Characteristics, Diagnosis, and Treatment of Aphasia in Patients With Brain Tumors: A Scoping Review

Tumor-related aphasia (TRA) affects approximately 24% of patients with brain tumors and significantly influences quality of life; yet, few studies have examined TRA across the disease trajectory. The aim of this scoping review was to examine the characteristics, diagnostic approaches, and therapeutic interventions for TRA.

Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines, we searched 6 biomedical databases (PubMed, Embase, Web of Science, PsycINFO, CINAHL, CENTRAL) from inception through June 2025. We included primary studies, reviews, and case reports, addressing TRA characteristics, evaluation, diagnosis, and treatment. Two independent reviewers performed title-abstract and full-text screening with substantial inter-rater reliability (Cohen κ = 0.78, proportionate agreement = 0.91), with a third reviewer reconciling disagreements. Data extracted included study design, primary focus, and key findings. Results are reported thematically across 4 a priori domains.

Of the 4,345 articles identified, 163 studies met eligibility criteria. Study designs were predominantly retrospective cohorts and case series (27%) and cross-sectional and observational studies (22%), followed by case reports (18%) and prospective studies (12%). Most studies addressed characteristics (47%) or diagnostic and surgical planning (33%), while fewer described treatment and rehabilitation (11%) and surgical principles (9%). Stroke-based assessments underestimated TRA, detecting aphasia in only 27% of patients compared with 77% identified by neuropsychological batteries. Tumor biology, particularly growth rate and molecular signatures, influenced compensatory capacity. Diagnostic approaches evolved from anatomical mapping to multimodal assessment integrating fMRI, navigated transcranial magnetic stimulation, and diffusion tensor imaging; awake intraoperative mapping remains the gold standard. Treatment studies supporting intensive speech therapy were limited, and no randomized controlled trials were identified.

TRA differs from stroke-related aphasia in pathophysiology and clinical presentation, requiring tumor-specific assessments and individualized surgical strategies. The predominance of retrospective and observational study designs limits the strength of current evidence. Future prospective studies with standardized outcome measures are needed to guide rehabilitation and surgical planning for this population.