The brief executive language screen: sensitivity and specificity in acute to early sub-acute stroke

Figures & data

Table 1. Descriptive Statistics for BELS Subtests: Controls and Stroke (LHS & RHS).

					Stroke (N = 88)
	Controls (N = 116)				ALL				LHS			RHS
	N	M(SD)	Range	5^th % ile	N	M(SD)	Range	%<5^th %ile (N LHS: N RHS: N Bilateral)	N	M(SD)	Range	N	M(SD)	Range
Age	116	63.15 (13.52)	18–88		88	62.88 (14.10)	18–91	-	29	62.34 (14.55)	28–91	57	63.56 (13.01)	18–86
Education	116	15.12 (3.56)	9–25		88	12.03 (2.71)	7–20	-	29	12.03 (2.31)	8–16	57	12.12 (2.87)	7–20
Reading (NART errors /50)	112	16.13 (6.55)	3–35		83	22.11 (7.29)	3–42	4 (1:1:1)	27	22.78 (5.81)	12–35	54	21.39 (7.73)	3–42
Naming (BNT-15 SF4 /15)	47	14.34 (0.89)	11–15		78	13.31 (2.04)	5–15	14 (6:5:0)	28	13.11 (2.47)	6–15	49	13.45 (1.78)	5–15
Visuospatial (VOSP IL /20)	102	19.57 (0.65)	17–20		85	19.39 (0.87)	16–20	1 (0:1:0)	29	19.48 (0.74)	17–20	54	19.31 (.95)	16–20
Comprehension (HSCT A SS)	80	5.80 (0.68)	3–7		68	5.10 (1.62)	1–7	3 (1:1:0)	24	5.08 (1.44)	1–7	43	5.09 (1.27)	1–6
Articulation
Oral Apraxia /10	116	9.75 (0.64)	7–10	8	88	9.09 (1.08)	4–10	7 (0:6:0)	29	9.28 (0.75)	8–10	57	8.98 (1.22)	4–10
Nominal Language
Word Comprehension /10	116	10.00 (0.00)	10–10	10	88	9.99 (0.11)	9–10	1 (1:0:0)	29	9.97 (0.19)	9–10	57	10.00 (.00)	10–10
Word Repetition /10	116	10.00 (0.00)	10–10	10	88	9.99 (0.11)	9–10	1 (0:1:0)	29	10.00 (0.00)	10–10	57	9.98 (.13)	9–10
Sentence Repetition /5	116	4.97 (0.16)	4–5	5	88	4.81 (0.48)	3–5	16 (4:10:0)	29	4.79 (0.56)	3–5	57	4.81 (.44)	3–5
Oral Naming /10	116	9.05 (1.01)	6–10	7	88	7.90 (1.73)	3–10	19 (7:9:1)	29	7.72 (1.80)	3–10	57	8.04 (1.71)	3–10
Action Naming /10	116	9.63 (0.67)	7–10	8	88	8.81 (1.67)	2–10	14 (4:8:0)	29	8.76 (1.48)	5–10	57	8.84 (1.79)	2–10
Nominal Language Total /20	116	19.31 (0.68)	17.50–20.00	17.93	88	18.15 (1.81)	10.50–20.00	28 (8:16:1)	29	18.03 (1.75)	12.75–20.00	57	18.24 (1.88)	10.50–20.00
Propositional Language and Executive Functions
