Determinants of aphasia recovery in first 3 months following first ever acute stroke: Experience from a tertiary care centre stroke unit in Kolkata, India
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1
Bangur Institute of Neurosciences, India
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2
Florida International University, United States
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3
KPC Medical College and Hospital, India
The recovery of aphasia following a vascular event is a complicated subject because of the multi-factorial interplay. Divergent evidence is available in the literature regarding the predictors of aphasia recovery particularly in the early post-stroke phase (Lazar et al., 2010; Pedersen et al., 1995). The aim of the present study was to explore the determinants of aphasia recovery in the first 3 months following first-ever acute stroke.
Methods: Screened cases of first-ever acute stroke were included in this study. The Bengali version of the Western Aphasia Battery (WAB), a validated scale, was used for language assessment (Keshree et al, 2013). All patients underwent initial language examination during the first week following stroke. Language tests were repeated between 90 and 100 days post-stroke in patients available for follow-up. Severity assessment was done by calculating aphasia quotient (AQ) and taking into account the severity scale as on the WAB. Lesion assessment was done by using Magnetic Resonance Imaging (MRI) (3T) for ischemic stroke (if not contraindicated) and computed tomography (CT) for hemorrhagic stroke. Demographic factors (age, gender and number of years of formal education), lesion-related factors (type of stroke, lesion volume, cortical versus sub-cortical location and site of lesion) and initial severity and type of aphasia were taken as independent variables while aphasia recovery (in terms of no change versus change to a milder type or complete recovery) was the dependent variable. Chi square and Fisher’s exact tests were carried out to study the factors associated with and without aphasia type change or recovery (as applicable). The means or medians of continuous variables were compared using the Student t-test or Mann whitney U test (as applicable). Chi square automatic interaction detection (CHAID) was performed to assess predictor importance and formulate a predictive model for aphasia recovery.
Results: Among 515 screened cases of first-ever acute stroke, 208 presented aphasia. At follow-up, 163 patients were available for repeat language assessment. In the univariate analysis, the following factors were associated with change to milder type or recovery- hemorrhagic stroke (p=0.000); pure sub-cortical stroke (p=0.001) and initial non-severe classification (p=0.000). From the perspective of initial aphasia type, most change (p=0.000) was observed with global aphasia and most recovery (p=0.000) was observed with milder aphasia types (trans-cortical motor, trans-cortical sensory and anomic). Sex and age were weaker predictors (p = 0.291 and 0.512, respectively) with men and younger patients presenting better recovery. In the CHAID analysis, most important predictor in favor of type change or recovery was found to be initial non-severe classification. The overall predictive value of the CHAID model was 67.2%.
Conclusions: In our sample, the most important determinant of aphasia recovery in early post-stroke phase was initial severity of aphasia. The findings of the present study might render help to clinicians in prognostication and judicious use of rehabilitation measures in resource limited setting.
Acknowledgements
We express our sincere gratitude to Professor Shyamal Kumar Das for his inspiring guidance in this research.
References
Keshree N.K., Kumar S., Basu S., Chakrabarty M., Kishore T. (2013). Adaptation of the western aphasia battery in Bangla. Psychology of Language and Communication, 17(2),189-201.
Lazar R.M., Minzer B., Antoniello D., Festa J.R., Krakauer J.W., Marshall R.S. (2010). Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke, 41, 1485–1488.
Pedersen P.M., Jorgensen H.S., Nakayama H., Raaschou H.O., Olsen T.S. (1995). Aphasia in acute stroke: incidence, determinants, and recovery. Annals of Neurology,38,659
Keywords:
Stroke,
Recovery,
early,
determinants,
Aphasia
Conference:
Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019.
Presentation Type:
Platform presentation
Topic:
Eligible for student award
Citation:
Lahiri
D,
Dubey
S,
Ardila
A,
Sanyal
D,
Das
G,
Roy
BK and
Gangopadhyay
G
(2019). Determinants of aphasia recovery in first 3 months following first ever acute stroke: Experience from a tertiary care centre stroke unit in Kolkata, India.
Front. Hum. Neurosci.
Conference Abstract:
Academy of Aphasia 57th Annual Meeting.
doi: 10.3389/conf.fnhum.2019.01.00037
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Received:
03 May 2019;
Published Online:
09 Oct 2019.
*
Correspondence:
Dr. Durjoy Lahiri, Bangur Institute of Neurosciences, Calcutta, India, dlahiri1988@gmail.com