Abstract
Objectives
To conduct a systematic review to elucidate the frequency, recovery, and associated
outcomes for poststroke aphasia over the long-term.
Data Sources
Using the Cochrane Stroke Strategy, we searched 10 databases, 13 journals, 3 conferences,
and the gray literature.
Study Selection
Our a priori protocol criteria included unselected samples of adult stroke patients
from randomized controlled trials or consecutive cohorts. Two independent reviewers
rated abstracts and articles for exclusion or inclusion, resolving discrepancies by
consensus.
Data Extraction
We documented aphasia frequencies by stroke type and setting, and computed odds ratios
(ORs) with their 95% confidence intervals (CIs) for outcomes.
Data Synthesis
We retrieved 2168 citations, reviewed 248 articles, and accepted 50. Median frequencies
for mixed stroke (ischemic and hemorrhagic) were 30% and 34% for acute and rehabilitation
settings, respectively. Frequencies by stroke type were lowest for acute subarachnoid
hemorrhage (9%) and highest for acute ischemic stroke (62%) when arrival to the hospital
was ≤3 hours from stroke onset. Articles monitoring aphasia for 1 year demonstrated
aphasia frequencies 2% to 12% lower than baseline. Negative outcomes associated with
aphasia included greater odds of in-hospital death (OR=2.7; 95% CI, 2.4–3.1) and longer
mean length of stay in days (mean=1.6; 95% CI, 1.0–2.3) in acute settings. Patients
with aphasia had greater disability from 28 days (OR=1.5; 95% CI, 1.3–1.7) to 2 years
(OR=1.7; 95% CI, 1.6–2.0) than those without aphasia. By 2 years, they used more rehabilitation
services (OR=1.5; 95% CI, 1.3–1.6) and returned home less frequently (OR=1.4; 95%
CI, 1.2–1.7).
Conclusions
Reported frequencies of poststroke aphasia range widely, depending on stroke type
and setting. Because aphasia is associated with mortality, disability, and use of
health services, we recommend long-term interdisciplinary vigilance in the management
of aphasia.
Keywords
List of abbreviations:
CI (confidence interval), LOS (length of stay), OR (odds ratio)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Aphasia during the acute phase in ischemic stroke.Cerebrovasc Dis. 2008; 25: 316-323
- Aphasia in patients with ischemic stroke.Acta Clin Croat. 2012; 51: 221-225
- Ischemic strokes are more severe in Poland than in the United States.Neurology. 2000; 43: 513-515
- Stroke rehabilitation of elderly patients in Singapore.Singapore Med J. 1991; 32: 55-60
- Predicting outcome after stroke: the role of aphasia.Disabil Rehabil. 2011; 33: 122-129
- Cardioembolic strokes: clinical features, specific cardiac disorders, and prognosis.Curr Cardiol Rev. 2010; 6: 150-161
- Aphasia in acute stroke: incidence, determinants, and recovery.Ann Neurol. 1995; 38: 659-666
- The incidence, co-occurrence and predictors of dysphagia, dysarthria and aphasia after first-ever acute ischemic stroke.J Commun Disord. 2013; 46: 238-248
- Validation of a new language screening tool for patients with acute stroke: The Language Screening Test (LAST).Stroke. 2011; 42: 1224-1229
- Validity of the aphasia item from the Scandinavian Stroke Scale.Cerebrovasc Dis. 2002; 13: 184-186
- The modified National Institutes of Health Stroke Scale: its time has come.Int J Stroke. 2009; 4: 267-273
Canadian Best Practice Recommendations for Stroke. Lindsay MP, Gubitz G, Bayley M, Phillips S, editors. On behalf of the Canadian Stroke Best Practices and Standards Working Group. 2013. Available at: http://www.strokebestpractices.ca. Accessed April 22, 2015.
- Diagnosis and management of language impairment in acute stroke.in: Holmgren E. Rudkilde E.S. Aphasia: classification, management practices, and prognosis. Nova Science, New York2013: 91-114
- Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors.J Eval Clin Pract. 2012; 18: 689-694
- Aphasia burden to hospitalized acute stroke patients: need for an early rehabilitation program.Int J Stroke. 2009; 4: 443-447
- Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe.Stroke. 2003; 34: 1114-1119
- Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study.J Am Geriatr Soc. 2009; 57: 2101-2106
- Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.Arch Phys Med Rehabil. 2010; 91: 196-202
- The one-year attributable cost of poststroke aphasia.Stroke. 2012; 43: 1429-1431
- Recommendations on stroke prevention, diagnosis, and therapy.Stroke. 1989; 20: 1407-1431
- Meta-analysis of Observational Studies in Epidemiology (MOOSE): a proposal for reporting. MOOSE Group.JAMA. 2000; 283: 2008-2012
Cochrane Stroke Group. Cochrane review groups. Available at: http://onlinelibrary.wiley.com/o/cochrane/clabout/articles/STROKE/frame.html. Accessed June 12, 2011.
Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane Collaboration. Updated March 2011. Available at: http://handbook.cochrane.org. Accessed April 10, 2014.
- R: a language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2013 (Available at:) (Accessed December 7, 2014)
- Qualitative descriptors of strength of association and effect size.J Soc Serv Res. 1996; 21: 37-59
- Review Manager (RevMan) [computer program]. Version 5.3.The Nordic Cochrane Centre, Copenhagen2014
- Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery.Ann Neurol. 2006; 60: 518-527
- Emotional behavior in acute stroke: the Lausanne Emotion in Stroke Study.Cogn Behav Neurol. 2005; 18: 37-44
- Intracerebral hemorrhage.Neurosciences (Riyadh). 2009; 14: 152-157
- Right cerebral hemisphere damage: incidence of language problems.Int J Rehabil Res. 1996; 19: 47-54
- Cardiac sources of embolism and cerebral infarction–clinical consequences and vascular concomitants: the Lausanne Stroke Registry.Neurology. 1991; 41: 855-859
- Delirium in acute subarachnoid hemorrhage.Cerebrovasc Dis. 2005; 19: 31-38
- A prospective study of predictors of poststroke depression.Neurology. 2005; 64: 428-433
- Developing a dysphagia program in an acute care hospital: a needs assessment.Dysphagia. 1991; 5: 159-165
- Stroke aphasia: 1,500 consecutive cases.Cerebrovasc Dis. 2011; 31: 392-399
- Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis.Stroke. 2006; 37: 1379-1384
- Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register.Stroke. 2013; 44: 605-611
- The spectrum of aphasia subtypes and etiology in subacute stroke.J Stroke Cerebrovasc Dis. 2013; 2: 1385-1392
- Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry.Stroke. 1998; 29: 2087-2093
- Treatment results of stroke patients aged >80 years receiving intravenous rt-PA.Cerebrovasc Dis. 2007; 24: 305-306
- Poststroke depression correlates with cognitive impairment and neurological deficits.Stroke. 1999; 30: 1875-1880
- The influence of gender and age on disability following ischemic stroke: the Framingham study.J Stroke Cerebrovasc Dis. 2003; 12: 119-126
- Apraxia and aphasia: the functional-anatomical basis for their dissociation.Neurology. 1984; 34: 40-47
- Incidence and outcome of poststroke urinary retention: a prospective study.Arch Phys Med Rehabil. 2000; 81: 1464-1467
- Incidence and predictors of post-stroke aphasia: the Arcadia Stroke Registry.Eur J Neurol. 2009; 16: 733-739
- Aphasia in acute stroke and relation to outcome.J Intern Med. 2001; 249: 413-422
- Frequency and prognostic value of cognitive disorders in stroke patients.Dement Geriatr Cogn Disord. 2008; 26: 356-363
- Progressing stroke with neurological deterioration.Arch Gerontol Geriatr. 2005; 41: 95-100
- Influence of age, sex, literacy and pathologic lesion on incidence, severity and type of aphasia.Acta Neurol Scand. 1981; 64: 370-382
- Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).Crit Care Med. 2012; 40: 484-490
- Predicting stroke inpatient rehabilitation outcome: the prominent role of neuropsychological disorders.Eur Neurol. 1996; 36: 385-390
- Mobility status after inpatient stroke rehabilitation: 1-year follow-up and prognostic factors.Arch Phys Med Rehabil. 2001; 82: 2-8
- Sex differences in first-ever acute stroke.Stroke. 2003; 34: 1581-1585
- On the occurrence and prognosis of aphasia in patients with cerebral infarction.Scand J Soc Med Suppl. 1979; 14: 128-133
- Trends in incidence, case-fatality rate, and severity of stroke in northern Sweden, 1985-1991.Stroke. 1994; 25: 1738-1745
- Clinical diagnosis of ischemic versus hemorrhagic stroke: applicability of existing scores in the emergency situation and proposal of a new score.Neuroepidemiology. 2002; 21: 8-17
- A new method for predicting recovery after stroke.Stroke. 2001; 32: 2867-2873
- Prognostic factors in stroke rehabilitation: the possible role of pharmacological treatment.Acta Neurol Scand. 2002; 105: 100-106
- Significance of aphasia after first-ever acute stroke: impact on early and late outcomes.Neuroepidemiology. 2009; 33: 96-102
- Incidence and types of speech disorders in stroke patients.Acta Clin Croat. 2011; 50: 491-494
- Nursing assessment of dysphagia among patients with stroke.Scand J Caring Sci. 1999; 4: 274-282
- [Depression at early period following acute cerebrovascular diseases] [Turkish].New/Yeni Symp J. 2006; 44: 44-48
- [Language disorders in stroke patients] [Turkish].J Rheumatol Med Rehabil. 2002; 13: 108-112
- [Incidence and clinical phenomenology of aphasic disorders after stroke] [Bosnian].Med Arch. 2009; 63: 197-199
- [Stroke followed by speech and language sequels: hospital procedures] [Portuguese].Rev Neurosci. 2011; 19: 229-236
