title: Poststroke aphasia : epidemiology, pathophysiology and treatment.
abstract: Aphasia, the loss or impairment of language caused by brain damage, is one of the most devastating cognitive impairments of stroke. Aphasia is present in 21-38% of acute stroke patients and is associated with high short- and long-term morbidity, mortality and expenditure. Recovery from aphasia is possible even in severe cases. While speech-language therapy remains the mainstay treatment of aphasia, the effectiveness of conventional therapies has not been conclusively proved. This has motivated attempts to integrate knowledge from several domains in an effort to plan more rational therapies and to introduce other therapeutic strategies, including the use of intensive language therapy and pharmacological agents. Several placebo-controlled trials suggest that piracetam is effective in recovery from aphasia when started soon after the stroke, but its efficacy vanishes in patients with chronic aphasia. Drugs acting on catecholamine systems (bromocriptine, dexamfetamine) have shown varying degrees of efficacy in case series, open-label studies and placebo-controlled trials. Bromocriptine is useful in acute and chronic aphasias, but its beneficial action appears restricted to nonfluent aphasias with reduced initiation of spontaneous verbal messages. Dexamfetamine improves language function in subacute aphasia and the beneficial effect is maintained in the long term, but its use is restricted to highly selected samples. Pharmacological agents operating on the cholinergic system (e.g. donepezil) have shown promise. Data from single-case studies, case series and an open-label study suggest that donepezil may have beneficial effects on chronic poststroke aphasia. Preliminary evidence suggests that donepezil is well tolerated and its efficacy is maintained in the long term. Randomised controlled trials of donepezil and other cholinergic agents in poststroke aphasia are warranted.
authors.affiliation: Centro de Investigaciones Médico-Sanitarias (CIMES), Departamento de Medicina, Universidad de Málaga, Campus Universitario Teatinos, University of Málaga, Málaga, Spain.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Berthier
mesh_terms: D000328:Adult; D000368:Aged; D001037:Aphasia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D008875:Middle Aged; D020521:Stroke / Q000150:complications*
references.citation: J Speech Hear Res. 1996 Oct;39(5):S27-36
references.pmid: 8898264
references.citation: Neurologist. 2003 Sep;9(5):225-9
references.pmid: 12971832
references.citation: Brain Lang. 2000 Jan;71(1):96-101
references.pmid: 10716818
references.citation: Cerebrovasc Dis. 2004;17(1):35-43
references.pmid: 14530636
references.citation: Brain Lang. 2000 Jul;73(3):456-65
references.pmid: 10860566
references.citation: Acta Neurol Belg. 1995 Dec;95(4):235-8
references.pmid: 8553797
references.citation: Proc Natl Acad Sci U S A. 1996 Feb 6;93(3):1249-53
references.pmid: 8577749
references.citation: Stroke. 1995 Dec;26(12):2254-9
references.pmid: 7491646
references.citation: Stroke. 1996 May;27(5):897-903
references.pmid: 8623110
references.citation: Brain. 1987 Oct;110 ( Pt 5):1211-29
references.pmid: 3499949
references.citation: Arch Neurol. 1998 Nov;55(11):1438-48
references.pmid: 9823828
references.citation: Brain. 1993 Dec;116 ( Pt 6):1527-40
references.pmid: 8293285
references.citation: Cochrane Database Syst Rev. 2000;(2):CD000425
references.pmid: 10796360
references.citation: Br J Disord Commun. 1990 Apr;25(1):45-60
references.pmid: 1695853
references.citation: Brain. 1998 Jun;121 ( Pt 6):1013-52
references.pmid: 9648540
references.citation: Expert Rev Neurother. 2004 Mar;4(2):211-7
references.pmid: 15853562
references.citation: Ann Neurol. 1997 Oct;42(4):554-63
references.pmid: 9382466
references.citation: Biol Psychiatry. 2003 Aug 1;54(3):376-87
references.pmid: 12893112
references.citation: J Neurol Neurosurg Psychiatry. 1982 Nov;45(11):957-61
references.pmid: 6184453
references.citation: Stroke. 1999 May;30(5):1150-3
references.pmid: 10229761
references.citation: Brain Lang. 2002 Aug;82(2):206-22
references.pmid: 12096877
references.citation: J Neuropsychiatry Clin Neurosci. 1999 Spring;11(2):268-70
references.pmid: 10333999
references.citation: Behav Brain Sci. 1999 Feb;22(1):1-38; discussion 38-75
references.pmid: 11301520
