Degree Of Aphasia Research Articles

Alienation, Aggressiveness and Aphasia: A Lacanian Psychoanalysis of the Cowley Father and Son in Sherwood Anderson’s “Queer”

Sherwood Anderson’s capture of the subtlety of inner worlds in his short story “Queer” collected in <i>Winesburg, Ohio</i> shows great insights into the complexity and paradoxes of human psychology, in terms of his deep exploration into issues including identity, neurosis and speech impairment, which demonstrate surprising coincidence with symptoms examined by Lacan. Elmer Cowley’s queer behaviors suggest that he has developed “self-punishment paranoia,” a mental disorder Lacan found and examined in his doctoral thesis. The term illustrates the paradoxical and alienating nature of the relationship between subjects and their identities. Elmer’s attacking of George Willard, the only newspaper reporter of Winesburg and the incarnation of the big Other, is equivalent to the attacking of himself, for George serves as Elmer’s ego-ideal through the mechanism of symbolic identification. Besides, the Cowley father and son also show a certain degree of aphasia. The seemingly nonsensical expression about laundry, which the Cowleys often utters unintendedly when they try to confront Winesburg residents, discloses the truth of the unconscious subject that they desire to be normal like other town folks. The Cowleys’ aphasia indicates their failure of being integrated into the Winesburg community. Anderson’s foresights of Lacanian psychoanalysis yet to be born in his time prove the prophet role a truly insightful writer can assume.

Speech Fluency, Depression, and Resilience in Chronic Aphasia

ABSTRACT Purpose Aphasia is a language disorder that generally occurs as a result of a stroke or other neurological causes. Depression is a widespread reaction to aphasia, and aphasia-related variables, sociodemographic factors, and psychological aspects such as personality traits have the potential to affect this reaction. The purpose of this study is to investigate whether depression or psychological resilience level varies between aphasia types (fluent or non-fluent) and whether resilience in chronic aphasia affects the level of depression between the two aphasia types. Method Twenty-one people with aphasia (10 non-fluent and 11 fluent) between the ages of 33 and 70 participated in this study. The type and degree of aphasia were assessed using the Test of Language Assessment in Aphasia. The psychological variables in this study were examined with the Cornell Scale for Depression in Dementia and the Brief Resilience Scale. The rater was blinded to the aphasia type while assessing the participants. Inter-group comparisons were examined with t-test, and inter-variable relationships were examined with both Spearman and covariance analyses. Results There was no significant difference between the fluent and non-fluent aphasic groups in terms of depression and resilience. Among all participants, there was a negative correlation between the total depression score and behavioral disturbances. Covariance analysis indicated that resilience had an effect on depression scores for both fluent and non-fluent aphasic participants. Conclusion The protective role of resilience in depression in a typical population may also be valid for aphasia. It is hence essential to approach depression by considering resilience.

Electro-Acupuncture on Aphasia after Stroke: A Systemic Review of Randomized Controlled Trials

Objectives: This study investigates the effect of electro-acupuncture on aphasia after stroke.Methods: A search of OASIS, NDSL, PubMed, Cochrane, and CNKI was executed between 4 January 2021 and 4 February 2021, with no limitation on publication year. Extraction and selection from the studies were made by 3 authors. The quality of the studies was evaluated using Cochrane’s risk of bias (RoB) tool.Results: 10 studies met the selection criteria. As the treatment site for electro-acupuncture, GV20 (Baihui) was used the most. In all studies, the region located on the head was used for treatment without distinguishing between acupoints and areas of scalp acupuncture, and the stimulation was organized into 3 conditions: speed, intensity, and time. The outcome indicators used before and after treatment focused on the evaluation of language function and the degree of aphasia. The results showed that using electro-acupuncture with speech rehabilitation therapy for aphasia after stroke was more effective than using speech rehabilitation therapy alone.Conclusions: In this review, electro-acupuncture for aphasia after stroke was found to have a significant effect compared to the previous treatment alone. However, because of limitations, information was not reliable enough. Additional research is needed to produce more objective evidence.