Beach WPM	114	124.82 (31.50)	38–228	73.75	82	90.50 (32.30)	31–189	29 (8:15:1)	27	92.07 (33.17)	37–189	53	90.34 (35.60)	31–186
GOAL Cookie WPM	114	151.45 (29.31)	79–256	106.50	82	115.16 (37.12)	38–214	45 (7:28:2)	27	123.15 (35.75)	65–208	53	111.70 (38.10)	38–214
Spontaneous Speech /20	111	14.72 (2.75)	8–20	10	81	10.74 (3.47)	4–18	30 (15:9:0)	27	8.52 (3.22)	4–16	52	11.81 (3.10)	4–18
S WPM	116	17.11 (4.65)	9–30	10	87	11.97 (4.65)	2–24	32 (7:19:2)	29	12.28 (4.94)	4–24	56	11.93 (4.58)	2–22
GOAL B WPM	116	17.00 (4.42)	5–27	10	87	10.52 (4.37)	0–20	44 (13:24:1)	29	9.76 (4.08)	0–16	56	10.93 (4.53)	2–20
Animal WPM	114	22.55 (4.33)	12–36	16.75	88	15.63 (5.18)	2–30	52 (13:33:0)	29	15.79 (6.36)	2–30	57	15.44 (4.58)	5–25
GOAL Fruit/Veg WPM	116	21.91 (4.46)	13–36	14	88	15.82 (5.52)	2–30	35 (10:21:0)	29	15.59 (6.40)	2–30	57	15.93 (5.18)	6–28
Verbal Fluency /16	114	14.67 (1.86)	8–16	10	87	8.87 (4.84)	0–16	51 (14:29:1)	29	9.03 (4.95)	0–16	56	8.79 (4.91)	0–16
Initiation Total /10	109	9.22 (1.56)	2.00–10.00	5.90	88	7.55 (2.87)	1–10	30 (9:15:1)	29	7.62 (2.73)	1.80–10.00	57	7.58 (2.89)	1.40–10.00
Inhibition /10	115	8.02 (1.86)	3–10	4	86	4.36 (3.24)	0–10	43 (7:28:1)	29	5.59 (3.11)	0–10	55	3.80 (3.17)	0–10
Strategy /2	115	1.81 (0.46)	0–2	1	86	1.02 (0.87)	0–2	36 (8:21:2)	29	1.28 (0.88)	0–2	55	0.93 (.84)	0–2
Sentence Completion /22	108	19.16 (2.41)	13–22	15	86	12.98 (5.56)	1.60–22.00	57 (13:34:2)	29	14.48 (4.75)	5.40–21.80	55	12.38 (5.75)	1.60–22.00
Motor Go No-GO /3	115	2.94 (0.27)	1–3	2	88	2.76 (0.48)	1–3	2 (2:0:0)	29	2.72 (0.59)	1–3	57	2.79 (.41)	2–3
Propositional Language and Executive Function /60	105	50.35 (4.78)	39.00–58.80	41.24	78	33.84 (10.07)	11.40–51.80	72 (20:34:2)	27	33.63 (10.23)	11.40–51.80	49	34.08 (10.17)	13.80–51.00
Memory
Incidental Verbal Memory /10	116	6.46 (1.77)	2–10	3.85	81	4.74 (2.27)	0–9	26 (5:14:2)	29	4.96 (2.62)	0–9	53	4.70 (2.12)	0–8
Total BELS /100	105	85.82 (5.25)	73.50–96.00	75.95	73	65.77 (12.66)	37.40–87.80	78 (18:37:2)	24	66.19 (13.61)	37.40–87.80	47	65.77 (12.45)	37.70–86.50

