LINGUISTIC COGNITIVE RESERVE MAY INFLUENCE POST-STROKE APHASIA RECOVERY AND REHABILITATION: THE "QUALICOME" STUDY

Aphasia is a disabling consequence for 30% of ischemic stroke patients. The wide variability of recovery among post-stroke aphasic patients despite similar baseline stroke severity and clinical characteristics could be in part explained by the involvement of a sort of ‘Linguistic Cognitive Reserve’. Therefore, an informant-based questionnaire named "QuALiCoMe”, was developed by an interdisciplinary work based on various branches of linguistics, cognitive psychology, educational research and neurology, with the aim of estimating the pre-morbid linguistic abilities in patients with post-stroke aphasia. Methods: Validation of QuALiCoMe questionnaire on 182 healthy subjects (HS) and 82 respective caregiver/cohabitant (CC). Pilot study: Frenchay Aphasia Screening Test (FAST) was administered within 48 hours after stroke onset (baseline) and after 6-month follow-up, and QuALiCoMe was administered to aphasic patient’s CC. As explanatory variable for aphasia recovery, we used delta-FAST score (baseline – follow-up). Results: QuALiCoMe demonstrated a good informativeness and reliability (high concordance between HS and CC), applicability, internal consistency and external validity. Sixty stroke patients (29 female, mean NIHSS 14.30+-7.11, mean FAST 10.0+-9.61) fulfilled inclusion criteria. In a multivariate analysis, corrected for age, baseline-NIHSS, education, speech and language therapy, and thrombolysis, QuALiCoMe score showed a trend for significance in predicting recovery from aphasia (p=0.062). Conclusions: This result represents the first clinical evidence of the role of Linguistic Cognitive Reserve as an outcome predictor in post-stroke aphasia. QuALiCoMe demonstrates a valid and promsing tool to estimate pre-morbid linguistic reserve in post-stroke aphasic patients. Its potential utility needs to be confirmed in larger cohorts of patients