Visual attention deficits in post-stroke aphasia: occurrence, impairment patterns, and response to cholinergic modulation

Background Though long overlooked in aphasia, visual attention deficits (VADs) have recently been noted to influence language outcomes. Yet, despite improvements in attention rehabilitation for people with aphasia (PWA), no pharmacological clinical trials have targeted the attention domain.Aims We aimed to evaluate (i) the occurrence and patterns of VADs in PWA following chronic left hemisphere strokes, as well as (ii) the effect of cholinergic modulation (donepezil) in a proof-of-concept randomized, placebo-controlled clinical trial.Methods & Procedures In Study 1, we compared outcomes on the California Computerized Attention Package (CalCAP) from 55 PWA relative to 25 healthy controls and a normative dataset. In Study 2, we examined VADs as a domain-specific outcome measure in 26 PWA in a double-blind, parallel, randomised, placebo-controlled clinical trial of the cholinergic agent donepezil. In both studies, aphasia was evaluated with the Western Aphasia Battery.Outcomes & Results In Study 1, PWA showed slower and less accurate responses than controls in CalCAP tests, and 69% of them presented VADs relative to normative data. Baseline outcomes in a high-demand attentional task significantly correlated with aphasia severity (r = .413, p < .05) in subjects with VADs. In Study 2, donepezil was superior to placebo (F(1,19) = 6.337; p = .021; η2p = .25) in enhancing performance on visual attention tasks with an executive component.Conclusions VADs are highly frequent in PWA, linked to aphasia severity, and partly addressable via cholinergic stimulation. These findings support further investigation of cholinergic modulation as a potential avenue for addressing non-linguistic cognitive deficits in aphasia.Clinical Trial Donepezil in Chronic Poststroke Aphasia: A Randomized Controlled Trial. ClinicalTrials.gov ID: NCT00196690. URL: https://clinicaltrials.gov/study/NCT00196690