Impact of brain frailty on language recovery in patients with acute post-stroke aphasia: a post-hoc analysis of the LEXI randomized controlled trial

Description

Wischmann and co-authors reanalyze a stroke trial in this 2026 post-hoc study, asking whether a worn-looking brain recovers language more slowly after stroke-related aphasia. The parent LEXI trial randomized patients with acute aphasia to tablet-assisted or standard speech therapy. This analysis scored each participant's baseline brain scan for frailty. The score, from 0 to 3, combined shrinkage, white matter damage, small scars, and old strokes.

Fifty-six patients, median age 75 years, entered the analysis, and 23.2 percent carried high frailty scores of 2 to 3 in the blinded ratings. Higher frailty independently predicted worse language scores at ninety days, with white matter damage doing most of the harm. More therapy hours helped regardless, and frailty did not measurably change therapy's benefit. The authors suggest routine white matter grading could sharpen prognosis and trial design.

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Source: https://europepmc.org/article/MED/PMC13425768