Multifactorial Analysis of Aphasia Severity and Language Recovery Following Acute Ischemic Stroke: A Cross-Sectional and Longitudinal Observational Study

Background Post-stroke aphasia (PSA) is a serious complication of cerebral infarction and may substantially affect patients' communication and quality of life. Early identification of factors associated with aphasia severity and language recovery may facilitate timely clinical management. This study aimed to investigate the severity and specific language dimensions of acute-phase PSA and to identify factors associated with spontaneous language recovery. Methods This observational study employed a cross-sectional analysis combined with longitudinal cohort follow-up to examine 102 patients with acute-phase PSA treated at the First Affiliated Hospital of Soochow University from October 2020 to March 2026. Aphasia was assessed using the Western Aphasia Battery (WAB). Baseline clinical data were collected, including sex, age, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores, infarct location, and reperfusion therapy (thrombolysis and/or thrombectomy). The study analyzed factors influencing aphasia severity, various dimensions of language function, and spontaneous language recovery. Results In the cross-sectional study, we found that reperfusion therapy, including thrombolysis and/or thrombectomy, was associated with lower odds of severe aphasia (P = 0.028), while higher NIHSS scores (P = 0.027) and infarct location involving frontal lobe (P = 0.015) were associated with severe aphasia. Further analysis of individual language domains showed that higher NIHSS scores were associated with lower scores in information content (P = 0.001), fluency (P < 0.001), auditory comprehension (P < 0.001), repetition (P = 0.001), and naming (P = 0.011); reperfusion therapy was associated with better naming performance (P = 0.018); frontal lobe involvement was associated with lower information content scores (P = 0.043) and naming scores (P = 0.029); and temporal lobe involvement was associated with lower auditory comprehension scores (P = 0.046). In the longitudinal cohort follow-up study, we found that higher diastolic blood pressure (DBP) at onset (P = 0.029) and a history of diabetes (P = 0.034) were associated with lower recovery ratio. Conclusions The severity and recovery of acute-phase PSA may be influenced by multiple factors, including overall stroke severity, reperfusion therapy, infarct location, and underlying comorbidities.