Yutaka Tanaka, M.D.
Tanaka Clinic, Ise Keiyu Hospital

Abstract:

Background: The role of anxiety has not been sufficiently explored in aphasia. In 2007 Beversdorf et al demonstrated improved naming ability in patients with Broca’s aphasia following treatment with the centrally acting beta-adrenergic receptor blocking agent, propanolol. In a subsequent pilot study (Tanaka et al 2009) we found that propanolol provides short term improvement of naming in Broca’s and Wernicke’s aphasia, and improvement of auditory comprehension in Wernicke’s aphasia. We hypothesized that the beta blocker might benefit persons with aphasia by reducing anxiety. The current project extends the results of our previous study, and further evaluates the relationship between aphasia and physiologic measures of anxiety, following treatment with propanolol.

Subjects and Methods: 11 patients with mild to moderate aphasia; 4 with Broca’s aphasia (mean age 67.3; range 56-78), 4 with Wernicke’s aphasia (mean age 69.3; Range: 45-79) and 3 with amnestic aphasia (mean age 64.7; Range: 44-74). The test battery consisted of the Boston Naming Test (BNT), Action Naming Test (ANT), two tests of auditory comprehension (yes/no and response to oral commands), FAS (word and vegetable), and the Cookie Theft Description from the Boston Diagnostic Aphasia Battery. Physiologic measures of autonomic function consisted of heart rate, blood pressure (both supine and standing), coefficient of variation of R-R intervals in the electrocardiogram (CV-RR100), and sympathetic skin response (SSR). The Beck Anxiety Inventory was used as the measure of anxiety. All participants received baseline testing on all tests, and then were given 10 mg of propanolol daily for 4 weeks. A second test session was carried out after the 4 weeks of administration of propanolol; and a third test was carried out one month after propanolol was discontinued.

Results: On the second testing four weeks after administration of propranolol, scores on the BNT, ANT, FAS (category) and auditory comprehension tests were significantly improved for all subjects. CV-RR100 was significantly reduced. There were no significant changes on the Beck Anxiety Inventory. There was no significant correlation between any test score and CV-RR100 change. The initial CV-RR100 was not related to percent change of any test score. There were no significant differences among the three groups.

Conclusion: Treatment of aphasia with the putative anti-anxiety agent propanolol produces significant improvement on a range of language tests, regardless of aphasia diagnostic category, coupled with predictable, significant changes in physiologic measures of autonomic function. In contrast, however, no changes were produced on a scale designed to measure anxiety.