Prognostic Implications of Poststroke Aphasia: A Multicenter Cohort Study in Tertiary Hospitals

BACKGROUND: Poststroke aphasia (PSA) may adversely affect recovery after ischemic stroke, but its association with functional decline and death remains unclear. We investigated the prognostic impact of PSA in survivors of stroke. METHODS: This international observational cohort study included patients admitted to tertiary hospitals in Japan and South Korea within 7 days of ischemic stroke between 2011 and 2023. PSA was assessed using the language subscore of the National Institutes of Health Stroke Scale at discharge. Outcomes were worsening of the modified Rankin Scale score by ≥1 point and all-cause death at 3 months in both cohorts and at 1 year in the Japanese cohort, using discharge as the index time point. Associations between PSA severity and outcomes were examined using multivariable models. RESULTS: Among 9868 patients, 1651 (16.7%) had PSA, which independently predicted 3-month worsening modified Rankin Scale score in Japan (odds ratio [OR], 2.52 [95% CI, 2.08-3.04]) and South Korea (OR, 1.68 [95% CI, 1.31-2.15]). PSA was associated with 3-month death in Japan (OR, 3.47 [95% CI, 2.38-5.07]), while only global PSA predicted 3-month death in South Korea (OR, 2.11 [95% CI, 1.28-3.47]). In Japan, PSA remained associated with 1-year worsening modified Rankin Scale score (OR, 1.84 [95% CI, 1.49-2.26]) and death (OR, 2.63 [95% CI, 2.03-3.40]). CONCLUSIONS: PSA is independently associated with functional decline and death after ischemic stroke. Early recognition and targeted management of PSA may improve poststroke outcomes.