Depression Risk in Post-Stroke Aphasia Patients: A Nationwide Population-Based Cohort Study

Depression and quality of life in patients with Broca's and subcortical stroke-related aphasia: A comparative study

AIM

Aphasia, primarily recognized as a language disorder following stroke, often is presented with concurrent emotional and social difficulties, including depression. This study investigated whether the type of aphasia-Broca's or subcortical-may be related to the prevalence of depression and overall quality of life (QOL) in affected individuals.

METHODS

The present study involved 46 individuals with chronic aphasia resulting from left hemisphere strokes. Participants were divided into two groups: those with Broca's aphasia and those with subcortical aphasia. Several assessment tools were utilized, including the Persian versions of Mini-Mental State Examination (MMSE), Western Aphasia Battery (P-WAB-1), the Beck Depression Inventory-II (BDI-II), and the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39).

RESULTS

The results indicated that the average severity of aphasia was significantly lower in the Broca's aphasia group (36.48 ± 8.05) compared to the subcortical aphasia group (62.83 ± 19.88). However, both groups demonstrated similar depression severity scores and their quality of life was largely comparable to each other.

CONCLUSION

This study underscores that living with aphasia, regardless of type, involves emotional and social challenges that may be extended beyond language difficulties, emphasizing the need to address these issues to improve the well-being of stroke survivors.

Increased risk of depression and associated symptoms in poststroke aphasia

Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.

A Review of Poststroke Aphasia Recovery and Treatment Options

Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.

How Does Aphasia Affect Quality of Life? Preliminary Reports

Aphasia leads to disability, which, in turn, limits and can result in a complete breakdown of roles and social bonds. Thus, the aim of this study was to assess the impact of aphasia disorders on the quality of life of patients after an ischemic stroke. A prospective study among 116 patients with an ischemic stroke (the study group: 68 participants, 38.25% female, included patients with aphasia after a stroke; the control group: 48 patients, 37.5% female, without aphasia) was conducted at the Neurological Department of the Provincial Specialist Hospital in Włocławek. The patients were assessed twice: the first assessment was conducted during hospitalization using the Aphasia Dynamics Assessment Scale and the Aphasia Test Method of Jadwiga Szumska, and the second assessment of the quality of life after six months was conducted using the WHOQOL-BREF questionnaire. The patients from the control group rated their overall quality of life more highly than the patients from the study group. Statistically significant differences were observed in the physical domain, the psychological domain, and the environmental domain. The analysis of sociodemographic factors indicated a negative impact on the quality of life of the following variables: female gender, 55-64 years of age, vocational education, and place of residence-rural area. The degree and type of aphasia influenced the overall quality of life. Studies with larger samples are necessary.