Escitalopram & Language Intervention for Subacute Aphasia (ELISA)

In this project, we will investigate the effects of a selective serotonin reuptake inhibitor (SSRI), escitalopram, on augmenting language therapy’s effectiveness in individuals with aphasia within the first three months after stroke. Escitalopram is a well-tolerated medication approved for the treatment of depression in the United States. It is our hope that due to the way in which it alters brain function, it may also improve aphasia recovery, even among those who do not have post-stroke depression.

Questions this project will address include:

• Does escitalopram have an effect on aphasia recovery after stroke that is independent of its effect on depression?
• Do patients whose stroke involves brain regions particularly important to language – the left superior temporal gyrus or arcuate fasciculus – experience a greater benefit from escitalopram on their language recovery than those whose stroke involves other brain regions?
• Is improvement in aphasia associated with better functional connectivity within the language network if the person is treated with escitalopram, when controlling for whether they have depression?
• Is improvement in mood associated with changes in functional connectivity of the frontolimbic circuits if the person is treated with escitalopram, when controlling for aphasia recovery?
• Do people with an uncommon gene associated with lower production of brain derived neurotrophic factor show a reduced response to aphasia treatment and smaller changes in connectivity in the language network than those without this previously identified stroke recovery risk factor?

Participants will take part in a randomized, double-blind, placebo-controlled trial.  Participants will receive escitalopram or placebo for 90 days and receive 15 sessions of speech therapy near the end of the drug period.  Participants will be evaluated one, five and twenty weeks after therapy ends. The primary outcome variable is change in accuracy of picture naming before and after treatment.  Researchers will also analyze brain MRI scans to study the effect of escitalopram.

We will use this information to help us understand factors that influence recovery in the acute-subacute phase after stroke, and to optimize post stroke speech and language therapy.

PICTURE IT: Producing Increasingly Complex Themes Using Right-hemisphere Engagement (PICTURE) Implemented with Telemedicine

This is a study designed to determine which of two behavioral language interventions for people with aphasia (language impairment) due to stroke, is more effective in improving language early after stroke.

 The two interventions are:

• A novel treatment, PICTURE IT (Producing Increasingly Complex Themes Using Right-hemisphere Engagement Implemented with Telemedicine) which focuses on engaging the right hemisphere of the brain
• An established computer delivered lexical (“naming”) intervention (CoDeLT) used previously in C-STAR trials

 Participants receive both interventions (15 sessions of each), separated by one week in a cross-over design. The sessions are provided remotely over Zoom, with a speech-language pathologist supervising, with randomized order of interventions and blinded assessors. The participants receive evaluations before, between, and after each block of therapy sessions. This study is currently providing preliminary data for a future large-scale trial.