Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

Abstract

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21-40% of stroke patients sustain permanent aphasia, which progressively worsens one's quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

Keywords: cognitive neurorehabilitation; pharmacotherapy; physical medicine; post-stroke aphasia; speech language therapies; telerehabilitation.

Figure 1

Diagram depicts brain stroke stages with clinical testing tools in different stroke phases evaluation. (NIHSS: National Institutes of Health Stroke Scale, GDS: geriatric depression scale, MAST: Mississippi Aphasia Screening Test, FAST: Frenchay Aphasia Screening Test, ADL: activity daily living, WAB: Western Aphasia Battery, BDAE: Boston Diagnostic Aphasia Examination, PALPA: Psycholinguistic Assessment of Language Processing in Aphasia, F-MS: Fugl-Meyer Scale, RMIL: Rivermead Mobility Index, SNAP: social network with aphasia profile test, SAQOL-39: aphasia quality of life scale-39).