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Wang S, Rao B, Miao G, Zhang X, Zheng J, Lin J, Yu M, Zhou X, Xu H, Liao W. The resting-state topological organization damage of language-related brain regions in post-stroke cognitive impairment. Brain Imaging Behav 2022; 16:2608-2617. [PMID: 36136202 DOI: 10.1007/s11682-022-00716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/27/2022]
Abstract
The topology of brain networks is the foundation of cognition. We hypothesized that stroke damaged topological organization resulting in cognitive impairment. The aim was to explore the damage pattern of the resting-state topology in post-stroke cognitive impairment (PSCI) patients. Thirty-seven patients with PSCI and thirty-seven gender- and age-matched healthy controls (HC) were recruited. The structural and functional data were collected from all subjects. The degree centrality (DC), betweenness centrality (BC), and global properties of brain networks were analyzed between groups. Spearman correlation analysis was performed between topological properties that changed significantly and clinical cognitive function scale scores. Compared with HC, the PSCI patients had significantly reduced DC in language-related brain regions and significantly higher DC in the right frontal lobe, hippocampus, and paracentral lobule. The decreased BC was located in the left caudate, thalamus, temporal, and frontal lobes. The increased BC was detected in the left cuneus and right precuneus. In addition, PSCI exhibited increased characteristic path length and decreased small-worldness. PSCI patients had impaired functional topology of the language-related brain regions, mainly in the left hemisphere. The enhanced processing and relaying information of some right high-order cognitive brain regions may be a compensatory mechanism. However, the whole brain's function integration was reduced, and there was an imbalance between efficiency and consumption.
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Affiliation(s)
- Sirui Wang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Guofu Miao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Junbin Lin
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaoli Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
| | - Weijing Liao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
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Katsuno Y, Ueki Y, Ito K, Murakami S, Aoyama K, Oishi N, Kan H, Matsukawa N, Nagao K, Tatsumi H. Effects of a new speech support application on intensive speech therapy and changes in functional brain connectivity in patients with post-stroke aphasia. Front Hum Neurosci 2022; 16:870733. [PMID: 36211132 PMCID: PMC9535658 DOI: 10.3389/fnhum.2022.870733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Aphasia is a language disorder that occurs after a stroke and impairs listening, speaking, reading, writing, and calculation skills. Patients with post-stroke aphasia in Japan are increasing due to population aging and the advancement of medical treatment. Opportunities for adequate speech therapy in chronic stroke are limited due to time constraints. Recent studies have reported that intensive speech therapy for a short period of time or continuous speech therapy using high-tech equipment, including speech applications (apps, can improve aphasia even in the chronic stage. However, its underlying mechanism for improving language function and its effect on other cognitive functions remains unclear. In the present study, we investigated whether intensive speech therapy using a newly developed speech support app could improve aphasia and other cognitive functions in patients with chronic stroke. Furthermore, we examined whether it can alter the brain network related to language and other cortical areas. Thus, we conducted a prospective, single-comparison study to examine the effects of a new speech support app on language and cognitive functions and used resting state functional MRI (rs-fMRI) regions of interest (ROI) to ROI analysis to determine changes in the related brain network. Two patients with chronic stroke participated in this study. They used the independent speech therapy system to perform eight sets of 20 randomly presented words/time (taking approximately 20 min), for 8 consecutive weeks. Their language, higher cognitive functions including attention function, and rs-fMRI, were evaluated before and after the rehabilitation intervention using the speech support app. Both patients had improved pronunciation, daily conversational situations, and attention. The rs-fMRI analysis showed increased functional connectivity of brain regions associated with language and attention related areas. Our results show that intensive speech therapy using this speech support app can improve language and attention functions even in the chronic stage of stroke, and may be a useful tool for patients with aphasia. In the future, we will conduct longitudinal studies with larger numbers of patients, which we hope will continue the trends seen in the current study, and provide even stronger evidence for the usefulness of this new speech support app.
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Affiliation(s)
- Yuta Katsuno
- Department of Rehabilitation Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- *Correspondence: Yoshino Ueki
| | - Keiichi Ito
- Department of Rehabilitation Medicine, Kamiida Rehabilitation Hospital, Nagoya, Japan
| | - Satona Murakami
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Satona Murakami
| | - Kiminori Aoyama
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoya Oishi
- Medical Innovation Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirohito Kan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katashi Nagao
- Department of Intelligent Systems, Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Hiroshi Tatsumi
- Department of Health Science, Aichi Gakuin University, Nagoya, Japan
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Common Neuroanatomical Substrate of Cholinergic Pathways and Language-Related Brain Regions as an Explanatory Framework for Evaluating the Efficacy of Cholinergic Pharmacotherapy in Post-Stroke Aphasia: A Review. Brain Sci 2022; 12:brainsci12101273. [PMID: 36291207 PMCID: PMC9599395 DOI: 10.3390/brainsci12101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the relative scarcity of studies focusing on pharmacotherapy in aphasia, there is evidence in the literature indicating that remediation of language disorders via pharmaceutical agents could be a promising aphasia treatment option. Among the various agents used to treat chronic aphasic deficits, cholinergic drugs have provided meaningful results. In the current review, we focused on published reports investigating the impact of acetylcholine on language and other cognitive disturbances. It has been suggested that acetylcholine plays an important role in neuroplasticity and is related to several aspects of cognition, such as memory and attention. Moreover, cholinergic input is diffused to a wide network of cortical areas, which have been associated with language sub-processes. This could be a possible explanation for the positive reported outcomes of cholinergic drugs in aphasia recovery, and specifically in distinct language processes, such as naming and comprehension, as well as overall communication competence. However, evidence with regard to functional alterations in specific brain areas after pharmacotherapy is rather limited. Finally, despite the positive results derived from the relevant studies, cholinergic pharmacotherapy treatment in post-stroke aphasia has not been widely implemented. The present review aims to provide an overview of the existing literature in the common neuroanatomical substrate of cholinergic pathways and language related brain areas as a framework for interpreting the efficacy of cholinergic pharmacotherapy interventions in post-stroke aphasia, following an integrated approach by converging evidence from neuroanatomy, neurophysiology, and neuropsychology.
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Does Executive Function Training Impact on Communication? A Randomized Controlled tDCS Study on Post-Stroke Aphasia. Brain Sci 2022; 12:brainsci12091265. [PMID: 36139001 PMCID: PMC9497246 DOI: 10.3390/brainsci12091265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia.
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Fan L, Li C, Huang ZG, Zhao J, Wu X, Liu T, Li Y, Wang J. The longitudinal neural dynamics changes of whole brain connectome during natural recovery from poststroke aphasia. NEUROIMAGE: CLINICAL 2022; 36:103190. [PMID: 36174256 PMCID: PMC9668607 DOI: 10.1016/j.nicl.2022.103190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/24/2022] [Accepted: 09/08/2022] [Indexed: 12/14/2022] Open
Abstract
Poststroke aphasia is one of the most dramatic functional deficits that results from direct damage of focal brain regions and dysfunction of large-scale brain networks. The reconstruction of language function depends on the hierarchical whole-brain dynamic reorganization. However, investigations into the longitudinal neural changes of large-scale brain networks for poststroke aphasia remain scarce. Here we characterize large-scale brain dynamics in left-frontal-stroke aphasia through energy landscape analysis. Using fMRI during an auditory comprehension task, we find that aphasia patients suffer serious whole-brain dynamics perturbation in the acute and subacute stages after stroke, in which the brains were restricted into two major activity patterns. Following spontaneous recovery process, the brain flexibility improved in the chronic stage. Critically, we demonstrated that the abnormal neural dynamics are correlated with the aberrant brain network coordination. Taken together, the energy landscape analysis exhibited that the acute poststroke aphasia has a constrained, low dimensional brain dynamics, which were replaced by less constrained and high dimensional dynamics at chronic aphasia. Our study provides a new perspective to profoundly understand the pathological mechanisms of poststroke aphasia.
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Affiliation(s)
- Liming Fan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China
| | - Chenxi Li
- Department of the Psychology of Military Medicine, Air Force Medical University, Xi’an, Shaanxi 710032, PR China
| | - Zi-gang Huang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China
| | - Jie Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China
| | - Xiaofeng Wu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China
| | - Tian Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China
| | - Youjun Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China,Corresponding authors at: The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Institute of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an 710049, PR China.
| | - Jue Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi 710049, PR China,National Engineering Research Center of Health Care and Medical Devices. Guangzhou, Guangdong 510500, PR China,The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, Shaanxi 710049, PR China,Corresponding authors at: The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Institute of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an 710049, PR China.
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Xie H, Jing J, Ma Y, Song Y, Yin J, Xu G, Li X, Li Z, Wang Y. Effects of simultaneous use of m-NMES and language training on brain functional connectivity in stroke patients with aphasia: A randomized controlled clinical trial. Front Aging Neurosci 2022; 14:965486. [PMID: 36158562 PMCID: PMC9489908 DOI: 10.3389/fnagi.2022.965486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The m-NMES had been demonstrated to redistribute brain resources and induce plastic changes in the stroke patients. However, the physiological mechanism and clinical efficacy of m-NMES combination with existing clinical rehabilitation programs remains unclear in patients with aphasia after stroke. This study aimed to investigate the effects of simultaneous use of m-NMES and language training (m-NMES-LT) with on cerebral oscillations and brain connection, as well as the effect on clinical efficacy. Materials and methods Total 21 right–handed adult patients with aphasia were randomly assigned to language training (LT) group and m-NMES-LT group, and tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations were measured by functional near-infrared spectroscopy in resting and treatment state during three consecutive weeks. Five characteristic frequency signals (I, 0.6–2 Hz; II, 0.145–0.6 Hz; III, 0.052–0.145 Hz; IV, 0.021–0.052 Hz; and V, 0.0095–0.021 Hz) were identified using the wavelet method. The wavelet amplitude (WA) and wavelet phase coherence (WPCO) were calculated to describe the frequency-specific cortical activities. Results The m-NMES-LT induced significantly higher WA values in contralesional PFC in intervals I, II, and V, and ipsilesional MC in intervals I-V than the resting state. The WPCO values between ipsilesional PFC-MC in interval III-IV, and between bilateral MC in interval III-IV were significantly higher than resting state. In addition, there was a significant positive correlation between WPCO and Western Aphasia Battery in m-NMES-LT group. Conclusion The language training combined with neuromuscular electrical stimulation on median nerve could improve and achieve higher clinical efficacy for aphasia. This is attributed to the m-NMES-LT could enhance cortical activation and brain functional connectivity in patients with aphasia, which was derived from myogenic, neurogenic, and endothelial cell metabolic activities.
