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The Swedish version of the Comprehensive Aphasia Test (CAT-S) : diagnostic accuracy and norm-referencing

Grönberg, Angelina LU ; Henriksson, Ingrid and Lindgren, Arne LU (2025) In Aphasiology
Abstract

Background: Standardised language tests provide a reliable framework for assessing language deficits in individuals with aphasia, but have long been lacking for various languages, including Swedish. The purpose of this study was to examine the diagnostic accuracy and establish the norm-references of the Swedish version of the Comprehensive Aphasia Test (CAT-S). Methods: Consecutive patients with acute first-ever ischemic stroke were included prospectively in the Lund Stroke Register Study (LSR) at Skåne University Hospital, Sweden. Inclusion criteria were native Swedish speakers and age > 18 years. People with aphasia (PWA) at baseline, according to the Language Screening Test (LAST) (score <15), n = 60, were assessed with The... (More)

Background: Standardised language tests provide a reliable framework for assessing language deficits in individuals with aphasia, but have long been lacking for various languages, including Swedish. The purpose of this study was to examine the diagnostic accuracy and establish the norm-references of the Swedish version of the Comprehensive Aphasia Test (CAT-S). Methods: Consecutive patients with acute first-ever ischemic stroke were included prospectively in the Lund Stroke Register Study (LSR) at Skåne University Hospital, Sweden. Inclusion criteria were native Swedish speakers and age > 18 years. People with aphasia (PWA) at baseline, according to the Language Screening Test (LAST) (score <15), n = 60, were assessed with The Comprehensive Aphasia Test (CAT) at one to three months post stroke. To compare language test performance between individuals with, and without aphasia, CAT was administered to two different reference groups: 1) stroke patients without aphasia (n = 21), and 2) neurotypical controls (n = 100). The reference groups were matched regarding gender and age, with included consecutive stroke patients in LSR. ROC and sensitivity/specificity analyses were performed to examine the diagnostic accuracy of CAT and establish cut-off scores. Linear regressions were performed to evaluate differences in language performance between the three groups, and Pearson correlations were used to examine associations within CAT domains. Results: CAT had a sensitivity of 92% (CI 0.82; 0.96), and a specificity of 90% (CI 0.83; 0.94). ROC analysis showed that CAT discriminates between persons with, and without aphasia with excellent diagnostic accuracy (AUC = 0.97, CI 0.95; 0.99). PWA scored significantly worse on CAT in comparison to reference groups, with 178.3 points (95% CI 149.6; 207.1) less than neurotypical controls, and 167.3 points (95% CI 124.1; 210.5) less than stroke patients without aphasia. The pairwise associations between the different domains of CAT for PWA showed significant correlations (r ≤.72 ≥.90, all p < 0.001). Conclusions: This study validates CAT-S as a diagnostic test for post-stroke aphasia. CAT-S can be used as a new reference standard for aphasia assessment in Sweden.

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Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aphasia assessment, Comprehensive Aphasia Test, diagnostic accuracy, norm referencing, sensitivity, validation
in
Aphasiology
publisher
Psychology Press
external identifiers
  • scopus:105009488598
ISSN
0268-7038
DOI
10.1080/02687038.2025.2468010
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
id
51e0e597-63c5-429b-a303-df178f4b6bfe
date added to LUP
2026-01-08 16:02:08
date last changed
2026-01-08 16:03:06
@article{51e0e597-63c5-429b-a303-df178f4b6bfe,
  abstract     = {{<p>Background: Standardised language tests provide a reliable framework for assessing language deficits in individuals with aphasia, but have long been lacking for various languages, including Swedish. The purpose of this study was to examine the diagnostic accuracy and establish the norm-references of the Swedish version of the Comprehensive Aphasia Test (CAT-S). Methods: Consecutive patients with acute first-ever ischemic stroke were included prospectively in the Lund Stroke Register Study (LSR) at Skåne University Hospital, Sweden. Inclusion criteria were native Swedish speakers and age &gt; 18 years. People with aphasia (PWA) at baseline, according to the Language Screening Test (LAST) (score &lt;15), n = 60, were assessed with The Comprehensive Aphasia Test (CAT) at one to three months post stroke. To compare language test performance between individuals with, and without aphasia, CAT was administered to two different reference groups: 1) stroke patients without aphasia (n = 21), and 2) neurotypical controls (n = 100). The reference groups were matched regarding gender and age, with included consecutive stroke patients in LSR. ROC and sensitivity/specificity analyses were performed to examine the diagnostic accuracy of CAT and establish cut-off scores. Linear regressions were performed to evaluate differences in language performance between the three groups, and Pearson correlations were used to examine associations within CAT domains. Results: CAT had a sensitivity of 92% (CI 0.82; 0.96), and a specificity of 90% (CI 0.83; 0.94). ROC analysis showed that CAT discriminates between persons with, and without aphasia with excellent diagnostic accuracy (AUC = 0.97, CI 0.95; 0.99). PWA scored significantly worse on CAT in comparison to reference groups, with 178.3 points (95% CI 149.6; 207.1) less than neurotypical controls, and 167.3 points (95% CI 124.1; 210.5) less than stroke patients without aphasia. The pairwise associations between the different domains of CAT for PWA showed significant correlations (r ≤.72 ≥.90, all p &lt; 0.001). Conclusions: This study validates CAT-S as a diagnostic test for post-stroke aphasia. CAT-S can be used as a new reference standard for aphasia assessment in Sweden.</p>}},
  author       = {{Grönberg, Angelina and Henriksson, Ingrid and Lindgren, Arne}},
  issn         = {{0268-7038}},
  keywords     = {{Aphasia assessment; Comprehensive Aphasia Test; diagnostic accuracy; norm referencing; sensitivity; validation}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{Psychology Press}},
  series       = {{Aphasiology}},
  title        = {{The Swedish version of the Comprehensive Aphasia Test (CAT-S) : diagnostic accuracy and norm-referencing}},
  url          = {{http://dx.doi.org/10.1080/02687038.2025.2468010}},
  doi          = {{10.1080/02687038.2025.2468010}},
  year         = {{2025}},
}