references.citation: CNS Spectr. 2000 Mar;5(3):59-69
references.pmid: 18277330
references.citation: J Speech Lang Hear Res. 1998 Feb;41(1):172-87
references.pmid: 9493743
references.citation: Drugs Aging. 2004;21(2):67-79
references.pmid: 14960125
references.citation: Nat Neurosci. 2002 Jul;5(7):695-9
references.pmid: 12055632
references.citation: Brain Lang. 1985 Nov;26(2):201-29
references.pmid: 2417656
references.citation: J Neurol Neurosurg Psychiatry. 1985 Aug;48(8):743-8
references.pmid: 2411876
references.citation: Rom J Neurol Psychiatry. 1994 Apr-Jun;32(2):77-90
references.pmid: 8075023
references.citation: Arch Phys Med Rehabil. 1993 Aug;74(8):830-6
references.pmid: 7688503
references.citation: Cochrane Database Syst Rev. 2001;(4):CD000424
references.pmid: 11687079
references.citation: Stroke. 2000 Sep;31(9):2112-6
references.pmid: 10978039
references.citation: Lancet. 1997 Jul 12;350(9071):116-7
references.pmid: 9228973
references.citation: Brain Lang. 1997 Jul;58(3):355-402; discussion 418-23
references.pmid: 9222518
references.citation: Brain Lang. 1997 Jan;56(1):55-67
references.pmid: 8994698
references.citation: Arch Phys Med Rehabil. 2001 Jan;82(1):139-44
references.pmid: 11239301
references.citation: Brain Lang. 1997 Dec;60(3):335-46
references.pmid: 9398387
references.citation: Brain Lang. 2000 Sep;74(2):141-56
references.pmid: 10950911
references.citation: Brain Lang. 1999 Nov;70(2):240-61
references.pmid: 10550229
references.citation: Drugs Aging. 2003;20(6):437-44
references.pmid: 12710863
references.citation: NeuroRehabilitation. 1995;5(2):183-93
references.pmid: 24525497
references.citation: Semin Speech Lang. 1999;20(1):19-31
references.pmid: 10100374
references.citation: Am J Phys Med Rehabil. 2003 Sep;82(9):725-9
references.pmid: 12960916
references.citation: Neurology. 1998 Nov;51(5):1395-8
references.pmid: 9818867
references.citation: J Neurol Neurosurg Psychiatry. 1986 Jan;49(1):11-6
references.pmid: 2420939
references.citation: Stroke. 1997 Dec;28(12):2347-52
references.pmid: 9412612
references.citation: J Neuropsychiatry Clin Neurosci. 2003 Winter;15(1):17-26
references.pmid: 12556567
references.citation: Neurology. 2000 Mar 14;54(5):1117-23
references.pmid: 10720284
references.citation: Neurology. 2000 Dec 26;55(12 ):1883-94
references.pmid: 11134389
references.citation: Brain Lang. 1999 Oct 15;70(1):1-12
references.pmid: 10534369
references.citation: Stroke. 2002 Mar;33(3):702-5
references.pmid: 11872891
references.citation: Arch Neurol. 1998 Apr;55(4):454-6
references.pmid: 9561971
references.citation: Psychopharmacology (Berl). 2001 Jun;155(4):440-2
references.pmid: 11441435
references.citation: Stroke. 2001 Jul;32(7):1621-6
references.pmid: 11441210
references.citation: Neurology. 1988 Jun;38(6):877-9
references.pmid: 3368068
references.citation: Front Biosci. 2003 Sep 01;8:s845-51
references.pmid: 12957880
references.citation: Neurology. 1995 May;45(5):865-71
references.pmid: 7746398
references.citation: J Neurol. 1997 Aug;244(8):505-9
references.pmid: 9309557
references.citation: Brain. 2002 May;125(Pt 5):1094-104
references.pmid: 11960898
references.citation: Pharmacopsychiatry. 1999 Mar;32 Suppl 1:25-32
references.pmid: 10338105
references.citation: Arch Phys Med Rehabil. 2001 Aug;82(8):1073-80
references.pmid: 11494187
references.citation: Arch Neurol. 1998 Nov;55(11):1417-9
references.pmid: 9823824
references.citation: Brain Lang. 1994 Nov;47(4):582-608
references.pmid: 7859056
references.citation: Clin Neuropharmacol. 1994 Aug;17(4):320-31
references.pmid: 9316679
references.citation: Eur J Disord Commun. 1995;30(3):303-16
references.pmid: 8547758
references.citation: Stroke. 2003 Aug;34(8):1944-50
references.pmid: 12855827
references.citation: Arch Neurol. 1979 Apr;36(4):190-6
references.pmid: 426663
references.citation: Br J Disord Commun. 1986 Apr;21(1):89-102
references.pmid: 3524652
references.citation: Brain. 1998 Nov;121 ( Pt 11):2083-94
references.pmid: 9827768
references.citation: Ann Neurol. 1995 Oct;38(4):659-66
references.pmid: 7574464
references.citation: Nature. 1995 Jun 8;375(6531):484-7
references.pmid: 7777056
references.citation: Scand J Public Health Suppl. 2003;61:60-9
references.pmid: 14660249
references.citation: Neuroimage. 2004 Mar;21(3):1124-46
references.pmid: 15006680
references.citation: Brain. 1998 Dec;121 ( Pt 12):2249-57