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Affiliation(s)
- Hui Xie
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jing Jing
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanping Ma
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Song
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jiahui Yin
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Gongcheng Xu
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xinglou Li
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
- Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, China
- Zengyong Li,
| | - Yonghui Wang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
- *Correspondence: Yonghui Wang,
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Bae CR, Na Y, Cho M, Hwang YM, Tae WS, Pyun SB. Structural Changes in the Arcuate Fasciculus and Recovery of Post-stroke Aphasia: A 6-Month Follow-up Study using Diffusion Tensor Imaging. Neurorehabil Neural Repair 2022; 36:633-644. [PMID: 36036555 DOI: 10.1177/15459683221121752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Temporal changes in the structural connectivity of major language tracts after stroke and their contribution to aphasia recovery are unclear. OBJECTIVE To investigate longitudinal arcuate fasciculus (AF) integrity changes and their relationship with post-stroke aphasia recovery using diffusion tensor imaging (DTI). METHODS Thirty-five patients with aphasia due to first-ever left hemispheric stroke underwent the Korean version of the Western Aphasia Battery and DTI at 1- and 6-month post stroke onset. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of both AF tracts were analyzed to evaluate the temporal changes in tract integrity and determine the correlation between changes (Δ; follow-up - initial) in DTI parameters and language scores. RESULTS At 6 months post-stroke, the mean FA decreased, and mean MD and RD increased in both hemispheres; however, compared with mean AD observed after 1 month, the mean observed at 6 months increased only in the left hemisphere (P < .05). ΔFA of the left AF and proportional change in the aphasia quotient showed a significant positive correlation (r = 0.365, P = .031). No correlation was found between changes in the right AF parameters and language score. The group with increased FA in the left AF showed more significant language improvement than the group with decreased FA. CONCLUSIONS During the subacute stage, the integrity of AF decreased in both hemispheres in patients with aphasia, and the change in structural connectivity of the left AF was associated with language improvement.
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Affiliation(s)
- Cho Rong Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoonhye Na
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minjae Cho
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.,BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Mi Hwang
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
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Schneider HR, Wawrzyniak M, Stockert A, Klingbeil J, Saur D. fMRI informed voxel-based lesion analysis to identify lesions associated with right-hemispheric activation in aphasia recovery. Neuroimage Clin 2022; 36:103169. [PMID: 36037659 PMCID: PMC9440420 DOI: 10.1016/j.nicl.2022.103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Several mechanisms have been attributed to post-stroke loss and recovery of language functions. However, the significance and timing of domain-general and homotopic right-hemispheric activation is controversial. We aimed to examine the effect of left-hemispheric lesion location and time post-stroke on right-hemispheric activation. Voxel-based lesion analyses were informed by auditory language-related fMRI activation of 71 patients with left middle cerebral artery stroke examined longitudinally in the acute, subacute and early chronic phase. Language activation was determined in several right-hemispheric regions of interest and served as regressor of interest for voxel-based lesion analyses. We found that an acute to chronic increase of language activation in the right supplementary motor area was associated with lesions to the left extreme capsule as part of the ventral language pathway. Importantly, this activation increase correlated significantly with improvement of out-of-scanner comprehension abilities. We interpret our findings in terms of successful domain-general compensation in patients with critical left frontotemporal disconnection due to damage to the ventral language pathway but relatively spared cortical language areas.
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Affiliation(s)
| | - Max Wawrzyniak
- Corresponding author at: Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103 Leipzig, Germany.
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Bulut T. Meta-analytic connectivity modeling of the left and right inferior frontal gyri. Cortex 2022; 155:107-131. [DOI: 10.1016/j.cortex.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/21/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
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Ding X, Zhang S, Huang W, Zhang S, Zhang L, Hu J, Li J, Ge Q, Wang Y, Ye X, Zhang J. Comparative efficacy of non-invasive brain stimulation for post-stroke aphasia: a network meta-analysis and meta-regression of moderators. Neurosci Biobehav Rev 2022; 140:104804. [DOI: 10.1016/j.neubiorev.2022.104804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 12/24/2022]
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de Wit MM, Matheson HE. Context-sensitive computational mechanistic explanation in cognitive neuroscience. Front Psychol 2022; 13:903960. [PMID: 35936251 PMCID: PMC9355036 DOI: 10.3389/fpsyg.2022.903960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Mainstream cognitive neuroscience aims to build mechanistic explanations of behavior by mapping abilities described at the organismal level via the subpersonal level of computation onto specific brain networks. We provide an integrative review of these commitments and their mismatch with empirical research findings. Context-dependent neural tuning, neural reuse, degeneracy, plasticity, functional recovery, and the neural correlates of enculturated skills each show that there is a lack of stable mappings between organismal, computational, and neural levels of analysis. We furthermore highlight recent research suggesting that task context at the organismal level determines the dynamic parcellation of functional components at the neural level. Such instability prevents the establishment of specific computational descriptions of neural function, which remains a central goal of many brain mappers - including those who are sympathetic to the notion of many-to-many mappings between organismal and neural levels. This between-level instability presents a deep epistemological challenge and requires a reorientation of methodological and theoretical commitments within cognitive neuroscience. We demonstrate the need for change to brain mapping efforts in the face of instability if cognitive neuroscience is to maintain its central goal of constructing computational mechanistic explanations of behavior; we show that such explanations must be contextual at all levels.
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Affiliation(s)
- Matthieu M. de Wit
- Department of Neuroscience, Muhlenberg College, Allentown, PA, United States
| | - Heath E. Matheson
- Department of Psychology, University of Northern British Columbia, Prince George, BC, Canada
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Integrity of the Left Arcuate Fasciculus Segments Significantly Affects Language Performance in Individuals with Acute/Subacute Post-Stroke Aphasia: A Cross-Sectional Diffusion Tensor Imaging Study. Brain Sci 2022; 12:brainsci12070907. [PMID: 35884714 PMCID: PMC9313217 DOI: 10.3390/brainsci12070907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objective: To investigate the correlation between the left arcuate fasciculus (AF) segments and acute/subacute post-stroke aphasia (PSA). Methods: Twenty-six patients underwent language assessment and MRI scanning. The integrity of the AF based on a three-segment model was evaluated using diffusion tensor imaging. All patients were classified into three groups according to the reconstruction of the left AF: completely reconstructed (group A, 8 cases), non-reconstructed (group B, 6 cases), and partially reconstructed (group C, 12 cases). The correlations and intergroup differences in language performance and diffusion indices were comprehensively estimated. Results: A correlation analyses showed that the lesion load of the language areas and diffusion indices on the left AF posterior and long segments was significantly related to some language subsets, respectively. When controlled lesion load was variable, significant correlations between diffusion indices on the posterior and long segments and comprehension, repetition, naming, and aphasia quotient were retained. Multiple comparison tests revealed intergroup differences in diffusion indices on the left AF posterior and long segments, as well as these language subsets. No significant correlation was found between the anterior segment and language performance. Conclusions: The integrity of the left AF segments, particularly the posterior segment, is crucial for the residual comprehension and repetition abilities in individuals with acute/subacute PSA, and lesion load in cortical language areas is an important factor that should be taken into account when illustrating the contributions of damage to special fiber tracts to language impairments.
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Zheng K, Chen M, Shen Y, Xu X, Gao F, Huang G, Ji Y, Su B, Song D, Fang H, Liu P, Ren C. Cerebellar Continuous Theta Burst Stimulation for Aphasia Rehabilitation: Study Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2022; 14:909733. [PMID: 35721014 PMCID: PMC9201405 DOI: 10.3389/fnagi.2022.909733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLanguage recovery is limited in moderate to severe post-stroke aphasia patients. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in improving language dysfunctions caused by post-stroke aphasia, but the treatment outcome is as yet mixed. Considerable evidence has demonstrated the essential involvement of the cerebellum in a variety of language functions, suggesting that it may be a potential stimulation target of TMS for the treatment of post-stroke aphasia. Theta burst stimulation (TBS) is a specific pattern of rTMS with shorter stimulation times and better therapeutic effects. The effect of continuous TBS (cTBS) on the cerebellum in patients with aphasia with chronic stroke needs further exploration.MethodsIn this randomized, sham-controlled clinical trial, patients (n = 40) with chronic post-stroke aphasia received 10 sessions of real cTBS (n = 20) or sham cTBS (n = 20) over the right cerebellar Crus I+ a 30-min speech-language therapy. The Western Aphasia Battery (WAB) serves as the primary measure of the treatment outcome. The secondary outcome measures include the Boston Diagnostic Aphasia Examination, Boston Naming Test and speech acoustic parameters. Resting-state fMRI data were also obtained to examine treatment-induced changes in functional connectivity of the cerebro-cerebellar network. These outcome measures are assessed before, immediately after, and 12 weeks after cerebellar cTBS intervention.DiscussionThis protocol holds promise that cerebellar cTBS is a potential strategy to improve language functions in chronic post-stroke aphasia. The resting-state fMRI may explore the neural mechanism underlying the aphasia rehabilitation with cerebellar cTBS.
