The Efficacy and Safety of Pharmacological Treatments for Post-stroke Aphasia

Abstract

Current evidence suggests that drugs, such as donepezil and memantine, can improve the prognosis of PSA. Donepezil has a significant effect in improving the ability of auditory comprehension, naming, repetition and oral expression. Memantine has a significant effect in improving the ability of naming, spontaneous speech and repetition. Bromocriptine showed no significant improvements in the treatment of aphasia after stroke. Data regarding galantamine, amphetamine and levodopa in the treatment of aphasia after stroke are limited and inconclusive.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

“…There are few, well-estimated drugs in clinical trials. Those with the most significant data that suggest improvement in the prognosis of PSA are donepezil and memantine [65]. Donepezil, which reversibly inhibits the cholinesterases and, consequently, increases acetylcholine concentrations, is widely known for improving the cognitive func-tioning in Alzheimer's disease patients.…”

“…On the other hand, Woodhead et al, in a double-blind, placebo-controlled, crossover study, found that donepezil was not beneficial in improving PSA; it in fact had a negative influence on speech outcome [67]. Considering the statements by Zhang-that donepezil has an effect on improving the ability of oral expression, auditory comprehension, naming, and repetition-it should be considered a potential therapy in following studies [65].…”

“…There is also solid evidence of memantine efficacy in PSA treatment. The most significant improvement was observed in language modalities as repetition, naming, and spontaneous speech [65]. Memantine is a non-competitive NMDA-receptor antagonist, and like donepezil, it is approved for Alzheimer's disease.…”

“…Leemann et al also observed no advantage in levodopa versus the placebo in the subacute period after a stroke, when it was combined with intensive computer therapy [80]. Bromocriptine also appears to raise vain hopes, as there are several studies denying improvement in the treatment of aphasia after a stroke [65,[81][82][83]. Nevertheless, in a study by Bragoni, a high dose of bromocriptine (up to 30 mg) was applied to 11 chronic non-fluent aphasics and a statistically significant benefit on reading comprehension was sustained, after a 60-day washout of the drug [84].…”

Pharmacotherapy of Traumatic Childhood Aphasia: Beneficial Effects of Donepezil Alone and Combined With Intensive Naming Therapy

“…The well-established strategy of using cognitive-enhancing drugs alone or in combination with speech-language therapy in adults with post-stroke aphasia (see Berthier and Pulvermuller, 2011 ; Berthier et al, 2011 ) has not been explored in CA. In adult post-stroke aphasia, several clinical trials have shown that a combined intervention with the cholinesterase inhibitor donepezil (DP) and speech-language therapy significantly improves language skills and communication (see Berthier et al, 2011 ; Zhang et al, 2018 ). The rationale for using cholinergic compounds to treat aphasia arises from the fact that brain lesions disrupt the cholinergic transmission from the basal forebrain and brainstem nuclei to the thalamus, basal ganglia, subcortical white matter, and cerebral cortex, including the left perisylvian language core ( Simić et al, 1999 ; Mesulam, 2004 ; Mena-Segovia and Bolam, 2017 ; Markello et al, 2018 ).…”