To be or not to be aphasic: use of story retelling as a marker in subclinical aphasia.

Purpose: This study examined story retelling in individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient (AQ) of the Western Aphasia Battery-Revised (WAB-R). The performance of these participants deemed "not aphasic by WAB" (NABW) was compared with the performance of non-aphasic participants and individuals with anomic aphasia. Method: Most participants were from a test development dataset for the Brief Assessment of Transactional Success in communication in aphasia (BATS), including four groups of 16 individuals: (1) a group who tested NABW; (2) a group with anomic aphasia matched on gender, age, education, and time post-onset; (3) a group with mild anomic aphasia who scored just below the NABW cutoff; and (4) a group of non-aphasic individuals matched on gender, age, and education with the NABW group. Groups were compared on main concepts of the BATS story retelling. Groups with aphasia were also compared on the main concepts of stories retold by non-aphasic conversation partners following co-construction of stories and on self-reported scores of the impact of aphasia on everyday communication. Results: The results showed significant differences in the retelling of the story's main concepts between the non-aphasic control and conversation partner groups, with non-monotonic decreases in performance in comparisons of groups with and without aphasia: from non-aphasic to NABW to mildly anomic to anomic. Individuals deemed NABW (and their conversation partners) did not perform significantly better than individuals with mild anomic aphasia (and their conversation partners) on story retell main concepts. There were significant differences in the production of AphasiaBank discourse main concepts between the group with anomia and both the non-aphasic and NABW groups, but not between the non-aphasic and NABW or those with mild aphasia. Conclusion: Individuals with aphasia who scored "non-aphasic" on the WAB demonstrated impairments in story retelling that align with their self-report of diminished everyday communicative functioning. This finding adds to growing support for the addition of a new measure of functional communication to the core outcome set of measures utilized in aphasia research. We propose the BATS, a measure that is sensitive across the spectrum of aphasia severity, including cases of mild and subclinical aphasia.