Table 2. Percentage of patients (and Proportion of LHS: RHS) Impaired on BELS Subsections.

	Whole Stroke Group		Stroke Group Without Aphasia
BELS Subsection	%<5^th (N LHS: N RHS: N Bilateral)	% of LHS: % of RHS	%<5^th (N LHS: N RHS: N Bilateral)	% of LHS: % of RHS
Oral Apraxia	7% (0:6:0)	0:11	8% (0:6:0)	0:12
Nominal Language	28% (8:16:1)	28:28	23% (5:12:0)	23:24
Propositional Language & Executive Functions	72% (20:34:2)	74:69	67% (14:28:1)	70:65
Memory	26% (5:14:2)	17:26	21% (2:11:1)	10:24
Total BELS	78% (18:37:2)	75:79	77% (13:32:1)	72:78

Table 3. Inferential statistics for BELS subtests: Comparison of controls and stroke groups.

	Whole Group				Without Aphasia
	N	t/U	p	d/r	N	t/U	p	d/r
Oromotor Functioning
Oral Apraxia/10	204	3114.50	<.001	.41	189	2516.50	<.001	.42
Nominal Language
Word Comprehension/10	204	5046.00	.251	-	189	4234.00	1.000	-
Word Repetition/10	204	5046.00	.251	-	189	4176.00	.207	-
Sentence Repetition/5	204	4419.50	<.001	.24	189	3818.50	.007	-
Oral Naming/10	204	3010.00	<.001	.36	189	2773.00	<.001	.30
Action Naming/10	204	3520.50	<.001	.30	189	3022.50	<.001	.28
Nominal Language Total /20	204	2788.50	<.001	.40	189	2506.00	<.001	.35
Propositional Language and Executive Functions
Beach WPM	196	7.44	<.001	1.08	181	6.38	<.001	.98
GOAL Cookie WPM	196	7.36	<.001	1.11	181	7.13	<.001	1.10
Spontaneous Speech Total /20	192	8.52	<.001	1.29	177	1500.00	<.001	.50
S WPM	203	2173.00	<.001	0.49	188	1977.50	<.001	.44
GOAL B WPM	203	10.40	<.001	1.48	188	9.01	<.001	1.35
Animal WPM	202	1454.50	<.001	0.61	187	1243.00	<.001	.59
GOAL Fruit/Veg WPM	204	8.47	<.001	1.23	189	7.48	<.001	1.12
Verbal Fluency Total /16	201	1459.50	<.001	.62	186	1347.50	<.001	.59
Initiation Raw/10	204	4227.50	.009	-	189	3670.50	.049	-
HC/5	204	4974.00	.195	-	189	4212.50	.740	-
LC/5	204	4245.50	.009	-	189	3693.50	.056	-
Initiation RT (seconds)	197	−5.64	<.001	.84	182	5412.50	<.001	.31
HC RT	197	6255.50	<.001	.26	182	5161.00	<.001	.25
LC RT	197	−5.55	<.001	.80	182	5424.00	<.001	.31
Initiation Total/10	197	3095.00	<.001	.32	182	2826.00	<.001	.26
Inhibition/10	201	1802.50	<.001	.55	187	1513.00	<.001	.54
HC/5	201	1822.00	<.001	.56	187	1514.50	<.001	.55
LC/5	201	2104.50	<.001	.50	187	1818.50	<.001	.48
Strategy/2	201	6941.50	<.001	.42	187	2178.50	<.001	.48
Sentence Completion /22	194	1510.50	<.001	.58	180	1398.00	<.001	.54
Motor Go No-GO/3	203	4235.00	<.001	.25	188	3732.50	.012	-
Propositional Language and Executive Function /60	183	13.40	<.001	2.20	169	448.50	<.001	.73
Memory
Incidental Verbal Memory /10	197	5.70	<.001	.86	183	2457.00	<.001	.31
TOTAL BELS
Total BELS /100	178	12.79	<.001	2.22	165	11.41	<.001	2.22

Note. Where data is non-parametric and unable to be transformed, Mann-Whitney U statistics are reported. Bonferroni correction was applied for control and stroke comparisons (α =.002). “r” indicates effect sizes for Mann-Whitney U tests (.10 = small.30 = medium.50 = large), and “d” indicates effect sizes for t-tests (.20 = small.50 = medium.80 = large).

Figure 1. ROC Curve for BELS Total Score.

Table 4. ROC curve statistics and cutoffs for BELS total score.

						95%CIs
	Sens.	Spec.	Cutoff	AUC	p	Upper	Lower	N Stroke	N Controls
Whole group	.89	.89	79.25	.94	.000	.91	.98	73	105
Without aphasia	.87	.89	78.75	.94	.000	.89	.98	60	105
LHS & Controls	.88	.81	81.05	.92	.000	.85	.99	24	105
Without aphasia	.83	.81	81.05	.90	.000	.81	.99	18	105
RHS & Controls	.92	.89	79.25	.95	.000	.92	.99	47	105
Without aphasia	.90	.89	78.75	.95	.000	.91	.99	41	105

Note. “Sens.” = Sensitivity (true positive rate; high sensitivity indicates few false negatives). “Spec.” = 1-Specificity (true negative rate; high value indicates few false positives). AUC = Area Under Curve (indicates ability of BELS to differentiate healthy and stroke groups).