Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2022; 12(3): 450-469
Published online Mar 19, 2022. doi: 10.5498/wjp.v12.i3.450
Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia
Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Sergio E Starkstein, Ricardo E Jorge, Jessica Aloisi, Marcelo L Berthier, Guadalupe Dávila
Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Guadalupe Dávila, Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Jessica Aloisi, Marcelo L Berthier, Guadalupe Dávila, Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
Lisa Edelkraut, Diana López-Barroso, María José Torres-Prioris, Marcelo L Berthier, Guadalupe Dávila, 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
Author contributions: Dávila G, Berthier ML, Edelkraut L, López-Barroso D and Torres-Prioris MJ were involved in the acquisition of the original data; Dávila G, Berthier ML and Edelkraut L conceived and designed the manuscript; Dávila G, Berthier ML and Edelkraut L reviewed the literature; López-Barroso D, Torres-Prioris MJ, Aloisi J, Starkstein SE and Jorge RE analyzed the language and neuropsychiatric original data; López-Barroso D and Torres-Prioris MJ analyzed neuroimaging data and created the figure; Dávila G, Berthier ML, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE and Edelkraut L wrote the manuscript; all authors gave final approval of the current version of the article to be published.
Supported by Ministerio de Economía, Industria y Competitividad, Instituto de Salud Carlos III, Madrid, Spain, No. PI16/01514.
Institutional review board statement: The study was approved by the Ethical Research of Drugs Committee Provincial of Malaga and the Spanish Drug and Healthcare Products Agency, Spain (Approval No. FIM-DON-2017-01).
Informed consent statement: All study participants, and their legal guardians, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guadalupe Dávila, PhD, Associate Professor, Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Campus de Teatinos, s/n, Malaga 29071, Spain. mgdavila@uma.es
Received: June 30, 2021
Peer-review started: June 30, 2021
First decision: July 28, 2021
Revised: August 13, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: March 19, 2022
ARTICLE HIGHLIGHTS
Research background

Aphasia due to stroke is associated with worse outcomes than in non-aphasic stroke patients. Worse outcomes in post-stroke aphasia often result from the co-occurrence of neuropsychiatric symptoms (NPS) and disorders.

Research motivation

Persons with aphasia (PWA) are frequently excluded from studies on stroke related NPS because of their language and communication deficits. The exclusion of PWA and stroke hinders obtaining relevant information on prevalence, diagnosis, associated deficits (cognitive impairment, functional disability), assessment, neurobiological mechanisms, and treatment of NPS in this population.

Research objectives

We report a two-part study consisting of a literature review on NPS (study 1) and an observational study on NPS in chronic post-stroke aphasia (study 2).

Research methods

In study 1, we reviewed the databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. In study 2, we evaluated aphasic deficits, activities of daily living and a spectrum of NPS and disorders using well-validated scales in 20 persons with chronic mild-to-moderate post-stroke aphasia associated with left hemisphere strokes. NPS were evaluated with the 12 symptom domains of the Neuropsychiatric Inventory and with three domain-specific scales for depression, anxiety, and apathy.

Research results

The literature review performed in study 1 revealed a spectrum of NPS in PSA including depression, anxiety, apathy, agitation/aggression, psychosis, and hypomania/mania. This broad spectrum of NPS was also found in observational study 2, since all but one PWA has more than one NPS (median number of NPS: 5, range: 1-8).

Research conclusions

A spectrum of NPS is highly prevalent in chronic PSA. Therefore, future comprehensive evaluations of NPS using multidomain and domain-specific scales will enable a better characterization of this broad spectrum favoring the design and implementation of adequate therapies.

Research perspectives

Since the spectrum of NPS in PWA and stroke is an underexplored research area, there are still many pending issues to be addressed. Essential areas of inquiry include knowing the incidence in acute and chronic stroke periods, risk factors (family and personal history of psychiatric disorders), clinical features, assessment instruments devised to test language and communication impaired patients, impact on quality of life, neurobiological correlates, short- and long-term outcomes, and response to psychological and biological interventions.