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To evaluate the types and severity of subcortical aphasia after stroke and to determine the predictors of the degree of aphasic impairment.
Medical records of 38 patients with post-stroke subcortical aphasia (19 males; mean age, 61.7±13.8 years) were reviewed retrospectively with respect to the following tests: the Korean version of the Western Aphasia Battery (K-WAB), the Korean version of the Modified Barthel Index (K-MBI), and the Fugl-Meyer Index (FMI). The severity of aphasia was evaluated by the aphasia quotient (AQ) and the language quotient (LQ).
Anomic aphasia was the most frequent type of aphasia (n=15, 39.5%), and the lesion most frequently observed in subcortical aphasia was located in the basal ganglia (n=19, 50.0%). Patients with lesions in the basal ganglia exhibited the lowest scores on the FMI for the upper extremities (p=0.04). Severity of aphasia was significantly correlated with the K-MBI (Pearson correlation coefficient: γ=0.45, p=0.01 for AQ and γ=0.53, p=0.01 for LQ) and FMI scores for the lower extremities (γ=0.43, p=0.03 for AQ and γ=0.49, p=0.05 for LQ). In a multivariate logistic regression analysis, K-MBI remained the only explanatory variable closely associated with aphasia severity.
This study showed the general characteristics of post-stroke subcortical aphasia, and it revealed that K-MBI was an associated and explanatory factor for aphasia severity.
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To elucidate the impact of co-occurring dysarthria and aphasia on functional recovery in post-stroke patients.
The medical records, including results of primary screening tests and secondary definite examinations for language problems, of 130 patients admitted to our institute's Department of Rehabilitation Medicine were retrospectively reviewed. Functional outcomes were assessed longitudinally using the Functional Ambulation Category (FAC), Mini-Mental State Examination-Korean version (MMSE-K), European Quality of Life-5 Dimensions 3-Level version (EQ-5D-3L), the Korean version of the Modified Barthel index (K-MBI), and Motricity Index (MI) of the hemiplegic side.
Patients were classified into four groups regarding language function: aphasia only (group A, n=9), dysarthria only (group D, n=12), aphasia and dysarthria (group AD, n=46), and none (group N, n=55). The initial functional outcome scores in the group AD were significantly poor compared to those of the groups N and A. Within groups, there were significant improvements in all outcome measurements in the groups AD and N. A between-group analysis revealed significant improvements in K-MBI for the group AD after adjusting for the initial severity and patient's age compared to other groups.
Post-stroke patients suffering from aphasia with dysarthria showed significantly lower initial functional level and relatively wide range of recovery potential in activities of daily living compared to patients without language problems.
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To investigate the effects of specific brain lesions on prognosis and recovery of post-stroke aphasia, and to assess the characteristic pattern of recovery.
Total of 15 subjects with first-ever, left hemisphere stroke, who were right handed, and who completed language assessment using the Korean version of the Western Aphasia Battery (K-WAB) at least twice during the subacute and chronic stages of stroke, were included. The brain lesions of the participants were evaluated using MRI-cron, SPM8, and Talairach Daemon software.
Subtraction of the lesion overlap map of the participants who showed more than 30% improvement in the aphasia quotient (AQ) by the time of their chronic stage (n=9) from the lesion overlap map of those who did not show more than 30% improvement in the AQ (n=6) revealed a strong relationship with Broca's area, inferior prefrontal gyrus, premotor cortex, and a less strong relationship with Wernicke's area and superior and middle temporal gyri. The culprit lesion related to poor prognosis, after grouping the subjects according to their AQ score in the chronic stage (a cut score of 50), revealed a strong relationship with Broca's area, superior temporal gyrus, and a less strong relationship with Wernicke's area, prefrontal cortex, and inferior frontal gyrus.
Brain lesions in the Broca's area, inferior prefrontal gyrus, and premotor cortex may be related to slow recovery of aphasia in patients with left hemisphere stroke. Furthermore, involvement of Broca's area and superior temporal gyrus may be associated with poor prognosis of post-stroke aphasia.
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To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients.
Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters.
All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group.
Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.
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To analyze cognitive functions of post-stroke aphasia patients compared to patients having right hemispheric stroke and left hemispheric lesions without aphasia, and to look for a relationship between cognitive deficits and aphasia severity.
Thirty-six patients with right hemispheric stroke (group 1), 32 with left hemispheric lesion without aphasia (group 2), and 26 left hemispheric stroke patients with aphasia (group 3) completed a set of tests in the computerized neurocognitive function batteries for attention, executive function and intelligence and Korean version of Western Aphasia Battery. Data analyses explored cognitive characteristics among the three groups and the correlation between cognitive deficits and aphasia severity.
Right hemispheric and left hemispheric stroke patients without aphasia showed similar findings except for digit span forward test. Cognitive tests for working memory and sustained attention were significantly impaired in the aphasic patients, but intelligence was shown to be similar in the three groups. Significant correlation between cognitive deficit and aphasia severity was only shown in some attention tests.
Cognitive deficits may be accompanied with post-stroke aphasia and there are possible associations between language and cognitive measures. Therefore, detection and treatment towards coexisting cognitive impairment may be necessary for efficient aphasia treatment.
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To investigate any additional effect of dual transcranial direct current stimulation (tDCS) compared with single tDCS in chronic stroke patients with aphasia.
