Initial Severity Of Aphasia Research Articles

Language disorders: diagnosis and treatment in neurological practice

Language disorders resulting from cerebral stroke or other focal brain lesions, as well as from some neurodegenerative diseases (aphasia) are common in neurological practice and have a negative impact on almost all kinds of social interaction and the quality of life of patients. The aim of this work was to study and summarize the information on aphasia in the world scientific lite-rature in order to achieve a consensus among representatives of different specialties and to optimize the diagnostic and treatment strategies in patients with language disorders. We searched for publications from 2001 to 2023 on language disorders in neurological diseases, diagnosis, and treatment of aphasia in the PubMed, Clinical Key Elsevier, Cochrane Library, and Google Scholar databases. The article highlights the historical aspects of the formation of modern ideas about language disorders and considers the main clinical forms of aphasia, their relationship with the topography of brain lesions. Diagnostic approaches in speech and language disorders include assessment of speech production, speech comprehension, naming, repetition, reading and writing, in addition to pronunciation and fluency, which is performed in clinical practice by neurologists, speech and language therapists. Based on a comprehensive assessment of language functions, language impairment can be classified as one or more of the seven main clinical forms of aphasia. The main predictors of a better recovery of language functions are a milder initial severity of aphasia, an earlier initiation of treatment and an adequate scope of therapy. The basis of treatment and rehabilitation for aphasia is speech and language therapy, which can be carried out by both specialists and the patient’s family or caregivers. The role of drug treatment and non-invasive brain stimulation in improving language functions is still very limited and requires further research. Teaching patients and their family certain rules of communication taking into account present language disorders is of great importance. Future treatment strategies for aphasia are likely to consist of a combination of a behavioral approach with pharmacotherapeutic and neuromodulatory interventions.

Multivariate lesion symptom mapping for predicting trajectories of recovery from aphasia.

Individuals with post-stroke aphasia tend to recover their language to some extent; however, it remains challenging to reliably predict the nature and extent of recovery that will occur in the long term. The aim of this study was to quantitatively predict language outcomes in the first year of recovery from aphasia across multiple domains of language and at multiple timepoints post-stroke. We recruited 217 patients with aphasia following acute left hemisphere ischaemic or haemorrhagic stroke and evaluated their speech and language function using the Quick Aphasia Battery acutely and then acquired longitudinal follow-up data at up to three timepoints post-stroke: 1 month (n = 102), 3 months (n = 98) and 1 year (n = 74). We used support vector regression to predict language outcomes at each timepoint using acute clinical imaging data, demographic variables and initial aphasia severity as input. We found that ∼60% of the variance in long-term (1 year) aphasia severity could be predicted using these models, with detailed information about lesion location importantly contributing to these predictions. Predictions at the 1- and 3-month timepoints were somewhat less accurate based on lesion location alone, but reached comparable accuracy to predictions at the 1-year timepoint when initial aphasia severity was included in the models. Specific subdomains of language besides overall severity were predicted with varying but often similar degrees of accuracy. Our findings demonstrate the feasibility of using support vector regression models with leave-one-out cross-validation to make personalized predictions about long-term recovery from aphasia and provide a valuable neuroanatomical baseline upon which to build future models incorporating information beyond neuroanatomical and demographic predictors.

Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke.

After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment. Previous studies have suggested that leukoaraiosis may be a clinically relevant predictor of aphasia outcomes and recovery, although findings have been inconsistent. We investigated the relationship between leukoaraiosis and aphasia in the first year after stroke. We recruited 267 patients with acute left hemispheric stroke and coincident fluid attenuated inversion recovery MRI. Patients were evaluated for aphasia within 5 days of stroke, and 174 patients presented with aphasia acutely. Of these, 84 patients were evaluated at ∼3 months post-stroke or later to assess longer-term speech and language outcomes. Multivariable regression models were fit to the data to identify any relationships between leukoaraiosis and initial aphasia severity, extent of recovery, or longer-term aphasia severity. We found that leukoaraiosis was present to varying degrees in 90% of patients. However, leukoaraiosis did not predict initial aphasia severity, aphasia recovery, or longer-term aphasia severity. The lack of any relationship between leukoaraiosis severity and aphasia recovery may reflect the anatomical distribution of cerebral small vessel disease, which is largely medial to the white matter pathways that are critical for speech and language function.

