Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke

Abstract

Background White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. Objective To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. Methods Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. Results The presence of severe WMH explained an additional 18% and 25% variance in early subacute ( t = −3.00, p = .004) and chronic ( t = −3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. Conclusions Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.

The volume and the distribution of premorbid white matter hyperintensities: Impact on post‐stroke aphasia

“…Fewer studies ( N = 5) have examined the relationship between WMH burden and aphasia outcomes after stroke. Wright et al ( 2018 ), Johnson et al ( 2022 ), and Vadinova et al ( 2023 ) identified a negative association between the degree of WMH and aphasia outcomes at different stages of recovery. Varkanitsa et al ( 2020 ) also found that a greater amount of WMH is negatively associated with response to language therapy, and a study by Basilakos et al ( 2019 ) also showed that a greater amount of WMH predicts a more rapid decline in language skills in chronic aphasia.…”