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Affiliation(s)
- Kai Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Mingyun Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinlei Xu
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Fanglan Gao
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Guilan Huang
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Yingying Ji
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Bin Su
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Da Song
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Hui Fang
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Peng Liu,
| | - Caili Ren
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- *Correspondence: Caili Ren,
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Meier EL, Kelly CR, Hillis AE. Dissociable language and executive control deficits and recovery in post-stroke aphasia: An exploratory observational and case series study. Neuropsychologia 2022; 172:108270. [PMID: 35597266 PMCID: PMC9728463 DOI: 10.1016/j.neuropsychologia.2022.108270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/30/2022] [Accepted: 05/13/2022] [Indexed: 01/04/2023]
Abstract
A growing body of evidence indicates many, but not all, individuals with post-stroke aphasia experience executive dysfunction. Relationships between language and executive function skills are often reported in the literature, but the degree of interdependence between these abilities remains largely unanswered. Therefore, in this study, we investigated the extent to which language and executive control deficits dissociated in 1) acute stroke and 2) longitudinal aphasia recovery. Twenty-three individuals admitted to Johns Hopkins Hospital with a new left hemisphere stroke completed the Western Aphasia Battery-Revised (WAB-R), several additional language measures (of naming, semantics, spontaneous speech, and oral reading), and three non-linguistic cognitive tasks from the NIH Toolbox (i.e., Pattern Comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sorting Test). Two participants with aphasia (PWA) with temporoparietal lesions, one of whom (PWA1) had greater temporal but less frontal and superior parietal damage than the other (PWA2), also completed testing at subacute (three months post-onset) and early chronic (six months post-onset) time points. In aim 1, principal component analysis on the acute test data (excluding the WAB-R) revealed language and non-linguistic executive control tasks largely loaded onto separate components. Both components were significant predictors of acute aphasia severity per the WAB-R Aphasia Quotient (AQ). Crucially, executive dysfunction explained an additional 17% of the variance in AQ beyond the explanatory power of language impairments alone. In aim 2, both case patients exhibited language and executive control deficits at the acute post-stroke stage. A dissociation was observed in longitudinal recovery of these patients. By the early chronic time point, PWA1 exhibited improved (but persistent) deficits in several language domains and recovered executive control. In contrast, PWA2 demonstrated mostly recovered language but persistent executive dysfunction. Greater damage to language and attention networks in these respective patients may explain the observed behavioral patterns. These results demonstrate that language and executive control can dissociate (at least to a degree), but both contribute to early post-stroke presentation of aphasia and likely influence longitudinal aphasia recovery.
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Affiliation(s)
| | | | - Argye E Hillis
- Department of Neurology, USA; Physical Medicine and Rehabilitation, USA; Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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65
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Kielar A, Patterson D, Chou YH. Efficacy of repetitive transcranial magnetic stimulation in treating stroke aphasia: Systematic review and meta-analysis. Clin Neurophysiol 2022; 140:196-227. [DOI: 10.1016/j.clinph.2022.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 12/12/2022]
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66
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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review. Neural Plast 2022; 2022:5635596. [PMID: 35494482 PMCID: PMC9050322 DOI: 10.1155/2022/5635596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
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67
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Meier EL, Kelly CR, Goldberg EB, Hillis AE. Executive control deficits and lesion correlates in acute left hemisphere stroke survivors with and without aphasia. Brain Imaging Behav 2022; 16:868-877. [PMID: 34647269 PMCID: PMC8514281 DOI: 10.1007/s11682-021-00580-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 01/18/2023]
Abstract
In contrast to the traditional definition of the disorder, many individuals with aphasia exhibit non-linguistic cognitive impairments, including executive control deficits. Classic lesion studies cite frontal lobe damage in executive dysfunction, but more recent lesion symptom-mapping studies in chronic aphasia present mixed results. In this study, we compared executive control abilities of acute stroke survivors with and without aphasia and investigated lesion correlates of linguistic and non-linguistic cognitive tasks. Twenty-nine participants with acute left hemisphere stroke resulting in aphasia (n = 14) or no aphasia (n = 15) completed clinical MRI and testing, including three NIH Toolbox Cognition Batteries (Pattern Comparison Processing Speed, Flanker Inhibitory Control and Attention, and Dimensional Change Card Sort Tests) and the Boston Naming Test. We compared performance between groups using Wilcoxon rank sum tests. We used Least Absolute Shrinkage and Selection Operator Regression to identify neural markers (percent regional damage, hypoperfusion within vascular territories, and total lesion volume) of executive control deficits and anomia. Group performance was comparable on the Pattern Comparison Processing Speed Test, but people with aphasia had poorer standard scores, lower accuracy, and slower response times on the Dimensional Change Card Sort Test than people without aphasia. Damage to extrasylvian regions (dorsolateral prefrontal cortex, intraparietal sulcus) was related to executive control deficits, whereas language network damage (to inferior frontal and superior and posterior middle temporal gyri) was linked to naming impairments. These results suggest people with aphasia can exhibit comorbid executive control impairments linked to damage outside classic language network areas.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, 228C FR, Boston, MA, 02215, USA.
| | - Catherine R Kelly
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily B Goldberg
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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68
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Lin BF, Yeh SC, Kao YCJ, Lu CF, Tsai PY. Functional Remodeling Associated With Language Recovery After Repetitive Transcranial Magnetic Stimulation in Chronic Aphasic Stroke. Front Neurol 2022; 13:809843. [PMID: 35330805 PMCID: PMC8940300 DOI: 10.3389/fneur.2022.809843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) has shown promising efficacy in improving the language functions in poststroke aphasia. However, randomized controlled trials were lacking to investigate the rTMS-related neuroimaging changes underlying the therapeutic effects on language improvement in chronic aphasia. Objective In this study, we aimed to evaluate the effects of low-frequency rTMS (LF-rTMS) on chronic poststroke aphasia. We hypothesized that the deactivation of the right pars triangularis could restore the balance of interhemispheric inhibition and, hence, facilitated the functional remodeling of language networks in both the hemispheres. Furthermore, the rTMS-induced functional reorganization should underpin the language recovery after rTMS. Methods A total of 33 patients (22 males; age: 58.70 ± 13.77 years) with chronic stroke in the left hemisphere and nonfluent aphasia were recruited in this randomized double-blinded study. The ratio of randomization between the rTMS and sham groups is 17:16. All the patients received real 1-Hz rTMS or sham stimulation (placebo coil delivered < 5% of magnetic output with similar audible click-on discharge) at the right posterior pars triangularis for 10 consecutive weekdays (stroke onset to the first stimulation: 10.97 ± 10.35 months). Functional connectivity of language networks measured by resting-state fMRI was calculated and correlated to the scores of the Concise Chinese Aphasia Test by using the stepwise regression analysis. Results After LF-rTMS intervention, significant improvement in language functions in terms of comprehension and expression abilities was observed compared with the sham group. The rTMS group showed a significant decrease of coupling strength between right pars triangularis and pars opercularis with a strengthened connection between right pars orbitalis and angular gyrus. Furthermore, the LF-rTMS significantly enhanced the coupling strength associated with left Wernicke area. Results of regression analysis showed that the identified functional remodeling involving both the hemispheres could support and predict the language recovery after LF-rTMS treatment. Conclusion We reported the therapeutic effects of LF-rTMS and corresponding functional remodeling in chronic poststroke aphasia. Our results provided neuroimage evidence reflecting the rebalance of interhemispheric inhibition induced by LF-rTMS, which could facilitate future research in the refinement of rTMS protocol to optimize the neuromodulation efficacy and benefit the clinical management of patients with stroke.
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Affiliation(s)
- Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ching Yeh
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Yu-Chieh Jill Kao
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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69
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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70
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Sheppard SM, Meier EL, Kim KT, Breining BL, Keator LM, Tang B, Caffo BS, Hillis AE. Neural correlates of syntactic comprehension: A longitudinal study. BRAIN AND LANGUAGE 2022; 225:105068. [PMID: 34979477 PMCID: PMC9232253 DOI: 10.1016/j.bandl.2021.105068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Broca's area is frequently implicated in sentence comprehension but its specific role is debated. Most lesion studies have investigated deficits at the chronic stage. We aimed (1) to use acute imaging to predict which left hemisphere stroke patients will recover sentence comprehension; and (2) to better understand the role of Broca's area in sentence comprehension by investigating acute deficits prior to functional reorganization. We assessed comprehension of canonical and noncanonical sentences in 15 patients with left hemisphere stroke at acute and chronic stages. LASSO regression was used to conduct lesion symptom mapping analyses. Patients with more severe word-level comprehension deficits and a greater proportion of damage to supramarginal gyrus and superior longitudinal fasciculus were likely to experience acute deficits prior to functional reorganization. Broca's area was only implicated in chronic deficits. We propose that when temporoparietal regions are damaged, intact Broca's area can support syntactic processing after functional reorganization occurs.
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Affiliation(s)
- Shannon M Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Communication Sciences & Disorders, Chapman University, Irvine, CA 92618, United States.
| | - Erin L Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Kevin T Kim
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Lynsey M Keator
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Bohao Tang
- Department of Biostatics, Johns Hopkins School of Public Health, Baltimore, MD 21287, United States
| | - Brian S Caffo
- Department of Biostatics, Johns Hopkins School of Public Health, Baltimore, MD 21287, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, United States
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71
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Li R, Mukadam N, Kiran S. Functional MRI evidence for reorganization of language networks after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:131-150. [PMID: 35078595 DOI: 10.1016/b978-0-12-823384-9.00007-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we review fMRI evidence for language reorganization in individuals with poststroke aphasia. Several studies in the current literature have utilized fMRI as a tool to understand patterns of functional reorganization in poststroke aphasia. Consistent with previous models that have been proposed to explain the trajectory of language recovery, differential patterns of language processing and language recovery have been identified across individuals with poststroke aphasia in different stages of recovery. Overall, a global network breakdown typically occurs in the early stages of aphasia recovery, followed by normalization in "traditional" left hemisphere language networks. Depending on individual characteristics, right hemisphere regions and bilateral domain-general regions may be further recruited. The main takeaway of this chapter is that poststroke aphasia recovery does not depend on individual neural regions, but rather involves a complex interaction among regions in larger networks. Many of the unresolved issues and contrastive findings in the literature warrant further research with larger groups of participants and standard protocols of fMRI implementation.
