Psychiatry

Internal medicine

Radiology

Engineering

Macroeconomics

Neuropsychology

Magnetic resonance imaging

Psychology

Economics

Neuroscience

Cognition

Stroke recovery

Depression (economics)

Rehabilitation

Aphasia

Arcuate fasciculus

Boston Naming Test

Stroke (engine)

Lesion

White matter

Proportional hazards model

Medicine

Mechanical engineering

Tractography

Physical medicine and rehabilitation

Annals of Neurology

Objective Many stroke patients show remarkable recovery of language after initial severe impairment, but it is difficult to predict which patients will show good recovery. We aimed to identify patient and lesion characteristics that together predict the best naming outcome in 4 studies. Methods We report 2 longitudinal studies that identified 2 variables at onset that were strongly associated with good recovery of naming (the most common residual deficit in aphasia) in the first 6 months after stroke: damage to left posterior superior temporal gyrus (pSTG) and/or superior longitudinal fasciculus/arcuate fasciculus (SLF/AF), and selective serotonin reuptake inhibitor (SSRI) use. We then tested these variables in 2 independent cohorts of chronic left hemisphere stroke patients, using chi‐square tests and multivariate logistic regression for dichotomous outcomes and t tests for continuous outcomes. Results Lesion load in left pSTG and SLF/AF was associated with poorer naming outcome. Preservation of these areas and use of SSRIs were associated with naming recovery, independent of lesion volume, time since stroke, and depression. Patients with damage to these critical areas showed better naming outcome if they took SSRIs for 3 months after stroke. Those with preservation of these critical areas achieved good recovery of naming regardless of SSRI use. Interpretation Lesion load in left pSTG and SLF/AF at onset predicts later naming performance. Although based on a small number of patients, our preliminary results suggest outcome might be modulated by SSRIs, but these associations need to be confirmed in a larger randomized controlled trial. Ann Neurol 2018;83:612–622

Predicting recovery in acute poststroke aphasia