title: Significance of aphasia after first-ever acute stroke: impact on early and late outcomes.
abstract: BACKGROUND
  We assessed the incidence and determinants of aphasia attributable to first-ever acute stroke. We also investigated early and long-term mortality and 1-year dependence in post-stroke patients.
  
  
  METHODS
  A 10-year prospective hospital-based study was conducted in the prefecture of Athens, Greece.
  
  
  RESULTS
  In total, 2,297 patients were included in the study, of whom 806 (35.1%) had aphasia. The presence of aphasia was independently associated with increasing age (OR: 1.19 per 10-year increase, 95% CI: 1.12-1.21) and atrial fibrillation (OR: 1.35, 95% CI: 1.08-1.67), and inversely associated with Scandinavian Stroke Scale (SSS) score (OR: 0.55 per 10-point increase, 95% CI: 0.52-0.59) and hypertension (OR: 0.77, 95% CI: 0.63-0.96). One-year dependence score (calculated with the modified Rankin score) was higher in aphasic patients compared to non-aphasics (p < 0.001). Moreover, severity of aphasia (estimated with a subscale of SSS) was found as an independent predictor of 1-year dependence. Most of the deaths in the aphasic patients were attributed to infections and neurological damage. Using the Kaplan-Meier limit method, the unadjusted probability of 10-year mortality was demonstrated to increase with the severity of aphasia (log-rank test: 233.9, p < 0.001) and, even after adjustment for several other factors, severity of aphasia remained an independent predictor of 10-year mortality.
  
  
  CONCLUSIONS
  Increasing age, atrial fibrillation and severity of stroke were associated with the risk of aphasia after stroke. Severity of aphasia is a strong predictor of long-term mortality and dependence of post-stroke patients.
authors.affiliation: Department of Neurology, University Hospital of Ioannina, Ioannina, Greece. stsouli@cc.uoi.gr
authors.forename: S
authors.initials: S
authors.lastname: Tsouli
authors.forename: A P
authors.initials: AP
authors.lastname: Kyritsis
authors.forename: G
authors.initials: G
authors.lastname: Tsagalis
authors.forename: E
authors.initials: E
authors.lastname: Virvidaki
authors.forename: K N
authors.initials: KN
authors.lastname: Vemmos
mesh_terms: D000368:Aged; D001037:Aphasia / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006115:Greece / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome