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The importance of the starting point: the role of aphasia severity in the prediction of early and chronic recovery in post-stroke aphasia
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Poster D43 in Poster Session D, Wednesday, October 25, 4:45 - 6:30 pm CEST, Espace Vieux-Port
Alberto Osa García1,2, Simona Maria Brambati3,4, Amélie Brisebois1,2, Bérengère Houzé3,4, Christoph Bedetti3,4, Alex Desautels1,5,6, Karine Marcotte1,2; 1School of Speech Pathology and Audiology, University of Montreal, 2Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal, Montreal, 3Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, 4Department of Psychology, University of Montreal, Montreal, 5Departement of neurosciences, University of Montreal, Montreal, 6Centre d’Études Avancées en Médecine du Sommeil, Montreal
INTRODUCTION: research in aphasia in the last decade has highlighted the importance of prediction models to help clinicians in patient’s follow-up management. For example, several anatomical predictors, such as white matter diffusion measures, have been suggested. Furthermore, chronic prediction models abound in literature because of easier logistics and the search of longer-term applicability. However, diffusion methodology and chosen measures vastly differ among studies, and the earlier phase of recovery is usually neglected. Here, we intended to explore how early recovery differs from chronic recovery in a cohort of participants with post-stroke aphasia. Our second aim is to study the prediction of both early and chronic aphasia recovery using language assessments and white matter-derived measures. METHODS: twenty-three participants (8 female, 71 y.o. ± 13.01) presenting acute aphasia following a non-lacunar stroke in the left hemisphere were recruited. A magnetic resonance imaging (MRI) and language assessment were conducted in the acute (2±1 days), subacute (10±3 days) and chronic phase (> 6 months). We measured aphasia severity with a Composite Score (CS) assessing naming, comprehension, and repetition at each time point (CSacute, CSsubacute, CSchronic) and recovery phases (Early Recovery [CSsubacute - CSacute,] and Chronic Recovery [CSchronic - CSsubacute]). The MRI was acquired on a 3T-Siemens scanner, including a T1-weighted (T1w) and a diffusion weighted imaging (DWI) sequence. Tractographies from bilateral Arcuate Fasciculus (AF), SLF (Superior Longitudinal Fasciculus), IFOF (Inferior Fronto-Occipital Fasciculus), and UF (Uncinate Fasciculus) were reconstructed, and fractional anisotropy (FA), axonal diffusivity (AD), and mean diffusivity (MD) were extracted. We used T-tests to compare the different scores, and multivariate regression analyses for each timepoint language score and recovery score with age, education, and lesion size as covariates. RESULTS: the amount of recovery was not different between early and chronic phases (t = -0.39, p = 0.7). At the early phase, prediction of subacute language status (CSsubacute) reached a R2 = 0.74, with baseline language assessment (CSacute) as the best predictor, with measures from left AF and lesion size as other significant predictors. However, early recovery was only partially predictable (R2 = 0.48), the best predictors being diffusion measures from the left AF and the left IFOF. At the chronic phase, prediction of chronic language status (CSchronic) reached a R2 = 0.76, with diffusion measures from left IFOF, left SLF and right SLF as the best predictors. Prediction of chronic recovery reached a R2 = 0.78, with diffusion measures from left IFOF, left SLF and right SLF and CSsubacute as best predictors. No moderation effect was found in the early recovery phase. CSsubacute showed a moderation effect in chronic phase on white matter measures (left IFOF and left SLF). CONCLUSION: similar trajectory of score changes was observed over the two recovery phases. Prediction in early stages depends greatly on the baseline language status, whereas prediction of chronic recovery seems related to anatomical factors but dependent on severity. These results highlight the need to study the different recovery phases to obtain a full picture of the role of these factors in post-stroke aphasia recovery.
Topic Areas: Disorders: Acquired,