Incidence of aphasia in acute stroke patients: PROSIT study

Background/Objective: Post stroke disability has been always related to motor impairment but there are some evidences that cognitive disturbances such as aphasia may contribute to stroke patients outcome. Data about the incidence and the contribute of aphasia on disability in stroke are still lacking. The aim of this study is to evaluate the incidence of aphasia and to compare clinical and demographic features in patients with and without aphasia. The populations studied is part of the Italian PROSIT study conducted during 2001. Methods: 15 researchers evaluated retrospectively 12.206 acute stroke patients’clinical records registering demographic, clinical and neurological conditions. From the initial series unconsciousness patients (2567) were excluded in order to avoid bias in aphasia estimation. The presence of aphasia was registered when reported on the first neurological examination. Non specific test for aphasia diagnosis were used. The 2 years follow-up was completed in 98% of patients. Results: Out of 9953 stroke patients 26% were aphasic. Of these patients the 74% presented arm and/or limb weakness that was in 82% on the right side, in 16% on the left side, in 2% bilateral. Aphasia seemed to be more frequent in women than man (53% vs 47%) and in patients older than 75 y.o. (59% vs 46%). Aphasic patients had a more severe stroke than non aphasics: 33% of aphasics compared to 15% of non-aphasics (p 0.000) presented plegia in arm and/or limb and 14% of aphasics compared to 12% of non aphasics (p 0.006) presented an ICH at CT scan. Aphasics died more frequently than non aphasics during hospitalisation and at follow up (10% vs 4% and 26% vs 16% respectively) and presented a more severe long term disability (Rankin scale score 2) than non aphasics (48% and 34%, respectively). Conclusions: This is the first study evaluating the incidence of aphasia in a wide Italian population of acute stroke patients. We found the presence of aphasia in 26% of acute stroke patients according to previous reports in other countries. The presence of aphasia is a component of long term disability in stroke patients. These findings suggest the need to plan speech rehabilitation programs all aphasic patients in order to reduce their long-term disability.