Is Aphasia Treatment Beneficial for the Elderly? A Review of Recent Evidence

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STROKE REHABILITATION (P RAGHAVAN, SECTION EDITOR)

Is Aphasia Treatment Beneficial for the Elderly? A Review of Recent Evidence Rachel Fabian 1 & Lisa Bunker 1 & Argye E. Hillis 1,2,3 Accepted: 3 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose of Review We review recent literature regarding aphasia therapy in the elderly. Relevant articles from the last 5 years were identified to determine whether or not there is evidence to support that various therapeutic approaches can have a positive effect on post-stroke aphasia in the elderly. Recent Findings There were no studies examining the effects of aphasia therapy specifically in the elderly within the timeframe searched. Therefore, we briefly summarize findings from 50 relevant studies that included large proportions of participants with post-stroke aphasia above the age of 65. A variety of behavioral and neuromodulation therapies are reported. Summary We found ample evidence suggesting that a variety of behavioral and neuromodulatory therapeutic approaches can benefit elderly individuals with post-stroke aphasia. Keywords Stroke . Aphasia . Elderly . Rehabilitation . Treatment . Therapy

Introduction Stroke is a leading cause of long-term disability [1], disproportionately affecting older adults; 70–77% of stroke patients are over 65 [2, 3], and about 17% are over 85 years old [4]. Very elderly patients have higher disability and receive less evidence-based care [5, 6]. The greatest expected increase in stroke prevalence is among those over age 75 [7]. Approximately 20–30% of strokes result in aphasia (neurogenic language impairment) [8, 9], and about 19% of stroke survivors over 65 continue to have aphasia at 6 months poststroke [10]. Aphasia can manifest as difficulty with comprehension, production, or both, in any modality (i.e., spoken language, reading/writing, or gesture). An individual’s Rachel Fabian and Lisa Bunker contributed equally to this work. This article is part of the Topical Collection on Stroke Rehabilitation * Argye E. Hillis [email protected] 1

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA

2

Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA

3

Cognitive Science, Johns Hopkins University, Baltimore, USA

independence can be significantly impacted by aphasia [11]. Communication is an essential part of human connection and is critical for maximizing and maintaining quality of life. Thus, remediation of aphasia after stroke aims to reduce language impairment and/or increase functional communication, participation, and quality of life and reduce care burden. Stroke survivors with aphasia are typically older than those without aphasia [9, 12], so it is particularly important to understand the role of aphasia treatment in the older population. In this article, we review the current literature regarding aphasia therapy in the elderly. Relevant publications within the past 5 years were identified by sea