Leukoaraiosis is not predictive of aphasia recovery

Abstract

Stroke-related aphasia affects 20% to 40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Hundred and ten right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Good recovery from aphasia was significantly associated with lower severity of aphasia initially ( P < 0.001) and smaller lesions ( P < 0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery.