eMedicine Specialties > Neurology > Behavioral Neurology and Dementia

Aphasia: Follow-up

Author: Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Coauthor(s): Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2009

Follow-up

Prognosis

  • The prognosis for life in a patient with aphasia depends on the cause of the aphasia. A left hemisphere glioblastoma may be associated with a very short life expectancy, whereas a minor stroke may have an excellent prognosis. It is the underlying pathology, not the aphasia itself, that determines prognosis. 
  • The prognosis for language recovery varies depending on the size and nature of the lesion and the age and overall health of the patient. Most patients, even elderly ones, experience some recovery in poststroke aphasia, and some recover completely.
    • In general, patients with preserved receptive language functions are better candidates for rehabilitation than are those with impaired comprehension.
    • The potential for functional recovery from primarily expressive aphasia such as Broca’s aphasia after a stroke is excellent.
    • The potential for recovery from a Wernicke aphasia due to a stroke is not as good as that for Broca aphasia, but most of these patients show some recovery.
    • The potential for recovery from aphasia due to an untreatable tumor or neurodegenerative disease is poor.
  • The prognosis for the patient to become independent is subtly different than that for language recovery. Patients may recover functionally and be able to live independently in spite of having a persisting aphasia, as long as they do not have other concomitant deficits such as the ability to use household tools (apraxia), often related to inferior parietal lobule or frontal involvement or other cognitive deficits. 
  • Although it was once taught that most improvement from aphasia occurs in the first six months after a stroke, most now acknowledge that recovery can occur many months or even years after the initial stroke that caused the impairment. In severe, global aphasia, there may actually be more improvement in the second 6 months after the stroke than in the first 6 months.

Patient Education

  • Family members may benefit from education regarding language impairment to care for affected patients.
  • The National Aphasia Association provides a variety of educational materials.
 


More on Aphasia

Overview: Aphasia
Differential Diagnoses & Workup: Aphasia
Treatment & Medication: Aphasia
Follow-up: Aphasia
References
[ CLOSE WINDOW ]

References

  1. Alexander MP, Naeser MA, Palumbo C. Broca's area aphasias: aphasia after lesions including the frontal operculum. Neurology. Feb 1990;40(2):353-62. [Medline].

  2. Kreisler A, Godefroy O, Delmaire C, et al. The anatomy of aphasia revisited. Neurology. Mar 14 2000;54(5):1117-23. [Medline].

  3. Naeser MA, Helm-Estabrooks N, Haas G, et al. Relationship between lesion extent in 'Wernicke's area' on computed tomographic scan and predicting recovery of comprehension in Wernicke's aphasia. Arch Neurol. Jan 1987;44(1):73-82. [Medline].

  4. Hillis AE, Gold L, Kannan V, et al. Site of the ischemic penumbra as a predictor of potential for recovery of functions. Neurology. Jul 15 2008;71(3):184-9. [Medline].

  5. Caramazza A. Minding the facts: a comment on Thompson-Schill et al.'s "A neural basis for category and modality specificity of semantic knowledge". Neuropsychologia. 2000;38(7):944-9. [Medline].

  6. Geschwind N. Disconnexion syndromes in animals and man. I. Brain. Jun 1965;88(2):237-94. [Medline].

  7. Damasio AR, Damasio H. The anatomic basis of pure alexia. Neurology. Dec 1983;33(12):1573-83. [Medline].

  8. Naeser MA, Alexander MP, Helm-Estabrooks N, et al. Aphasia with predominantly subcortical lesion sites: description of three capsular/putaminal aphasia syndromes. Arch Neurol. Jan 1982;39(1):2-14. [Medline].

  9. Fromm D, Holland AL, Swindell CS, et al. Various consequences of subcortical stroke. Prospective study of 16 consecutive cases. Arch Neurol. Oct 1985;42(10):943-50. [Medline].

  10. Alexander MP, Naeser MA, Palumbo CL. Correlations of subcortical CT lesion sites and aphasia profiles. Brain. Aug 1987;110 (Pt 4):961-91. [Medline].

  11. Weiller C, Willmes K, Reiche W, et al. The case of aphasia or neglect after striatocapsular infarction. Brain. Dec 1993;116 (Pt 6):1509-25. [Medline].

  12. Crosson B. Subcortical Functions in Language and Memory. New York, NY: Guilford; 1992.

  13. Dejerine J. Contribution a l'etude anatomo-pathologique et clinique des differentes varieties de cecite verbales. Memoires Societe Biologie. 1892;4:61-90.

  14. Benton AL. The fiction of the Gerstmann syndrome. J Neurol Neurosurg Psychiatry. 1961;24:961-991.

  15. Benton AL. Gerstmann's syndrome. Arch Neurol. May 1992;49(5):445-7. [Medline].

  16. Berthier ML, Green C, Lara JP, Higueras C, Barbancho MA, Dávila G, et al. Memantine and constraint-induced aphasia therapy in chronic poststroke aphasia. Ann Neurol. May 2009;65(5):577-85. [Medline].

  17. Alexander MP, Benson DF, Stuss DT. Frontal lobes and language. Brain Lang. Nov 1989;37(4):656-91. [Medline].

  18. Alexander MP, Hiltbrunner B, Fischer RS. Distributed anatomy of transcortical sensory aphasia. Arch Neurol. Aug 1989;46(8):885-92. [Medline].

  19. Appell J, Kertesz A, Fisman M. A study of language functioning in Alzheimer patients. Brain Lang. Sep 1982;17(1):73-91. [Medline].

  20. Auerbach SH, Allard T, Naeser M, et al. Pure word deafness. Analysis of a case with bilateral lesions and a defect at the prephonemic level. Brain. Jun 1982;105:271-300. [Medline].

  21. Bakar M, Kirshner HS, Wertz RT. Crossed aphasia. Functional brain imaging with PET or SPECT. Arch Neurol. Oct 1996;53(10):1026-32. [Medline].

  22. Benson DF, Ardila A. Aphasia. A clinical perspective. 1. First ed. New York: Oxford University Press; 1996:1-441.

  23. Benton AL, Hamsher K De S, Varney NR, et al. Contributions to Neuropsychological Assessment. New York: Oxford University Press; 1983.

  24. Benton AL, Hamsher KD. Multilingual Aphasia Examination. Iowa City, IA: AJA Associates; 1989.

  25. Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke. Apr 2003;34(4):987-93. [Medline].

  26. Boatman D, Gordon B, Hart J, et al. Transcortical sensory aphasia: revisited and revised. Brain. Aug 2000;123 (Pt 8):1634-42. [Medline].

  27. Bookheimer S. Functional MRI of language: new approaches to understanding the cortical organization of semantic processing. Annu Rev Neurosci. 2002;25:151-88. [Medline].

  28. Bowers D, Bauer RM, Heilman KM. The nonverbal affect lexicon: theoretical perspectives from neuropsychological studies of affect perception. Neuropsychology. 1993;7:433-44.

  29. Broca P. Remarques sur le siege de la faculte du language articule, suivies d'une observation d'aphemie. Bull Soc Anat Paris. 1861;2:330-57.

  30. Catani M, Jones DK, ffytche DH. Perisylvian language networks of the human brain. Ann Neurol. Jan 2005;57(1):8-16. [Medline].

  31. Catani M, Mesulam M. The arcuate fasciculus and the disconnection theme in language and aphasia: history and current state. Cortex. Sep 2008;44(8):953-61. [Medline].

  32. Cummings JL, Benson F, Hill MA, et al. Aphasia in dementia of the Alzheimer type. Neurology. Mar 1985;35(3):394-7. [Medline].

  33. Damasio AR. Aphasia. N Engl J Med. Feb 20 1992;326(8):531-9. [Medline].

  34. de Boissezon X, Peran P, de Boysson C, et al. Pharmacotherapy of aphasia: myth or reality?. Brain Lang. Jul 2007;102(1):114-25. [Medline].

  35. De Renzi E, Vignolo LA. The token test: A sensitive test to detect receptive disturbances in aphasics. Brain. Dec 1962;85:665-78. [Medline].

  36. DeWitt LD, Grek AJ, Buonanno FS, et al. MRI and the study of aphasia. Neurology. Jun 1985;35(6):861-5. [Medline].

  37. Freedman M, Alexander MP, Naeser MA. Anatomic basis of transcortical motor aphasia. Neurology. Apr 1984;34(4):409-17. [Medline].

  38. Freund CS. Uber optische Aphasie und Seelenblindheit. Archiv Psychiatrie Nervenkrankheiten. 1889;20:276-97.

  39. Goodglass H, Kaplan E. The Assessment of Aphasia and Related Disorders. Philadelphia, PA: Lea and Febiger; 1972.

  40. Goodglass H, Wingfield A, Hyde MR, et al. Category specific dissociations in naming and recognition by aphasic patients. Cortex. Mar 1986;22(1):87-102. [Medline].

  41. Hall DA, Anderson CA, Filley CM, et al. A French accent after corpus callosum infarct. Neurology. May 13 2003;60(9):1551-2. [Medline].

  42. Hillis AE. Aphasia: progress in the last quarter of a century. Neurology. Jul 10 2007;69(2):200-13. [Medline].

  43. Jacobs DH, Shuren J, Gold M, et al. Physostigmine pharmacotherapy for anomia. Neurocase. 1996;2:83-92.

  44. Kaplan E, Goodglass H, Weintraub S. The Boston Naming Test. Philadelphia, PA: Lea and Febiger; 1978.

  45. Kertesz A. Western Aphasia Battery. London, Ontario: University of Western Ontario Press; 1980.

  46. Kertesz A, Sheppard A. The epidemiology of aphasic and cognitive impairment in stroke: age, sex, aphasia type and laterality differences. Brain. Mar 1981;104:117-28. [Medline].

  47. Kirshner HS. Behavioral neurology. Practical science of mind and brain. 1. 2. Boston. Butterworth Heinemann. 2002;1-474.