Cerebral Small Vessel Disease Burden: An Independent Biomarker for Anomia Treatment Responsiveness in Chronic Stroke Patients With Aphasia

ObjectiveTo determine whether MRI-based cerebral small vessel disease (cSVD) burden predicts treatment-induced aphasia recovery in chronic stroke patients above and beyond initial aphasia severity and stroke-lesion volume. DesignRetrospective. Four cSVD neuroimaging markers were rated using validated visual scales: white matter hyperintensities, enlarged perivascular spaces, lacunes, and global cortical atrophy. We also calculated a cSVD total score. We employed linear regression models to model treatment response as a function of cSVD burden. We also ran correlation analyses to determine the association among cSVD burden and pre-treatment linguistic and non-linguistic cognition. SettingResearch clinic. ParticipantsThe study includes data from 30 chronic stroke patients with aphasia who received treatment for word finding difficulties and completed additional pre-treatment neuroimaging and behavioral assessments (N=30). Interventions120-minute sessions of anomia treatment 2 times per week for up to 12 weeks. Main Outcome MeasuresChange in accuracy on the treatment probes measured as a percentage (ie, change in accuracy percentage score=post-treatment accuracy percentage minus pre-treatment accuracy percentage). ResultsBaseline cSVD burden predicted response to anomia treatment independently from demographic and stroke-related factors. Patients with lower cSVD burden exhibited enhanced rehabilitation response compared with those with higher cSVD burden (β=-6.816e-02, P=.019). cSVD burden was highly associated with nonverbal executive function at baseline (r=-0.49, P=.005): patients with lower cSVD burden exhibited higher performance on nonverbal executive function tasks compared with participants with higher cSVD burden. No association was observed among cSVD burden and performance on language tasks at the baseline. ConclusionscSVD, a marker of brain reserve and a robust risk factor for post-stroke dementia, may be used as a biomarker for distinguishing patients who are more likely to respond to anomia therapy from those who are less likely to do so and for individualizing treatment parameters (eg, targeting both linguistic and nonlinguistic cognition in severe cSVD).

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.

Associations between stroke severity, aphasia severity, lesion location, and lesion size in acute stroke, and aphasia severity one year post stroke

ABSTRACT Background The aim of the present study was to investigate the associations stroke severity, aphasia severity, lesion location and lesion size in acute stroke, and aphasia severity in the subacute and chronic stages post stroke. We hypothesized that initial stroke severity and aphasia severity were associated with the patient’s aphasia severity in the subacute and chronic stages of stroke. We expected to find that lesions within the left frontotemporal regions of the brain were associated with aphasia severity post-stroke. Methods Thirty-three patients with aphasia were included in the study. They were assessed with a standardized aphasia test at admission to the hospital (T1), after 3 months (T2) and finally after 12 months (T3). Stroke severity, initial physical impairment, and initial functional independence were also assessed at T1. Diffusion-weighted magnetic resonance imaging was performed as clinical-routine at admission. Voxel-based lesion symptom mapping and a region of interest analysis (ROI) was performed to analyze MRI-findings. Results & Outcomes Initial lesion size and aphasia severity were associated with aphasia severity at T2. Initial stroke severity, aphasia severity, and lesion size were not associated with aphasia severity at T3, but the patients’ aphasia severity at T2 predicted aphasia severity at T3. Lesion analysis showed that lesions within the left postcentral gyrus and the left inferior parietal gyrus were significantly associated with aphasia severity at T3. The ROI-analysis did not yield any significant regions of interest to explain the total variance of the patients’ change in scores on the aphasia test from T1 to T3. Conclusion Lesions within the postcentral gyrus and the inferior parietal gyrus are associated with aphasia severity at T3. Lesion size in the acute stages of stroke is associated with aphasia severity at T1 and T2, but not T3. However, neither initial aphasia severity nor stroke severity was associated with aphasia severity at T3. Aphasia severity in T2 is however strongly associated with aphasia severity in T3.

