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
Processing time: 260 Days and 19.5 Hours
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.

Keywords: Aphasia; Stroke; Neuropsychiatric symptoms; Anxiety; Apathy; Depression

Core Tip: The literature on neuropsychiatric disorders in persons with aphasia (PWA) is limited, given that this population is usually excluded from neuropsychiatric evaluations. This article provides a state-of-art analysis on the prevalence, nature, pathophysiology, assessment, and treatment of neuropsychiatric symptoms (NPS) in PWA. We also report findings from a proof-of-concept observational study that included 20 PWA after chronic left hemisphere lesions which identified a spectrum of NPS, primarily depression, irritability, agitation, anxiety, and apathy.