Long-term prognosis and health-related quality of life for people with Aphasia in Sweden

Abstract

ABSTRACT Background People with aphasia (PWA) after ischemic stroke often have difficulties in communication and social participation. To individualise rehabilitation and optimise recovery, there is a need for knowledge regarding prevalence of aphasia, and language functions in relation to long-term recovery and health-related quality of life (HRQoL). In this study, we examined these issues in a Swedish setting. Methods We screened consecutive persons with first-ever ischemic stroke admitted to Skåne University Hospital, Sweden, at baseline (median day 4 post stroke onset) for aphasia with the Language Screening Test (LAST). We then performed a detailed follow-up of PWA at 1, 3, and 12 months after stroke onset with the Swedish version of the Comprehensive Aphasia Test (CAT) for evaluation of cognition and language, and with the self-reported Aphasia Impact Questionnaire (AIQ) for evaluation of HRQoL. We analysed aphasia recovery and potential associations between aphasia severity, language functions, stroke severity according to National Institutes of Health Stroke Scale (NIHSS), and HRQoL. Results Initial aphasia was present in 27% (n = 60 of 221) of stroke persons in the acute phase. At 1 month after stroke onset, 74% (n = 40 of 54 survivors with initial aphasia) had remaining aphasia, at 3 months 67% (n = 34 of 51) had aphasia and at 12 months post stroke 61% (n = 30 of 49) had remaining aphasia. Improvement of aphasia was greatest during the first months after onset, with significant improvement regarding naming (p= 0.01), repetition (p= 0.03) and comprehension of written language (p= 0.01). HRQoL remained significantly associated with aphasia severity after adjusting for stroke severity and age. At 3 months, 87% (n = 26) of PWA reported that aphasia affected their ability to communicate with the environment, had negative consequences on level of participation (73%, n = 22), and their emotional well-being (87%, n = 26). There were no significant temporal changes regarding HRQoL between 3 and 12 months post stroke. Conclusion Chronic aphasia was observed in 61% of all alive persons presenting with baseline aphasia after ischemic stroke. Aphasia has negative consequences on HRQoL for PWA and aphasia severity impacts HRQoL regardless of stroke severity.