Dutch Diagnostic Instrument for Mild Aphasia (DIMA): standardisation and a first clinical application in two brain tumour patients

Figures & data

Table 1. Demographic characteristics of the 211 healthy participants.

Demographics	Mean	SD	Range
Age in years	50.31	19.75	18.07–85.37
Education in years	13.62	3.43	6–30
Demographics	Groups	Number of participants	Percentage
Gender	M	107	50.7
	F	104	49.3
Age group	18–54 y	115	4.5
	55–85 y	96	45.5
Education level	≤ 12 y	98	46.4
	> 12 y	113	53.6
Nationality	D	103	40.3
	B	108	59.7
Handedness	L	17	8.1
	A	9	4.3
	R	181	87.4
	Missing	4	1.9

Legend: SD = standard deviation, M = male, F = female, y = year, D = Dutch, B = Belgian, L = left-handed, A = ambidexter, R = right-handed.

Table 2. Demographic characteristics of the 233 healthy participants (E-Prime).

Demographics	Mean	SD	Range
Age in years	43.58	16.80	18.00–79.80
Education in years	14.63	3.94	6–30
Demographics	Groups	Number of participants	Percentage
Gender	M	113	48.5
	F	120	51.5
Age group	18–54 y	163	70.0
	55–85 y	70	30.0
Education level	≤ 12 y	101	43.3
	> 12 y	132	56.7
Nationality	D	112	48.1
	B	121	51.9
Handedness	L	20	8.6
	A	7	3.0
	R	205	88.0
	Missing	1	0.4

Legend: SD = standard deviation, M = male, F = female, y = year, D = Dutch, B = Belgian, L = left-handed, A = ambidexter, R = right-handed.

Table 3. Task description and examples of the DIMA.

Linguistic level	Task	Stimuli (examples)	N^o items
Phonology	Repetition:		40
	PHON A. 3-syllabic words		10
	Alternating stress patterns	Gorilla (gorilla), oefening (practice)
	Phonemic similarities	Domino (domino)
	consonant clusters	constructie (construction)
	PHON B. 3–6 syllabic compound words		10
	Alternating stress patterns with phonemic similarities and/or consonant clusters	Opdrachtgever (client), ontdekkingsreiziger (explorer), afstandsbediening (remote control), schouderblad (shoulder blade)
	PHON C. 3–4 syllabic non-words		10
	Alternating stress patterns with phonemic similarities and/or consonant clusters	Inima, anato kikira trendelorig
	PHON D. sentences		10
	Alternating length with phonemic similarities and/or consonant clusters	Harry rent zich rot – 4 words (Harry is running fast), Iedere vrijdag eten we vreselijke vissticks – 6 words (Every Friday we eat terrible fishsticks), De Griek ontdekte vier nietjes in de band van zijn fiets – 11 words (The Greek discovered four staples in the tire of his bike) In welke la leg jij de lepel? (In which drawer do you put the spoon? De prikkelbare panter besprong haar prooi (The irritable panther jumped its prey)
	PHON E. Sentence judgment		10
	Phonologically (in)correct sentences	De wikker gaat naar parot (The wikker goes to parot)
Semantics	Semantic odd picture out:		10
	SEM A. objects	Slang, hond, kat (snake, dog, cat)	5
	SEM B. actions	Scheren, douchen, baden (shave, shower, bathe)	5
	SEM C. Sentence judgment		10
	Semantically (in)correct sentences	De sigaar verveelde zich (The cigar was bored)
Morphosyntax/grammar	SYN A. Sentence completion	Hij viel van … (He fell from …), Om 5 uur … (At 5 o’clock …)	10
	SYN B. Sentence judgment		10
	Syntactically (in)correct sentences	Hij gaat geschilderd op de muur (He goes painted on the wall)

Table 4. Test-scores F.E pre- and postoperatively.

Tests	Preop		Postop
	Raw score	Standard z-score or percentile	Raw score	Standard z-score or percentile
Classical language tests
Boston Naming Test	52/60	−1.00	53/60	−0.74
Shortened Token Test	32/36	0.83	35.5/36	0.69
Category fluency animals	24	−0.67	n/a	n/a
Category fluency professions	12	−1.69*	n/a	n/a
Letter fluency	38	−0.43	n/a	n/a
Diagnostic Instrument for Mild Aphasia
PHON A: repetition words	9/10	>7 perc.	9/10	>7 perc.
PHON B: repetition compounds	8/10	>7 perc.	7/10	>7 perc.
PHON C: repetition non-words	7/10	>7 perc.	6/10	>7 perc.
PHON D: repetition sentences	5/10	>7 perc.	5/10	>7 perc.
Total repetition	29/40	<2 perc**	27/40	<2 perc**
SEM A: semantic odd-picture-out objects	5 /5	>7 perc.	5/5	>7 perc.
SEM B: semantic odd-picture-out actions	5/ 5	>7 perc.	5/5	>7 perc.
SYN A: sentence completion	9/10	>7 perc.	9/10	>7 perc.
Total DIMA production score	48/ 60	<2perc**		<2 perc**
Sentence judgment (E-prime)
PHON E: sentence judgment accuracy	5/5	>7 perc.	n/a	n/a
PHON E: sentence judgment reaction time	13,291 ms	<7 perc*	n/a	n/a
SEM C: sentence judgment accuracy	5/5	>7 perc.	n/a	n/a
SEM C: sentence judgment reaction time	11,175 ms	>7 perc.	n/a	n/a
SYN B: sentence judgment accuracy	5/5	>7 perc.	n/a	n/a
SYN B: sentence judgment reaction time	47,476 ms	< 7 perc.*	n/a	n/a
Cognitive screening
Hopkins verbal learning direct recall	30/36	0.32	22/36	−1.79*
Hopkins verbal learning delayed recall	11/12	0.41	n/a	n/a
Hopkins recognition true positives	10/12	0.50	n/a	n/a
Hopkins recognition false positives	1/12	0.33	n/a	n/a
Trail Making Test A	13 sec	2.10	17 sec	1.20
Trail Making Test B	59 sec	−0.40	45 sec	0.40
Trail Making Test BA		−1.80*		−0.30

Perc: percentile. Cut-off: * mild impairment (lower than 7^th percentile), **impairment (lower than 2^nd percentile). n/a: not administered. Ms: milliseconds. PHON: phonology, SEM: semantics and SYN: syntax.

Figure 1. (a-f) Pre- and postoperative Diffusion Tensor Images (DTI) and Magnetic Resonance Imaging (MRI) with reconstruction of the arcuate fasciculus (AF) in patient F.E.

Table 5. Test-scores D.E.

Tests	Postop
	Raw score	Standard z-score or percentile
Classical language tests
Object Naming Test (DuLIP)	76/100	<7 perc*
Shortened Token Test	35.5/36	−1.00
Category fluency animals	12	−2.10**
Category fluency professions	6	−2.60**
Letter fluency	27	−1.00
Diagnostic Instrument for Mild Aphasia
PHON A: repetition words	10/10	>7 perc.
PHON B: repetition compounds	9/10	>7 perc.
PHON C: repetition non-words	7/10	<2 perc**
PHON D: repetition sentences	5/10	<2 perc**
Total repetition	31/40	>7 perc.
SEM A: semantic odd-picture-out objects	4/5	>7 perc.
SEM B: semantic odd-picture-out actions	3/5	>7 perc.
SYN A: sentence completion	7/10	>7 perc.
Total DIMA production score	45/60	>7 perc.
PHON E: sentence judgment accuracy	n/a	n/a
PHON E: sentence judgment reaction time	n/a	n/a
SEM C: sentence judgment accuracy	n/a	n/a
SEM C: sentence judgment reaction time	n/a	n/a
SYN B: sentence judgment accuracy	n/a	n/a
SYN B: sentence judgment reaction time	n/a	n/a
Cognitive screening
WAIS digit span forward	6/18	>7 perc
WAIS digit span backwards	8/18	>7 perc
Trail Making Test A	78 sec	−2.90**
Trail Making Test B	225 sec	−3.10**
Trail Making Test BA		−2.00**

Perc: percentile. Cut-off: * mild impairment (lower than 7^th percentile), **impairment (lower than 2^nd percentile). n/a: not administered.

short-legendFigure 2.