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Affiliation(s)
- Ran Li
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States.
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72
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Perani D, Cappa SF. The contribution of positron emission tomography to the study of aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:151-165. [PMID: 35078596 DOI: 10.1016/b978-0-12-823384-9.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniela Perani
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy; In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano F Cappa
- Department of Humanities and Life Sciences, University Institute for Advanced Studies IUSS Pavia, Pavia, Italy; Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy.
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73
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Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:397-414. [PMID: 35034751 PMCID: PMC10149040 DOI: 10.1016/b978-0-12-819410-2.00021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The language system is perhaps the most unique feature of the human brain's cognitive architecture. It has long been a quest of cognitive neuroscience to understand the neural components that contribute to the hierarchical pattern processing and advanced rule learning required for language. The most important goal of this research is to understand how language becomes impaired when these neural components malfunction or are lost to stroke, and ultimately how we might recover language abilities under these circumstances. Additionally, understanding how the language system develops and how it can reorganize in the face of brain injury or dysfunction could help us to understand brain plasticity in cognitive networks more broadly. In this chapter we will discuss the earliest features of language organization in infants, and how deviations in typical development can-but in some cases, do not-lead to disordered language. We will then survey findings from adult stroke and aphasia research on the potential for recovering language processing in both the remaining left hemisphere tissue and in the non-dominant right hemisphere. Altogether, we hope to present a clear picture of what is known about the capacity for plastic change in the neurobiology of the human language system.
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Affiliation(s)
- Kelly C Martin
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - W Tyler Ketchabaw
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - Peter E Turkeltaub
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, United States.
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74
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Meier EL. The role of disrupted functional connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:99-119. [PMID: 35078613 DOI: 10.1016/b978-0-12-823384-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result in aphasia, a neurologic disorder characterized by receptive and/or expressive deficits in spoken and/or written language. Most often, aphasia is the consequence of stroke-termed poststroke aphasia (PSA)-yet, aphasia can also manifest due to neurodegenerative disease, specifically, a disorder called primary progressive aphasia (PPA). In recent years, functional connectivity neuroimaging studies have provided emerging evidence supporting theories regarding the relationships between language impairments, structural brain damage, and functional network properties in these two disorders. This chapter reviews the current evidence for the "network phenotype of stroke injury" hypothesis (Siegel et al., 2016) as it pertains to PSA and the "network degeneration hypothesis" (Seeley et al., 2009) as it pertains to PPA. Methodologic considerations for functional connectivity studies, limitations of the current functional connectivity literature in aphasia, and future directions are also discussed.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States.
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75
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Buklina SB, Kaftanov AN, Melikyan AG, Kopachev DN, Batalov AI. [Crossed aphasia in neurosurgical practice: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:103-111. [PMID: 35170283 DOI: 10.17116/neiro202286011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Crossed aphasia in dexstral (CAD) is an extremely rare disorder. To date, about 200 cases have been described in the literature. MATERIAL AND METHODS The authors report 4 cases of CAD. Luria's neuropsychological examination was carried out. Functional asymmetry in the arm was analyzed using the Annett questionnaire. MRI and intraoperative findings confirmed localization of lesion in the right hemisphere in all patients. RESULTS A 59-year-old right-handed man developed frontotemporal aphasia after previous resection of right-sided glioblastoma of fronto-insular-temporal region. In a 31-year-old right-handed man, crossed aphasia occurred after extensive hemorrhage from arteriovenous malformation into the right frontotemporoparietal region. A 39-year-old right-handed man developed severe combined aphasia after resection of diffuse glioma of the right insular-temporal region. A 10-year-old right-handed boy developed aphasia with word forgetting after resection of a large tumor of the right temporal lobe. All patients had impaired dynamic praxis. Other cognitive functions were intact. CONCLUSION The authors discuss possible combinations of functions in one hemisphere for both right-handers and left-handers and emphasize diverse types of functional asymmetries described in the literature. Different localizations of functions in right-handers and left-handers indicate that local zones with different methods of information processing (successive or simultaneous) can coexist in one hemisphere. Therefore, the functions requiring different processing of information (for example, speech with praxis or spatial functions) can develop in one hemisphere. Cognitive impairment depends not only on the type of functional asymmetry, but also on localization of lesion. Crossed aphasia in right-handers indicates the rarest normal type of functional brain asymmetry with localization of speech functions in the right hemisphere. Possible aphasia in right-handers following damage to homologues of speech zones in the right hemisphere can require additional examination of these patients.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | | | | | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
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76
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Yongyue Z, Yang S, Li Z, Rongjin Z, Shumin W. Functional Brain Imaging Based on the Neurovascular Unit for Evaluating Neural Networks after Strok. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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77
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Deng X, Wang B, Zong F, Yin H, Yu S, Zhang D, Wang S, Cao Y, Zhao J, Zhang Y. Right-hemispheric language reorganization in patients with brain arteriovenous malformations: A functional magnetic resonance imaging study. Hum Brain Mapp 2021; 42:6014-6027. [PMID: 34582074 PMCID: PMC8596961 DOI: 10.1002/hbm.25666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/29/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022] Open
Abstract
Brain arteriovenous malformation (AVM), a presumed congenital lesion, may involve traditional language areas but usually does not lead to language dysfunction unless it ruptures. The objective of this research was to study right-hemispheric language reorganization patterns in patients with brain AVMs using functional magnetic resonance imaging (fMRI). We prospectively enrolled 30 AVM patients with lesions involving language areas and 32 age- and sex-matched healthy controls. Each subject underwent fMRI during three language tasks: visual synonym judgment, oral word reading, and auditory sentence comprehension. The activation differences between the AVM and control groups were investigated by voxelwise analysis. Lateralization indices (LIs) for the frontal lobe, temporal lobe, and cerebellum were compared between the two groups, respectively. Results suggested that the language functions of AVM patients and controls were all normal. Voxelwise analysis showed no significantly different activations between the two groups in visual synonym judgment and oral word reading tasks. In auditory sentence comprehension task, AVM patients had significantly more activations in the right precentral gyrus (BA 6) and right cerebellar lobule VI (AAL 9042). According to the LI results, the frontal lobe in oral word reading task and the temporal lobe in auditory sentence comprehension task were significantly more right-lateralized in the AVM group. These findings suggest that for patients with AVMs involving language cortex, different language reorganization patterns may develop for different language functions. The recruitment of brain areas in the right cerebral and cerebellar hemispheres may play a compensatory role in the reorganized language network of AVM patients.
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Affiliation(s)
- Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bo Wang
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China.,State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Fangrong Zong
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hu Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaochen Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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78
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Functional differentiation in the language network revealed by lesion-symptom mapping. Neuroimage 2021; 247:118778. [PMID: 34896587 PMCID: PMC8830186 DOI: 10.1016/j.neuroimage.2021.118778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 12/18/2022] Open
Abstract
Theories of language organization in the brain commonly posit that different regions underlie distinct linguistic mechanisms. However, such theories have been criticized on the grounds that many neuroimaging studies of language processing find similar effects across regions. Moreover, condition by region interaction effects, which provide the strongest evidence of functional differentiation between regions, have rarely been offered in support of these theories. Here we address this by using lesion-symptom mapping in three large, partially-overlapping groups of aphasia patients with left hemisphere brain damage due to stroke (N = 121, N = 92, N = 218). We identified multiple measure by region interaction effects, associating damage to the posterior middle temporal gyrus with syntactic comprehension deficits, damage to posterior inferior frontal gyrus with expressive agrammatism, and damage to inferior angular gyrus with semantic category word fluency deficits. Our results are inconsistent with recent hypotheses that regions of the language network are undifferentiated with respect to high-level linguistic processing.
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79
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Brain Abnormalities in Pontine Infarction: A Longitudinal Diffusion Tensor Imaging and Functional Magnetic Resonance Imaging study. J Stroke Cerebrovasc Dis 2021; 31:106205. [PMID: 34879300 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The aim of this study was to make a reasonable and accurate assessment of the prognosis of patients with pontine infarction. We assessed the changes in structure and function in the whole brain after pontine infarction from the acute to chronic phase using diffustion tensor imaging and functional magnetic resonance imaging. MATERIALS AND METHODS Sixteen individuals with a recent pontine infarction and sixteen healthy controls were recruited and underwent 3.0T DTI, resting-state fMRI and upper extremity Fugl-Myer (UE-FM) functional evaluation at five time points: within one week (T1), half a month (T2), one month (T3), three months (T4), and six months (T5) after onset. Tract-based spatial statistics was used to conduct a voxelwise analysis. RESULTS The fractional anisotropy (FA) values were significantly lower in the pontine infarction group than in the control group. Then, specific ROIs were analyzed. The FA values of 10 regions of interest were significantly increased at T2 compared with those at T1. The FA value of the corticospinal tract was significantly increased at T3 compared with that at T2. Regional brain activity results showed that the amplitude of low frequency fluctuations value of the frontal lobe decreased at T1, then increased. Finally, The UE-FM scores showed the same increased trend. CONCLUSION These findings show that the microstructure changes most significantly within half a month after pontine infarction and stabilizes after one month. The recovery of motor function in the later period is mainly caused by changes in the cortex. This facilitates more treatment options.
