Diagnosing and managing post-stroke aphasia

Abstract

Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery.

Keywords: Aphasia; medication; noninvasive brain stimulation; rehabilitation; speech therapy; stroke.

Figure 1.

Aphasia Classification. The eight aphasia subtypes identified by the Boston neoclassical system are defined based on measures of fluency, comprehension, and repetition. Note the figure depicts lesions that are often associated with each subtype of aphasia, however there is inherent heterogeneity in stroke patients and a patient may present with a specific subtype of aphasia even if their lesion does not match the area depicted in this figure.