J Clin Neurol.  2014 Apr;10(2):75-83. 10.3988/jcn.2014.10.2.75.

Why Is It Difficult to Predict Language Impairment and Outcome in Patients with Aphasia after Stroke?

• Charidimou A
• Kasselimis D
• Varkanitsa M
• Selai C
• Potagas C
• Evdokimidis I

• KMID: 2287524
• DOI: http://doi.org/10.3988/jcn.2014.10.2.75

Abstract

One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. Despite intense research in the field of aphasiology, the type of language impairment has not yet been localized and correlated with brain damage, making it difficult to predict the language outcome for stroke patients with aphasia. Our primary objective is to present the available evidence that highlights the difficulties of predicting language impairment after stroke. The different levels of complexity involved in predicting the lesion site from language impairment and ultimately predicting the long-term outcome in stroke patients with aphasia were explored. Future directions and potential implications for research and clinical practice are highlighted.

Keyword

stroke; aphasia; language impairment

MeSH Terms

Aphasia*
Brain
Humans
Quality of Life
Stroke*

Reference

1. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997; 349:1269–1276.

2. Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull. 2009; 92:7–32.

3. Price CJ, Seghier ML, Leff AP. Predicting language outcome and recovery after stroke: the PLORAS system. Nat Rev Neurol. 2010; 6:202–210.

4. Price CJ, Crinion J. The latest on functional imaging studies of aphasic stroke. Curr Opin Neurol. 2005; 18:429–434.

5. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011; 76:1006–1014.

6. Papagno C, Vallar G. Verbal short-term memory and vocabulary learning in polyglots. Q J Exp Psychol A. 1995; 48:98–107.

7. Potagas C, Kasselimis D, Evdokimidis I. Short-term and working memory impairments in aphasia. Neuropsychologia. 2011; 49:2874–2878.

8. Prins R, Bastiaanse R. The early history of aphasiology: from the Egyptian surgeons (c. 1700 BC) to Broca (1861). Aphasiology. 2006; 20:762–791.

9. Meyer A. The frontal lobe syndrome, the aphasias and related conditions. A contribution to the history of cortical localization. Brain. 1974; 97:565–600.

10. Finger S. Paul Broca (1824-1880). J Neurol. 2004; 251:769–770.

11. Broca P. Remarks on the seat of the faculty of articulated language, following an observation of aphemia (loss of speech). Bull Soc Anat Paris. 1861; 36:330–357.

12. Berker EA, Berker AH, Smith A. Translation of Broca's 1865 report. Localization of speech in the third left frontal convolution. Arch Neurol. 1986; 43:1065–1072.

13. Dronkers NF, Plaisant O, Iba-Zizen MT, Cabanis EA. Paul Broca's historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain. 2007; 130(Pt 5):1432–1441.

14. Pearce JM. Broca's aphasiacs. Eur Neurol. 2009; 61:183–189.

15. Broca P. Nouvelle observation d'aphémie produite par une lésion de la moitié postérieure des deuxième et troisième circonvolutionfrontales gauches. Bull Soc Anat Paris. 1861; 36:398–407.

16. Wernicke C. Der Aphasische Symptomencomplex: Eine Psychologische Studie auf Anatomischer Basis. Breslau: Cohn & Weigert;1874.

17. Bogen JE, Bogen GM. Wernicke's region--Where is it? Ann N Y Acad Sci. 1976; 280:834–843.

18. Thomson AD, Cook CC, Guerrini I, Sheedy D, Harper C, Marshall EJ. Wernicke's encephalopathy revisited. Translation of the case history section of the original manuscript by Carl Wernicke 'Lehrbuch der Gehirnkrankheiten fur Aerzte and Studirende' (1881) with a commentary. Alcohol Alcohol. 2008; 43:174–179.

19. Keller SS, Crow T, Foundas A, Amunts K, Roberts N. Broca's area: nomenclature, anatomy, typology and asymmetry. Brain Lang. 2009; 109:29–48.

20. Graves RE. The legacy of the Wernicke-Lichtheim model. J Hist Neurosci. 1997; 6:3–20.

21. Naeser MA, Hayward RW. Lesion localization in aphasia with cranial computed tomography and the Boston Diagnostic Aphasia Exam. Neurology. 1978; 28:545–551.

22. Cappa SF, Cavallotti G, Guidotti M, Papagno C, Vignolo LA. Subcortical aphasia: two clinical-CT scan correlation studies. Cortex. 1983; 19:227–241.

23. Cappa SF, Vignolo LA. CT scan studies of aphasia. Hum Neurobiol. 1983; 2:129–134.

24. Basso A, Lecours AR, Moraschini S, Vanier M. Anatomoclinical correlations of the aphasias as defined through computerized tomography: exceptions. Brain Lang. 1985; 26:201–229.

25. Naeser MA, Palumbo CL, Helm-Estabrooks N, Stiassny-Eder D, Albert ML. Severe nonfluency in aphasia. Role of the medial subcallosal fasciculus and other white matter pathways in recovery of spontaneous speech. Brain. 1989; 112(Pt 1):1–38.

26. Alexander MP, Naeser MA, Palumbo C. Broca's area aphasias: aphasia after lesions including the frontal operculum. Neurology. 1990; 40:353–362.

27. Mohr JP, Pessin MS, Finkelstein S, Funkenstein HH, Duncan GW, Davis KR. Broca aphasia: pathologic and clinical. Neurology. 1978; 28:311–324.

28. Fedorenko E, Thompson-Schill SL. Reworking the language network. Trends Cogn Sci. 2014; 18:120–126.

29. Brust JC, Shafer SQ, Richter RW, Bruun B. Aphasia in acute stroke. Stroke. 1976; 7:167–174.

30. Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry. 1994; 57:202–207.

31. Godefroy O, Dubois C, Debachy B, Leclerc M, Kreisler A. Lille Stroke Program. Vascular aphasias: main characteristics of patients hospitalized in acute stroke units. Stroke. 2002; 33:702–705.

32. Nespoulous JL, Dordain M, Perron C, Ska B, Bub D, Caplan D, et al. Agrammatism in sentence production without comprehension deficits: reduced availability of syntactic structures and/or of grammatical morphemes? A case study. Brain Lang. 1988; 33:273–295.

33. Fernandez B, Cardebat D, Demonet JF, Joseph PA, Mazaux JM, Barat M, et al. Functional MRI follow-up study of language processes in healthy subjects and during recovery in a case of aphasia. Stroke. 2004; 35:2171–2176.

34. Cereda C, Ghika J, Maeder P, Bogousslavsky J. Strokes restricted to the insular cortex. Neurology. 2002; 59:1950–1955.

35. Selnes OA, van Zijl PC, Barker PB, Hillis AE, Mori S. MR diffusion tensor imaging documented arcuate fasciculus lesion in a patient with normal repetition performance. Aphasiology. 2002; 16:897–902.

36. Hund-Georgiadis M, Zysset S, Weih K, Guthke T, von Cramon DY. Crossed nonaphasia in a dextral with left hemispheric lesions: a functional magnetic resonance imaging study of mirrored brain organization. Stroke. 2001; 32:2703–2707.

37. Kumar R, Masih AK, Pardo J. Global aphasia due to thalamic hemorrhage: a case report and review of the literature. Arch Phys Med Rehabil. 1996; 77:1312–1315.

38. Love T, Swinney D, Wong E, Buxton R. Perfusion imaging and stroke: a more sensitive measure of the brain bases of cognitive deficits. Aphasiology. 2002; 16:873–883.

39. Nagaratnam N, Gilhotra JS. Acute mixed transcortical aphasia following an infarction in the left putamen. Aphasiology. 1998; 12:489–493.

40. Schneider SL, Wijdick FM, Duffy JR, O'Brien TJ. Wernicke's aphasia after putaminal hemorrhage: unusual clinical and SPECT findings. Aphasiology. 1999; 13:755–765.

41. Lazzarino LG, Nicolai A, Valassi F, Biasizzo E. Language disturbances from mesencephalo-thalamic infarcts. Identification of thalamic nuclei by CT-reconstructions. Neuroradiology. 1991; 33:300–304.

42. Maeshima S, Toshiro H, Sekiguchi E, Okita R, Yamaga H, Ozaki F, et al. Transcortical mixed aphasia due to cerebral infarction in left inferior frontal lobe and temporo-parietal lobe. Neuroradiology. 2002; 44:133–137.

43. Bogousslavsky J, Regli F, Assal G. Isolation of speech area from focal brain ischemia. Stroke. 1985; 16:441–443.

44. Kuljic-Obradovic D, Labudovic G, Basurovic N, Savic M. Neuropsychological deficits after bithalamic hemorrhages. J Neurol Sci. 2007; 257:174–176.

45. Blank SC, Scott SK, Murphy K, Warburton E, Wise RJ. Speech production: Wernicke, Broca and beyond. Brain. 2002; 125(Pt 8):1829–1838.

46. Yang ZH, Zhao XQ, Wang CX, Chen HY, Zhang YM. Neuroanatomic correlation of the post-stroke aphasias studied with imaging. Neurol Res. 2008; 30:356–360.

47. Kreisler A, Godefroy O, Delmaire C, Debachy B, Leclercq M, Pruvo JP, et al. The anatomy of aphasia revisited. Neurology. 2000; 54:1117–1123.

48. Fridriksson J, Bonilha L, Rorden C. Severe Broca's aphasia without Broca's area damage. Behav Neurol. 2007; 18:237–238.

49. Hillis AE. Aphasia: progress in the last quarter of a century. Neurology. 2007; 69:200–213.

50. Gruber O, Müller T, Falkai P. Dynamic interactions between neural systems underlying different components of verbal working memory. J Neural Transm. 2007; 114:1047–1050.

51. Hickok G, Poeppel D. The cortical organization of speech processing. Nat Rev Neurosci. 2007; 8:393–402.

52. Naeser MA, Helm-Estabrooks N, Haas G, Auerbach S, Srinivasan M. Relationship between lesion extent in 'Wernicke's area' on computed tomographic scan and predicting recovery of comprehension in Wernicke's aphasia. Arch Neurol. 1987; 44:73–82.

53. Wise RJ, Scott SK, Blank SC, Mummery CJ, Murphy K, Warburton EA. Separate neural subsystems within 'Wernicke's area'. Brain. 2001; 124(Pt 1):83–95.

54. Saling MM. Disorders of language. In : Schapira AH, Byrne E, DiMauro S, Frackowiak RS, Johnson RT, Mizuno Y, editors. Neurology and Clinical Neuroscience. Philadelphia: Mosby Elsevier;2007. p. 31–42.

55. Sène Diouf F, Mapoure Y, Ndiaye M, Touré K, Diagne NS, Thiam A, et al. [Vascular aphasias: clinical, epidemiologicaland evolutionary aspects]. Dakar Med. 2008; 53:68–75.

56. Thomalla G, Glauche V, Koch MA, Beaulieu C, Weiller C, Röther J. Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke. Neuroimage. 2004; 22:1767–1774.

57. Liang Z, Zeng J, Zhang C, Liu S, Ling X, Xu A, et al. Longitudinal investigations on the anterograde and retrograde degeneration in the pyramidal tract following pontine infarction with diffusion tensor imaging. Cerebrovasc Dis. 2008; 25:209–216.

58. Young MP, Hilgetag CC, Scannell JW. On imputing function to structure from the behavioural effects of brain lesions. Philos Trans R Soc Lond B Biol Sci. 2000; 355:147–161.

59. Sporns O, Tononi G, Edelman GM. Connectivity and complexity: the relationship between neuroanatomy and brain dynamics. Neural Netw. 2000; 13:909–922.

60. Honey CJ, Sporns O. Dynamical consequences of lesions in cortical networks. Hum Brain Mapp. 2008; 29:802–809.

61. Alstott J, Breakspear M, Hagmann P, Cammoun L, Sporns O. Modeling the impact of lesions in the human brain. PLoS Comput Biol. 2009; 5:e1000408.