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80
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LaCroix AN, James E, Rogalsky C. Neural Resources Supporting Language Production vs. Comprehension in Chronic Post-stroke Aphasia: A Meta-Analysis Using Activation Likelihood Estimates. Front Hum Neurosci 2021; 15:680933. [PMID: 34759804 PMCID: PMC8572938 DOI: 10.3389/fnhum.2021.680933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/22/2021] [Indexed: 02/04/2023] Open
Abstract
In post-stroke aphasia, language tasks recruit a combination of residual regions within the canonical language network, as well as regions outside of it in the left and right hemispheres. However, there is a lack of consensus as to how the neural resources engaged by language production and comprehension following a left hemisphere stroke differ from one another and from controls. The present meta-analysis used activation likelihood estimates to aggregate across 44 published fMRI and PET studies to characterize the functional reorganization patterns for expressive and receptive language processes in persons with chronic post-stroke aphasia (PWA). Our results in part replicate previous meta-analyses: we find that PWA activate residual regions within the left lateralized language network, regardless of task. Our results extend this work to show differential recruitment of the left and right hemispheres during language production and comprehension in PWA. First, we find that PWA engage left perilesional regions during language comprehension, and that the extent of this activation is likely driven by stimulus type and domain-general cognitive resources needed for task completion. In contrast to comprehension, language production was associated with activation of the right frontal and temporal cortices. Further analyses linked right hemisphere regions involved in motor speech planning for language production with successful naming in PWA, while unsuccessful naming was associated with the engagement of the right inferior frontal gyrus, a region often implicated in domain-general cognitive processes. While the within-group findings indicate that the engagement of the right hemisphere during language tasks in post-stroke aphasia differs for expressive vs. receptive tasks, the overall lack of major between-group differences between PWA and controls implies that PWA rely on similar cognitive-linguistic resources for language as controls. However, more studies are needed that report coordinates for PWA and controls completing the same tasks in order for future meta-analyses to characterize how aphasia affects the neural resources engaged during language, particularly for specific tasks and as a function of behavioral performance.
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Affiliation(s)
- Arianna N LaCroix
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Eltonnelle James
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Corianne Rogalsky
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
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81
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Gilmore N, Katz DI, Kiran S. Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation. ACTA ACUST UNITED AC 2021; 6:714-727. [PMID: 34746412 DOI: 10.1044/2021_persp-21-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. Method This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Affiliation(s)
- Natalie Gilmore
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
| | - Douglas I Katz
- Neurology, Boston University School of Medicine, Boston, USA
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
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82
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Zhang J, Zhou Z, Li L, Ye J, Shang D, Zhong S, Yao B, Xu C, Yu Y, He F, Ye X, Luo B. Cerebral perfusion mediated by thalamo-cortical functional connectivity in non-dominant thalamus affects naming ability in aphasia. Hum Brain Mapp 2021; 43:940-954. [PMID: 34698418 PMCID: PMC8764486 DOI: 10.1002/hbm.25696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/04/2023] Open
Abstract
Naming is a commonly impaired language domain in various types of aphasia. Emerging evidence supports the cortico‐subcortical circuitry subserving naming processing, although neurovascular regulation of the non‐dominant thalamic and basal ganglia subregions underlying post‐stroke naming difficulty remains unclear. Data from 25 subacute stroke patients and 26 age‐, sex‐, and education‐matched healthy volunteers were analyzed. Region‐of‐interest‐wise functional connectivity (FC) was calculated to measure the strength of cortico‐subcortical connections. Cerebral blood flow (CBF) was determined to reflect perfusion levels. Correlation and mediation analyses were performed to identify the relationship between cortico‐subcortical connectivity, regional cerebral perfusion, and naming performance. We observed increased right‐hemispheric subcortical connectivity in patients. FC between the right posterior superior temporal sulcus (pSTS) and lateral/medial prefrontal thalamus (lPFtha/mPFtha) exhibited significantly negative correlations with total naming score. Trend‐level increased CBF in subcortical nuclei, including that in the right lPFtha, and significant negative correlations between naming and regional perfusion of the right lPFtha were observed. The relationship between CBF in the right lPFtha and naming was fully mediated by the lPFtha‐pSTS connectivity in the non‐dominant hemisphere. Our findings suggest that perfusion changes in the right thalamic subregions affect naming performance through thalamo‐cortical circuits in post‐stroke aphasia. This study highlights the neurovascular pathophysiology of the non‐dominant hemisphere and demonstrates thalamic involvement in naming after stroke.
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Affiliation(s)
- Jie Zhang
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.,Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Zhou
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lingling Li
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Ye
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Desheng Shang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuchang Zhong
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Bo Yao
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Cong Xu
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yamei Yu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangping He
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangming Ye
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Benyan Luo
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
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83
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Truzman T, Rochon E, Meltzer J, Leonard C, Bitan T. Simultaneous Normalization and Compensatory Changes in Right Hemisphere Connectivity during Aphasia Therapy. Brain Sci 2021; 11:1330. [PMID: 34679395 PMCID: PMC8534113 DOI: 10.3390/brainsci11101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.
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Affiliation(s)
- Tammar Truzman
- Communication Sciences and Disorders Department and IIPDM, University of Haifa, Haifa 3498838, Israel
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Elizabeth Rochon
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- KITE Research Institute, Toronto Rehab, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Jed Meltzer
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department, University of Toronto, Toronto, ON M5S 1A1, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Carol Leonard
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Tali Bitan
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department and IIPDM, University of Haifa, Haifa 3498838, Israel
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84
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Morales H. Current and Future Challenges of Functional MRI and Diffusion Tractography in the Surgical Setting: From Eloquent Brain Mapping to Neural Plasticity. Semin Ultrasound CT MR 2021; 42:474-489. [PMID: 34537116 DOI: 10.1053/j.sult.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Decades ago, Spetzler (1986) and Sawaya (1998) provided a rough brain segmentation of the eloquent areas of the brain, aimed to help surgical decisions in cases of vascular malformations and tumors, respectively. Currently in clinical use, their criteria are in need of revision. Defining functions (eg, sensorimotor, language and visual) that should be preserved during surgery seems a straightforward task. In practice, locating the specific areas that could cause a permanent vs transient deficit is not an easy task. This is particularly true for the associative cortex and cognitive domains such as language. The old model, with Broca's and Wernicke's areas at the forefront, has been superseded by a dual-stream model of parallel language processing; named ventral and dorsal pathways. This complicated network of cortical hubs and subcortical white matter pathways needing preservation during surgery is a work in progress. Preserving not only cortical regions but most importantly preserving the connections, or white matter fiber bundles, of core regions in the brain is the new paradigm. For instance, the arcuate fascicululs and inferior fronto-occipital fasciculus are key components of the dorsal and ventral language pathways, respectively; and their damage result in permanent language deficits. Interestedly, the damage of the temporal portions of these bundles -where there is a crossroad with other multiple bundles-, appears to be more important (permanent) than the damage of the frontal portions - where plasticity and contralateral activation could help. Although intraoperative direct cortical and subcortical stimulation have contributed largely, advanced MR techniques such as functional MRI (fMRI) and diffusion tractography (DT), are at the epi-center of our current understanding. Nevertheless, these techniques posse important challenges: such as neurovascular uncoupling or venous bias on fMRI; and appropriate anatomical validation or accurate representation of crossing fibers on DT. These limitations should be well understood and taken into account in clinical practice. Unifying multidisciplinary research and clinical efforts is desirable, so these techniques could contribute more efficiently not only to locate eloquent areas but to improve outcomes and our understanding of neural plasticity. Finally, although there are constant anatomical and functional regions at the individual level, there is a known variability at the inter-individual level. This concept should strengthen the importance of a personalized approach when evaluating these regions on fMRI and DT. It should strengthen the importance of personalized treatments as well, aimed to meet tailored needs and expectations.
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Affiliation(s)
- Humberto Morales
- Section of Neuroradiology, University of Cincinnati Medical Center, Cincinnati, OH.
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85
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Morrison RA, Hays SA, Kilgard MP. Vagus Nerve Stimulation as a Potential Adjuvant to Rehabilitation for Post-stroke Motor Speech Disorders. Front Neurosci 2021; 15:715928. [PMID: 34489632 PMCID: PMC8417469 DOI: 10.3389/fnins.2021.715928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Stroke often leaves lasting impairments affecting orofacial function. While speech therapy is able to enhance function after stroke, many patients see only modest improvements after treatment. This partial restoration of function after rehabilitation suggests that there is a need for further intervention. Rehabilitative strategies that augment the effects of traditional speech therapy hold promise to yield greater efficacy and reduce disability associated with motor speech disorders. Recent studies demonstrate that brief bursts of vagus nerve stimulation (VNS) can facilitate the benefits of rehabilitative interventions. VNS paired with upper limb rehabilitation enhances recovery of upper limb function in patients with chronic stroke. Animal studies reveal that these improvements are driven by VNS-dependent synaptic plasticity in motor networks. Moreover, preclinical evidence demonstrates that a similar strategy of pairing VNS can promote synaptic reorganization in orofacial networks. Building on these findings, we postulate that VNS-directed orofacial plasticity could target post-stroke motor speech disorders. Here, we outline the rationale for pairing VNS with traditional speech therapy to enhance recovery in the context of stroke of speech motor function. We also explore similar treatments that aim to enhance synaptic plasticity during speech therapy, and how VNS differs from these existing therapeutic strategies. Based on this evidence, we posit that VNS-paired speech therapy shows promise as a means of enhancing recovery after post-stroke motor speech disorders. Continued development is necessary to comprehensively establish and optimize this approach, which has the potential to increase quality of life for the many individuals suffering with these common impairments.
