Poststroke aphasia : epidemiology, pathophysiology and treatment.
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.
Berthier
Marcelo L
ML
Centro de Investigaciones Médico-Sanitarias (CIMES), Departamento de Medicina, Universidad de Málaga, Campus Universitario Teatinos, University of Málaga, Málaga, Spain.
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*
J Speech Hear Res. 1996 Oct;39(5):S27-36
8898264
Neurologist. 2003 Sep;9(5):225-9
12971832
Brain Lang. 2000 Jan;71(1):96-101
10716818
Cerebrovasc Dis. 2004;17(1):35-43
14530636
Brain Lang. 2000 Jul;73(3):456-65
10860566
Acta Neurol Belg. 1995 Dec;95(4):235-8
8553797
Proc Natl Acad Sci U S A. 1996 Feb 6;93(3):1249-53
8577749
Stroke. 1995 Dec;26(12):2254-9
7491646
Stroke. 1996 May;27(5):897-903
8623110
Brain. 1987 Oct;110 ( Pt 5):1211-29
3499949
Arch Neurol. 1998 Nov;55(11):1438-48
9823828
Brain. 1993 Dec;116 ( Pt 6):1527-40
8293285
Cochrane Database Syst Rev. 2000;(2):CD000425
10796360
Br J Disord Commun. 1990 Apr;25(1):45-60
1695853
Brain. 1998 Jun;121 ( Pt 6):1013-52
9648540
Expert Rev Neurother. 2004 Mar;4(2):211-7
15853562
Ann Neurol. 1997 Oct;42(4):554-63
9382466
Biol Psychiatry. 2003 Aug 1;54(3):376-87
12893112
J Neurol Neurosurg Psychiatry. 1982 Nov;45(11):957-61
6184453
Stroke. 1999 May;30(5):1150-3
10229761
Brain Lang. 2002 Aug;82(2):206-22
12096877
J Neuropsychiatry Clin Neurosci. 1999 Spring;11(2):268-70
10333999
Behav Brain Sci. 1999 Feb;22(1):1-38; discussion 38-75
11301520
CNS Spectr. 2000 Mar;5(3):59-69
18277330
J Speech Lang Hear Res. 1998 Feb;41(1):172-87
9493743
Drugs Aging. 2004;21(2):67-79
14960125
Nat Neurosci. 2002 Jul;5(7):695-9
12055632
Brain Lang. 1985 Nov;26(2):201-29
2417656
J Neurol Neurosurg Psychiatry. 1985 Aug;48(8):743-8
2411876
Rom J Neurol Psychiatry. 1994 Apr-Jun;32(2):77-90
8075023
Arch Phys Med Rehabil. 1993 Aug;74(8):830-6
7688503
Cochrane Database Syst Rev. 2001;(4):CD000424
11687079
Stroke. 2000 Sep;31(9):2112-6
10978039
Lancet. 1997 Jul 12;350(9071):116-7
9228973
Brain Lang. 1997 Jul;58(3):355-402; discussion 418-23
9222518
Brain Lang. 1997 Jan;56(1):55-67
8994698
Arch Phys Med Rehabil. 2001 Jan;82(1):139-44
11239301
Brain Lang. 1997 Dec;60(3):335-46
9398387
Brain Lang. 2000 Sep;74(2):141-56
10950911
Brain Lang. 1999 Nov;70(2):240-61
10550229
Drugs Aging. 2003;20(6):437-44
12710863
NeuroRehabilitation. 1995;5(2):183-93
24525497
Semin Speech Lang. 1999;20(1):19-31
10100374
Am J Phys Med Rehabil. 2003 Sep;82(9):725-9
12960916
Neurology. 1998 Nov;51(5):1395-8
9818867
J Neurol Neurosurg Psychiatry. 1986 Jan;49(1):11-6
2420939
Stroke. 1997 Dec;28(12):2347-52
9412612
J Neuropsychiatry Clin Neurosci. 2003 Winter;15(1):17-26
12556567
Neurology. 2000 Mar 14;54(5):1117-23
10720284
Neurology. 2000 Dec 26;55(12 ):1883-94
11134389
Brain Lang. 1999 Oct 15;70(1):1-12
10534369
Stroke. 2002 Mar;33(3):702-5
11872891
Arch Neurol. 1998 Apr;55(4):454-6
9561971
Psychopharmacology (Berl). 2001 Jun;155(4):440-2
11441435
Stroke. 2001 Jul;32(7):1621-6
11441210
Neurology. 1988 Jun;38(6):877-9
3368068
Front Biosci. 2003 Sep 01;8:s845-51
12957880
Neurology. 1995 May;45(5):865-71
7746398
J Neurol. 1997 Aug;244(8):505-9
9309557
