai, J., Foley, N., Hellings, C., Teasell, R. 2006. Identification of aphasia post stroke: A review of screening assessment tools. Brain Inj 20(6): 559-68

Shin, Y.C., Khoong, E.S., Mohamed Ismail, F., Al Taher, A.M., A Razak, R. 2019. Speech- language pathology in Malaysia. Perspect ASHA Spec Interest Groups 4(5): 1162-6.

Vidović, M., Sinanović, O., Šabaškić, L., Hatičić, A., Brkić, E. 2011. Incidence and types of speech disorders in stroke patients. Acta Clin Croat 50(4): 491-4.

Worral, T. 2017. Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia. Centre for Clinical Research Excellence in Aphasia Rehabilitation. https://www.aph.gov.au/DocumentStore [5 March, 2019].

Yourganov, G., Smith, K.G., Fridriksson, J., Rorden, C. 2015. Predicting aphasia type from brain damage measured with structural MRI. Cortex 73: 203-15.