Incidence Of Aphasia Research Articles

Incidence of Aphasia in Ischemic Stroke

Introduction: A decrease in ischemic stroke (IS) incidence has been observed in high income countries during the last decades. Whether this has influenced the occurrence of aphasia in IS is uncertain. We therefore examined the incidence rate and potentially related determinants of aphasia in IS. Methods: We prospectively examined consecutive patients admitted to hospital with first-ever acute IS between March 1, 2017, and February 28, 2018, as part of the Lund Stroke Register (LSR) Study, comprising patients from the uptake area of Skåne University Hospital, Lund, Sweden. Patients were assessed with National Institutes of Health Stroke Scale (NIHSS) at stroke onset. Presence of aphasia was evaluated with NIHSS item 9 (language). We registered IS subtypes and risk factors. To investigate possible temporal changes in aphasia incidence, we made comparisons with corresponding LSR data from 2005 to 2006. Incidence rates were calculated and adjusted to the European Standard Population (ESP) and to the Swedish population. Results: Among 308 included IS patients, 30% presented with aphasia (n = 91; 95% CI: 25–35), a proportion of aphasia in IS that was similar to 2005–2006. The incidence rate of aphasia was 31 per 100,000 person-years adjusted to the ESP (95% CI: 25–38 per 100,000 person-years) corresponding to a significant decrease of 30% between 2005–2006 and 2017–2018. The decrease was significantly more pronounced in men. The initial severity of aphasia remained unchanged, with the majority of patients having severe to global aphasia. No significant differences between vascular stroke risk factors were noted among stroke patients with or without aphasia. Conclusion: Even though the overall IS incidence rate has decreased during the first decades of the 21st century, the proportion of IS patients with aphasia at stroke onset remains stable at 30%. Aphasia continues to be an important symptom that needs to be considered in stroke care and rehabilitation.

The Incidence of Aphasia, Cognitive Deficits, Apraxia, Dysarthria, and Dysphagia in Acute Post Stroke Persian Speaking Adults.

Stroke is a major cause of serious disabilities in adults. While communication deficits post stroke are prevalent and disabling, early detection of them is important during acute phase. There is limited data published on the incidence of communication disorders in Persian speaking adults following post stroke to our knowledge. The present study aims to determine the incidence and associated factors of aphasia, cognitive deficits, motor speech disorders (apraxia and dysarthria) as well as dysphagia following acute post stroke in Persian speaking adults. 100 stroke patients were assessed using P-WAB, MMSE, Oral Apraxia test, Informal Dysarthria assessment, and MASA. The data was collected from 2 hospitals in Tehran using convenient sampling for the duration of 1year. Based on our findings, the incidence of aphasia, cognitive deficits, oral apraxia, dysarthria, and dysphagia was in respectively 61.8%, 76%, 30%, 61%, and 39% of stroke patients during the acute phase. Patients with aphasia were significantly older (mean age, 59.29 vs. 64.95), and had fewer education years (9.21 vs. 5.45) compared to individuals without aphasia (p < .05). Co-occurrence of aphasia and dysarthria, dysphasia, cognitive deficits, and apraxia was in respectively 40%, 31%, 55%, and 25%. Due to the high incidence of neurogenic communication disorders and dysphagia during the acute post stroke, especially in the elderly and the less educated patients, prompt and rapid detection of these deficits and rehabilitation is essential to ameliorate patients' quality of life and social participation, and reduce the comorbidities risk.

Posttraumatic growth following aphasia: a prospective cohort study of the first year post-stroke

ABSTRACT Background Notable positive change arising from the struggle with a major crisis (known as posttraumatic growth – PTG) has been reported following war, accidents and life-threatening illnesses. Whilst negative changes following aphasia are well-documented, positive changes, such as PTG, have not been sufficiently explored. Aims To determine whether people with aphasia can experience PTG throughout their first year post-stroke both quantitatively (Posttraumatic Growth Inventory) and qualitatively (video-taped open-ended interviews). Methods & Procedures Thirteen people with a first incidence of aphasia were assessed at four points in the first year, using a prospective longitudinal cohort study design. Outcomes & Results On the PTG Inventory, there were no significant differences in the mean total score nor in the five posttraumatic growth domains at each stage, although there was a trend to greater growth over time, particularly in relationships, appreciation of life and personal growth. Reflective comments reinforce this evidence and indicate the importance of post-aphasia relationships, enhanced positive traits, a greater appreciation of life and a changed sense of what is important. Conclusions It is apparent that some participants can experience PTG and are redefining themselves positively. Strategies to promote the development of PTG in parallel with other therapeutic tools are detailed.

