Discourse Measures From the Modern Cookie Theft Picture Description Are Sensitive to Mild Communication Deficits Not Captured by the Western Aphasia Battery–Revised Aphasia Quotient

Purpose: The Western Aphasia Battery–Revised (WAB-R) is often used for diagnosis of aphasia. However, persons scoring above the WAB-R diagnostic cutoff may still present with language difficulties indicative of aphasia. Identifica tion of residual language challenges is critical for treatment referral or inclusion in research. We examined differences in discourse following acute left hemisphere stroke for those above/below the WAB-R diagnostic cutoff com pared to healthy controls, as well as recovery during the first year. Method: Sixty-eight participants with acute left-hemisphere stroke completed the WAB-R and were classified as aphasic by WAB-R (ABW; n = 42) or not aphasic by WAB-R (NABW; n = 26). They completed the Modern Cookie Theft (MCT) picture description task at two time points: acute and either 3, 6, or 12 months poststroke. Responses were analyzed for content units, total verbal output, efficiency, and lateralization of content (i.e., right vs. left side of stimulus) and compared to 49 healthy controls. Differences between groups were exam ined using Wilcoxon rank-sum tests. Change over time was examined using robust linear mixed-effects regression. Results: Wilcoxon tests showed differences between healthy controls and ABW or NABW on all MCT metrics except efficiency for those NABW. Regression models showed no main effects of group or interaction between group and time point. Conclusions: The NABW group showed deficits in verbal output, content pro duction, and laterality on the MCT picture description task, suggesting the pres ence of possible aphasia and hemispatial neglect. Measures derived from the MCT may be more sensitive to residual language/communication difficulties not captured by the WAB-R. The NABW group also showed similar patterns of recovery as the ABW group, highlighting the MCT task’s ability to capture change for those with mild impairments. Results support use of the MCT task in clinical settings, particularly if/when mild deficits are probable/suspected.