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Affiliation(s)
- Robert A Morrison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
| | - Seth A Hays
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States.,Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Michael P Kilgard
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
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86
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Lwi SJ, Herron TJ, Curran BC, Ivanova MV, Schendel K, Dronkers NF, Baldo JV. Auditory Comprehension Deficits in Post-stroke Aphasia: Neurologic and Demographic Correlates of Outcome and Recovery. Front Neurol 2021; 12:680248. [PMID: 34456845 PMCID: PMC8397517 DOI: 10.3389/fneur.2021.680248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: One of the most challenging symptoms of aphasia is an impairment in auditory comprehension. The inability to understand others has a direct impact on a person's quality of life and ability to benefit from treatment. Despite its importance, limited research has examined the recovery pattern of auditory comprehension and instead has focused on aphasia recovery more generally. Thus, little is known about the time frame for auditory comprehension recovery following stroke, and whether specific neurologic and demographic variables contribute to recovery and outcome. Methods: This study included 168 left hemisphere chronic stroke patients stroke patients with auditory comprehension impairments ranging from mild to severe. Univariate and multivariate lesion-symptom mapping (LSM) was used to identify brain regions associated with auditory comprehension outcomes on three different tasks: Single-word comprehension, yes/no sentence comprehension, and comprehension of sequential commands. Demographic variables (age, gender, and education) were also examined for their role in these outcomes. In a subset of patients who completed language testing at two or more time points, we also analyzed the trajectory of recovery in auditory comprehension using survival curve-based time compression. Results: LSM analyses revealed that poor single-word auditory comprehension was associated with lesions involving the left mid- to posterior middle temporal gyrus, and portions of the angular and inferior-middle occipital gyri. Poor yes/no sentence comprehension was associated almost exclusively with the left mid-posterior middle temporal gyrus. Poor comprehension of sequential commands was associated with lesions in the left posterior middle temporal gyrus. There was a small region of convergence between the three comprehension tasks, in the very posterior portion of the left middle temporal gyrus. The recovery analysis revealed that auditory comprehension scores continued to improve beyond the first year post-stroke. Higher education was associated with better outcome on all auditory comprehension tasks. Age and gender were not associated with outcome or recovery slopes. Conclusions: The current findings suggest a critical role for the posterior left middle temporal gyrus in the recovery of auditory comprehension following stroke, and that spontaneous recovery of auditory comprehension can continue well beyond the first year post-stroke.
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Affiliation(s)
- Sandy J Lwi
- Veterans Affairs Northern California Health Care System, Martinez, CA, United States
| | - Timothy J Herron
- Veterans Affairs Northern California Health Care System, Martinez, CA, United States
| | - Brian C Curran
- Veterans Affairs Northern California Health Care System, Martinez, CA, United States
| | - Maria V Ivanova
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Krista Schendel
- Veterans Affairs Northern California Health Care System, Martinez, CA, United States
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Juliana V Baldo
- Veterans Affairs Northern California Health Care System, Martinez, CA, United States
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87
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Deifelt Streese C, Tranel D. Combined lesion-deficit and fMRI approaches in single-case studies: Unique contributions to cognitive neuroscience. Curr Opin Behav Sci 2021; 40:58-63. [PMID: 33709012 PMCID: PMC7943030 DOI: 10.1016/j.cobeha.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although lesion-deficit case studies are foundational in cognitive neuroscience, published papers presenting single lesion cases are declining. In this review, we argue that there is a valuable place for single-case lesion-deficit research, especially when combined with functional neuroimaging methods, such as functional magnetic resonance imaging (fMRI). To support this, we present a summary of notable findings from single-case combined lesion-deficit and fMRI studies published in recent years (2017-2020). These studies show the unique value that this combined approach brings to the understanding of complex functions, brain-level connectivity, and plasticity and recovery. We encourage researchers to consider combining lesion-deficit and functional imaging methods in the analysis of single cases, as this approach affords unique opportunities to address challenging unanswered questions about brain-behavior relationships.
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Affiliation(s)
- Carolina Deifelt Streese
- Department of Neurology; Carver College of Medicine; 200 Hawkins Drive, Iowa City, IA, 52242; United States
| | - Daniel Tranel
- Department of Neurology; Carver College of Medicine; 200 Hawkins Drive, Iowa City, IA, 52242; United States
- Department of Psychological and Brain Sciences; University of Iowa; 340 Iowa Avenue, Iowa City, IA, 52242; United States
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88
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Hartwigsen G, Bengio Y, Bzdok D. How does hemispheric specialization contribute to human-defining cognition? Neuron 2021; 109:2075-2090. [PMID: 34004139 PMCID: PMC8273110 DOI: 10.1016/j.neuron.2021.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
Uniquely human cognitive faculties arise from flexible interplay between specific local neural modules, with hemispheric asymmetries in functional specialization. Here, we discuss how these computational design principles provide a scaffold that enables some of the most advanced cognitive operations, such as semantic understanding of world structure, logical reasoning, and communication via language. We draw parallels to dual-processing theories of cognition by placing a focus on Kahneman's System 1 and System 2. We propose integration of these ideas with the global workspace theory to explain dynamic relay of information products between both systems. Deepening the current understanding of how neurocognitive asymmetry makes humans special can ignite the next wave of neuroscience-inspired artificial intelligence.
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Affiliation(s)
- Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany.
| | - Yoshua Bengio
- Mila, Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - Danilo Bzdok
- Mila, Montreal, QC, Canada; Montreal Neurological Institute, McConnell Brain Imaging Centre, Faculty of Medicine, McGill University, Montreal, QC, Canada; Department of Biomedical Engineering, Faculty of Medicine, and School of Computer Science, McGill University, Montreal, QC, Canada.
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89
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Gerrits R, Verhelst H, Dhollander T, Xiang L, Vingerhoets G. Structural perisylvian asymmetry in naturally occurring atypical language dominance. Brain Struct Funct 2021; 227:573-586. [PMID: 34173870 DOI: 10.1007/s00429-021-02323-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/14/2021] [Indexed: 01/15/2023]
Abstract
Functional and anatomical hemispheric asymmetries abound in the neural language system, yet the relationship between them remains elusive. One attractive proposal is that structural interhemispheric differences reflect or even drive functional language laterality. However, studies on structure-function couplings either find that left and right language dominant individuals display similar leftward structural asymmetry or yield inconsistent results. The current study aimed to replicate and extend prior work by comparing structural asymmetries between neurologically healthy left-handers with right hemispheric language dominance (N = 24) and typically lateralized left-handed controls (N = 39). Based on structural MRI data, anatomical measures of six 'language-related' perisylvian structures were derived, including the surface area of five gray matter regions with known language functions and the FDC (combined fiber density and fiber-bundle cross-sectional area) of the arcuate fasciculus. Only the surface area of the pars triangularis and the anterior insula differed significantly between participant groups, being on average leftward asymmetric in those with typical dominance, but right lateralized in volunteers with atypical language specialization. However, these findings did not survive multiple testing correction and the asymmetry of these structures demonstrated much inter-individual variability in either subgroup. By integrating our findings with those reported previously we conclude that while some perisylvian anatomical asymmetries may differ subtly between typical and atypical speech dominants at the group level, they serve as poor participant-specific predictors of hemispheric language specialization.
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Affiliation(s)
- Robin Gerrits
- Department of Experimental Psychology, Ghent University, Ghent, Belgium.
| | - Helena Verhelst
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Li Xiang
- Centre for Reproductive Health, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Guy Vingerhoets
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
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90
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Kourtidou E, Kasselimis D, Angelopoulou G, Karavasilis E, Velonakis G, Kelekis N, Zalonis I, Evdokimidis I, Potagas C, Petrides M. The Role of the Right Hemisphere White Matter Tracts in Chronic Aphasic Patients After Damage of the Language Tracts in the Left Hemisphere. Front Hum Neurosci 2021; 15:635750. [PMID: 34239424 PMCID: PMC8258417 DOI: 10.3389/fnhum.2021.635750] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
The involvement of the right hemisphere (RH) in language, and especially after aphasia resulting from left hemisphere (LH) lesions, has been recently highlighted. The present study investigates white matter structure in the right hemisphere of 25 chronic post-stroke aphasic patients after LH lesions in comparison with 24 healthy controls, focusing on the four cortico-cortical tracts that link posterior parietal and temporal language-related areas with Broca’s region in the inferior frontal gyrus of the LH: the Superior Longitudinal Fasciculi II and III (SLF II and SLF III), the Arcuate Fasciculus (AF), and the Temporo-Frontal extreme capsule Fasciculus (TFexcF). Additionally, the relationship of these RH white matter tracts to language performance was examined. The patients with post-stroke aphasia in the chronic phase and the healthy control participants underwent diffusion tensor imaging (DTI) examination. The aphasic patients were assessed with standard aphasia tests. The results demonstrated increased axial diffusivity in the RH tracts of the aphasic patients. Patients were then divided according to the extent of the left hemisphere white matter loss. Correlations of language performance with radial diffusivity (RD) in the right hemisphere homologs of the tracts examined were demonstrated for the TFexcF, SLF III, and AF in the subgroup with limited damage to the LH language networks and only with the TFexcF in the subgroup with extensive damage. The results argue in favor of compensatory roles of the right hemisphere tracts in language functions when the LH networks are disrupted.