Efficacy of cognitive behavior language therapy for aphasia following stroke: Implications for language education research

Background/Objective:Evidence from previous research has shown that the incidence of aphasia following a stroke is high in Nigeria and other countries, and there is a call for intervention programs. The objective of the current study was to investigate the efficacy of cognitive behavior language therapy (CBLT) on aphasia following a stroke.Methods:The study was designed as a group randomized trial, which involved treatment and no-treatment control procedures. The participants of the study were 86 patients who had experienced aphasia following a stroke. The Porch Index of Communicative Ability (PICA) and Speech-Language Unhelpful Thoughts and Beliefs Scale (SLUTBS) were the measures used in the study. The repeated measures analysis of variance procedure, with Partial eta squared , adjusted R2, mean, standard deviation, and upper/lower limit was followed in analyzing the data collected in the study.Results:The CBLT intervention significantly reduced aphasia following a stroke and significantly reduced speech-language and unhelpful thought and beliefs among aphasic stroke patients exposed to the treatment intervention when compared with the no-treatment control group.Conclusion:Based on the findings of the study, language educators, speech and language pathologists and therapists in education institutions, hospitals, and rehabilitation centers should adopt the principles of CBLT used in the current study to help them improve communication ability among aphasia stroke patients.

Determinants of Living Well With Aphasia in the First Year Poststroke: A Prospective Cohort Study

ObjectiveTo determine factors that contribute to living well with aphasia in the first 12 months poststroke. DesignProspective longitudinal cohort study. SettingHospitalized care, ambulatory care, and general community. ParticipantsA referred sample of people (N=58) with a first incidence of aphasia after stroke was assessed at 3, 6, 9, and 12 months postonset. Participants were recruited through speech-language pathologists in 2 capital cities in Australia. Presence of aphasia was determined through the Western Aphasia Battery-Revised by an experienced speech-language pathologist. InterventionsNot applicable. Main Outcome MeasuresThe main outcomes were the 5 domains of the Assessment for Living with Aphasia at 3, 6, 9, and 12 months poststroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity, and a self-rating of successfully living with aphasia at the same time points. Mixed effects modeling was used to determine which factors contributed to the trajectory of each of the 5 domains of participation, impairment, environment, personal factors, and life with aphasia. ResultsHigher household income, larger social network size, being a woman, and having milder aphasia were positively associated with the participation domain. Graduate or postgraduate educational levels, low mood, and poor physical functioning were negatively associated with the participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia, and aphasia severity. Low mood was consistently negatively associated with all of the domains. ConclusionsPsychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months postonset. Aphasia rehabilitation needs to attend more to these factors to optimize outcomes.

Fourteen cases of transient aphasia induced by head-up tilt test

Objective To explore the clinical characteristics and the possible pathogenesis for transient aphasia induced by head-up tilt test(HUTT). Methods The data of 4 401 cases(aged from 2 to 79 years) were reviewed retrospectively with unexplained syncope, pre-syncope, or dizziness who had visited syncope specialists at out-patient department or had been hospitalized in the Second Xiangya Hospital of Central South University, and they underwent HUTT from Sep.2000 to Apr.2014.The clinical characteristics were summarized and the possible pathogenesis for transient aphasia was analyzed. Results (1)The total incidence of aphasia was 3.18‰(14/4 401 cases). The incidence in adult(≥18 years old) was significantly higher than that in children( 0.05]. According to the hemodynamic changes, the incidences in vasodepressor, the mixed type, cardioinhibition and the negative response were 6.05‰(10/1 654 cases), 4.18‰(2/479 cases), 0(0/36 cases) and 0.9‰(2/2 232 cases) respectively, and the differences among the 4 groups were significant(χ2=8.22, P<0.05); the difference existed between the vasodepressor and the negative response(χ2=8.18, P<0.01). The total incidence of the positive response patients was 5.53‰(12/2 169 cases), and the difference was notable compared with the negative response patients (χ2=6.07, P<0.05). (2)The onset time and the duration time of transient aphasia: the onset time was from 4 to 17 minutes during baseline head-up tilt test, mean (11.3±6.7) minutes, or 2-10 minutes during sublingual nitroglycerin-provocated head-up tilt test, mean (5.2±2.7) minutes.Aphasia duration was from 3 minutes to 4 hours, and the median time was 20 minutes. Conclusions There is a risk of provoking transient aphasia during HUTT, which reminds that the performer should alert possible occurrence of this complication during the test, especially when the patient has a positive response, or is an adult. Key words: Head-up tilt test; Transient aphasia; Clinical characteristic