Shifting of global aphasia to Wernicke\u2019s aphasia in a patient with intact motor function: a case report

BackgroundGlobal aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency.Case presentationA 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow.ConclusionA patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

Abstract P356: Wernicke’s Vertical Occipital Fasciculus in Post-Stroke Reading

Introduction: The vertical-occipital fasciculus (VOF), which was initially described by Wernicke more than a century ago but recently rediscovered, connects visual association cortices to the posterior language areas. We hypothesized that the vertical-occipital fasciculus plays a critical role in reading. Methods: Thirty-two participants with subacute to chronic left hemispheric stroke leading to varying degrees of aphasia were enrolled in the study and underwent concurrent diffusion tensor imaging (DTI) and language assessment. Assessments included the Boston Diagnostic Aphasia Examination (BDAE) to assess oral reading and reading comprehension and the Boston Naming Test to assess picture naming. Two major cortico-cortical projection pathways, VOF, connected with posterior language cortices and frontal aslant tract (FAT), connecting anterior language areas, were mapped with deterministic tractography and quantified bilaterally. We conducted partial correlations between fractional anisotropy (FA) values of the tracts and reading and picture naming scores, controlling for age, education, and total lesion load. We corrected for multiple comparisons at the false discovery rate (FDR) (p&lt;0.05). Results: FA of left VOF was found to be significantly correlated with BDAE total reading scores (r=0.49, p=0.004), and this remained significant after FDR correction (p=0.03). Although a significant correlation was seen between picture naming and left VOF FA (r=0.41, p=0.02), and right VOF FA (r=0.37, p=0.04), these associations were not significant after FDR correction (p&gt;0.05). FAT FA values were not significantly associated with oral reading or picture naming tests. Conclusion: This study provides preliminary evidence that left VOF plays a potential role in reading after left hemispheric stroke.

Further Evidence of the Positive Influence of Repetitive Transcranial Magnetic Stimulation on Speech and Language in Patients with Aphasia after Stroke: Results from a Double-Blind Intervention with Sham Condition

Background: After a stroke, up to 20% of patients suffer from aphasia. The preferred treatment for stroke-related aphasia (SRA) is regular speech and language training (SLT). In the present study, we investigated to what extent adjuvant repetitive transcranial magnetic stimulation (rTMS) might enhance recovery. While there is growing evidence of the positive effect of adjuvant rTMS on aphasia, no study has yet been based on an Iranian sample. Method: A total of 12 patients (mean age: 55 years; right-handed; 7 women) underwent treatment for SRA 1 month after stroke. The standard treatment consisted of regular 45-min SLT sessions 5 times a week for 2 consecutive weeks. Additionally, patients were randomly assigned either to adjuvant rTMS (5 times a week for 30 min) or to a sham condition (5 times a week for 30 min). At baseline and after 2 weeks of intervention, the degree of aphasia was assessed with the Farsi version of the Western Aphasia Battery. rTMS was applied to the inferior posterior frontal gyrus of the right hemisphere. Results: Speech and language improved over time, but more so in the rTMS than in the sham condition. Large effect sizes were observed for content, fluency, and the aphasia quotient; medium effect sizes were observed for command comprehension and repetition, while effect sizes were small for auditory comprehension and naming. Conclusions: Among patients with SRA, compared to a sham condition, adjuvant rTMS improved speech and language skills. The present results add to the accumulating evidence that rTMS as a neuromodulation technique has the capacity to enhance the effect of conventional SLT.

A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia.

Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia. Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio. Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia. The current results supported the sketch model of language-gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.

Phonological encoding in apraxia of speech and aphasia

Background: Apraxia of speech (AOS) is considered a speech motor planning/programming disorder. While it is possible that co-occurring phonological impairments exist, the speech motor planning/programming deficit often makes it difficult to assess the phonological encoding stage directly. Studies using online methods have suggested that activation of phonological information may be protracted in AOS.Aims: The present study was designed to investigate the integrity of the phonological encoding stage in AOS and aphasia. We tested two specific hypotheses, the Frame Hypothesis and the Segment Hypothesis. According to the Frame Hypothesis, speakers with AOS have an impairment in retrieving metrical frames (e.g., number of syllables); according to the Segment Hypothesis, speakers with AOS have an impairment in retrieving segments (e.g., consonants).Methods & Procedures: Four individuals with AOS and varying degrees of aphasia, two speakers with aphasia, and 13 age-matched control speakers completed an online priming task in which participants name pictures in sets that do or do not share number of syllables (e.g., balcony-coconut-signature vs. balcony-carrot-sock), the initial consonant (e.g., carpenter-castle-cage vs. carpenter-beaver-sun), or both (e.g., boomerang-butterfly-bicycle vs. boomerang-sausage-cat). Error rates and reaction times were measured.Outcomes & Results: Data for controls replicated previous literature. Reaction time data supported the Segment Hypothesis for speakers with AOS and for one speaker with aphasia without AOS, with no differences in pattern from controls for the other speaker with aphasia without AOS.Conclusions: These results suggest that speakers with AOS may also have difficulties at the phonological encoding stage. Theoretical and clinical implications of these findings are discussed.

Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment battery in Chinese patients with post-stroke aphasia. Cognitive functions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery (WAB) Scale, respectively. The Results of LOTCA were analyzed and compared across different groups, in the light of gender, age, educational background, the length of illness, and the degree of aphasia. Neither the score of subtests of the LOTCA nor the overall scores of LOTCA of aphasia patients with different gender and educational background differed (all P>0.05). In different age groups, apart from thinking operation (F=3.373, P=0.016), visuomotor organization (F=3.124, P=0.022), attention (F=3.729, P=0.009) and the total score (F=2.683, P=0.041), there was no difference in terms of the other subtest scores of LOTCA (all P>0.05). In the groups of different length of time with illness, apart from orientation (F=2.982, P=0.039) and attention (F=3.485, P=0.022), the score of other subtests and the total score of LOTCA were not different (all P>0.05). In the groups of different degree of aphasia, apart from attention (F=2.061, P=0.074), both the score of other subtests and the total score of LOTCA differed (all P<0.05). LOTCA might be suitable to assessing the cognitive ability of post-stroke Chinese patients with aphasia.

Meticulous nursing in cerebral contusion of aphasia patients of hyperbaric oxygen

Objective To investigate the meticulous nursing of hyperbaric oxygen in the treatment of cerebral contusion and laceration in aphasic patients clinical treatment effect.Methods From 2006 March to 201 1 March,75 cerebral contusion patients with aphasia treated with hyperbaric oxygen were randomly divided into two groups,the observation group was 40 cases and control group had 35 cases.The control group was given hyperbaric oxygen (HBO) in combination with conventional neurosurgical treatment approach for treatment and nursing,observation group was added on the basis of by nurses for patients with different degree of aphasia type.Two groups of patients after treatment effect were compared. Results After treatment,the treatment efficiency of observation group were higher than those in control group,the difference was significant (P ＜ 0.05 ).Conclusions The meticulous nursing for hyperbaric oxygen therapy in the treatment of cerebral contusion and laceration in patients with aphasia recovery plays an important role,which not only effectively promotes the functional recovery of patients with language,and could further improve patients＇ outcomes and quality of life,so the method is worth popularizing. Key words: Meticulous nursing; Hyperbaric oxygen; Cerebral contusion and laceration with aphasia; Therapeutic effect

A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia

Background: Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT) in acute stroke patients with aphasia. Methods: A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA) and the Amsterdam-Nijmegen everyday language test (ANELT), both performed by speech pathologists, blinded for randomization. Results: The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years) improved more on ANELT by day 21 than those with <12 years of education (3.4 vs. 1.0, respectively). In 34 patients in the treatment group and 19 in the control group improvement was ≧1 on ANELT (p < 0.05). There was no difference in the degree of aphasia at baseline except for fluency, which was higher in the group responding to treatment. Conclusions: Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.

Morphological-syntactic deficits in the production of Slovak-speaking aphasic patients

Background: Grammatical deficits in aphasia have been the subject of research in many languages. It is stated that the symptoms vary depending on morphological-syntactic properties of a studied language. Only a few studies have mapped the symptoms of the grammatical impairment in inflective languages, but the Slovak language has not been studied so far. Aims: The primary aim of our study was to map grammatical deficits in aphasic patients speaking Slovak by analysing some aspects of morphology and syntax. We studied the influence of the type of aphasia, the degree of non-fluent aphasia, and the method eliciting speech on the fluency of patients' production. Methods & Procedures: We analysed production in 7 patients with anomic and 4 patients with non-fluent (Broca's) aphasia. Patients with Broca's aphasia were divided into 2 groups according to the fluency of their production. The speech of patients with a more severe degree of aphasia consisted of content words separated with long pauses. Production of patients with a mild degree of Broca's aphasia was non-fluent sometimes full of perseverations, repairs and false starts but with some syntactic organisation. The samples of spontaneous speech were obtained with two methods: interview and picture description. The speech production of patients was tape-recorded, transcribed, and analysed. The analysis included various aspects of morphology and syntax. Outcomes & Results: According to our results, patients with anomic aphasia did not have apparent problems with any aspect of morphology, but errors occurred on the level of complex syntactic constructions. The speech production of patients with Broca's aphasia was deficient and some symptoms (the use of grammatical morphemes, contextually disallowed verbal ellipses) varied depending on the degree of aphasia. Conclusions: This analysis revealed morphological-syntactic deficits in Slovak-speaking aphasic patients. The results indicate that the symptoms depend not only on the type of aphasia but also on the degree of Broca's aphasia. We compared these results with studies carried out in other languages (for example, Czech, Polish, Serbo-Croatian, Hungarian, Turkish).