Combination of Verb Network Strengthening Treatment with TMS and tDCS: Preliminary results

Non-invasive brain stimulation (NIBS) techniques combined with behavioral speech/language therapies have recently been suggested as a promising method for language recovery in people with aphasia (PWA). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are currently the most common types of NIBS for aphasia rehabilitation. In this study, we combined either rTMS or tDCS with a behavioral therapy approach, Verb Network Strengthening Treatment (VNeST), that has neither been used before in a Russian-speaking post-stroke population nor combined with any type of NIBS. In a case series study, we demonstrate the results of two groups of participants: 1) 4 PWA who received one daily session of VNeST preceded by 20-minutes of rTMS for 8 – 12 days; and 2) 4 PWA who received 2 sessions of VNeST a day, with the first 20 minutes of the first daily session combined with tDCS, for 10 days. We assessed the accuracy of action naming and sentence production and found a significant improvement in sentence production in the tDCS + VNeST group, while the other group did not show a significant improvement in these tasks. Interestingly, we found a correlation between improvement in sentence production and the number of sessions regardless of the stimulation type and another correlation between improvement in action naming and initial aphasia severity. This study is a first attempt to apply the combination of these techniques in Russian. Our preliminary findings prompt larger-scale research to study the potential of this method.

Prognostic factors for recovery of aphasia after acute ischemic stroke—a review

Introduction : Stroke, as defined by the World Health Organization, is the rapid development of clinical signs of focal brain dysfunction lasting more than 24 hours or leading to death for no reason other than vascular origin. Subarachnoid hemorrhage is not included. Aphasia is a common symptom of stroke. The improvement of aphasia takes place mainly within the first 3 months. The four main components of the classical aphasic syndrome are: comprehension, repetition, naming, and fluency. Understanding usually indicates earlier and complete recovery and is essential for basic communication. Nevertheless, persistent, albeit less pronounced, impaired communication ability remains a major problem for the individual patient with aphasia. Materials and Methods : The article has summarized information from different databases like Google Scholar and reviewed the factors influencing the recovery of aphasia after acute ischemic stroke. Results: The factors that really affect recovery are the initial severity of aphasia, which is inextricably linked to the size and location of the lesion. Conclusion: Stroke is the leading cause of long-term disability in Western countries and the functional outcome depends on the severity of the stroke. The initial severity of aphasia affects the recovery of language functions.

Cue responsiveness as a measure of emerging language ability in aphasia

ABSTRACT Background Prior research suggests that initial aphasia severity, lesion size, and lesion location are the most salient factors in predicting recovery outcomes. While these factors provide important prognostic information, information that is individualized and readily available to clinicians is limited. Deficits in naming are common to all aphasia types and are routinely targeted in aphasia assessment and treatment, with cues provided to facilitate lexical retrieval. Objectives In this study, we examine aphasia recovery factors that are readily available to clinicians, examining whether a person’s ability to improve naming with cues, indicating “stimulability,” will be predictive of future word retrieval. Methods Ten participants with aphasia following a left-hemisphere stroke participated in initial assessment, seven of whom met criteria for longitudinal assessment. Stroke and early clinical recovery data were collected for all participants. At four timepoints over one year we evaluated longitudinal participants’ naming ability and measured the proportion of successful lexical retrieval with the presentation of phonemic, feature, and sentence cues. Results For all participants, multiple descriptive factors regarding recovery, including lesion information, information from the acute inpatient timeframe, and communication opportunities, were examined. For individuals followed longitudinally, naming stimulability did not consistently predict naming accuracy at the subsequent assessment timepoint. Individuals’ attempts at naming emerged as a metric related to future naming performance warranting further evaluation. Conclusions Multiple factors related to recovery must be considered when providing prognostic information. Naming stimulability and attempts at naming provide some information regarding future performance, but are not consistently reliable across timepoints.