Aphasia and Swallowing Problems in Subjects With Incident Stroke in Rural Northern Tanzania: A Case-Control Study

This study was carried out to quantify the degree of cognitive impairment and the extent of speech, language, and swallowing problems in a representative cohort of Swahili-speaking people with stroke in Tanzania. A case-control design was used, comparing people with and without stroke on a screening test for aphasia (spoken comprehension and expression), a water swallow test, and the Community Screening Instrument for Dementia (CSI-D). Fifty-eight persons between 6 and 60 months (median 36) post stroke and 58 age- and gender-matched control subjects were assessed. Twenty-eight strokes were left hemisphere; 25, right; 2, posterior circulation; and 3, undetermined. Forty-nine of 58 (84%) control subjects scored 19 to 20 (maximum) on the language screen compared with 26 of 56 (46%) persons with stroke who completed the assessment. Higher age and lower educational attainment, but not gender or time since stroke, were associated with poorer performance on language and swallow assessments. Poorer CSI-D score was significantly correlated with all items. Greater disability (Barthel Index score) was significantly correlated with poorer performance in all items except rate of drinking water. Those with a left hemisphere stroke performed less well on understanding and expression items but better than other subjects with stroke on the water swallow task. This is the first attempt to describe aphasia incidence in a sub-Saharan African language. Further work on the psychometric properties of the screening instrument is warranted. Given that it delivers a relatively coarse indication of language disturbance, it is likely that incidence of aphasia in the current cohort is underestimated.

Aphasia and Swallowing Problems in Subjects With Incident Stroke in Rural Northern Tanzania: A Case-Control Study

Objectives: This study was carried out to quantify the degree of cognitive impairment and the extent of speech, language, and swallowing problems in a representative cohort of Swahili-speaking people with stroke in Tanzania. Methods: A case-control design was used, comparing people with and without stroke on a screening test for aphasia (spoken comprehension and expression), a water swallow test, and the Community Screening Instrument for Dementia (CSI-D). Results: Fifty-eight persons between 6 and 60 months (median 36) post stroke and 58 age- and gender-matched control subjects were assessed. Twenty-eight strokes were left hemisphere; 25, right; 2, posterior circulation; and 3, undetermined. Forty-nine of 58 (84%) control subjects scored 19 to 20 (maximum) on the language screen compared with 26 of 56 (46%) persons with stroke who completed the assessment. Higher age and lower educational attainment, but not gender or time since stroke, were associated with poorer performance on language and swallow assessments. Poorer CSI-D score was significantly correlated with all items. Greater disability (Barthel Index score) was significantly correlated with poorer performance in all items except rate of drinking water. Those with a left hemisphere stroke performed less well on understanding and expression items but better than other subjects with stroke on the water swallow task. Conclusions: This is the first attempt to describe aphasia incidence in a sub-Saharan African language. Further work on the psychometric properties of the screening instrument is warranted. Given that it delivers a relatively coarse indication of language disturbance, it is likely that incidence of aphasia in the current cohort is underestimated.

Recent advances in the treatment of post-stroke aphasia.

