Pedersen Palle Møller, Vinter Kirsten, Olsen Tom Skyhøj
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Cerebrovasc Dis. 2004;17(1):35-43. doi: 10.1159/000073896. Epub 2003 Oct 3.
To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke.
270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1 year after stroke.
The frequencies of the different types of aphasia in acute first-ever stroke were: global 32%, Broca's 12%, isolation 2%, transcortical motor 2%, Wernicke's 16%, transcortical sensory 7%, conduction 5% and anomic 25%. These figures are not substantially different from what has been found in previous studies of more or less selected populations. The type of aphasia always changed to a less severe form during the first year. Nonfluent aphasia could evolve into fluent aphasia (e.g., global to Wernicke's and Broca's to anomic), whereas a fluent aphasia never evolved into a nonfluent aphasia. One year after stroke, the following frequencies were found: global 7%, Broca's 13%, isolation 0%, transcortical motor 1%, Wernicke's 5%, transcortical sensory 0%, conduction 6% and anomic 29%. The distribution of aphasia types in acute and chronic aphasia is, thus, quite different. The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasia. Thus, a scoring of general stroke severity helps to improve the accuracy of the prognosis for the language function. One year after stroke, fluent aphasics were older than nonfluent aphasics, whereas such a difference was not found in the acute phase.
确定未经筛选的急性卒中患者失语症的类型、严重程度及演变情况，并评估卒中后1年语言功能转归的潜在预测因素。
从丹麦哥本哈根的三家医院连续纳入270例急性卒中失语患者（203例为首次卒中患者），采用西方失语成套测验进行评估。卒中后1年重复评估。
急性首次卒中患者中不同类型失语症的发生率为：完全性失语32%，布罗卡失语12%，孤立性失语2%，经皮质运动性失语2%，韦尼克失语16%，经皮质感觉性失语7%，传导性失语5%，命名性失语25%。这些数据与既往对或多或少经过筛选的人群的研究结果并无显著差异。在第一年中，失语症类型总是转变为较轻的形式。非流利性失语可演变为流利性失语（如完全性失语转变为韦尼克失语，布罗卡失语转变为命名性失语），而流利性失语从不演变为非流利性失语。卒中后1年，各类型失语症的发生率如下：完全性失语7%，布罗卡失语13%，孤立性失语0%，经皮质运动性失语1%，韦尼克失语5%，经皮质感觉性失语0%，传导性失语6%，命名性失语29%。因此，急性和慢性失语症的类型分布差异很大。失语症的初始严重程度和初始卒中严重程度（通过斯堪的纳维亚卒中量表评估）可预测语言功能转归，但年龄、性别或失语症类型不能预测。因此，对一般卒中严重程度进行评分有助于提高语言功能预后的准确性。卒中后1年，流利性失语患者比非流利性失语患者年龄更大，而在急性期未发现这种差异。