Table

		Main effects				Interaction effects
Test	Df	Nat	Age	Gen	Edu	N*A	N*G	N*E	A*G	A*E	G*E
Phon A	1, 200	15.37***	3.44	0.39	2.66	3.59	0.00	3.28	0.13	0.13	0.52
Phon B	1, 199	8.68**	5.67*	3.68	4.48*	2.34	1.48	0.69	2.19	0.11	10.74**
Phon C	1, 199	15.96***	12.67***	0.00	9.15**	5.42*	0.25	0.00	0.50	1.76	2.26
Phon D	1, 200	6.01*	13.78***	0.09	5.82*	1.30	0.42	0.01	1.35	1.47	3.62
Phon All	1, 198	19.35***	16.08***	0.39	8.88**	4.55*	0.46	0.28	1.60	1.39	5.20*
Sem A	1, 200	0.15	29.88***	0.50	1.74	0.25	0.21	0.11	0.79	0.78	0.05
Sem B	1, 199	0.00	55.96***	0.40	5.47*	0.02	0.87	1.50	0.12	2.24	0.28
Sem All	1, 199	0.07	67.55***	0.69	5.55*	0.14	0.17	0.48	0.51	2.38	0.06
Syn A	1, 200	3.62	11.92**	0.38	5.88*	0.31	1.94	2.64	0.08	0.50	2.44
Total	1, 197	11.43**	42.78***	0.80	13.16***	3.14	1.14	0.21	1.21	2.32	4.78*

Legend: N = nationality, A = age, E = education, G = gender, Df = degrees of freedom

Significance levels: * p < 0.05, ** p < 0.01, *** p < 0.001

Table

		Main effects				Interaction effects
Test	Df	Nat	Age	Gen	Edu	N*A	N*G	N*E	A*G	A*E	G*E
Sem C Acc	1, 222	1.37	0.49	1.13	1.16	0.76	3.16	0.81	0.17	1.11	0.12
Sem C RT	1, 222	3.40	19.73***	0.03	7.99**	1.06	0.70	0.00	0.18	2.27	0.47
Syn B Acc	1, 222	1.07	2.81	5.94*	10.25**	0.60	1.44	2.16	5.64*	2.50	0.86
Syn B RT	1, 218	9.21**	34.90***	0.09	15.20***	3.39	0.02	0.52	5.01*	0.10	0.00
Phon E Acc	1, 222	1.63	0.84	2.22	5.16*	1.32	0.57	1.16	1.87	1.87	0.31
Phon E RT	1, 221	9.77**	39.35***	2.26	38.12***	1.64	1.41	2.51	2.07	0.70	0.20
Total Acc	1, 222	0.26	0.78	5.56*	9.21**	0.11	3.37	0.44	3.75	3.46	0.24
Total RT	1, 217	10.21**	42.38***	0.22	22.23***	1.92	0.28	1.28	2.44	0.29	0.00

Legend: N = nationality, A = age, E = education, G = gender, Df = degrees of freedom

Significance levels: * p < 0.05, ** p < 0.01, *** p < 0.001

Table

Test	Statistics	Gr1 <55 ≤12y (n = 51)	Gr2 <55 >12y (n = 61)	Gr3 >55 ≤12y (n = 47)	Gr4 >55 >12y (n = 49)	Total (n = 211)
Phon A	Mean	9.84	9.90	9.40	9.71	9.73
	Median	10	10	10	10	10
	Range	8–10	8–10	4–10	6–10	4–10
	Cut-off Pc 2	8	8.24	4	6	7.24
	Cut-off Pc 7	9	9	7.36	8.5	8.84
Phon B	Mean	9.78	9.92	9.21	9.61	9.66
	Median	10	10	10	10	10
	Range	8–10	8–10	4–10	7–10	4–10
	Cut-off Pc 2	8	8.24	4	7	6
	Cut-off Pc 7	9	9.34	5.36	7.5	8
Phon C	Mean	9.27	9.56	8.02	8.53	9.00
	Median	10	10	9	10	10
	Range	6–10	7–10	2–10	3–10	2–10
	Cut-off Pc 2	6	7	2	3	4.24
	Cut-off Pc 7	7	8	4.36	6.5	6
Phon D	Mean	9.25	9.49	8.04	8.84	8.95
	Median	10	10	8	10	9
	Range	6–10	5–10	0–10	1–10	0–10
	Cut-off Pc 2	6	5.72	0	1	5
	Cut-off Pc 7	7.64	8	5.36	6	7
Phonology All	Mean	38.22	38.47	34.79	37.12	37.38
	Median	39	39	36	39	39
	Range	33–40	32–40	16–40	19–40	16–40
	Cut-off Pc 2	33	32.48	16	19	24.24
	Cut-off Pc 7	34.28	36.34	25.36	30.50	31
Sem A	Mean	4.75	4.80	3.96	4.27	4.48
	Median	5	5	4	5	5
	Range	3–5	3–5	0–5	0–5	0–5
	Cut-off Pc 2	3.04	3	0	0	1.24
	Cut-off Pc 7	4	4	2	2.5	3
Sem B	Mean	4.46	4.61	3.13	3.73	4.11
	Median	5	5	3	4	5
	Range	3–5	2–5	0–5	0–5	0–5
	Cut-off Pc 2	3	2.24	0	0	0
	Cut-off Pc 7	3.64	4	0	0.5	1
Semantics All	Mean	9.37	9.56	7.09	8.00	8.59
	Median	10	10	8	8	9
	Range	8–10	7–10	1–10	1–10	1–10
	Cut-off Pc 2	8	7.24	1	1	2.24
	Cut-off Pc 7	8	8.34	2.36	4.5	5
Syn A	Mean	9.59	9.70	8.74	9.29	9.36
	Median	10	10	9	10	10
	Range	7–10	7–10	4–10	5–10	4–10
	Cut-off Pc 2	7	7.24	4	5	6
	Cut-off Pc 7	8	9	6	7	7.84
Total	Mean	57.12	58.13	50.51	54.41	55.30
	Median	58	59	52	56	57
	Range	48–60	50–60	29–60	31–60	29–60
	Cut-off Pc 2	48.12	50.96	29	31	35.72
	Cut-off Pc 7	52.64	55	38.36	43	46