Aphasia is an impairment of language use following brain damage. There is no consensual definition of aphasia beyond this general description (Code and Petheram, 2011). In a more restricted definition, however, aphasia is an impairment of linguistic processing at the phonological, morphological, lexical semantic or syntactic level which is usually caused by lesions of the left cerebral hemisphere. This impairment can affect language reception and expression depending on the various aphasic syndromes (McNeil and Pratt, 2001). Aphasia results in restrictions in those activities of daily living which rely on communication. In terms of the International Classification of Functioning, Disability and Health (WHO, 2001), limitations in functional communication pose significant challenges to social participation (Davidson et al., 2008) and reduce the patients’ quality of life (Kauhanen et al., 1999; Shadden, 2005). Recent data on the incidence of aphasia following stroke range between 0.02 and 0.06 % with a prevalence between 0.1 and 0.4 % in the developed world (Code and Petheram, 2011). Spontaneous behavioral recovery usually occurs to some degree in the weeks to months after stroke and depends on many factors such as the infarct size and location and the severity of initial stroke deficits (Cramer, 2008). Traditionally, proposed mechanisms of the neurological intrinsic recovery are the resolution of edema surrounding the infarcted area (Katzman et al., 1977; Lo, 1986) and reperfusion of incompletely damaged, but highly vulnerable perilesional tissue (see Donnan et al., 2013). These local mechanisms are supposed to support early recovery (in days to weeks after stroke) and do not depend on behavioral experience but have been targeted by pharmacological treatments: of more than a thousand drugs tested in animal models, 114 have been studied in clinical trials (Perez de la Ossa and Davalos, 2007) and to date none of these potentially neuroprotective agents was found to be effective in humans. Only rapid reperfusion with recombinant tissue plasminogen activator (rTPA) does improve functional outcome after ischemic stroke, but its use is limited by a short therapeutic window (4.5 hours following stroke), the risk of hemorrhage and potential ischemia/reperfusion injury (Lakhan et al., 2009). In contrast, neuronal network reorganization, which also occurs spontaneously, has been related to later recovery and can be influenced by environmental and behavioral factors (Cramer, 2008; Nudo, 2011, 2013). On the molecular level, regulation of gene expression in the unaffected peri-infarct tissue seems to favour the synthesis of growth promoting and to suppress the synthesis of growth inhibiting proteins thus creating a permissive environment for axonal/dendritic sprouting and may thus offer a window of opportunity for behavioural interventions to be effective (Carmichael, 2006). Even after standard treatments provided by the health care systems, the majority of people with aphasia have a chronic communication disability. Speech and language therapy (SLT) is the current standard of care for aphasia treatment but supplemental therapeutic strategies are emerging. The aim of this short review is to give an overview of current advances in research on behavioural, pharmacological and electrophysiological treatments for post-stroke aphasia.

Myopathie squelettique associée à la sclérodermie systémique (ScS) : particularités cliniques et apport pronostique de la biopsie musculaire. Étude cas témoin

To determine factors that contribute to living well with aphasia in the first 12 months poststroke.Prospective longitudinal cohort study.Hospitalized care, ambulatory care, and general community.A referred sample of people (N=58) with a first incidence of aphasia after stroke was assessed at 3, 6, 9, and 12 months postonset. Participants were recruited through speech-language pathologists in 2 capital cities in Australia. Presence of aphasia was determined through the Western Aphasia Battery-Revised by an experienced speech-language pathologist.Not applicable.The main outcomes were the 5 domains of the Assessment for Living with Aphasia at 3, 6, 9, and 12 months poststroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity, and a self-rating of successfully living with aphasia at the same time points. Mixed effects modeling was used to determine which factors contributed to the trajectory of each of the 5 domains of participation, impairment, environment, personal factors, and life with aphasia.Higher household income, larger social network size, being a woman, and having milder aphasia were positively associated with the participation domain. Graduate or postgraduate educational levels, low mood, and poor physical functioning were negatively associated with the participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia, and aphasia severity. Low mood was consistently negatively associated with all of the domains.Psychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months postonset. Aphasia rehabilitation needs to attend more to these factors to optimize outcomes.

Un rôle des Heat Shock Protéines dans l'auto-immunité associée au VHC?

To determine factors that contribute to living well with aphasia in the first 12 months poststroke.Prospective longitudinal cohort study.Hospitalized care, ambulatory care, and general community.A referred sample of people (N=58) with a first incidence of aphasia after stroke was assessed at 3, 6, 9, and 12 months postonset. Participants were recruited through speech-language pathologists in 2 capital cities in Australia. Presence of aphasia was determined through the Western Aphasia Battery-Revised by an experienced speech-language pathologist.Not applicable.The main outcomes were the 5 domains of the Assessment for Living with Aphasia at 3, 6, 9, and 12 months poststroke. The independent variables included demographics, physical functioning, social network, mood, aphasia severity, and a self-rating of successfully living with aphasia at the same time points. Mixed effects modeling was used to determine which factors contributed to the trajectory of each of the 5 domains of participation, impairment, environment, personal factors, and life with aphasia.Higher household income, larger social network size, being a woman, and having milder aphasia were positively associated with the participation domain. Graduate or postgraduate educational levels, low mood, and poor physical functioning were negatively associated with the participation domain. Factors positively associated with other domains included higher income, self-ratings of successfully living with aphasia, and aphasia severity. Low mood was consistently negatively associated with all of the domains.Psychosocial determinants were the most significant predictors of living well with aphasia in the first 12 months postonset. Aphasia rehabilitation needs to attend more to these factors to optimize outcomes.