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Affiliation(s)
- Evie Kourtidou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Angelopoulou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Georgios Velonakis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Ioannis Zalonis
- Eginition Hospital, Neuropsychological Laboratory, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Petrides
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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91
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Sihvonen AJ, Ripollés P, Leo V, Saunavaara J, Parkkola R, Rodríguez-Fornells A, Soinila S, Särkämö T. Vocal music listening enhances post-stroke language network reorganization. eNeuro 2021; 8:ENEURO.0158-21.2021. [PMID: 34140351 PMCID: PMC8266215 DOI: 10.1523/eneuro.0158-21.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
Abstract
Listening to vocal music has been recently shown to improve language recovery in stroke survivors. The neuroplasticity mechanisms supporting this effect are, however, still unknown. Using data from a three-arm single-blind randomized controlled trial including acute stroke patients (N=38) and a 3-month follow-up, we set out to compare the neuroplasticity effects of daily listening to self-selected vocal music, instrumental music, and audiobooks on both brain activity and structural connectivity of the language network. Using deterministic tractography we show that the 3-month intervention induced an enhancement of the microstructural properties of the left frontal aslant tract (FAT) for the vocal music group as compared to the audiobook group. Importantly, this increase in the strength of the structural connectivity of the left FAT correlated with improved language skills. Analyses of stimulus-specific activation changes showed that the vocal music group exhibited increased activations in the frontal termination points of the left FAT during vocal music listening as compared to the audiobook group from acute to 3-month post-stroke stage. The increased activity correlated with the structural neuroplasticity changes in the left FAT. These results suggest that the beneficial effects of vocal music listening on post-stroke language recovery are underpinned by structural neuroplasticity changes within the language network and extend our understanding of music-based interventions in stroke rehabilitation.Significance statementPost-stroke language deficits have a devastating effect on patients and their families. Current treatments yield highly variable outcomes and the evidence for their long-term effects is limited. Patients often receive insufficient treatment that are predominantly given outside the optimal time window for brain plasticity. Post-stroke vocal music listening improves language outcome which is underpinned by neuroplasticity changes within the language network. Vocal music listening provides a complementary rehabilitation strategy which could be safely implemented in the early stages of stroke rehabilitation and seems to specifically target language symptoms and recovering language network.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Centre for Clinical Research, The University of Queensland, Australia
| | - Pablo Ripollés
- Department of Psychology, New York University, USA
- Music and Audio Research Laboratory, New York University, USA
- Center for Language Music and emotion, New York UniversityUSA
| | - Vera Leo
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital and University of Turku, Finland
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Education Psychology, University of Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Finland
| | - Seppo Soinila
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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92
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Association between aphasia severity and brain network alterations after stroke assessed using the electroencephalographic phase synchrony index. Sci Rep 2021; 11:12469. [PMID: 34127750 PMCID: PMC8203681 DOI: 10.1038/s41598-021-91978-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Electroencephalographic synchrony can help assess brain network status; however, its usefulness has not yet been fully proven. We developed a clinically feasible method that combines the phase synchrony index (PSI) with resting-state 19-channel electroencephalography (EEG) to evaluate post-stroke motor impairment. In this study, we investigated whether our method could be applied to aphasia, a common post-stroke cognitive impairment. This study included 31 patients with subacute aphasia and 24 healthy controls. We assessed the expressive function of patients and calculated the PSIs of three motor language-related regions: frontofrontal, left frontotemporal, and right frontotemporal. Then, we evaluated post-stroke network alterations by comparing PSIs of the patients and controls and by analyzing the correlations between PSIs and aphasia scores. The frontofrontal PSI (beta band) was lower in patients than in controls and positively correlated with aphasia scores, whereas the right frontotemporal PSI (delta band) was higher in patients than in controls and negatively correlated with aphasia scores. Evaluation of artifacts suggests that this association is attributed to true synchrony rather than spurious synchrony. These findings suggest that post-stroke aphasia is associated with alternations of two different networks and point to the usefulness of EEG PSI in understanding the pathophysiology of aphasia.
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93
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Quiñones I, Amoruso L, Pomposo Gastelu IC, Gil-Robles S, Carreiras M. What Can Glioma Patients Teach Us about Language (Re)Organization in the Bilingual Brain: Evidence from fMRI and MEG. Cancers (Basel) 2021; 13:2593. [PMID: 34070619 PMCID: PMC8198785 DOI: 10.3390/cancers13112593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
Recent evidence suggests that the presence of brain tumors (e.g., low-grade gliomas) triggers language reorganization. Neuroplasticity mechanisms called into play can transfer linguistic functions from damaged to healthy areas unaffected by the tumor. This phenomenon has been reported in monolingual patients, but much less is known about the neuroplasticity of language in the bilingual brain. A central question is whether processing a first or second language involves the same or different cortical territories and whether damage results in diverse recovery patterns depending on the language involved. This question becomes critical for preserving language areas in bilingual brain-tumor patients to prevent involuntary pathological symptoms following resection. While most studies have focused on intraoperative mapping, here, we go further, reporting clinical cases for five bilingual patients tested before and after tumor resection, using a novel multimethod approach merging neuroimaging information from fMRI and MEG to map the longitudinal reshaping of the language system. Here, we present four main findings. First, all patients preserved linguistic function in both languages after surgery, suggesting that the surgical intervention with intraoperative language mapping was successful in preserving cortical and subcortical structures necessary for brain plasticity at the functional level. Second, we found reorganization of the language network after tumor resection in both languages, mainly reflected by a shift of activity to right hemisphere nodes and the recruitment of ipsilesional left nodes. Third, we found that this reorganization varied according to the language involved, indicating that L1 and L2 follow different reshaping patterns after surgery. Fourth, oscillatory longitudinal effects were correlated with BOLD laterality changes in superior parietal and middle frontal areas. These findings may reflect that neuroplasticity impacts on the compensatory involvement of executive control regions, supporting the allocation of cognitive resources as a consequence of increased attentional demands. Furthermore, these results hint at the complementary role of this neuroimaging approach in language mapping, with fMRI offering excellent spatial localization and MEG providing optimal spectrotemporal resolution.
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Affiliation(s)
- Ileana Quiñones
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
| | - Lucia Amoruso
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
| | | | - Santiago Gil-Robles
- BioCruces Research Institute, 48015 Bilbao, Spain;
- Department of Neurosurgery, Hospital Quironsalud, 28223 Madrid, Spain
| | - Manuel Carreiras
- Neurobiology of Language Group, Basque Center on Cognition, Brain and Language (BCBL), 20009 Donostia-San Sebastián, Spain; (L.A.); (M.C.)
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Basque Language and Communication, University of the Basque Country, UPV/EHU, 48940 Bilbao, Spain
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94
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Yourganov G, Stark BC, Fridriksson J, Bonilha L, Rorden C. Effect of Stroke on Contralateral Functional Connectivity. Brain Connect 2021; 11:543-552. [PMID: 33757303 DOI: 10.1089/brain.2020.0901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Stroke can induce large-scale functional reorganization of the brain; however, the spatial patterns of this reorganization remain largely unknown. Methods: Using a large (N = 116) sample of participants who were in the chronic stages of stroke, we present a systematic study of the association between brain damage and functional connectivity (FC) within the intact hemisphere. We computed correlations between regional cortical damage and contralateral FC. Results: We identified left-hemisphere regions that had the most pronounced effect on the right-hemisphere FC, and, conversely, right-hemisphere connections where the effect of damage was particularly strong. Notably, the vast majority of significant correlations were positive: damage was associated with an increase in regional contralateral connectivity. Discussion: These findings lend evidence of the reorganization of contralateral cortical networks as a response to brain damage, which is more pronounced in a set of well-connected regions where connectivity increases with the amount of damage.
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Affiliation(s)
- Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology Integration, Clemson University, Clemson, South Carolina, USA
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, Indiana, USA.,Program in Neuroscience, Indiana University, Bloomington, Indiana, USA
| | - Julius Fridriksson
- Department of Communication Science and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
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95
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Wang P, Knösche TR, Chen L, Brauer J, Friederici AD, Maess B. Functional brain plasticity during L1 training on complex sentences: Changes in gamma-band oscillatory activity. Hum Brain Mapp 2021; 42:3858-3870. [PMID: 33942956 PMCID: PMC8288093 DOI: 10.1002/hbm.25470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 01/12/2023] Open
Abstract
The adult human brain remains plastic even after puberty. However, whether first language (L1) training in adults can alter the language network is yet largely unknown. Thus, we conducted a longitudinal training experiment on syntactically complex German sentence comprehension. Sentence complexity was varied by the depth of the center embedded relative clauses (i.e., single or double embedded). Comprehension was tested after each sentence with a question on the thematic role assignment. Thirty adult, native German speakers were recruited for 4 days of training. Magnetoencephalography (MEG) data were recorded and subjected to spectral power analysis covering the classical frequency bands (i.e., theta, alpha, beta, low gamma, and gamma). Normalized spectral power, time‐locked to the final closure of the relative clause, was subjected to a two‐factor analysis (“sentence complexity” and “training days”). Results showed that for the more complex sentences, the interaction of sentence complexity and training days was observed in Brodmann area 44 (BA 44) as a decrease of gamma power with training. Moreover, in the gamma band (55–95 Hz) functional connectivity between BA 44 and other brain regions such as the inferior frontal sulcus and the inferior parietal cortex were correlated with behavioral performance increase due to training. These results show that even for native speakers, complex L1 sentence training improves language performance and alters neural activities of the left hemispheric language network. Training strengthens the use of the dorsal processing stream with working‐memory‐related brain regions for syntactically complex sentences, thereby demonstrating the brain's functional plasticity for L1 training.
