Progression of Aphasia Severity in the Chronic Stages of Stroke

Abstract

Background and Purpose The severity of aphasic impairment in chronic stroke survivors is typically thought to be stable by 6 months postonset. However, a recent study showed that stroke survivors with aphasia experience language improvement or decline in the chronic phase, years beyond onset. Little is known about why some individuals improve whereas others remain stable or decline. Additionally, no study has tracked changes in aphasia from assessments completed at multiple time points across many years. The current study offers a comprehensive analysis of potential predictive demographic and health information to determine which factors predict dynamic changes in aphasia severity in chronic stroke. Methods Individuals in the chronic stage of a single-event, left-hemisphere ischemic stroke were identified from an archival database and included for study ( N = 39). Participants were included if they had undergone 2 or more standardized language assessments acquired at time points at least 6 months apart, with the 1st assessment at least 6 months postinjury. A linear mixed-effects model was used to determine the impact of treatment and a variety of demographic and health factors on language change. Results Over time, half of the participants improved (51%), whereas approximately a quarter (26%) decreased, and a quarter (23%) remained stable. A greater number of aphasia treatment hours significantly predicted language improvement ( p = .03), whereas older stroke age was associated with long-term decline ( p = .04). Two interactions were found to be significant in predicting improvement in individuals with diabetes: Increased exercise and younger age at stroke were significant in predicting outcomes ( p < .05). Conclusions Factors that significantly influence language recovery in chronic aphasia include stroke age and receiving aphasia treatment. For those with diabetes, increased exercise was shown to improve outcomes. Results from this study offer clinicians greater insight into the influence of patient factors on long-term recovery from stroke aphasia while suggesting a potential adjunct to language therapy: exercise. Supplemental Material https://doi.org/10.23641/asha.7849304.

Figure 1.

Spaghetti plot of all included participants' aphasia quotient (AQ; y-axis) as a function of treatment. The x-axis depicts the order of Western Aphasia Battery assessment. Point size is indicative of treatment hours, where larger points indicate more treatment hours (see inset legend). Colors are used to distinguish between different participants.

Figure 2.

(Top) Main effect of age at stroke by aphasia quotient with 95% confidence intervals (p = .04). (Bottom) Main effect of estimated treatment by aphasia quotient with 95% confidence intervals (p = .03).

Figure 3.

(Top) Interaction between diabetes presence and days exercised per week (p = .02). (Bottom) Interaction between diabetes presence and age at stroke (p = .05). yrs = years.