Skip to main content

Advertisement

SpringerLink
Log in

Aphasia As a Predictor of Stroke Outcome

  • Behavior (HS Kirshner, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Aphasia is a common feature of stroke, affecting 21–38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes.

Recent Findings

During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement.

Summary

Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention. FastStats—cerebrovascular disease or stroke. 2017. https://www.cdc.gov/nchs/fastats/stroke.htm.

  3. Ovbiagele B, Goldstein LB, Higashida RT, Howard VJ, Johnston SC, Khavjou OA, et al. Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke. 2013;44(8):2361–75.

    Article  PubMed  Google Scholar 

  4. Dhamoon MS, Moon YP, Paik MC, Sacco RL, Elkind MS. Trajectory of functional decline before and after ischemic stroke: the Northern Manhattan Study. Stroke. 2012;43(8):2180–4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Elman RJ, Bernstein-Ellis E. The efficacy of group communication treatment in adults with chronic aphasia. J Speech Lang Hear Res. 1999;42(2):411–9.

    Article  CAS  PubMed  Google Scholar 

  6. National Stroke Association. Stroke 101 fact sheet 2011 [Aug 6, 2012]. Available from: http://www.stroke.org/site/DocServer/STROKE_101_Fact_Sheet.pdf?docID=4541.

  7. Ellis C, Simpson AN, Bonilha H, Mauldin PD, Simpson KN. The one-year attributable cost of poststroke aphasia. Stroke. 2012;43(5):1429–31.

    Article  PubMed  PubMed Central  Google Scholar 

  8. •• Boehme AK, Martin-Schild S, Marshall RS, Lazar RM. Effect of aphasia on acute stroke outcomes. Neurology. 2016;87(22):2348–54. The first study to examine the impact of aphasia during the acute stroke period on inpatient complications, length of stay, and discharge disability and to compare these outcomes to those associated with hemiparesis

    Article  PubMed  Google Scholar 

  9. Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. J Commun Disord. 2013;46(3):238–48.

    Article  PubMed  Google Scholar 

  10. Oliveira FF, Damasceno BP. Global aphasia as a predictor of mortality in the acute phase of a first stroke. Arq Neuropsiquiatr. 2011;69(2B):277–82.

    Article  PubMed  Google Scholar 

  11. Laska AC, Hellblom A, Murray V, Kahan T, Von Arbin M. Aphasia in acute stroke and relation to outcome. J Intern Med. 2001;249(5):413–22.

    Article  CAS  PubMed  Google Scholar 

  12. Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc. 2009;57(11):2101–6.

    Article  PubMed  Google Scholar 

  13. Pedersen PM, Vinter K, Olsen TS. Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc Dis. 2004;17(1):35–43.

    Article  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. Hospitalization for stroke in U.S. Hospitals, 1989–2009. NCHS Data Brief No. 95; 2012. https://www.cdc.gov/nchs/products/databriefs/db95.htm.

  15. Rac VE, Sahakyan Y, Fan I, Ieraci L, Hall R, Kelloway L, et al. The characteristics of stroke units in Ontario: a pan-provincial survey. BMC Health Serv Res. 2017;17(1):154.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Canadian Stroke Network. The quality of stroke care in Canada. 2011. p. 356. http://canadianstrokenetwork.ca/en/wp-content/uploads/2014/08/QoSC-EN.pdf.

  17. Stroke Unit Trialists Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013;9. https://doi.org/10.1002/14651858.CD000197.pub3.

  18. Bersano A, Burgio F, Gattinoni M, Candelise L, Group PS. Aphasia burden to hospitalised acute stroke patients: need for an early rehabilitation programme. Int J Stroke. 2009;4(6):443–7.

