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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence

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Abstract

This review considers the role of drug therapy in the treatment of post-stroke aphasia, the evidence for efficacy of different agents, and the theory-based explanations of drug-related benefits for aphasia rehabilitation. Pharmacological interventions modulating stroke-induced disruption of diverse neurotransmitters may improve language and communication deficits in aphasic patients through facilitation of brain plasticity and long-term potentiation. However, benefits are not evident for all compounds and refinement in clinical trial designs is required. Some pharmacological trials have failed because drug treatment was not combined with speech-language therapy, while other trials combining drugs with intensive model-driven therapies also failed probably because of short-trial duration, inadequate sample selection, or lack of drug action. Preliminary data reveals that combining neuroscience-based intensive aphasia techniques (constraint-induced aphasia therapy) and drugs acting on cholinergic and glutamatergic neurotransmitter systems are associated with better outcomes than other strategies and long-term maintenance of benefits. Although further studies are needed, current state of the evidence suggests that drug therapy may play a key role in the treatment of post-stroke aphasia.

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Abbreviations

CAL:

Communicative Activity Log

CIAT:

Constraint-induced aphasia therapy

CILT:

Constraint-induced language therapy

CPAP:

Continuous positive airway pressure

fMRI:

Functional magnetic resonance imaging

NMDA:

N-methyl-D-aspartate

PSA:

Post-stroke aphasia

WAB:

Western Aphasia Battery

WAB-AQ:

Western Aphasia Battery-Aphasia Quotient

RTC:

Randomized Controlled Trial

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Acknowledgements

This research was funded in part by the Ministerio de Educación y Ciencia, Spain (grant SEJ2007-67,793) (MLB) and the Medical Research Council, UK (grants U1055.04.003.00001.01 and MC_US_A060_0034) (FP). We thank Alejandro Nabrozidis and Seán Froudist Walsh for neuroimaging analysis and Macarena Travesí for drawing Fig. 2. Special thanks to Professor Ronald M. Lazar for his insightful comments on the final version of the draft.

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  1. Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, C/Marques de Beccaria 3, 29010, Malaga, Spain

    Marcelo L. Berthier, Guadalupe Dávila & Natalia García Casares

  2. Cognition and Brain Science Unit, Medical Research Council, Cambridge, UK

    Friedemann Pulvermüller

  3. Area of Psychobiology, Faculty of Psychology, University of Malaga, Malaga, Spain

    Guadalupe Dávila

  4. Unit of Molecular Imaging, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain

    Antonio Gutiérrez

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  1. Marcelo L. Berthier
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Correspondence to Marcelo L. Berthier.

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Berthier, M.L., Pulvermüller, F., Dávila, G. et al. Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 21, 302–317 (2011). https://doi.org/10.1007/s11065-011-9177-7

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