Aphasia in acute stroke and relation to outcome

The natural course of aphasia in unselected, consecutive stroke patients is not well established. We investigated morbidity, mortality and recovery for different types of aphasia in consecutive unselected aphasic patients with acute stroke. Setting and subjects. In 119 aphasic patients, the type and degree of aphasia were assessed acutely and at 3, 6 and 18 months after stroke onset, using Reinvang's 'Grunntest for afasi' and Amsterdam-Nijmegen-Everyday-Language-Test.

About one-third of patients with acute stroke had presented with aphasia. Mortality among the aphasic patients during the 18-month follow-up was twice that in non-aphasics (36 vs. 16%). Presence of atrial fibrillation was associated with poorer prognosis. At 18 months, 24% of the 119 aphasic patients had recovered completely, 43% still had significant aphasia, and 21% had died. The proportion with global aphasia decreased from almost 25% acutely to a few per cent after 18 months, that with Wernicke's aphasia from 25% to less than 10%, whereas conduction aphasia increased from 13 to 23% during follow-up. Among those with initial mild aphasia, 70% recovered completely. Great improvement was observed in patients with initial low degree of speech function. Younger patients recovered to a greater extent than older patients.

The high long-term mortality among aphasics may be seen as an indirect sign of advanced cardiovascular disease. A combination of different and adjusted aphasia tests provided the possibility to assess almost all acute aphasic patients. Irrespective of type and degree of aphasia, great improvements were seen in almost all aphasic patients. Even patients with severe speech impairment have a considerable potential for recovery, particularly in the first 3 months after stroke.