Language as a threat: multimodal evaluation and interventions for overwhelming linguistic anxiety in severe aphasia

Abstract

Linguistic anxiety (LA) is an abnormal stress response to verbal tasks, often heightened during language testing in people with aphasia (PWA), affecting the accuracy of cognitive evaluations. This study examined a woman with severe chronic mixed transcortical aphasia, caused by left frontal and parietal hemorrhages, treated with the dopamine agonist Rotigotine and Intensive Language-Action Therapy (ILAT). During formal language testing, LA triggered echolalia, perseverations, and frustration, complicating task completion. However, improvements were greater when her husband conducted evaluations at home. Autonomic measures showed higher reactivity during impaired tasks versus preserved ones. Imaging revealed decreased left-side brain activity and compensatory right hemisphere engagement. The findings suggest that involving trained laypersons in evaluating and treating PWA with LA can enhance outcomes and highlight the need for multidimensional approaches to understand the interplay between anxiety and language deficits.