Aphasia, depression, and cognitive dysfunction are common consequences of stroke, but knowledge of their interrelationship is limited. This 1-year prospective study was designed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric, neurological, and cognitive correlates. We studied a series of 106 consecutive patients (46 women and 60 men, mean age 65.8 years) with first-ever ischaemic brain infarction. The patients were clinically examined, and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later. Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke. Aphasia was diagnosed in 34% of the patients during the acute phase, and two thirds of them remained so 12 months later. Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62% 12 months after stroke. The prevalence of major depression increased from 11 to 33% during the 12-month follow-up period. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits. Although the prevalence of depression in aphasic patients decreases in the long term, the proportion of patients suffering from major depression seems to increase. We emphasize the importance of the multidimensional evaluation of aphasic stroke patients.

Keywords:
Aphasia, Depression, Cognition, Stroke
1.
Wade DT, Hewer RL, David RM, Enderby PM: Aphasia after stroke: Natural history and associated deficits. J Neurol Neurosurg Psychiatry 1986;49:11–16.
2.
Starkstein SE, Robinson RG: Aphasia and depression. Aphasiology 1988;2:1–20.
3.
Kotila M, Waltimo O, Niemi M-L, Laaksonen R, Lempinen M: The profile of recovery from stroke and factors influencing outcome. Stroke 1984;15:1039–1044.
4.
Parikh RM, Robinson RG, Lipsey JR, Starkstein SE, Fedoroff JP, Price TR: The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol 1990;47:785–789.
5.
Åström M, Adolfsson R, Asplund K: Major depression in stroke patients: A 3-year longitudinal study. Stroke 1993;24:976–982.
6.
Demeurisse G, Demol O, Derouck M, de Beukelaer R, Coekaerts M-J, Capon A: Quantitative study of the rate of recovery from aphasia due to ischemic stroke. Stroke 1980;11:455–458.
7.
Kertesz A, McCabe P: Recovery patterns and prognosis in aphasia. Brain 1977;100:1–18.
8.
Robinson RG: Neuropsychiatric consequences of stroke. Annu Rev Med 1997;48:217–229.
9.
Primeau F: Post-stroke depression: A critical review of the literature. Can J Psychiatry 1988;33:757–765.
10.
Kauhanen M-L, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Määttä R, Nieminen P, Sotaniemi KA, Myllylä VV: Post-stroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875–1880.
11.
Lendrem W, Lincoln NB: Spontaneous recovery of language in patients with aphasia between 4 and 34 weeks after stroke. J Neurol Neurosurg Psychiatry 1985;48:743–748.
12.
Robinson RG, Benson DF: Depression in aphasic patients: Frequency, severity, and clinical-pathological correlations. Brain Lang 1981;14:282–291.
13.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke: Background and study protocol. Stroke 1985;16:885–890.
14.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. Md Med J 1965;14:61–65.
15.
Rankin J: Cerebral vascular accidents in patients over the age of 60. 2. Prognosis. Scott Med J 1957;2:200–215.
16.
Kertesz A: The Western Aphasia Battery. New York, Grune & Stratton, 1982.
17.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Revised, ed 3. Washington, American Psychiatric Association, 1987.
18.
Wechsler D: Wechsler Adult Intelligence Scale – Revised. New York, Psychological Corporation, 1981.
19.
Wechsler D: Stadardized memory scale for clinical use. J Psychol 1954;19:87–95.
20.
Cronholm B, Ottosson J: Reliability and validity of a memory test battery. Acta Psychiatr Scand 1963;39:218–234.
21.
Christensen AL: Luria’s Neuropsychological Investigation. Copenhagen, Munksgaard, 1975.
22.
Hosmer DW, Lemeshow S: Applied Logistic Regression. New York, John Wiley & Sons, 1989.
23.
Kotila M, Numminen H, Waltimo O, Kaste M: Depression after stroke: Results of the Finnstroke Study. Stroke 1998;29:368–372.
24.
Pedersen PM, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS: Aphasia in acute stroke: Incidence, determinants, and recovery. Ann Neurol 1995;38:659–666.
25.
Reinvang I: The natural history of aphasia. Adv Neurol 1984;42:13–22.
26.
Kertesz A: Recovery from aphasia. Adv Neurol 1984;42:23–39.
27.
Siirtola M, Siirtola T: Evolution of aphasia (abstract). J Clin Exp Neuropsychol 1985;7:159.
28.
Pashek GV, Holland AL: Evolution of aphasia in the first year post-onset. Cortex 1988;24:411–423.
29.
Herrmann M, Bartels C, Wallesch C-W: Depression in acute and chronic aphasia: Symptoms, pathoanatomical-clinical correlations and functional implications. J Neurol Neurosurg Psychiatry 1993;56:672–678.
30.
Sharpe M, Hawton K, Seagroatt V, Bamford J, House A, Molyneux A, Sandercock P, Warlow C: Depressive disorders in long-term survivors of stroke: Associations with demographic and social factors, functional status, and brain lesion volume. Br J Psychiatry 1994;164:380–386.
31.
Benson DF: Psychiatric aspects of aphasia. Br J Psychiatry 1973;123:555–566.
32.
Miceli G, Caltagirone C, Gainotti G, Masullo C, Silveri MC, Villa G: Influence of age, sex, literacy and pathologic lesions on incidence, severity and type of aphasia. Acta Neurol Scand 1981;64:370–382.
33.
Basso A, Capitani E, Luzzatti C, Spinnler H: Intelligence and left hemisphere disease: The role of aphasia and size of lesion. Brain 1981;104:721–734.
34.
Kertesz A: Aphasia and Associated Disorders: Taxonomy, Localization and Recovery. Orlando, Grune & Stratton, 1979, pp 253–262.
35.
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M: Dementia three months after stroke: Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke 1997;28:785–792.
36.
Beeson PM, Bayles KA, Rubens AB, Kaszniak AW: Memory impairment and executive control in individuals with stroke-induced aphasia. Brain Lang 1993;45:253–275.
37.
Feher EP, Mahurin RK, Doody RS, Cooke N, Sims J, Pirozzolo FJ: Establishing the limits of the Mini-Mental State: Examination of ‘subtests’. Arch Neurol 1992;49:87–92.
© 2000 S. Karger AG, Basel
2000
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.