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Variability in language recovery after first-time stroke

Department of Neurology, Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA

Correspondence to:
Dr Ronald M Lazar, Neurological Institute, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA; ral22{at}columbia.edu

Aim: To characterise the course of language recovery after first-time stroke.

Methods: Using our Performance and Recovery in Stroke Study (PARIS) database, we evaluated consecutive first-time stroke patients with aphasia and diffusion-weighted-image-positive lesions on admission and at 90 days.

Results: Twenty-two of 91 patients had language disorders. Initial syndrome scores were positively correlated with 90-day scores (r = 0.60) and negatively correlated with the change in score from baseline to follow-up (r = –0.66). Neither lesion size, age nor education correlated with initial syndrome severity or with performance at 90 days. Level of education was not associated with degree of recovery. A multiple regression model that combined lesion size, age and initial syndrome was significant (p = 0.03) but only explained 29% of the variance. Patients with severe deficits at baseline in individual language domains could recover, improve to a less severe deficit or not improve at all.

Conclusion: There was significant variability in language recovery after first-time stroke, even in more severe, initial syndromes. Traditional predictors of post-stroke language outcomes did not reliably predict function at 90 days. These data suggest that other factors that account for functional stroke recovery have not yet been identified.