Assessing cortisol reactivity to a linguistic task as a marker of stress in individuals with left-hemisphere stroke and aphasia

Purpose: In this study, the authors explore a method of measuring physiologic and perceived stress in individuals with aphasia by investigating salivary cortisol reactivity and subjectively perceived stress in response to a standardized linguistic task. Method: Fifteen individuals with aphasia and 15 age-matched healthy controls participated in a linguistic task involving speaking to an unfamiliar listener and a nonlinguistic task consisting of the Mirror Drawing Test (Starch, 1910). Salivary cortisol samples were taken following a 30-min baseline period, at the beginning and end of each task, and at 10-min intervals throughout the posttask period. Perceptions of stress also were assessed. Results: No significant difference was found in cortisol levels over time within the group with aphasia between the linguistic and nonlinguistic task; however, the control group demonstrated greater cortisol reactivity during the linguistic task than during the nonlinguistic task. For the linguistic task only, the control group demonstrated greater cortisol reactivity than did the group with aphasia. Both groups perceived greater stress posttask than pretask, although the aphasia group perceived greater stress than did the control group. Conclusion: Adults with aphasia perceived greater stress than did healthy controls; however, this paradigm did not stimulate salivary cortisol reactivity in the aphasia group. A potential reason for this may be differences in the type or degree of psychosocial variables that are important in modulating stress in this population. Other considerations when developing methods for assessing physiologic stress include habituation and hypothalamic-pituitary- adrenal (HPA) axis dysregulation related to the neurological changes poststroke.