references.pmid: 9874478
references.citation: Stroke. 1999 Nov;30(11):2331-40
references.pmid: 10548667
references.citation: Brain. 1993 Dec;116 ( Pt 6):1509-25
references.pmid: 8293284
references.citation: Brain. 1991 Jun;114 ( Pt 3):1409-27
references.pmid: 2065258
references.citation: Exp Brain Res. 1998 Nov;123(1-2):13-7
references.pmid: 9835387
references.citation: Cerebrovasc Dis. 2000 Nov-Dec;10(6):455-61
references.pmid: 11070376
references.citation: Arch Gerontol Geriatr. 1993 Mar-Apr;16(2):149-64
references.pmid: 15374345
references.citation: Restor Neurol Neurosci. 1992 Jan 1;4(1):47-50
references.pmid: 21551653
references.citation: J Neurol Neurosurg Psychiatry. 1999 Feb;66(2):155-61
references.pmid: 10071093
references.citation: Aphasiology. 2002 Sep 1;16(9):859-871
references.pmid: 16823466
references.citation: Neurology. 1996 Dec;47(6):1504-11
references.pmid: 8960735
references.citation: Ann Neurol. 1995 Jun;37(6):723-32
references.pmid: 7778845
references.citation: Neurology. 1992 Aug;42(8):1637-8
references.pmid: 1641168
references.citation: J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):222-7
references.pmid: 10896697
references.citation: Stroke. 2003 Apr;34(4):987-93
references.pmid: 12649521
references.citation: J Rehabil Med. 2003 May;(41 Suppl):27-33
references.pmid: 12817654
references.citation: Brain Lang. 1999 Apr;67(2):134-47
references.pmid: 10092346
references.citation: Arch Phys Med Rehabil. 1997 Mar;78(3):245-50
references.pmid: 9084344
references.citation: Arch Phys Med Rehabil. 2000 Dec;81(12 ):1596-615
references.pmid: 11128897
references.citation: Neuroscience. 1997 Oct;80(4):1159-69
references.pmid: 9284068
references.citation: Arch Phys Med Rehabil. 1992 Apr;73(4):373-6
references.pmid: 1554312
references.citation: Neurology. 2003 Apr 8;60(7):1183-5
references.pmid: 12682331
references.citation: Curr Neurol Neurosci Rep. 2002 Nov;2(6):511-5
references.pmid: 12359105
references.citation: Brain Lang. 2000 Jan;71(1):129-31
references.pmid: 10716826
references.citation: Brain. 2001 Jan;124(Pt 1):20-9
references.pmid: 11133784
references.citation: Cognition. 1993 Aug;48(2):139-61
references.pmid: 8243030
references.citation: Ann Neurol. 2002 Jan;51(1):59-68
references.pmid: 11782985
references.citation: Neurol Sci. 2000 Feb;21(1):19-22
references.pmid: 10938198
references.citation: Stroke. 2003 Oct;34(10):2323-30
references.pmid: 12970516
references.citation: J Intern Med. 2001 May;249(5):413-22
references.pmid: 11350565
references.citation: J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):416-21
references.pmid: 8774407
references.citation: Eur J Pharmacol. 2003 Jul 4;472(1-2):57-63
references.pmid: 12860473
references.citation: Brain Lang. 2003 Jun;85(3):357-68
references.pmid: 12744947
references.citation: Electroencephalogr Clin Neurophysiol. 1997 Feb;102(2):86-97
references.pmid: 9060859
references.citation: Neurology. 1987 Nov;37(11):1765-70
references.pmid: 3670614
references.citation: Psychol Rev. 1986 Jul;93(3):283-321
references.pmid: 3749399
references.citation: Brain. 1998 Aug;121 ( Pt 8):1545-56
references.pmid: 9712015
references.citation: Top Stroke Rehabil. 2003 Summer;10 (2):66-76
references.pmid: 13680518
references.citation: Psychol Bull. 1999 Sep;125(5):544-75
references.pmid: 10489541
references.citation: Stroke. 2001 Sep;32(9):2093-8
references.pmid: 11546902
references.citation: Curr Neurol Neurosci Rep. 2002 Nov;2(6):505-10
references.pmid: 12359104
references.citation: J Chem Neuroanat. 2002 Mar;23(3):223-30
references.pmid: 11861128
references.citation: Brain Lang. 2001 Mar;76(3):317-31
references.pmid: 11247647
references.citation: Cochrane Database Syst Rev. 2000;(4):CD001190
references.pmid: 11034704
references.citation: Neurology. 1995 Dec;45(12):2272-4
references.pmid: 8848206
references.citation: Stroke. 1999 Jul;30(7):1370-9
references.pmid: 10390309
references.citation: Neurology. 2003 Apr 8;60(7):1218-9
references.pmid: 12682346
references.citation: Neurology. 1993 Nov;43(11):2319-22
references.pmid: 8232949
references.citation: Arch Phys Med Rehabil. 1997 Aug;78(8):841-6
references.pmid: 9344303
references.citation: Arch Neurol. 1986 Jul;43(7):653-8
references.pmid: 3524513
references.citation: Neurology. 1995 Dec;45(12):2170-3
references.pmid: 8848187
references.citation: Ann Neurol. 1999 Apr;45(4):430-8
references.pmid: 10211466