title: Variability in language recovery after first-time stroke.
abstract: 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.
authors.affiliation: Department of Neurology, Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York, NY 10032, USA. ral22@columbia.edu
authors.forename: R M
authors.initials: RM
authors.lastname: Lazar
authors.forename: A E
authors.initials: AE
authors.lastname: Speizer
authors.forename: J R
authors.initials: JR
authors.lastname: Festa
authors.forename: J W
authors.initials: JW
authors.lastname: Krakauer
authors.forename: R S
authors.initials: RS
authors.lastname: Marshall
mesh_terms: 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