Aphasia in acute stroke

University dissertation from Stockholm : Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital

Abstract: Aphasia is a language impairment due to a brain lesion, usually in the left hemisphere, and is a common symptom in acute stroke. The aims of this thesis were to evaluate aphasia in acute stroke patients, to assess spontaneous language recovery, to evaluate the test instruments, to evaluate the efficacy of drug treatment, and speech and language therapy for recovery of aphasia, and to assess the possibility to reliable identify depression in aphasic patients. The patients were gathered from three study populations. The first study population was a cohort of consecutive acute stroke patients where we assessed the incidence of aphasia, morbidity and mortality. The second study population was included in a randomized placebo controlled trial (RCT) to evaluate the efficacy of moclobemide, a MAO-A inhibitor, on aphasia recovery, where we also evaluated the possibility to identify depression in aphasic patients. The third study population is an ongoing RCT to evaluate the efficacy of early speech and language therapy (SLT) for acute aphasic stroke patients. Aphasia was present in one third of our acute stroke patients. The aphasic patients had three times higher short-term mortality than the non-aphasics. Long-term mortality was twice as high in the aphasic patients. Patients with aphasia have more severe strokes than those without aphasia, and the communication deficit in itself makes the patient more disabled. Aphasic patients have longer hospital stay, and require more rehabilitation resources than other stroke patients. Cerebral emboli and atrial fibrillation were almost twice as common in aphasic patients as in non-aphasics. Indeed, in every patient with aphasia and an ischemic stroke an embolic source should be looked for. There is a considerable spontaneous recovery and most of the recovery takes place within the first month. The initial degree of aphasia predicts the final stage. The aphasia instruments used: Norsk Grunntest for Afasi and Amsterdam-Nijmegen Everyday Language Test show an important consistency in the three studies. The degree of aphasia measured according to these tests can predict complete recovery. Patients with mild aphasia in the acute stage will recover completely to a high extent. Treatment with moclobemide showed no improvement on the degree of aphasia beyond that of placebo. A randomized controlled trial on early SLT for acute stroke patients has been found feasible to perform with the design and methods used. Two thirds of acute aphasic stroke patients, with all types of aphasia, could be reliably investigated for depression according to DSM-IV criteria within the first weeks after stroke onset. With the help of proxy, almost all could be diagnosed. There was a trend for more depression in patients with emotionalism at baseline. In stroke patients some depression symptoms occur irrespective of an ongoing depression. Hence, depression may possibly be over-diagnosed in the individual stroke patient with aphasia.

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