Determinants of aphasia recovery: exploratory decision tree analysis

ABSTRACT One hundred and sixty-three aphasia patients underwent initial language examination during the first week following stroke and 90–100 days post-stroke. Demographic factors (age, gender, and number of years of formal education), lesion-related factors (type of stroke, lesion volume, cortical versus sub-cortical location, and site of lesion), as well as initial severity and type of aphasia were taken as independent variables while aphasia recovery (in terms of no change versus change to a milder type or complete recovery) was the dependent variable. Chi square automatic interaction detection (CHAID) was performed to assess predictor importance and formulate a predictive model for aphasia recovery. Initial severity of aphasia followed by initial aphasia symptomatology was found to be the most important factor determining aphasia recovery. Age and gender had some importance. Lesion-related factors did not reach statistical significance as independent determinant of aphasia recovery. The predictive value of the model was 66.87%

Predicting Early Post-stroke Aphasia Outcome From Initial Aphasia Severity.

Background: The greatest degree of language recovery in post-stroke aphasia takes place within the first weeks. Aphasia severity and lesion measures have been shown to be good predictors of long-term outcomes. However, little is known about their implications in early spontaneous recovery. The present study sought to determine which factors better predict early language outcomes in individuals with post-stroke aphasia.Methods: Twenty individuals with post-stroke aphasia were assessed <72 h (acute) and 10–14 days (subacute) after stroke onset. We developed a composite score (CS) consisting of several linguistic sub-tests: repetition, oral comprehension and naming. Lesion volume, lesion load and diffusion measures [fractional anisotropy (FA) and axial diffusivity (AD)] from both arcuate fasciculi (AF) were also extracted using MRI scans performed at the same time points. A series of regression analyses were performed to predict the CS at the second assessment.Results: Among the diffusion measures, only FA from right AF was found to be a significant predictor of early subacute aphasia outcome. However, when combined in two hierarchical models with FA, age and either lesion load or lesion size, the initial aphasia severity was found to account for most of the variance (R2 = 0.678), similarly to the complete models (R2 = 0.703 and R2 = 0.73, respectively).Conclusions: Initial aphasia severity was the best predictor of early post-stroke aphasia outcome, whereas lesion measures, though highly correlated, show less influence on the prediction model. We suggest that factors predicting early recovery may differ from those involved in long-term recovery.

Factors affecting vascular aphasia severity

ABSTRACT Background: Recent studies have emphasized the importance of initial aphasia severity as a determinant of aphasia recovery. However, data on predictors of initial post-stroke aphasia severity itself are far from adequate in the available literature. Aims: The objective of the present study was to enumerate the predictors of initial aphasia severity following stroke. Methods & Procedures: Bengali version of Western Aphasia Battery (BWAB), a validated instrument, was used for language examination. All patients were examined for language deficit during the first week after stroke. Severity was estimated by deducing aphasia quotient (AQ) and considering the severity scale as per BWAB. Lesion assessment was carried out by magnetic resonance imaging (3T) in ischemic stroke (if no contraindications were found) and computed tomography in hemorrhagic stroke. Demographic factors (age, gender, bilingualism, and number of years of formal education), lesion-related factors (type of stroke, lesion volume, cortical versus sub-cortical location, and site of lesion), and initial aphasia type were independent variables, whereas initial aphasia severity (non-severe, AQ = 50 or more; severe, AQ <50) was the dependent variable. Appropriate statistical tests were applied for the analysis of collected data. Among the 515 screened participants with first-ever acute stroke, 208 presented aphasia. Outcomes & Results: On univariate analysis, the factors found to be associated with higher initial severity were monolingualism (p = .014), hemorrhagic stroke (p < .001), larger lesion volume (p < .001), cortico-subcortical mixed stroke lesion (p < .001), and a non-fluent type of aphasia (p < .001). As per binary logistic regression analysis, independent predictors of higher severity were higher volume of lesion (p < .001, OR = 1.651), hemorrhagic stroke (p = .004, OR = 11.987), and non-fluent aphasia (p = .012, OR = 4.796). The overall predictive value of the regression model was 90.4%. Conclusion: The most significant determinants of initial aphasia severity in our sample of stroke patients were lesion-related factors and non-fluent aphasia.

Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke.

ObjectiveTo investigate longitudinal changes in language function in left-hemispheric ischemic stroke patients as well as factors that influence language recovery until 1 year after stroke onset.MethodsWe analyzed data from 235 patients with first-ever left-hemispheric ischemic stroke. All patients completed the Korean version of the Frenchay Aphasia Screening Test (K-FAST) at 7 days (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after stroke onset. Repeated measures analysis of variance (ANOVA) was used to investigate changes in language function between time points. Subgroup analysis was performed according to the K-FAST scores at T1. Stroke lesion volume was assessed using diffusion tensor images, and involvement of language-related brain regions was examined. Multiple regression analysis was used to analyze factors influencing improvement of K-FAST score.ResultsThe K-FAST scores at T1, T2, T3, and T4 differed significantly (p<0.05). In the subgroup analysis, only the severe group showed continuous significant improvement by 1 year. Factors that negatively influenced improvement of language function were the age at onset, initial National Institutes of Health Stroke Scale (NIHSS) score, and initial K-FAST score, whereas education level and stroke lesion volume positively affected recovery. Involvement of language-related brain regions did not significantly influence long-term language recovery after ischemic stroke.ConclusionRecovery of language function varied according to the severity of the initial language deficit. The age at stroke onset, education level, initial severity of aphasia, initial NIHSS score, and total stroke lesion volume were found to be important factors for recovery of language function.

Lesion-aphasia discordance in acute stroke among Bengali-speaking patients: Frequency, pattern, and effect on aphasia recovery

Abstract Introduction Contemporary research papers have highlighted the issue of lesion-aphasia discordance in reference to the classic ‘associationist’ model provided by Wernicke-Lichtheim. The objective of the present study is to explore frequency, pattern and evolution of lesion-discordant aphasia following first ever acute stroke in Bengali-speaking subjects. Methods Bengali version of Western Aphasia Battery, a validated scale, was used for language assessment in our study subjects. Lesion localization was done by using Magnetic resonance imaging (MRI) (3T) for ischemic stroke (if not contraindicated) and computed tomography (CT) for hemorrhagic stroke. Among 515 screened cases of first-ever acute stroke, 208 presented aphasia. Language assessment was done between 7 and 14 days in all study subjects and was repeated between 90 and 100 days in patients available for follow-up. Ischemic stroke cases with contraindication for MRI underwent CT imaging. Discordance between lesion and aphasic phenotype was determined only for right-handed subjects with cortical involvement (isolated or in combination with sub-cortical white matter) in the left hemisphere. Appropriate statistical tests were used to analyze the collected data. Results Lesion-aphasia discordance was found in 20 out of 134 patients with aphasia who were dextral and had cortical involvement in the left hemisphere (14.92%). The pattern of discordance observed were- posterior lesion with Broca's aphasia (4; 20%); posterior lesion with global aphasia (8; 40%); anterior lesion with global aphasia (4; 20%), and posterior lesion with mixed transcortical aphasia (4; 20%). On univariate analysis, the factors significantly associated with lesion-aphasia discordance were hemorrhagic stroke (p = 0.000); posterior perisylvian location (p = 0.002), and higher education (p = 0.048). After adjusting for all other variables, hemorrhagic stroke was found to have strong association with lesion-aphasia discordance (p = 0.001, OR = 11.764, 95% CI, 2.83–50.0). Discordant cases were more likely to recover or change to a milder type compared to concordant cases (p = 0.007, OR = 11.393, 95% CI, 1.960–66.231), after adjusting for all other variables including initial severity of aphasia (p = 0.006, OR = 8.388, 95% CI, 1.816–38.749). Conclusion Lesion-aphasia discordance following acute stroke is not uncommon among Bengali-speaking subjects. In the discordant group, preponderance towards non-fluent aphasia was observed. Discordance occurred more frequently after hemorrhagic stroke. Subjects with lesion-discordant aphasia presented better recovery during early post-stroke phase.