Brain. 2002 May;125(Pt 5):1094-104
11960898
Pharmacopsychiatry. 1999 Mar;32 Suppl 1:25-32
10338105
Arch Phys Med Rehabil. 2001 Aug;82(8):1073-80
11494187
Arch Neurol. 1998 Nov;55(11):1417-9
9823824
Brain Lang. 1994 Nov;47(4):582-608
7859056
Clin Neuropharmacol. 1994 Aug;17(4):320-31
9316679
Eur J Disord Commun. 1995;30(3):303-16
8547758
Stroke. 2003 Aug;34(8):1944-50
12855827
Arch Neurol. 1979 Apr;36(4):190-6
426663
Br J Disord Commun. 1986 Apr;21(1):89-102
3524652
Brain. 1998 Nov;121 ( Pt 11):2083-94
9827768
Ann Neurol. 1995 Oct;38(4):659-66
7574464
Nature. 1995 Jun 8;375(6531):484-7
7777056
Scand J Public Health Suppl. 2003;61:60-9
14660249
Neuroimage. 2004 Mar;21(3):1124-46
15006680
Brain. 1998 Dec;121 ( Pt 12):2249-57
9874478
Stroke. 1999 Nov;30(11):2331-40
10548667
Brain. 1993 Dec;116 ( Pt 6):1509-25
8293284
Brain. 1991 Jun;114 ( Pt 3):1409-27
2065258
Exp Brain Res. 1998 Nov;123(1-2):13-7
9835387
Cerebrovasc Dis. 2000 Nov-Dec;10(6):455-61
11070376
Arch Gerontol Geriatr. 1993 Mar-Apr;16(2):149-64
15374345
Restor Neurol Neurosci. 1992 Jan 1;4(1):47-50
21551653
J Neurol Neurosurg Psychiatry. 1999 Feb;66(2):155-61
10071093
Aphasiology. 2002 Sep 1;16(9):859-871
16823466
Neurology. 1996 Dec;47(6):1504-11
8960735
Ann Neurol. 1995 Jun;37(6):723-32
7778845
Neurology. 1992 Aug;42(8):1637-8
1641168
J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):222-7
10896697
Stroke. 2003 Apr;34(4):987-93
12649521
J Rehabil Med. 2003 May;(41 Suppl):27-33
12817654
Brain Lang. 1999 Apr;67(2):134-47
10092346
Arch Phys Med Rehabil. 1997 Mar;78(3):245-50
9084344
Arch Phys Med Rehabil. 2000 Dec;81(12 ):1596-615
11128897
Neuroscience. 1997 Oct;80(4):1159-69
9284068
Arch Phys Med Rehabil. 1992 Apr;73(4):373-6
1554312
Neurology. 2003 Apr 8;60(7):1183-5
12682331
Curr Neurol Neurosci Rep. 2002 Nov;2(6):511-5
12359105
Brain Lang. 2000 Jan;71(1):129-31
10716826
Brain. 2001 Jan;124(Pt 1):20-9
11133784
Cognition. 1993 Aug;48(2):139-61
8243030
Ann Neurol. 2002 Jan;51(1):59-68
11782985
Neurol Sci. 2000 Feb;21(1):19-22
10938198
Stroke. 2003 Oct;34(10):2323-30
12970516
J Intern Med. 2001 May;249(5):413-22
11350565
J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):416-21
8774407
Eur J Pharmacol. 2003 Jul 4;472(1-2):57-63
12860473
Brain Lang. 2003 Jun;85(3):357-68
12744947
Electroencephalogr Clin Neurophysiol. 1997 Feb;102(2):86-97
9060859
Neurology. 1987 Nov;37(11):1765-70
3670614
Psychol Rev. 1986 Jul;93(3):283-321
3749399
Brain. 1998 Aug;121 ( Pt 8):1545-56
9712015
Top Stroke Rehabil. 2003 Summer;10 (2):66-76
13680518
Psychol Bull. 1999 Sep;125(5):544-75
10489541
Stroke. 2001 Sep;32(9):2093-8
11546902
Curr Neurol Neurosci Rep. 2002 Nov;2(6):505-10
12359104
J Chem Neuroanat. 2002 Mar;23(3):223-30
11861128
Brain Lang. 2001 Mar;76(3):317-31
11247647
Cochrane Database Syst Rev. 2000;(4):CD001190
11034704
Neurology. 1995 Dec;45(12):2272-4
8848206
Stroke. 1999 Jul;30(7):1370-9
10390309
Neurology. 2003 Apr 8;60(7):1218-9
12682346
Neurology. 1993 Nov;43(11):2319-22
8232949
Arch Phys Med Rehabil. 1997 Aug;78(8):841-6
9344303
Arch Neurol. 1986 Jul;43(7):653-8
3524513
Neurology. 1995 Dec;45(12):2170-3
8848187
Ann Neurol. 1999 Apr;45(4):430-8
10211466