Table

Test	Statistics	Gr1 <55 ≤12y (n = 63)	Gr2 <55 >12y (n = 95)	Gr3 >55 ≤12y (n = 33)	Gr4 >55 >12y (n = 37)	Total (n = 230)
Sem C acc	Mean	4.71	4.63	4.67	4.89	4.69
	Median	5	5	5	5	5
	Range	2–5	0–5	0–5	4–5	0–5
	Cut-off Pc 2	2	0.92	0	4	1.62
	Cut-off Pc 7	3	4	3.38	4	4
Sem C RT	Mean	13,040	10,654	15,294	14,370	12,542
	Median	12,249	9719	14,354	13,383	11,622.5
	Range	4635–28750	3830–20787	7195–28605	7210–25939	3830–28750
	Cut-off Pc 2	28,421	19,097	-	-	25,676
	Cut-off Pc 7	19,895	17,416	25,396	24,626	19,963
Syn B acc	Mean	4.46	4.65	4.09	4.59	4.51
	Median	5	5	4	5	5
	Range	0–5	2–5	1–5	3–5	0–5
	Cut-off Pc 2	0.56	2.92	1	3	2
	Cut-off Pc 7	3.48	3	2	3.66	3
Syn B RT	Mean	15,016	12,693	18,793	16,119	14,738
	Median	14,196	11,891	17,392	15,824	13,662
	Range	7550–25126	4172–23952	10,865–32939	8935–29393	4172–32939
	Cut-off Pc 2	25,090	23,602	-	-	28,610
	Cut-off Pc 7	24,097	20,389	28,824	23,844	23,544
Phon E acc	Mean	4.89	4.94	4.73	4.97	4.90
	Median	5	5	5	5	5
	Range	2–5	2–5	0–5	4–5	0–5
	Cut-off Pc 2	2.28	3.84	0	4	3.62
	Cut-off Pc 7	4.48	5	4	5	5
Phon E RT	Mean	12,163	8073	15,111	12,164	10,836
	Median	10,789	7461	13,645	11,550	9706
	Range	4087–27983	3183–18898	6967–26566	5848–29520	3183–29520
	Cut-off Pc 2	27,811	15,575	-	-	26,100
	Cut-off Pc 7	20,153	12,602	25,343	18,989	19,237
Total acc	Mean	14.06	14.22	13.48	14.46	14.10
	Median	14	15	14	15	15
	Range	9–15	9–15	1–15	12–15	1–15
	Cut-off Pc 2	9.28	9.92	1	12	10
	Cut-off Pc 7	12	12	10.38	13	12
Total RT	Mean	40,219	31,419	49,197	42,653	38,116
	Median	37,535	29,288	45,574	40,795	35,269
	Range	16,272–73779	11,185–53575	26,509–83027	24,604–70095	11,185–83027
	Cut-off Pc 2	72,894	52,492	-	-	71,820
	Cut-off Pc 7	62,582	49,331	79,217	67,461	61,564