Eleven chronic stroke patients (aged 52.6±13.4 years, nine men) with aphasia were enrolled. Single anodal tDCS was applied over the left inferior frontal gyrus (IFG) and a cathodal electrode was placed over the left buccinator muscle. Dual tDCS was applied as follows: 1) anodal tDCS over the left IFG and cathodal tDCS over the left buccinator muscle and 2) cathodal tDCS over the right IFG and anodal tDCS over the right buccinator muscle. Each tDCS was delivered for 30 minutes at a 2-mA intensity. Speech therapy was provided during the last 15 minutes of the tDCS. Before and after the stimulation, the Korean-Boston Naming Test and a verbal fluency test were performed.
The dual tDCS produced a significant improvement in the response time for the Korean-Boston Naming Test compared with the baseline assessment, with a significant interaction between the time and type of interventions. Both single and dual tDCS produced a significant improvement in the number of correct responses after stimulation with no significant interaction. No significant changes in the verbal fluency test were observed after single or dual tDCS.
The results conveyed that dual tDCS using anodal tDCS over the left IFG and cathodal tDCS over the right IFG may be more effective than a single anodal tDCS over the left IFG.
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To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients.
Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy.
Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients.
We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.
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Crossed aphasia refers to language disturbance due to right-hemisphere lesions in right-handed individuals, while magnetic apraxia is described as 'forced grasping and groping' caused by lesions in the contralateral frontal lobe. This is a case report of a 70-year-old right handed woman who suffered from crossed transcortical motor aphasia and left hand magnetic apraxia due to right anterior cerebral artery infarction. The definite mechanism of this disorder is not yet understood, but neurophysiological observations suggest that affected supplementary motor areas may be responsible for this phenomenon.
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To compare the voice onset time (VOT) differences of Korean stops in the initial and intervocalic positions between the aphasic patients with peculiarities of aspiration and a control group.
We examined 15 aphasic patients (nine males, six females) who had suffered a stroke (average age 49.7 years) and 15 healthy controls (average age 47.4 years). An aphasia examination was made by an aphasia battery of three standard tests and VOT was analyzed instrumentally. Stop consonants in the initial and intervocalic position were measured to categorize them according to aphasia types, place of articulation, and manner of articulation.
VOT of the aphasic patients with peculiarities of aspiration had a greater difference than that of the controls, indicating that the temporal non-coordination between the laryngeal adjustment and oral articulators of aphasic patients happens due to the VOT of stops in the initial and intervocalic positions (p<0.05).
VOT of stop consonants in the initial position produced by aphasic patients tends to be proportional to their breathing. It can cause glottal width and make aphasic patients' VOT duration longer. Lastly, the method to measure the VOT of aphasic patients is more significant for the types of phonation than for the places of articulation, and makes it possible to induce abnormal VOT.
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To determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke.
The language function was evaluated using Korean version of Western aphasia battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of aphasia. The factors related with good responses were also checked.
AQ% improved from pre- to post-therapy (14.94±6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05).
Speech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.
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Objective: The purpose of this study is to evaluate the types of aphasia and the clinicoanatomic correlation in aphasic patients with subcortical lesions, and to investigate the change in the types of aphasia during the recovery stage.
Method: Twenty-three stroke patients (16 men and 7 women) with left subcortical lesion was investigated. On the basis of the brain CT or MRI findings, the patients were divided into the 4 groups. Language dysfuntion was evaluated using the modified Western Aphasia Battery (WAB) and the type of aphasia and aphasia quotient were determined. Initial examination was performed within 2 months post-onset in all of the patients and the follow-up examination was done after 6 months post-onset in 9 patients.
Results: The most common type was anomic aphasia (39%). The type of subcortical aphasia was variable regardless of the sites of left subcortical lesion. Aphasia quotient was significantly related with the lesion size (γ = 0.05, p＜0.05) and the initial Barthel index (γ = 0.65, p＜0.05). The scores of all the subtests of the modified WAB and aphasia quotient were significantly decreased in the group with the cortical involvement or the history of operation. On the follow-up examination, the scores of fluency, information and naming subtests were significantly increased.
Conclusion: The most common type of aphasia was anomic aphasia and the type of subcortical aphasia was not correlated to the anatomic lesion. Severity of subcortical aphasia would be related with the lesion size, the history of operation or the cortical involvement. The prognosis of subcortical aphasia was generally good.
Objective: The purposes of this study were to identify the incidence of subcortical aphasia and to investigate the different linguistic characteristics and prognosis.
Method: Twenty-nine stroke patients(18 men and 11 women) with aphasia were investigated in the study. On the basis of the findings of brain CT and MRI images, the patients were divided into either cortical aphasia group or subcortical aphasia group. Fifteen cortical aphasia patients and 14 subcortical aphasia patients underwent an aphasia screening test. Fluency, comprehension, speech, naming, repetition, reading, and writing abilities were evaluated as the modalities of language. All patients received the speech therapy and were reevaluated at three months after the initial evaluation.
Results: The incidence of subcortical aphasia was 48.3% of all aphasia patients from the stroke. Subcortical aphasia patients showed more variable types of aphasia and less linguistic damage than the cortical aphasia patients. The prognosis of subcortical aphasia patients was better than the cortical aphasia patients. Especially the cases of global aphasia from the subcortical lesions showed a rapid recovery and good prognosis.
Conclusion: Early recognition of the subcortical aphasia and a comprehensive speech therapy would be beneficial for the improvement of linguistic function in the subcortical aphasia patients.
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