Significance of aphasia after first-ever acute stroke: impact on early and late outcomes

• Published in: Neuroepidemiology Vol. 33; no. 2; p. 96
• Main Authors: Tsouli, S, Kyritsis, A P, Tsagalis, G, Virvidaki, E, Vemmos, K N
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2009
• Subjects: Aged; Aphasia - etiology; Aphasia - mortality; Aphasia - therapy; Cause of Death; Cohort Studies; Female; Glasgow Coma Scale; Greece - epidemiology; Hospitalization; Humans; Hypertension - complications; Hypertension - epidemiology; Kaplan-Meier Estimate; Male; Proportional Hazards Models; Prospective Studies; Risk Factors; Stroke - complications; Stroke - mortality; Stroke - therapy; Treatment Outcome; Greece
• ISSN: 1423-0208
• DOI: 10.1159/000222091

We assessed the incidence and determinants of aphasia attributable to first-ever acute stroke. We also investigated early and long-term mortality and 1-year dependence in post-stroke patients.
A 10-year prospective hospital-based study was conducted in the prefecture of Athens, Greece.
In total, 2,297 patients were included in the study, of whom 806 (35.1%) had aphasia. The presence of aphasia was independently associated with increasing age (OR: 1.19 per 10-year increase, 95% CI: 1.12-1.21) and atrial fibrillation (OR: 1.35, 95% CI: 1.08-1.67), and inversely associated with Scandinavian Stroke Scale (SSS) score (OR: 0.55 per 10-point increase, 95% CI: 0.52-0.59) and hypertension (OR: 0.77, 95% CI: 0.63-0.96). One-year dependence score (calculated with the modified Rankin score) was higher in aphasic patients compared to non-aphasics (p < 0.001). Moreover, severity of aphasia (estimated with a subscale of SSS) was found as an independent predictor of 1-year dependence. Most of the deaths in the aphasic patients were attributed to infections and neurological damage. Using the Kaplan-Meier limit method, the unadjusted probability of 10-year mortality was demonstrated to increase with the severity of aphasia (log-rank test: 233.9, p < 0.001) and, even after adjustment for several other factors, severity of aphasia remained an independent predictor of 10-year mortality.
Increasing age, atrial fibrillation and severity of stroke were associated with the risk of aphasia after stroke. Severity of aphasia is a strong predictor of long-term mortality and dependence of post-stroke patients.