A comparison of VLSM and VBM in a cohort of patients with post-stroke aphasia

Studies attempting to map post-stroke cognitive or motor symptoms to lesion location have been available in the literature for over 150 years. In the last two decades, two computational techniques have been developed to identify the lesion sites associated with behavioural impairments. Voxel Based Morphometry (VBM) has now been used extensively for this purpose in many different patient populations. More recently, Voxel-based Lesion Symptom Mapping (VLSM) was developed specifically for the purpose of identifying lesion–symptom relationships in stroke patients, and has been used extensively to study, among others functions, language, motor abilities and attention. However, no studies have compared the results of these two techniques so far. In this study we compared VLSM and VBM in a cohort of 20 patients with chronic post-stroke aphasia. Comparison of the two techniques showed overlap in regions previously found to be relevant for the tasks used, suggesting that using both techniques and looking for overlaps between them can increase the reliability of the results obtained. However, overall VBM and VLSM provided only partially concordant results and the differences between the two techniques are discussed.

Structural brain changes in First Episode Schizophrenia compared with Fronto-Temporal Lobar Degeneration: a meta-analysis

BACKGROUND

The authors sought to compare gray matter changes in First Episode Schizophrenia (FES) compared with Fronto-Temporal Lobar Degeneration (FTLD) using meta-analytic methods applied to neuro-imaging studies.

METHODS

A systematic search was conducted for published, structural voxel-based morphometric MRI studies in patients with FES or FTLD. Data were combined using anatomical likelihood estimation (ALE) to determine the extent of gray matter decreases and analysed to ascertain the degree of overlap in the spatial distribution of brain changes in both diseases.

RESULTS

Data were extracted from 18 FES studies (including a total of 555 patients and 621 comparison subjects) and 20 studies of FTLD or related disorders (including a total of 311 patients and 431 comparison subjects). The similarity in spatial overlap of brain changes in the two disorders was significant (p = 0.001). Gray matter deficits common to both disorders included bilateral caudate, left insula and bilateral uncus regions.

CONCLUSIONS

There is a significant overlap in the distribution of structural brain changes in First Episode Schizophrenia and Fronto-Temporal Lobar Degeneration. This may reflect overlapping aetiologies, or a common vulnerability of these regions to the distinct aetio-pathological processes in the two disorders.

Both the Middle Temporal Gyrus and the Ventral Anterior Temporal Area Are Crucial for Multimodal Semantic Processing: Distortion-corrected fMRI Evidence for a Double Gradient of Information Convergence in the Temporal Lobes

Most contemporary theories of semantic memory assume that concepts are formed from the distillation of information arising in distinct sensory and verbal modalities. The neural basis of this distillation or convergence of information was the focus of this study. Specifically, we explored two commonly posed hypotheses: (a) that the human middle temporal gyrus (MTG) provides a crucial semantic interface given the fact that it interposes auditory and visual processing streams and (b) that the anterior temporal region—especially its ventral surface (vATL)—provides a critical region for the multimodal integration of information. By utilizing distortion-corrected fMRI and an established semantic association assessment (commonly used in neuropsychological investigations), we compared the activation patterns observed for both the verbal and nonverbal versions of the same task. The results are consistent with the two hypotheses simultaneously: Both MTG and vATL are activated in common for word and picture semantic processing. Additional planned, ROI analyses show that this result follows from two principal axes of convergence in the temporal lobe: both lateral (toward MTG) and longitudinal (toward the anterior temporal lobe).

“Object Categorization: Reversals and Explanations of the Basic-Level Advantage” (Rogers & Patterson, 2007): A simplicity account

T. T. Rogers and K. Patterson (2007), in their article “Object Categorization: Reversals and Explanations of the Basic-Level Advantage” ( Journal of Experimental Psychology: General, 136, 451–469), reported an impressive set of results demonstrating a reversal of the highly robust basic-level advantage both in patients with semantic dementia and in healthy individuals engaged in a speeded categorization task. To explain their results, as well as the usual basic-level advantage seen in healthy individuals, the authors employed a parallel distributed processing theory of conceptual knowledge. In this paper, we introduce an alternative way of explaining the results of Rogers and Patterson, which is premised on a more restricted set of assumptions born from standard categorization theory. Specifically, we provide evidence that their results can be accounted for based on the predictions of the simplicity model of unsupervised categorization.

