Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Sergio E Starkstein, Ricardo E Jorge, Jessica Aloisi, Marcelo L Berthier, Guadalupe Dávila, Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Sergio E Starkstein, Ricardo E Jorge, Jessica Aloisi, Marcelo L Berthier, Guadalupe Dávila

Abstract

Background: Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.

Aim: To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.

Methods: Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).

Results: The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.

Conclusion: Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.

Keywords: Anxiety; Apathy; Aphasia; Depression; Neuropsychiatric symptoms; Stroke.

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Lesion overlap map from the 20 participants overlaid on a brain template in Montreal Neurological Institute standard space. The maximum lesion overlap (red color) (85%, n = 17) involved regions comprising the left arcuate fasciculus (long and the anterior segments), the insula and the putamen. Different sectors of the left anterior cingulate gyrus were involved in six participants. L: left.

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