Aphasia in acute stroke: Incidence, determinants, and recovery

TLDR

Understanding the frequency and recovery of aphasia is crucial for stroke rehabilitation and informs language brain organization. The study prospectively enrolled 881 consecutive acute stroke patients and assessed aphasia at admission, weekly during hospitalization, and at 6‑month follow‑up using the Scandinavian Stroke Scale aphasia score. At admission 38 % of patients had aphasia, decreasing to 18 % at discharge; remission was rapid, with 95 % achieving stable language function within 2, 6, or 10 weeks for mild, moderate, or severe aphasia respectively, and initial severity alone predicted outcome, while sex, handedness, lesion side, and age had little effect.

Abstract

Abstract Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language. We studied prospectively and consecutively an unselected and community‐based sample of 881 patients with acute stroke. Assessment of aphasia was done at admission, weekly during the hospital stay, and at a 6‐months follow‐up using the aphasia score of the Scandinavian Stroke Scale. Thirty‐eight percent had aphasia at the time of admission; at discharge 18% had aphasia. Sex was not a determinant of aphasia in stroke, and no sex difference in the anterior‐posterior distribution of lesions was found. The remission curve was steep: Stationary language function in 95% was reached within 2 weeks in those with initial mild aphasia, within 6 weeks in those with moderate, and within 10 weeks in those with severe aphasia. A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia. Initial severity of aphasia was the only clinically relevant predictor of aphasia outcome. Sex, handedness, and side of stroke lesion were not independent outcome predictors, and the influence of age was minimal.