62. Price CJ, Friston KJ. Degeneracy and cognitive anatomy. Trends Cogn Sci. 2002; 6:416–421.

63. Keinan A, Kaufman A, Sachs N, Hilgetag CC, Ruppin E. Fair localization of function via multi-lesion analysis. Neuroinformatics. 2004; 2:163–168.

64. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008; 371:1612–1623.

65. Hossmann KA. Pathophysiology and therapy of experimental stroke. Cell Mol Neurobiol. 2006; 26:1057–1083.

66. van der Zwan A, Hillen B. Review of the variability of the territories of the major cerebral arteries. Stroke. 1991; 22:1078–1084.

67. van der Zwan A, Hillen B, Tulleken CA, Dujovny M, Dragovic L. Variability of the territories of the major cerebral arteries. J Neurosurg. 1992; 77:927–940.

68. Basso A, Bracchi M, Capitani E, Laiacona M, Zanobio ME. Age and evolution of language area functions. A study on adult stroke patients. Cortex. 1987; 23:475–483.

69. Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003; 34:1114–1119.

70. Fischer U, Arnold M, Nedeltchev K, Schoenenberger RA, Kappeler L, Höllinger P, et al. Impact of comorbidity on ischemic stroke outcome. Acta Neurol Scand. 2006; 113:108–113.

71. Arnold M, Halpern M, Meier N, Fischer U, Haefeli T, Kappeler L, et al. Age-dependent differences in demographics, risk factors, co-morbidity, etiology, management, and clinical outcome of acute ischemic stroke. J Neurol. 2008; 255:1503–1507.

72. Bushnell CD, Lee J, Duncan PW, Newby LK, Goldstein LB. Impact of comorbidities on ischemic stroke outcomes in women. Stroke. 2008; 39:2138–2140.

73. Geva S, Correia M, Warburton EA. Diffusion tensor imaging in the study of language and aphasia. Aphasiology. 2011; 25:543–558.

74. Mechelli A, Penny WD, Price CJ, Gitelman DR, Friston KJ. Effective connectivity and intersubject variability: using a multisubject network to test differences and commonalities. Neuroimage. 2002; 17:1459–1469.

75. Seghier ML, Lee HL, Schofield T, Ellis CL, Price CJ. Inter-subject variability in the use of two different neuronal networks for reading aloud familiar words. Neuroimage. 2008; 42:1226–1236.

76. Kherif F, Josse G, Seghier ML, Price CJ. The main sources of intersubject variability in neuronal activation for reading aloud. J Cogn Neurosci. 2009; 21:654–668.

77. Murphy TH, Corbett D. Plasticity during stroke recovery: from synapse to behaviour. Nat Rev Neurosci. 2009; 10:861–872.

78. Price CJ. The anatomy of language: a review of 100 fMRI studies published in 2009. Ann N Y Acad Sci. 2010; 1191:62–88.

79. Richardson FM, Price CJ. Structural MRI studies of language function in the undamaged brain. Brain Struct Funct. 2009; 213:511–523.

80. Ardila A. A proposed reinterpretation and reclassification of aphasic syndromes. Aphasiology. 2010; 24:363–394.

81. Ardila A. Aphasia revisited: a reply to Buckingham, Kertesz, and Marshall. Aphasiology. 2010; 24:413–422.

82. Buckingham HW. Aristotle's functional association psychology. The syntagmatic and the paradigmatic axes in the neurolinguistics of Roman Jakobson and Alexander Luria: an anatomical and functional quagmire. Aphasiology. 2010; 24:395–403.

83. Kertesz A. Ardila's attempt to alter aphasiology. Aphasiology. 2010; 24:404–407.

84. Marshall J. Classification of aphasia: are there benefits for practice? Aphasiology. 2010; 24:408–412.

85. Smits M, Visch-Brink EG, van de Sandt-Koenderman ME, van der Lugt A. Advanced magnetic resonance neuroimaging of language function recovery after aphasic stroke: a technical review. Arch Phys Med Rehabil. 2012; 93:1 Suppl. S4–S14.