    Article  CAS  PubMed  Google Scholar 

  19. •• Flowers HL, Skoretz SA, Silver FL, Rochon E, Fang J, Flamand-Roze C, et al. Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2016;97(12):2188–201 e8. An excellent review of post-stroke outcomes from the viewpoint of speech-language pathology, with major emphasis on the period between admission to acute rehabilitation and two-years after stroke onset

    Article  PubMed  Google Scholar 

  20. Gialanella B, Bertolinelli M, Lissi M, Prometti P. Predicting outcome after stroke: the role of aphasia. Disabil Rehabil. 2011;33(2):122–9.

    Article  PubMed  Google Scholar 

  21. Tsouli S, Kyritsis AP, Tsagalis G, Virvidaki E, Vemmos KN. Significance of aphasia after first-ever acute stroke: impact on early and late outcomes. Neuroepidemiology. 2009;33(2):96–102.

    Article  CAS  PubMed  Google Scholar 

  22. Dunn LE, Schweber AB, Manson DK, Lendaris A, Herber C, Marshall RS, et al. Variability in motor and language recovery during the acute stroke period. Cerebrovasc Dis Extra. 2016;6(1):12–21.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lazar RM, Speizer AE, Festa JR, Krakauer JW, Marshall RS. Variability in language recovery after first-time stroke. J Neurol Neurosurg Psychiatry. 2008;79(5):530–4.

    Article  CAS  PubMed  Google Scholar 

  24. Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, et al. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke. 1994;25(11):2220–6.

    Article  CAS  PubMed  Google Scholar 

  25. Scandinavian Stroke Study Group. Multicenter trial of hemodilution in ischemic stroke—background and study protocol. Stroke. 1985;16:885–90.

    Article  Google Scholar 

  26. Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke. 1986;17(4):731–7.

    Article  CAS  PubMed  Google Scholar 

  27. Gonzalez-Fernandez M, Christian AB, Davis C, Hillis AE. Role of aphasia in discharge location after stroke. Arch Phys Med Rehabil. 2013;94(5):851–5.

    Article  PubMed  Google Scholar 

  28. Paolucci S, Matano A, Bragoni M, Coiro P, De Angelis D, Fusco FR, et al. Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. A matched comparison. Cerebrovasc Dis. 2005;20(5):400–6.

    Article  PubMed  Google Scholar 

  29. Brady MC, Kelly H, Godwin J, Enderby P, Campbell P. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2016;6:CD000425.

    Google Scholar 

  30. Meinzer M, Rodriguez AD, Gonzalez Rothi LJ. First decade of research on constrained-induced treatment approaches for aphasia rehabilitation. Arch Phys Med Rehabil. 2012;93(1 Suppl):S35–45.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fridriksson J, Hubbard HI, Hudspeth SG, Holland AL, Bonilha L, Fromm D, et al. Speech entrainment enables patients with Broca’s aphasia to produce fluent speech. Brain. 2012;135(Pt 12):3815–29.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Naeser MA, Martin PI, Ho M, Treglia E, Kaplan E, Bashir S, et al. Transcranial magnetic stimulation and aphasia rehabilitation. Arch Phys Med Rehabil. 2012;93(1 Suppl):S26–34.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wortman-Jutt S, Edwards DJ. Transcranial direct current stimulation in Poststroke aphasia recovery. Stroke. 2017;48(3):820–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S—SC 650, Birmingham, AL, 35294, USA

    Ronald M. Lazar

  2. Department of Neurology, Columbia University Medical Center, 710 W168th St, New York, NY, 10032, USA

    Amelia K. Boehme

Authors
  1. Ronald M. Lazar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amelia K. Boehme
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ronald M. Lazar.

Ethics declarations

Conflict of Interest

Ronald M. Lazar and Amelia K. Boehme declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Behavior

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lazar, R.M., Boehme, A.K. Aphasia As a Predictor of Stroke Outcome. Curr Neurol Neurosci Rep 17, 83 (2017). https://doi.org/10.1007/s11910-017-0797-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-017-0797-z

Keywords

Search

Navigation