Communication outcome after stroke: a new measure of the carer’s perspective

Objective: To validate a measure of the carer’s perspective of a stroke survivor’s communication in everyday life. Design: Cross-sectional, interview-based, psychometric study. Setting: A community sample from the northwest of England, UK. Subjects: Fifty-eight carers and 58 stroke survivors with communication problems (aphasia and/or dysarthria) following a stroke within the previous 4—12 months. Interventions: Administration of the 20-item Carer Communication Outcome after Stroke (Carer COAST) scale, on two occasions, within a two-week period; the 15-item Carers of Older People in Europe (COPE) Index, the patient Communication Outcome after Stroke (COAST) Scale, and collection of demographic and other data relating to the stroke survivor’s disability (Barthel Index), degree of aphasia (Frenchay Aphasia Screening Test) and hospital diagnosis of aphasia/dysarthria. Main measures: Acceptability (missing values), reliability (internal consistency and test—retest reliability) and construct validity. Results: Carer COAST showed good acceptability (no incomplete items, sample spread 24—100%), internal consistency and test—retest reliability for the scale (a = 0.94; intraclass correlation (ICC) = 0.91) and its subscales (a = 0.78—0.90; ICC = 0.75—0.87), and indicative evidence on construct validity (Carer COAST, COPE subscales and COAST). There were statistically significant correlations between the communication items of Carer COAST and the negative impact of caregiving (rs = —0.29) and the financial difficulties of caregiving (rs = —0.38). Conclusions: The Carer COAST scale has considerable potential as a reliable and valid measure of the carer’s perspective on the communication effectiveness of stroke survivors. Intercorrelations with COPE provide specific evidence of the impact of caring for a person with communication difficulties following a stroke.

Development of a reliable self-report outcome measure for pragmatic trials of communication therapy following stroke: the Communication Outcome after Stroke (COAST) scale

Objective: To develop and validate a clinically feasible measure of communication effectiveness for people with any type of communication problem following stroke. Design: Cross-sectional, interview-based, psychometric study, building on the development phase for construction of the Communication Outcome after Stroke (COAST) scale. Setting: A community sample from the northwest of England, UK. Subjects: One hundred and two people with communication problems (aphasia and/or dysarthria) following a stroke, within the previous 4—12 months. Interventions: Administration of the COAST scale, on two occasions, within a two-week period, and collection of demographic and other data relating to disability, degree of aphasia (where appropriate) and hospital diagnosis of aphasia/dysarthria. Main measures: Acceptability (missing values), reliability (internal consistency and test—retest reliability) and item analysis (item redundancy). Results: Ninety-seven (visit 1) and 98 (visit 2) respondents provided usable data for the psychometric analysis. The 29-item COAST scale showed good acceptability (few missing values, sample spread 28—100%), internal consistency and test—retest reliability for the scale (α = 0.95; ICC = 0.90) and its subscales (α = 0.65—0.93; ICC = 0.72—0.88), but possible item redundancy. A revised scale of 20 items was produced, demonstrating good internal consistency and test—retest reliability (α = 0.83—92; ICC = 0.72—0.88). Conclusions: The COAST is a patient-centred, practical and reliable measure that can be used to assess self-perceived communication effectiveness for people with aphasia and/or dysarthria. Further testing on construct validity and responsiveness to change is needed before the measure can be firmly recommended for use within clinical practice and research.

Predictors of life situation among significant others of depressed or aphasic stroke patients

The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients. Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties. Descriptive, cross-sectional study. The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others. Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0.001). With respect to the aphasic patients, perceived personality change (p < 0.001) and living with the patient (p = 0.004) were factors that had a negative effect on the life situation of the significant other. This study highlights that the perception of the patient's need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group. Assessments of the spouses' perception as well as of the patients' factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.

Design and Methods of a Randomized Controlled Trial on Early Speech and Language Therapy in Patients with Acute Stroke and Aphasia

Purpose: Most clinicians would recommend speech and language therapy (SLT) for aphasic patients. The question of when and for how long SLT should be administered still remains controversial. The aim of this trial is to evaluate the efficacy of early SLT in patients with acute stroke and aphasia in a randomized controlled trial. This report will present design and methods and discuss feasibility. Method: Consecutive patients with first ever ischemic stroke and aphasia are assessed by the Amsterdam-Nijmegen Everyday Language Test (ANELT) and a short version of the Norsk Grunntest for Afasi. The treatment is language enrichment therapy, and the therapy is given 45 min/day for 15 weekdays. The primary outcome is the difference in the degree of aphasia between the SLT treated group and the control group measured by ANELT at 3 weeks. Results: Around 10% of acute consecutive patients with aphasia are included. Of the first 79 included patients, 86% have completed the study according to protocol. We intend to include 125 patients, which provide sufficient statistical power to detect a clinically significant difference in the degree of aphasia. Conclusion: It is feasible to conduct a randomized controlled study on very early SLT for acute aphasic patients.