Leukoaraiosis Is Associated With a Decline in Language Abilities in Chronic Aphasia

Background. A fraction of stroke survivors with chronic aphasia experience declines in language abilities over time, but the reason for this remains unclear. Objective. To evaluate the effect of leukoaraiosis on baseline aphasia severity and long-term changes in aphasia severity. This study directly compares the predictive capacity of leukoaraiosis severity to that of lesion damage, a factor known to account for a substantial proportion of variance in the degree of language impairment and recovery. Methods. Using a longitudinal database of behavioral and neuroimaging data from 35 individuals in the chronic stage of recovery after a single-event left-hemisphere stroke (9 females, mean stroke age = 55.8 ± 9.1 years, mean months poststroke at initial evaluation = 36.3 ± 40.8), we examined 2 lines of inquiry: (1) to what extent does leukoaraiosis severity at initial evaluation predict aphasia severity and (2) to what extent does leukoaraiosis severity at initial evaluation predict longitudinal change in aphasia severity. Participants underwent high-resolution magnetic resonance imaging for the purpose of lesion volume analysis and leukoaraiosis severity rating. Biographical information was also considered. Results. Lesion volume and time poststroke at initial assessment best predicted initial aphasia severity (adjusted R2 = 0.37). Leukoaraiosis severity and initial aphasia severity significantly predicted decline in language abilities at follow-up, accounting for approximately one-third of the variance (adjusted R2 = 0.33). More severe leukoaraiosis was associated with a 4.3 odds increase of decline. Conclusions. Leukoaraiosis is a significant risk factor for declining language abilities in aphasia and should be considered for better identification of individuals at risk for long-term decline, which can guide clinical decision making.

Acute Diffusivity Biomarkers for Prediction of Motor and Language Outcome in Mild-to-Severe Stroke Patients.

Background and Purpose- Early severity of stroke symptoms-especially in mild-to-severe stroke patients-are imperfect predictors of long-term motor and aphasia outcome. Motor function and language processing heavily rely on the preservation of important white matter fasciculi in the brain. Axial diffusivity (AD) from the diffusion tensor imaging model has repeatedly shown to accurately reflect acute axonal damage and is thus optimal to probe the integrity of important white matter bundles and their relationship with long-term outcome. Our aim was to investigate the independent prognostic value of the AD of white matter tracts in the motor and language network evaluated at 24 hours poststroke for motor and aphasia outcome at 3 months poststroke. Methods- Seventeen (motor cohort) and 28 (aphasia cohort) thrombolyzed patients with initial mild-to-severe stroke underwent a diffusion tensor imaging sequence at 24 hours poststroke. Motor and language outcome were evaluated at 3 months poststroke with a composite motor score and the aphasia handicap scale. We first used stepwise regression to determine which classic (age, initial motor or aphasia severity, and lesion volume) and imaging (ratio of affected/unaffected AD of motor and language fasciculi) factors were related to outcome. Second, to determine the specificity of our a priori choices of fasciculi, we performed voxel-based analyses to determine if the same, additional, or altogether new regions were associated with long-term outcome. Results- The ratio of AD in the corticospinal tract was the sole predictor of long-term motor outcome, and the ratio of AD in the arcuate fasciculus-along with age and initial aphasia severity-was an independent predictor of 3-month aphasia outcome. White matter regions overlapping with these fasciculi naturally emerged in the corresponding voxel-based analyses. Conclusions- AD of the corticospinal tract and arcuate fasciculus are effective biomarkers of long-term motor and aphasia outcome, respectively.

Aphasia outcome: the interactions between initial severity, lesion size and location.

