Variability in language recovery after first-time stroke.
BACKGROUND
Predicting aphasia recovery after stroke has been difficult due to substantial variability in outcomes. Few studies have characterised the nature and extent of recovery, beginning with baselines at 24-72 hours after stroke onset.


OBJECTIVE
To characterise the course of language recovery after first-time stroke.


METHODS
Using our Performance and Recovery in Stroke Study (PARIS) database, we evaluated consecutive first-time stroke patients with aphasia and diffusion-weighted-image-positive lesions on admission and at 90 days.


RESULTS
Twenty-two of 91 patients had language disorders. Initial syndrome scores were positively correlated with 90-day scores (r = 0.60) and negatively correlated with the change in score from baseline to follow-up (r = -0.66). Neither lesion size, age nor education correlated with initial syndrome severity or with performance at 90 days. Level of education was not associated with degree of recovery. A multiple regression model that combined lesion size, age and initial syndrome was significant (p = 0.03) but only explained 29% of the variance. Patients with severe deficits at baseline in individual language domains could recover, improve to a less severe deficit or not improve at all.


CONCLUSIONS
There was significant variability in language recovery after first-time stroke, even in more severe, initial syndromes. Traditional predictors of post-stroke language outcomes did not reliably predict function at 90 days. These data suggest that other factors that account for functional stroke recovery have not yet been identified.
Lazar
R M
RM
Department of Neurology, Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York, NY 10032, USA. ral22@columbia.edu
Speizer
A E
AE
Festa
J R
JR
Krakauer
J W
JW
Marshall
R S
RS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000849:Anomia / Q000175:diagnosis; D001037:Aphasia / Q000175:diagnosis*; D032882:Comprehension; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013068:Speech Production Measurement; D020521:Stroke / Q000150:complications* / Q000175:diagnosis