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Affiliation(s)
- Peng Wang
- Max Planck Institute for Human Cognitive and Brain SciencesBrain Networks GroupLeipzigGermany
| | - Thomas R. Knösche
- Max Planck Institute for Human Cognitive and Brain SciencesBrain Networks GroupLeipzigGermany
| | - Luyao Chen
- Beijing Normal UniversityCollege of Chinese Language and CultureBeijing
- Max Planck Institute for Human Cognitive and Brain SciencesDepartment of NeuropsychologyLeipzigGermany
| | - Jens Brauer
- Max Planck Institute for Human Cognitive and Brain SciencesDepartment of NeuropsychologyLeipzigGermany
- Friedrich Schiller UniversityOffice of the Vice‐President for Young ResearchersJenaGermany
| | - Angela D. Friederici
- Max Planck Institute for Human Cognitive and Brain SciencesDepartment of NeuropsychologyLeipzigGermany
| | - Burkhard Maess
- Max Planck Institute for Human Cognitive and Brain SciencesBrain Networks GroupLeipzigGermany
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96
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Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23:183-201. [PMID: 34102754 PMCID: PMC8189855 DOI: 10.5853/jos.2020.05015] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.
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Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye Elizabeth Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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97
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Voets NL, Parker Jones O, Isaac C, Mars RB, Plaha P. Tracking longitudinal language network reorganisation using functional MRI connectivity fingerprints. NEUROIMAGE-CLINICAL 2021; 30:102689. [PMID: 34215157 PMCID: PMC8122112 DOI: 10.1016/j.nicl.2021.102689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/03/2022]
Abstract
FMRI connectivity fingerprints represent patient-unique language networks. Fingerprints can be statistically tested to detect reorganisation in individuals. Connectivity fingerprints track surgery-related adaptations in individual patients. Network-level changes appear related to presence of language symptoms.
Large individual differences in how brain networks respond to treatment hinder efforts to personalise treatment in neurological conditions. We used a brain network fingerprinting approach to longitudinally track re-organisation of complementary phonological and semantic language networks in 19 patients before and after brain-tumour surgery. Patient task fingerprints were individually compared to normal networks established in 17 healthy controls. Additionally, pre- and post-operative patient fingerprints were directly compared to assess longitudinal network adaptations. We found that task networks remained stable over time in healthy controls, whereas treatment induced reorganisation in 47.4% of patient fluency networks and 15.8% of semantic networks. How networks adapted after surgery was highly unique; a subset of patients (10%) showed ‘normalisation’ while others (21%) developed newly atypical networks after treatment. The strongest predictor of adaptation of the fluency network was the presence of clinically reported language symptoms. Our findings indicate a tight coupling between processes disrupting performance and neural network adaptation, the patterns of which appear to be both task- and individually-unique. We propose that connectivity fingerprinting offers potential as a clinical marker to track adaptation of specific functional networks across treatment interventions over time.
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Affiliation(s)
- Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Oiwi Parker Jones
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Claire Isaac
- Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rogier B Mars
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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98
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Arheix-Parras S, Barrios C, Python G, Cogné M, Sibon I, Engelhardt M, Dehail P, Cassoudesalle H, Moucheboeuf G, Glize B. A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: Leads for future studies. Neurosci Biobehav Rev 2021; 127:212-241. [PMID: 33862065 DOI: 10.1016/j.neubiorev.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia. OBJECTIVE This systematic review summarizes the role of rTMS in aphasia rehabilitation. METHODS We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy. RESULTS In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this systematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance. CONCLUSIONS The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies.
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Affiliation(s)
- Sophie Arheix-Parras
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Charline Barrios
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Grégoire Python
- Faculté de psychologie, Université de Genève, Geneva, Switzerland
| | - Mélanie Cogné
- Department of Physical Medicine and Rehabilitation, CHU de Rennes, Rennes, France
| | - Igor Sibon
- INCIA, CNRS, UMR5287, University of Bordeaux, F-33400, Talence, France; Stroke Unit, Clinical Neurosciences Department, CHU de Bordeaux, 33076, Bordeaux, France
| | - Mélanie Engelhardt
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Patrick Dehail
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Hélène Cassoudesalle
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Geoffroy Moucheboeuf
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Bertrand Glize
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France; Faculté de psychologie, Université de Genève, Geneva, Switzerland; Institute of Neurodegenerative Diseases, CNRS UMR 5293, Université de Bordeaux, F-33000, Bordeaux, France.
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99
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Kerleroux B, Tomasino C, Soriano D, Rodrigues PG, Moura FS, Cottier JP, Bibi R, Herbreteau D, Hak JF, Ifergan H, Janot K, Annan M, Boulouis G, Narata AP. EASY score (Eloquent, Age and baseline SYmptoms score) for outcome prediction in patients with acute ischemic stroke. Clin Neurol Neurosurg 2021; 205:106626. [PMID: 33873121 DOI: 10.1016/j.clineuro.2021.106626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A pragmatic tool for the early and reliable prediction of recovery in patients with acute ischemic stroke is needed. We aimed to test the addition of brain eloquent areas involvement in variables predicting poor outcome, using a simple scoring system. METHODS Retrospective study of patients with anterior circulation acute ischemic stroke treated with best medical treatment and/or endovascular reperfusion. Primary outcome measure was 3-months poor outcome (mRs 3-6). We developed a prognostic model based on clinical data and a quantitative scoring system of the main eloquent brain areas involved on early follow-up CT, and analyzed its accuracy to predict poor outcome comparatively to three other prognostic models. The final model was used to develop a score for outcome prediction based on the multivariable analysis. RESULTS A total of 197 patients were included (poor outcome = 62; mean age 67 ± 15.1 years; 44% females). Independent predictors of poor outcome were increasing age (p < 0.001), baseline NIHSS (p = 0.03), and the involvement of two brain areas: posterior limb of internal capsule (p < 0.001) and postero-superior corona radiata (p < 0.001). This model showed to be the most accurate to predict poor outcome (Balance Accuracy = 77.74%; C-Statistic = 0.891). The derived risk score attributing points for each of these variables (EASY score) showed similar performances (Balance Accuracy = 82.11%; C-Statistic = 0.90). CONCLUSION The EASY score is an easy-to-apply and accurate tool to predict the 3-months functional outcome after ischemic stroke, relying on simple clinical features and the assessment of two key eloquent brain areas on early follow-up CT.
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Affiliation(s)
- Basile Kerleroux
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France; Neuroradiology Department, CH Sainte-Anne, 1 Rue Cabanis, Paris, France.
| | | | - Diogo Soriano
- Engineering, Modeling and Applied Social Sciences Center - ABC Federal University Santo André, SP, Brazil
| | - Paula G Rodrigues
- Engineering, Modeling and Applied Social Sciences Center - ABC Federal University Santo André, SP, Brazil
| | - Fernando Silva Moura
- Engineering, Modeling and Applied Social Sciences Center - ABC Federal University Santo André, SP, Brazil
| | | | - Richard Bibi
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France
| | - Denis Herbreteau
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France
| | - Jean François Hak
- Neuroradiology Department, CH Sainte-Anne, 1 Rue Cabanis, Paris, France; Neuroradiology Department, CHU La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Héloïse Ifergan
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France
| | - Kévin Janot
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France
| | - Mariam Annan
- Neurology CHRU de Tours, 2 bd Tonnelé, Tours, France
| | - Grégoire Boulouis
- Neuroradiology Department, CHRU de Tours, 2 bd Tonnelé, Tours, France; Neuroradiology Department, CH Sainte-Anne, 1 Rue Cabanis, Paris, France
| | - Ana Paula Narata
- Department of Neuroradiology, University Hospital of Southampton, Tremona Rd, Southampton, UK
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100
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Gárriz-Luis M, Narbona J, Sánchez-Carpintero R, Pastor MA, Fernández-Seara MA, Crespo-Eguilaz N. Neuroplasticity during the transition period: How the adolescent brain can recover from aphasia. A pilot study. Brain Dev 2021; 43:556-562. [PMID: 33451879 DOI: 10.1016/j.braindev.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Increasing clinical and scientific attention is given to the transition of neurological stages from child to adult. Data on brain plasticity during adolescence is interesting for providing adequate evidence-based medical attention to neurological conditions in this population. Acquired aphasia is well described in adults and children, but not in adolescence. OBJECTIVE We describe a 5-year follow-up of language in three adolescent subjects with post-brain injury aphasia. METHODS We analysed and scored formal aspects of language three times, language hemispheric dominance twice with dichotic listening test and functional magnetic resonance imaging (fMRI) brain activation patterns that supported expressive and comprehensive language during the recovery period. RESULTS We found similarities to both paediatric and adult aphasia in these three adolescents. While the level of recovery resembled that of children with aphasia, a more efficient language rehabilitation occurred in those who remained with left hemispheric dominance in the chronic stage, as it is reported in adults. CONCLUSIONS Our analysis and long-term follow-up provide data for a better understanding on how the injured brain matures during adolescence. More studies with larger samples will help to understand the function of the remaining networks and the recovery from injury in this particular age group.
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Affiliation(s)
- Maite Gárriz-Luis
- Paediatric Neurology Unit. Paediatrics Department, University Clinic of Navarra, Pio XII 36, Pamplona, Navarra 31008, Spain.
| | - Juan Narbona
- Paediatric Neurology Unit. Paediatrics Department, University Clinic of Navarra, Pio XII 36, Pamplona, Navarra 31008, Spain; Mind-Brain Group, ICS, University of Navarra, Address: Pio XII 36, Pamplona, Navarra 31008 Spain.
| | - Rocío Sánchez-Carpintero
- Paediatric Neurology Unit. Paediatrics Department, University Clinic of Navarra, Pio XII 36, Pamplona, Navarra 31008, Spain.
| | - María A Pastor
- Laboratory of Neuroimaging, Centre for Applied Medical Research, University Clinic of Navarra, Address: Pio XII 36, Pamplona, Navarra 31008 Spain.
| | - María A Fernández-Seara
- Department of Radiology, University Clinic of Navarra. Address: Pio XII 36, Pamplona, Navarra 31008 Spain.
| | - Nerea Crespo-Eguilaz
- Paediatric Neurology Unit. Paediatrics Department, University Clinic of Navarra, Pio XII 36, Pamplona, Navarra 31008, Spain.
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