The outcome of aphasia at 3months is variable in patients with moderate/severe stroke. The aim was to predict 3-month aphasia outcome using prediction models including initial severity in addition to the interaction between lesion size and location at the acute phase. Patients with post-stroke aphasia (assessed by the Aphasia Rapid Test at day 7-ART D7) and MRI performed at day 1 were enrolled (n = 73). Good outcome at 3-months was defined by an Aphasia Handicap Score of 0-2. Each infarct lesion was overlapped with an area of interest in the left temporo-parietal region to compute an intersection index (proportion of the critical region damaged by the infarct). We tested ART D7, age, lesion volume, and intersection index as well as a combined variable lesion volume*intersection in a univariate analysis. Then, we performed a multivariate analysis to investigate which variables were independent predictors of good outcome. ART at D7, infarct volume, and the intersection index were univariate predictors of good outcome. In the multivariate analysis, ART D7 and "volume ≥ 50ml or intersection index ≥ 20%" correctly classified 89% of the patients (p < 0.0001). When added to the model, the interaction between both variables was significant indicating that the impact of the size or site variable depends on the initial severity of aphasia. In patients with initially severe aphasia, large infarct size or critical damage in left temporoparietal junction is associated with poor language outcome at 3months.

Determinants of aphasia recovery in first 3 months following first ever acute stroke: Experience from a tertiary care centre stroke unit in Kolkata, India

Determinants of aphasia recovery in first 3 months following first ever acute stroke: Experience from a tertiary care centre stroke unit in Kolkata, India

Language improvement one week after thrombolysis in acute stroke.

Language recovery following acute stroke is difficult to predict due to several evaluation factors and time constraints. We aimed to investigate the predictors of aphasia recovery and to identify the National Institute of Health and Stroke Scale (NIHSS) items that best reflect linguistic performance, 1 week after thrombolysis. We retrieved data from a prospective registry of patients with aphasia secondary to left middle cerebral artery (MCA) stroke treated with intravenous thrombolysis. Complete recovery at day 7 (D7) was measured in a composite verbal score (CVS) (Σ Language+Questions+Commands NIHSS scores). Lesion size was categorized by the Alberta Stroke Program Early CT score (ASPECTS) and vascular patency by ultrasound. CVS was correlated with standardized aphasia testing if both were performed within a two-day interval. Of 228 patients included (age average 67.32 years, 131 men), 72% presented some language improvement that was complete in 31%. Total recovery was predicted by ASPECTS (OR=1.65; 95% CI, 1.295-2.108; P < 0.00) and baseline aphasia severity (OR=0.439; 95% CI, 0.242-0.796; P < 0.007). CVS correlated better with standardized aphasia measures (aphasia quotient, severity, comprehension) than NIHSS_Language item. Lesion size and initial aphasia severity are the main predictors of aphasia recovery one week after thrombolysis. A NIHSS composite verbal score seems to capture the global linguistic performance better than the language item alone.

Retrospective Analysis of Outcomes from Two Intensive Comprehensive Aphasia Programs

Positive outcomes from intensive therapy for individuals with aphasia have been reported in the literature. Little is known about the characteristics of individuals who attend intensive comprehensive aphasia programs (ICAPs) and what factors may predict who makes clinically significant changes when attending such programs. Demographic data on participants from 6 ICAPs showed that individuals who attend these programs spanned the entire age range (from adolescence to late adulthood), but they generally tended to be middle-aged and predominantly male. Analysis of outcome data from 2 of these ICAPs found that age and gender were not significant predictors of improved outcome on measures of language ability or functional communication. However, time post onset was related to clinical improvement in functional communication as measured by the Communication Activities of Daily Living, second edition (CADL-2). In addition, for one sample, initial severity of aphasia was related to outcome on the Western Aphasia Battery–Revised, such that individuals with more severe aphasia tended to show greater recovery compared to those with mild aphasia. Initial severity of aphasia also was highly correlated with changes in CADL-2 scores. These results suggest that adults of all ages with aphasia in either the acute or chronic phase of recovery can continue to show positive improvements in language ability and functional communication with intensive treatment.