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- The FIMTM.The Center for Outcome Measurement in Brain Injury. 2000; (Available at:) (Accessed July 15, 2015)
- Modification of Rankin Scale: recovery of motor function after stroke.Stroke. 1988; 12: 1497-1500
- The Canadian Neurological Scale: validation and reliability assessment.Neurology. 1989; 39: 638-643
- Acute ischemic stroke—from symptom recognition to thrombolysis.Acta Neurol Scand. 2013; 127: 57-64
- Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion.Brain Lang. 2004; 89: 524-530
- Effect of socioeconomic status on aphasia severity and recovery.Brain Lang. 2001; 78: 254-257
- Influence of size and side of cerebral lesions on spontaneous recovery of aphasia and on success of language therapy.Brain Lang. 1994; 47: 684-698
- Spontaneous recovery of language in patients with aphasia between 4 and 34 weeks after stroke.J Neurol Neurosurg Psychiatry. 1985; 48: 743-748
- Spontaneous evolution of aphasia after ischaemic stroke.Aphasiology. 1992; 6: 387-396
- Gender and recovery from aphasia after stroke.J Nerv Ment Dis. 1985; 173: 605-609
- Raven IQ and language recovery following stroke.J Clin Neuropsychol. 1984; 6: 302-308
- Aphasia after stroke: type, severity, and prognosis.Cerebrovasc Dis. 2004; 17: 35-43
- Variability in language recovery after first-time stroke.J Neurol Neurosurg Psychiatry. 2008; 79: 530-534
- Prognostic indicators and the pattern of recovery of communication in aphasic stroke patients.J Neurol Neurosurg Psychiatry. 1983; 46: 130-139
- Social participation through the eyes of people with aphasia.Int J Lang Commun Disord. 2010; 45: 537-550
- What are the important factors in health-related quality of life for people with aphasia? A systematic review.Arch Phys Med Rehabil. 2012; 93: 586-595
- IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke.Circulation. 2011; 123: 739-749
Supplemental References
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- The Canadian Neurological Scale: validation and reliability assessment.Neurology. 1989; 39: 638-643
- Assessment of coma and impaired consciousness. A practical scale.Lancet. 1974; 2: 81-84
- Assessment of outcome after severe brain damage.Lancet. 1975; 7905: 480-484
- Surgical risk as related to time of intervention in the repair of intracranial aneurysms.J Neurosurg. 1968; 28: 14-20
- Modification of Rankin Scale: recovery of motor function after stroke.Stroke. 1988; 12: 1497-1500
- Measurements of acute cerebral infarction: a clinical examination scale.Stroke. 1989; 20: 864-870
- Multicenter trial of hemodilution in ischemic stroke: background and study protocol.Stroke. 1985; 16: 885-890
- Validation of four scales for the acute stage of stroke.J Intern Med. 1994; 236: 125-136
- Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial.Stroke. 1993; 24: 35-41
- Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale.J Neurosurg. 1988; 68: 985-986
- Classification and natural history of clinically identifiable subtypes of cerebral infraction.Lancet. 1991; 337: 1521-1526
- Aachener Aphasie Test (AAT).Organizzazioni Speciali, Florence1991
- Amersterdam-Nijmegen-Everyday-Language-Test. Construction, reliability and validity.Aphasiology. 1994; 8: 381-407
- The assessment of aphasia and related disorders.Lea & Febiger, Philadelphia1983
- [Minnesota Test for Differential Diagnosis of Aphasia, MTDDA] [German].Institute of Speech Therapy, University Hospital Basle, Basel1981
- The Boston Naming Test.Lea & Febiger, Philadelphia1983
- The Multilingual Aphasia Examination.AJA Associates, Iowa City1994
- The Frenchay Aphasia Screening Test: a short simple test appropriate for nonspecialists.Int Rehabil Med. 1987; 8: 166-170
- Aphasia rehabilitation in patients with stroke.Int J Rehabil Res. 2001; 24: 241-244
- Brief assessment of severe language impairments: initial validation of the Mississippi Aphasia Screening Test.Brain Inj. 2005; 19: 685-691
- Manual of the Norwegian Basic Aphasia Assessment.Scandinavian Books, Oslo1980
- The validity of functional assessment with neuropsychological tests in aphasic stroke patients.Scand J Psychol. 1985; 26: 208-218
- The Right Hemisphere Language Battery.Whurr, London1989
- The Token Test: a sensitive test to detect receptive disturbances in aphasics.Brain. 1962; 85: 665-678
- Western Aphasia Battery.Grune and Stratton, New York1982
- [Lausanne University Hospital Neuropsychological Examination Battery] [French].Neuropsychology Division, Lausanne1985
- Comprehensive cognitive neurological assessment in stroke.Acta Neurol Scand. 2009; 119: 162-171
Article Info
Publication History
Published online: April 07, 2016
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
