Does COVID-19 Impact Less on Post-stroke Aphasia? This Is Not the Case

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected people's mental health resulting in severe psychological consequences. One of the leading causes of long-term disability worldwide is aphasia. The language changes experienced by a person with aphasia (PWA) often have a sudden and long-lasting negative impact on social interaction, quality of life, and emotional wellbeing. The main aim of this study was to investigate the impact of COVID-19 on the different psychosocial dimensions which affect PWA.

Methods: This retrospective study included 73 PWA and 81 elderly matched controls. All patients were in the chronic phase. They were all discharged from rehabilitation services, which left them with different degrees of language deficits (i.e., severe vs. mild vs. moderate). All participants were administered the hospital anxiety and depression scale (HADS) through an online survey. PWA also took part in the stroke and aphasia quality of life scale questionnaire (SAQOL-39).

Results: Although the comparison between two different time points [one month before (T0) and one month after the lockdown (T1)] led to a significant increase in depression and anxiety symptoms in both groups (PWA vs. control), lower rates of depression and anxiety were found in PWA compared to the healthy group. Significant deterioration was also present in PWA in the communication and psychosocial scales of the SAQOL-39 test, which correlated with the observed changes in the psychological domains. Interestingly, the results were not significantly influenced by the degree of aphasia severity. Similarly, in both groups, none of the demographic variables (gender, age, and educational level) significantly affected the scores in the different subscales.

Conclusions: This evidence which, at first glance, seems to suggest that PWA have been partially spared from the impact of COVID-19, actually masks a dramatic situation that has always characterized this population. Indeed, given that PWA already live in a state of social isolation and emotional instability, these conditions might have, paradoxically, limited the effects of the coronavirus. However, as our results showed a deterioration in the emotional state and communication skills of our patients, possible solutions are discussed in order to prevent further decline of their cognitive abilities.

Keywords: COVID-19; anxiety; aphasia (language); depression; psychosocial well being; stroke.

FIGURE 1

HADS mean scores (pre- and during COVID-19) for anxiety (anx) and depression (dep) scales, respectively, in the PWA and control groups. Sig. two tailed paired t-tests: ^∗p ≤ 0.05.

FIGURE 2

HADS mean scores difference between during (T1) and pre-COVID-19 (T0) for anxiety and depression scales, respectively, in the PWA and control groups. Sig. mixed ANOVA design – interaction time × group: ^∗p ≤ 0.05.

FIGURE 3

SAQOL-39 mean scores (pre- and during COVID-19) in the PWA group. Sig. two tailed paired t-tests: ^∗p ≤ 0.05. Legend: globalqol, mean score in SAQOL-39 total score; physical, mean score in physical scale; communication, mean score in communication scale; psychosocial, mean score in psychosocial scale; energy, mean score in energy scale.