  48. Kirshner HS. 1-532. In: Handbook of neurological speech and language disorders. First ed. New York: Marcel Dekker, Inc; 1995.

  49. Kirshner HS, Alexander M, Lorch MP, et al. Continuum: Disorders of speech and language. Baltimore MD: Lippincott Williams & Wilkins CONTINUUM.; 1999.

  50. Kirshner HS, Casey PF, Henson J, et al. Behavioural features and lesion localization in Wernicke's aphasia. Aphasiology. 1989;3:169-176.

  51. Kirshner HS, Hughes T, Fakhoury T, et al. Aphasia secondary to partial status epilepticus of the basal temporal language area. Neurology. Aug 1995;45(8):1616-8. [Medline].

  52. Kirshner HS, Kistler KH. Aphasia after right thalamic hemorrhage. Arch Neurol. Oct 1982;39(10):667-9. [Medline].

  53. Kirshner HS, Tanridag O, Thurman L, et al. Progressive aphasia without dementia: two cases with focal spongiform degeneration. Ann Neurol. Oct 1987;22(4):527-32. [Medline].

  54. Lazar RM, Antoniello D. Variability in recovery from aphasia. Curr Neurol Neurosci Rep. Nov 2008;8(6):497-502. [Medline].

  55. Love T, Swinney D, Walenski M, et al. How left inferior frontal cortex participates in syntactic processing: Evidence from aphasia. Brain Lang. Dec 2008;107(3):203-19. [Medline].

  56. Mariën P, Paghera B, De Deyn PP, et al. Adult crossed aphasia in dextrals revisited. Cortex. Feb 2004;40(1):41-74. [Medline].

  57. Martin PI, Naeser MA, Theoret H, et al. Transcranial magnetic stimulation as a complementary treatment for aphasia. Semin Speech Lang. May 2004;25(2):181-91. [Medline].

  58. Mega MS, Alexander MP. Subcortical aphasia: the core profile of capsulostriatal infarction. Neurology. Oct 1994;44(10):1824-9. [Medline].

  59. Mesulam MM. Primary progressive aphasia. Ann Neurol. Apr 2001;49(4):425-32. [Medline].

  60. Morris HH, Luders H, Lesser RP, et al. Transient neuropsychological abnormalities (including Gerstmann's syndrome) during cortical stimulation. Neurology. Jul 1984;34(7):877-83. [Medline].

  61. Nicholas M, Obler L, Albert M, et al. Lexical retrieval in healthy aging. Cortex. Dec 1985;21(4):595-606. [Medline].

  62. Nishio S, Takemura N, Ikai Y, et al. Sensory aphasia after closed head injury. J Clin Neurosci. May 2004;11(4):442-4. [Medline].

  63. Ojemann G, Ojemann J, Lettich E, et al. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. 1989. J Neurosurg. Feb 2008;108(2):411-21. [Medline].

  64. Price CJ, Wise RJ, Watson JD, et al. Brain activity during reading. The effects of exposure duration and task. Brain. Dec 1994;117 (Pt 6):1255-69. [Medline].

  65. Robey RR. A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res. Feb 1998;41(1):172-87. [Medline].

  66. Schiff HB, Alexander MP, Naeser MA, et al. Aphemia. Clinical-anatomic correlations. Arch Neurol. Nov 1983;40(12):720-7. [Medline].

  67. Shuren JE, Hammond CS, Maher LM, et al. Attention and anosognosia: the case of a jargonaphasic patient with unawareness of language deficit. Neurology. Feb 1995;45(2):376-8. [Medline].

  68. Tanridag O, Kirshner HS. Language disorders in stroke syndromes of the dominant capsulostriatum-- a clinical review. Aphasiology. 1987;1:107-117.

  69. Thompson C. Functional neuroimaging: applications for studying aphasia. In: LaPointe LL eds. Aphasia and related neurogenic language disorders. 3rd ed. New York: Thieme; 2005:19-39.

  70. Thompson CK, den Ouden DB. Neuroimaging and recovery of language in aphasia. Curr Neurol Neurosci Rep. Nov 2008;8(6):475-83. [Medline].

  71. Wertz RT, Weiss DG, Aten JL, et al. Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study. Arch Neurol. Jul 1986;43(7):653-8. [Medline].

  72. Yang ZH, Zhao XQ, Wang CX, et al. Neuroanatomic correlation of the post-stroke aphasias studied with imaging. Neurol Res. May 2008;30(4):356-60. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

aphasia, disorder of language, language disorder, language dysfunction, inability to speak, brain damage, brain injury, left cerebral hemisphere, alexia, disorder of reading, agraphia, disorder of writing, apraxia, buccofacial apraxia, disorder of skilled movements, aphasia, fMRI

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Coauthor(s)

Daniel H Jacobs, MD, Associate Professor of Neurology, University of Central Florida College of Medicine
Daniel H Jacobs, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience
Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Medical Editor

Joseph Quinn, MD, Assistant Professor, Department of Neurology, Portland VA Medical Center, Oregon Health Sciences University
Joseph Quinn, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.