Premorbid language function: a prognostic factor for functional outcome in aphasia?

ABSTRACT

Background

Stroke lesion size and location are understood to be more accurate predictors of recovery from aphasia than demographic variables such as age, education, or socioeconomic status.

Aims

We hypothesise that markedly high premorbid language function can influence functional recovery from aphasia.

Methods & Procedures

This case study reports the recovery of a 64-year-old right-handed male, with large left posterior cerebral artery territory infarct involving the thalamus, occipital lobe and posteromedial temporal lobe. The report is informed by retrospective review of clinical notes, language assessment, and interviews with the participant and his family. Premorbidly, he had acquired fluency in five additional languages in early adulthood, followed by a career in senior roles within corporate communications.

Outcomes & Results

Following severe expressive aphasia in the acute period, the subacute and chronic phases were characterised by residual mild anomia and cognitive communication difficulties apparent on formal assessment, yet masked in functional contexts through compensatory strategies and preservation of an authoritative premorbid communication style.

Conclusions

The current report provides single-case evidence that individuals with markedly high premorbid metalinguistic skills may, in functional contexts, be able to compensate for expressive aphasic deficits and preserve their communicative competence. The discrepancy between the participant’s performance on formal versus informal language assessment underscores the necessity for both perspectives for accurate diagnosis of aphasia. Consideration of premorbid language function can usefully guide clinical decision-making about intervention for individuals with aphasia.

KEYWORDS:

• Aphasia
• stroke
• predictors of recovery
• premorbid language function
• metalinguistic awareness
• functional outcome

Acknowledgments

Thank you to AB, his family, and treating clinicians, for sharing their experiences and reviewing earlier drafts of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Pseudonym initials