Association between aphasia and risk of dementia after stroke


      • Aphasia was associated with an increased risk of developing vascular dementia in patients with first-episode stroke but not dementia of non-vascular type.
      • The association between aphasia and risk of vascular dementia did not differ by age and sex.
      • The strength of the association between aphasia and vascular dementia was similar among patients with ischemic and hemorrhagic stroke.


      Background and purpose

      Although findings from published studies suggest post-stroke aphasia is associated with an increased risk of dementia, few studies have evaluated its association in a nationally representative cohort with long-term follow-up. No studies have reported data by type of stroke. Therefore, we examined the association between post-stroke aphasia and the risk of developing dementia.


      Using claims data from Taiwan's universal health insurance program, a cohort of patients ≥18 years old with an initial hospitalization for stroke in 2002–2005 were identified and followed up until December 31, 2016. Patients with newly diagnosed aphasia during stroke hospitalization or within 6 months of discharge were defined as the aphasia group. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing overall, vascular, and non-vascular dementia in patients with and without post-stroke aphasia.


      During a median follow-up period of 7.9 and 8.6 years for the aphasia (n=17063) and non-aphasia groups (n=105940), respectively, overall dementia incidence was similar, whereas vascular dementia incidence was higher in the aphasia group (7.52 vs. 5.52 per 1000 person-years). The adjusted HRs (95% confidence intervals) were 1.11 (1.06–1.17), 1.42 (1.31–1.53), and 0.94 (0.88–1.01) for overall, vascular, and non-vascular dementia, respectively. The association between aphasia and the risk of vascular dementia did not differ by stroke type (P for interaction=0.43). The analysis of 16856 propensity score-matched pairs revealed similar results.


      Patients with post-stroke aphasia have an increased risk of developing vascular dementia irrespective of the type of stroke.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mijajlović M.D.
        • et al.
        Post-stroke dementia - a comprehensive review.
        BMC Med. 2017; 15: 11
        • Plowman E.
        • Hentz B.
        • Ellis Jr., C.
        Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors.
        J Eval Clin Pract. 2012; 18: 689-694
        • Censori B.
        • et al.
        Dementia after first stroke.
        Stroke. 1996; 27: 1205-1210
        • Desmond D.W.
        • et al.
        Frequency and clinical determinants of dementia after ischemic stroke.
        Neurology. 2000; 54: 1124-1131
        • Inzitari D.
        • et al.
        Incidence and determinants of poststroke dementia as defined by an informant interview method in a hospital-based stroke registry.
        Stroke. 1998; 29: 2087-2093
        • Treves T.A.
        • et al.
        Risk of dementia after a first-ever ischemic stroke: A 3-year longitudinal study.
        Cerebrovas Dis. 1997; 7: 48-52
        • Zhou D.H.
        • et al.
        Study on frequency and predictors of dementia after ischemic stroke: the Chongqing stroke study.
        J Neurol. 2004; 251: 421-427
        • Pohjasvaara T.
        • et al.
        Clinical determinants of poststroke dementia.
        Stroke. 1998; 29: 75-81
        • Pendlebury S.T.
        • Rothwell P.M.
        Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study.
        Lancet Neurol. 2019; 18: 248-258
        • Hsing A.W.
        • Ioannidis J.P.
        Nationwide population science: lessons from the Taiwan National Health Insurance Research Database.
        JAMA Intern Med. 2015; 175: 1527-1529
        • Brady M.C.
        • et al.
        Speech and language therapy for aphasia following stroke.
        Cochrane Database Syst Rev. 2016; (2016)Cd000425
        • Gerstenecker A.
        • Lazar R.M.
        Language recovery following stroke.
        Clin Neuropsychol. 2019; 33: 928-947
        • Liu C.C.
        • et al.
        Gender and age differences and the trend in the incidence and prevalence of dementia and Alzheimer's disease in Taiwan: A 7-year National Population-Based Study.
        Biomed Res Int. 2019; (2019)5378540
        • Fujiyoshi A.
        • et al.
        Validity of death certificate and hospital discharge ICD codes for dementia diagnosis: the multi-ethnic study of atherosclerosis.
        Alzheimer Dis Assoc Disord. 2017; 31: 168-172
        • Sung S.F.
        • et al.
        Developing a stroke severity index based on administrative data was feasible using data mining techniques.
        J Clin Epidemiol. 2015; 68: 1292-1300
        • Austin P.C.
        A comparison of 12 algorithms for matching on the propensity score.
        Stat Med. 2014; 33: 1057-1069
        • Austin P.C.
        The performance of different propensity score methods for estimating marginal hazard ratios.
        Stat Med. 2013; 32: 2837-2849
        • Corraini P.
        • et al.
        Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke.
        Stroke. 2017; 48: 180-186
        • Staekenborg S.S.
        • et al.
        Neurological signs in relation to type of cerebrovascular disease in vascular dementia.
        Stroke. 2008; 39: 317-322
        • Ochfeld E.
        • et al.
        Ischemia in broca area is associated with broca aphasia more reliably in acute than in chronic stroke.
        Stroke. 2010; 41: 325-330
        • Venkat P.
        • Chopp M.
        • Chen J.
        Models and mechanisms of vascular dementia.
        Exp Neurol. 2015; 272: 97-108
        • Duncombe J.
        • et al.
        Chronic cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia. Closing the translational gap between rodent models and human vascular cognitive impairment and dementia.
        Clin Sci (Lond). 2017; 131: 2451-2468
        • Bouhrara M.
        • et al.
        Evidence of demyelination in mild cognitive impairment and dementia using a direct and specific magnetic resonance imaging measure of myelin content.
        Alzheimers Dement. 2018; 14: 998-1004
        • Basilakos A.
        • et al.
        Leukoaraiosis is associated with a decline in language abilities in chronic aphasia.
        Neurorehabil Neural Repair. 2019; 33: 718-729
        • Hase Y.
        • et al.
        White matter degeneration in vascular and other ageing-related dementias.
        J Neurochem. 2018; 144: 617-633
        • Shehata G.A.
        • et al.
        The effect of aphasia upon personality traits, depression and anxiety among stroke patients.
        J Affect Disord IF3. 2015; 172 (432): 312-314
        • Mitchell A.J.
        • et al.
        Prevalence and predictors of post-stroke mood disorders: a meta-analysis and meta-regression of depression, anxiety and adjustment disorder.
        Gen Hosp Psychiatry. 2017; 47: 48-60
        • Lin W.C.
        • et al.
        Depression and the risk of vascular dementia: a population-based retrospective cohort study.
        Int J Geriatr Psychiatry. 2017; 32: 556-563
        • Diniz B.S.
        • et al.
        Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies.
        Br J Psychiatry. 2013; 202: 329-335
        • Grönberg A.
        • et al.
        Incidence of aphasia in ischemic stroke.
        Neuroepidemiology. 2022;
        • Dickey L.
        • et al.
        Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.
        Arch Phys Med Rehabil. 2010; 91: 196-202
        • Flowers H.L.
        • et al.
        Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2016; 97 (e8): 2188-2201
        • Solomon A.
        • et al.
        Validity of dementia and Alzheimer's disease diagnoses in Finnish national registers.
        Alzheimers Dement. 2014; 10: 303-309