Pharmacotherapy for post-stroke aphasia: what are the options?

ABSTRACT

Introduction

Aphasia is a common, long-lasting aftermath of stroke lesions. There is an increased integration of pharmacotherapy as an adjunctive strategy to speech and language therapy (SLT) for post-stroke aphasia (PSA). Nevertheless, more research in pharmacotherapy for acute and chronic PSA is necessary, including the election of drugs that target different neurotransmitter systems and deficits in specific language domains.

Areas covered

This article updates the role of pharmacotherapy for PSA, focusing the spotlight on some already investigated drugs and candidate agents deserving of future research. Refining the precision of drug election would require using multimodal biomarkers to develop personalized treatment approaches. There is a solid need to devise feasible randomized controlled trials adapted to the particularities of the PSA population. The emergent role of multimodal interventions combining one or two drugs with noninvasive brain stimulation to augment SLT is emphasized.

Expert opinion

Pharmacotherapy can improve language deficits not fully alleviated by SLT. In addition, the ‘drug-only’ approach can also be adopted when administering SLT is not possible. The primary goal of pharmacotherapy is reducing the overall aphasia severity, although targeting language-specific deficits (i.e. naming, spoken output) also contributes to improving functional communication. Unfortunately, there is still little information for recommending a drug for specific language deficits.

KEYWORDS:

• aphasia
• neuroplasticity
• neurotransmitters
• noninvasive brain stimulation
• pharmacotherapy
• speech-language therapy
• stroke

Article highlights

• Post-stroke aphasia is a highly prevalent disorder impacting many aspects of the personal life.

• Recent advances in the provision and response to speech-language therapy in post-stroke aphasia can be further heightened with the aid of pharmacotherapy.

• Although the safety and efficacy of agents targeting the glutamatergic, cholinergic, dopaminergic, and serotonergic systems have been studied in post-stroke aphasia, further research is strongly needed.

• Not all language deficits respond to the same pharmacological agent. Therefore, selecting the appropriate drug for treating a specific language deficit requires more research.

• Future research should also examine combining one or two drugs with model-oriented language therapies and noninvasive brain stimulation.

Abbreviations

PSA	=	Post-stroke aphasia
SLT	=	Speech-language therapy
RCT	=	Randomised controlled trial
PWA	=	Persons with aphasia
AD	=	Alzheimer’s disease
SSRI	=	Selective serotonin reuptake inhibitors
NIBS	=	Non-invasive brain stimulation

Declaration of interest

M L Berthier was funded with an independent research grant by Pfizer Spain and Eisai for the referenced study by Berthier et al. (2023). The principal investigator designed, conducted, and controlled the study, and Pfizer Spain provided donepezil. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

M L Berthier has been supported by the European Social Fund (FEDER: EQC2018-004803-P). G Dávila has been supported by the Junta de Andalucía, Spain (Grant: P20_00501).