Aphasia after Stroke: the SPEAK Study

Aphasia is a disorder of the production and comprehension of written and spoken language as a result of acquired brain damage. This damage is located in the dominant hemisphere, which is the left hemisphere for nearly all the right-handers and for about 70% of the left-handers. The evolvement of aphasia is usually rapid if caused by a head injury or stroke, but can also evolve slowly as a consequence of a brain tumor, infection, or dementia. The most common cause of aphasia is a stroke. The number of people living with aphasia in the Netherlands is approximately 30,000. Every year, about 9,600 new cases of aphasia after stroke occur. The first and main question of patients and their family in the acute stage of stroke is whether the symptoms will decrease, and the patient will ever be able to speak and comprehend as before the stroke again. The severity of aphasia after stroke ranges from having difficulties with infrequent words, complex sentences and texts, to being completely unable to speak, comprehend, read, or write. The impact on one’s ability to communicate is devastating, not only for the patients with aphasia but also for their family and friends. Patients with aphasia are no longer sufficiently capable of expressing and clarifying their thoughts, wishes, and needs, which puts an aphasic patient at a higher risk for depression. Ninety percent of persons with aphasia feel socially isolated. Stroke patients with aphasia also have a higher mortality rate and a worse rehabilitation outcome than stroke patients without aphasia. In this thesis, I address the natural course and prognosis of aphasia after stroke in a large Dutch multicenter prospective study, the Sequential Prognostic Evaluation of Aphasia after stroKe study, known as the SPEAK study