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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Capizzi A, Woo J, Magat E. Poststroke aphasia treatment: A review of pharmacologic therapies and noninvasive brain stimulation techniques. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, Miller E. Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation. J Clin Med 2021; 10:jcm10173778. [PMID: 34501229 PMCID: PMC8432240 DOI: 10.3390/jcm10173778] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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Affiliation(s)
- Natalia Cichon
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
- Correspondence:
| | - Lidia Wlodarczyk
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland;
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Justyna Redlicka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
| | - Leslaw Gorniak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
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Beversdorf DQ. The Role of the Noradrenergic System in Autism Spectrum Disorders, Implications for Treatment. Semin Pediatr Neurol 2020; 35:100834. [PMID: 32892961 PMCID: PMC7477304 DOI: 10.1016/j.spen.2020.100834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is frequently associated with anxiety and hyperarousal. While the pathological changes in the noradrenergic system in ASD are not entirely clear, a number of functional indices of the sympathetic/parasympathetic balance are altered in individuals with ASD, often with a high degree of inter-individual variability. The neuropsychopharmacological effects of α2 agonists and β-adrenergic antagonists make agents targeting these receptors of particular interest. α2 agonists have shown beneficial effects for attention deficit hyperactivity disorder (ADHD) and in other domains in individuals with ASD, but effects on core ASD symptoms are less clear. Case series and single dose psychopharmacological challenges suggest that treatment with β-adrenergic antagonists has beneficial effects on language and social domains. Additionally, psychophysiological markers and premorbid anxiety may predict response to these medications. As a result, β-adrenergic antagonists are currently being utilized in a clinical trial for improving core symptoms as well as anxiety in individuals with ASD.
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Affiliation(s)
- David Q Beversdorf
- Departments of Radiology, Neurology, and Psychological Sciences, and the Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri-Columbia, Columbia, MO, William and Nancy Thompson Endowed Chair in Radiology..
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Effects of stress on functional connectivity during problem solving. Neuroimage 2020; 208:116407. [DOI: 10.1016/j.neuroimage.2019.116407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/24/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
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Vasenina E, Levin O. Speech disorders and anxiety: interaction mechanisms and therapy potential. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:136-144. [DOI: 10.17116/jnevro2020120041136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Beversdorf DQ. Neuropsychopharmacological regulation of performance on creativity-related tasks. Curr Opin Behav Sci 2019; 27:55-63. [PMID: 31106256 PMCID: PMC6519931 DOI: 10.1016/j.cobeha.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A number of factors affect performance on tasks associated with creativity. Two pharmacological systems in particularly been identified as important for their impact on creativity, the noradrenergic system and the dopaminergic systems. Furthermore, stress is also established as an important factor impacting performance, most likely mediated by its effects on these neurotransmitter systems. Herein, we review the current literature on the relationships between stress, the noradrenergic system, the dopaminergic system, and other pharmacological factors and their effects on performance on tasks associated with creativity.
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Affiliation(s)
- David Q Beversdorf
- William and Nancy Thompson Endowed Chair in Radiology, University of Missouri
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Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother 2017; 17:1091-1107. [PMID: 28847186 DOI: 10.1080/14737175.2017.1373020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Aphasia is among the most debilitating outcomes of stroke. Aphasia is a language disorder occurring in 10-30% of stroke survivors. Speech and Language Therapy (SLT) is the gold standard, mainstay treatment for aphasia, but gains from SLT may be incomplete. Pharmaceutical and noninvasive brain stimulation (NIBS) techniques may augment the effectiveness of SLT. Areas covered: Herein reviewed are studies of the safety and efficacy of these adjunctive interventions for aphasia, including randomized placebo-controlled and open-label trials, as well as case series from Pubmed, using search terms 'pharmacological,' 'tDCS' or 'TMS' combined with 'aphasia' and 'stroke.' Expert commentary: Relatively small studies have included participants with a range of aphasia types and severities, using inconsistent interventions and outcome measures. Results to-date have provided promising, but weak to moderate evidence that medications and/or NIBS can augment the effects of SLT for improving language outcomes. We end with recommendations for future approaches to studying these interventions, with multicenter, double-blind, randomized controlled trials.
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Affiliation(s)
- Sadhvi Saxena
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Argye E Hillis
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Cahana-Amitay D, Oveis AC, Sayers JT, Pineles SL, Spiro A, Albert ML. Biomarkers of "Linguistic Anxiety" in aphasia: a proof-of-concept case study. CLINICAL LINGUISTICS & PHONETICS 2015; 29:401-413. [PMID: 25815438 DOI: 10.3109/02699206.2015.1014572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a proof-of-concept case study designed to evaluate the presence of "Linguistic Anxiety" in a person with mild aphasia. The participant (aged 68) was tested on linguistic and non-linguistic cognitive tasks administered under conditions that differed in levels of anxiety. A validated anxiety-induction technique rarely used in previous aphasia studies was employed: the participant was instructed to prepare for a public speaking presentation. Measures of linguistic and non-linguistic cognitive performance, and anxiety (self-report and psychophysiologic) were obtained. The participant exhibited increased psychophysiologic stress reactivity (heart rate, skin conductance and self-report ratings) in the high-anxiety condition. In the state of increased anxiety, performance on language tasks, in particular discourse production, declined relative to performance in low-anxiety settings. Even in mild aphasia, language-based anxiety can interfere with language performance. This finding provides a basis for carrying out a study with a larger sample that can open a new path to assessment and treatment of persons with aphasia.
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Hecht PM, Will MJ, Schachtman TR, Welby LM, Beversdorf DQ. Beta-adrenergic antagonist effects on a novel cognitive flexibility task in rodents. Behav Brain Res 2014; 260:148-54. [DOI: 10.1016/j.bbr.2013.11.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/23/2013] [Accepted: 11/24/2013] [Indexed: 11/16/2022]
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Wilkinson D, Morris R, Milberg W, Sakel M. Caloric vestibular stimulation in aphasic syndrome. Front Integr Neurosci 2013; 7:99. [PMID: 24391559 PMCID: PMC3870329 DOI: 10.3389/fnint.2013.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/08/2013] [Indexed: 11/13/2022] Open
Abstract
Caloric vestibular stimulation (CVS) is commonly used to diagnose brainstem disorder but its therapeutic application is much less established. Based on the finding that CVS increases blood flow to brain structures associated with language and communication, we assessed whether the procedure has potential to relieve symptoms of post-stroke aphasia. Three participants, each presenting with chronic, unilateral lesions to the left hemisphere, were administered daily CVS for four consecutive weeks. Relative to their pre-treatment baseline scores, two of the three participants showed significant improvement on both picture and responsive naming at immediate and 1-week follow-up. One of these participants also showed improved sentence repetition, and another showed improved auditory word discrimination. No adverse reactions were reported. These data provide the first, albeit tentative, evidence that CVS may relieve expressive and receptive symptoms of aphasia. A larger, sham-controlled study is now needed to further assess efficacy.
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Affiliation(s)
- David Wilkinson
- School of Psychology, University of Kent Canterbury, Kent, UK
| | - Rachael Morris
- School of Psychology, University of Kent Canterbury, Kent, UK
| | - William Milberg
- Department of Psychiatry, Harvard Medical School Boston, MA, USA
| | - Mohamed Sakel
- East Kent Neuro-Rehabilitation Service, East Kent Hospitals University NHS Foundation Trust Kent, UK
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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 2011; 21:302-17. [DOI: 10.1007/s11065-011-9177-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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Cahana-Amitay D, Albert ML, Pyun SB, Westwood A, Jenkins T, Wolford S, Finley M. Language as a Stressor in Aphasia. APHASIOLOGY 2011; 25:593-614. [PMID: 22701271 PMCID: PMC3372975 DOI: 10.1080/02687038.2010.541469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Healthcare System, 150 South Huntington Avenue Boston, MA 02130
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Berthier ML, Pulvermüller F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol 2011; 7:86-97. [PMID: 21297651 DOI: 10.1038/nrneurol.2010.201] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
In this review, we discuss the basic mechanisms of neural regeneration and repair and attempt to correlate findings from animal models of stroke recovery with clinical trials for aphasia. Several randomized controlled clinical trials involving manipulation of different neurotransmitter systems, including noradrenergic, dopaminergic, cholinergic, and glutamatergic systems, have shown signals of efficacy. Biological approaches such as anti-Nogo and cell replacement therapy have shown efficacy in preclinical models but have yet to reach proof of concept in the clinic. Finally, noninvasive cortical stimulation techniques have been used in a few small trials and have shown promising results. It appears that the efficacy of all these platforms can be potentiated through coupling with concomitant behavioral intervention. Given this array of potential mechanisms that exist to augment and/or stimulate neural reorganization after stroke, we are optimistic that approaches to aphasia therapy will transition from compensatory models to models in which brain reorganization is the goal.
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