Descriptive study of 192 adults with speech and language disturbances.

Aphasia is a very disabling condition caused by neurological diseases. In Brazil, we have little data on the profile of aphasics treated in rehabilitation centers. To present a descriptive study of 192 patients, providing a reference sample of speech and language disturbances among Brazilians. Retrospective study. Speech Pathology Unit linked to the Neurology Division of the Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo. All patients (192) referred to our Speech Pathology service from 1995 to 2000. We collected data relating to demographic variables, etiology, language evaluation (functional evaluation, Boston Diagnostic Aphasia Examination, Boston Naming and Token Test), and neuroimaging studies. The results obtained in language tests and the clinical and neuroimaging data were organized and classified. Seventy aphasics were chosen for constructing a profile. Fourteen subjects with left single-lobe dysfunction were analyzed in detail. Seventeen aphasics were compared with 17 normal subjects, all performing the Token Test. One hundred subjects (52%) were men and 92 (48%) women. Their education varied from 0 to 16 years (average: 6.5; standard deviation: 4.53). We identified the lesion sites in 104 patients: 89% in the left hemisphere and 58% due to stroke. The incidence of aphasia was 70%; dysarthria and apraxia, 6%; functional alterations in communication, 17%; and 7% were normal. Statistically significant differences appeared when comparing the subgroup to controls in the Token Test. We believe that this sample contributes to a better understanding of neurological patients with speech and language disturbances and may be useful as a reference for health professionals involved in the rehabilitation of such disorders.

The Incidence of Aphasia and Global Aphasia in Left Brain-Damaged Patients

Two hundred and twenty three right-handed patients consecutively admitted to the wards in a 21-month period for a left-sided cerebrovascular disease were examined 15 to 30 days after the stroke for the presence of aphasia. Twenty-seven of them could not be assessed. Of the remaining 196, 108 (55.1 %) were aphasic. The incidence of global aphasia (43%) in the latter group was higher than in previous studies. Based on CT-scan data it was associated in 32% of patients with a deep lesion and only in 5 3 % with an antero-posterior cortical-subcortical lesion, contrary to what is traditionally assumed. There was no sex difference in the incidence and distribution of aphasia.

Aphasia in illiterates

Abstract The incidence and severity of language dysfunctions in literate and illiterate subjects suffering unilateral cerebral impairment of the left hemisphere is examined. Three groups of 25 monolingual right-handed subjects are included in the study: (1) literate adults with unilateral right or left-brain lesion, (2) illiterate adults with unilateral right- or left-brain lesion, (3) illiterate subjects with no history of neurological problems as a control group. Average scores among the 3 groups are compared, as well as among the 2 groups of brain-damaged subjects relative to laterality of lesion. A quantitative analysis of the incidence of aphasia in literate and illiterate subjects is performed. The participation of the right hemisphere in language processing is discussed. The question whether the illiterate's cerebral organization of language differs from that of the person who reads and writes is examined. The data obtained in this study lend support to the notion that illiterates experience less intrahemispheric specialization on the left side than their literate counterparts.

Differential diagnosis in phoniatrics and pediatric audiology. Language-aphasia

The incidence of aphasia in a population of 100 000 is about 60 new cases a year. Although the aphasic patient represents a neurological problem, aphasia seems rather to be a linguistic one. Therefore, this report on the diagnosis of aphasia includes a comprehensive linguistic introduction on the function and structure of language. After a presentation of different aphasiologic schools and their classification of the aphasic syndromes, the differential diagnoses of other neurological disorders of verbal communication from aphasia are given. The subsequent section concerns the clinical investigation of aphasia. Finally, the most common tests for aphasia are reviewed.

Handedness and aphasia: An inferential method for determining the mode of cerebral speech specialization

This paper presents a method to infer the cerebral mode of speech in the left- and right-handed. The method is applied to the known reports on the incidence of aphasia following a unilateral brain injury in adults (1935–1973) [1]. Two different models were found. In the left-handed, a complex model of unilateral (left=0.24, right=0.00) and bilateral speech (0.76) was inferred. In the right-handed, a less complex model of unilateral speech specialization (left=0.95, right=0.05) was inferred.