Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

Abstract

BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders. AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia. METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416). RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety. CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.

Reversing the Ruin: Rehabilitation, Recovery, and Restoration After Stroke

“…An important caveat to rehabilitation is the frequent and common co-occurrence of post-stroke depression and other neuropsychiatric disorders [ 155 , 156 ], and their impact on therapy participation and success. For an estimated one in three [ 156 ] to five [ 77 ] individuals with stroke [ 157 ], effective pharmacological and counseling is key to patients experiencing the greatest benefit associated with their rehabilitation therapy.…”

Impact of post‐stroke aphasia on functional communication, quality of life, perception of health and depression: A case–control study

“…However, the actual prevalence and overall impact of depression amongst people with aphasia may be underreported in the literature due to the exclusion of patients with moderate to severe communication impairments from most studies [3]. The reported prevalence of post‐stroke depression in systematic [3] and narrative reviews [4] is approximately 52%, which is higher than the 38% (95% confidence interval 33–43) cumulative pooled incidence of depression at 1 year after stroke in the overall stroke population [2].…”

Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study

“… 8 The Edelkraut study found that there is a higher incidence of depression in stroke patients with aphasia. 9 The Williams and Demeyere study found that cognitive deficits in spatial attention, executive function, memory, number and language processing, and praxis could exacerbate depressive symptoms at 6 months post-stroke. 10 Depression seriously threatens the recovery and health outcomes for stroke patients.…”