Reasons for recovery after stroke: A perspective based on personal experience

Purpose. The purpose of this study was to learn more about individual beliefs and personal strategies used to support the period of recovery after stroke. It sought to identify the factors that were perceived to be enablers as well as challenges to recovery. Personal actions or experiences, which were perceived to be effective in influencing progress, would be identified.Method. Qualitative in-depth interviews were carried out with 10 participants (mean age 61.8 years). Time following stroke onset ranged between 6 weeks and 13 months. All participants had some residual activity limitation and three participants had varying degrees of aphasia. The interviews were ∼60 – 90 minutes and all data was subjected to content analysis.Results. Analyses of interview data identified two main themes which were perceived to have influenced progress after stroke. The first related to internal factors such as personal control over progress, optimism and fears of dependency and the second included more external factors, such as the influence of therapeutic interactions and success with a specified marker of independence such as dressing, washing and walking.Conclusion. An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individual's preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.

Aphasia in acute stroke and relation to outcome.

The natural course of aphasia in unselected, consecutive stroke patients is not well established. We investigated morbidity, mortality and recovery for different types of aphasia in consecutive unselected aphasic patients with acute stroke. Setting and subjects. In 119 aphasic patients, the type and degree of aphasia were assessed acutely and at 3, 6 and 18 months after stroke onset, using Reinvang's 'Grunntest for afasi' and Amsterdam-Nijmegen-Everyday-Language-Test. About one-third of patients with acute stroke had presented with aphasia. Mortality among the aphasic patients during the 18-month follow-up was twice that in non-aphasics (36 vs. 16%). Presence of atrial fibrillation was associated with poorer prognosis. At 18 months, 24% of the 119 aphasic patients had recovered completely, 43% still had significant aphasia, and 21% had died. The proportion with global aphasia decreased from almost 25% acutely to a few per cent after 18 months, that with Wernicke's aphasia from 25% to less than 10%, whereas conduction aphasia increased from 13 to 23% during follow-up. Among those with initial mild aphasia, 70% recovered completely. Great improvement was observed in patients with initial low degree of speech function. Younger patients recovered to a greater extent than older patients. The high long-term mortality among aphasics may be seen as an indirect sign of advanced cardiovascular disease. A combination of different and adjusted aphasia tests provided the possibility to assess almost all acute aphasic patients. Irrespective of type and degree of aphasia, great improvements were seen in almost all aphasic patients. Even patients with severe speech impairment have a considerable potential for recovery, particularly in the first 3 months after stroke.

Impairment of language is related to left parieto-temporal glucose metabolism in aphasic stroke patients

Twenty-six aphasic patients who had an ischaemic infarct in the territory of the left middle cerebral artery (MCA) were investigated. Cranial computed tomography (CT) showed various lesion sites: infarcts restricted to cortical structures in 12 patients, combined cortical and subcortical infarcts in 7 and isolated subcortical infarcts sparing the left cortex in another 7 cases. 18F-2-fluoro-2-deoxyglucose positron emission tomography revealed remote hypometabolism of the left convexity cortex and of the left basal ganglia, which was extended further than the morphological infarct zone in all cases. Types and degrees of aphasia were classified using the Aachener Aphasie Test (AAT): 10 patients had global aphasia, 2 Broca's, 5 Wernicke's, and 5 amnesic aphasia. Four patients suffered from minimal or residual aphasic symptoms. The AAT results were compared with the regional cerebral metabolic rates of glucose of the left hemisphere. Irrespective of the infarct location all five AAT subtests (Token test, repetition, written language, confrontation naming, auditory and reading comprehension) were closely correlated among each other and with left parieto-temporal metabolic rates, whereas left frontal and left basal ganglia metabolism showed no significant correlation. The close relation between left temporo-parietal functional activity and all five AAT subtests suggests that the different aspects of aphasia tested by AAT can be related to a common disorder of language processing in those areas.

Depression among patients with stroke.

Ninety-two stroke patients and 30 control patients participated in this study. Stroke patients showed a higher frequency of depression than controls. Stroke patients with the lesion in the right hemisphere were more depressed than patients with the lesion in the left hemisphere. No correlation was found between the degree of depression and the degree of impaired physical function, degree of aphasia or volume of lesion.