Structural abnormalities in the dyslexic brain: a meta-analysis of voxel-based morphometry studies

We used coordinate-based meta-analysis in order to objectively quantify gray matter abnormalities reported in nine Voxel-Based Morphometry studies of developmental dyslexia. Consistently across studies, reduced gray matter volume in dyslexic readers was found in the right superior temporal gyrus and left superior temporal sulcus. These results were related to findings from previous meta-analyses on functional brain abnormalities in dyslexic readers. Convergence of gray matter reduction and reading-related underactivation was found for the left superior temporal sulcus. Recent studies point to the presence of both functional and structural abnormalities in left temporal and occipito-temporal brain regions before reading onset.

The cortical organization of lexical knowledge: a dual lexicon model of spoken language processing

Current accounts of spoken language assume the existence of a lexicon where wordforms are stored and interact during spoken language perception, understanding and production. Despite the theoretical importance of the wordform lexicon, the exact localization and function of the lexicon in the broader context of language use is not well understood. This review draws on evidence from aphasia, functional imaging, neuroanatomy, laboratory phonology and behavioral results to argue for the existence of parallel lexica that facilitate different processes in the dorsal and ventral speech pathways. The dorsal lexicon, localized in the inferior parietal region including the supramarginal gyrus, serves as an interface between phonetic and articulatory representations. The ventral lexicon, localized in the posterior superior temporal sulcus and middle temporal gyrus, serves as an interface between phonetic and semantic representations. In addition to their interface roles, the two lexica contribute to the robustness of speech processing.

The role of plasticity-related functional reorganization in the explanation of central dyslexias

This investigation explored the hypothesis that patterns of acquired dyslexia may reflect, in part, plasticity-driven relearning that dynamically alters the division of labour (DOL) between the direct, orthography → phonology (O → P) pathway and the semantically mediated, orthography → semantics → phonology (O → S → P) pathway. Three simulations were conducted using a variant of the triangle model of reading. The model demonstrated core characteristics of normal reading behaviour in its undamaged state. When damage was followed by reoptimization (mimicking spontaneous recovery), the model reproduced the deficits observed in the central dyslexias-acute phonological damage combined with recovery matched data taken from a series of 12 phonological dyslexic patients-whilst progressive semantic damage interspersed with recovery reproduced data taken from 100 observations of semantic dementia patients. The severely phonologically damaged model also produced symptoms of deep dyslexia (imageability effects, production of semantic and mixed semantic/visual errors). In all cases, the DOL changed significantly in the recovery period, suggesting that postmorbid functional reorganization is important in understanding behaviour in chronic-stage patients.

The path to memory is guided by strategy: distinct networks are engaged in associative encoding under visual and verbal strategy and influence memory performance in healthy and impaired individuals

Given the diversity of stimuli encountered in daily life, a variety of strategies must be used for learning new information. Relating and encoding visual and verbal stimuli into memory has been probed using various tasks and stimulus types. Engagement of specific subsequent memory and cortical processing regions depends on the stimulus modality of studied material; however, it remains unclear whether different encoding strategies similarly influence regional activity when stimulus type is held constant. In this study, participants encoded object pairs using a visual or verbal associative strategy during fMRI, and subsequent memory was assessed for pairs encoded under each strategy. Each strategy elicited distinct regional processing and subsequent memory effects: middle/superior frontal, lateral parietal, and lateral occipital for visually associated pairs and inferior frontal, medial frontal, and medial occipital for verbally associated pairs. This regional selectivity mimics the effects of stimulus modality, suggesting that cortical involvement in associative encoding is driven by strategy and not simply by stimulus type. The clinical relevance of these findings, probed in a patient with a recent aphasic stroke, suggest that training with strategies utilizing unaffected cortical regions might improve memory ability in patients with brain damage.

[Frontotemporal dementias]

Frontotemporal dementias (FTD) account for only 5-7% of all dementia aetiologies. However, FTD is one common form of dementia in the presenile period with a symptom onset between an age of 45 and 65 years. FTD are clinically classified into a group of rare genetic variants, the behavioural variant, primary progressive aphasias and a variant including motor neuron symptoms (FTD-MNS). In recent years the pathobiological characteristics of some FTD variants was clarified, demonstrating a pathological accumulation of TAR-DNA binding protein 43 (TDP-43) as a common pathological substrate. The revised diagnostic criteria of the behavioural variant of the FTD require at least three of six clinically discriminating features (disinhibition, apathy, loss of sympathy, perseverative behaviours, hyperorality and dysexecutive neuropsychological profile). The primary progressive aphasias are classified in a nonfluent/agrammatic variant, a logopenic variant and a semantic variant according to clinical and imaging features. Movement disorders and more precisely a Parkinsonian syndrome can be part of the FTD spectrum. Some clinical features overlap the clinical diagnosis of a progressive supranuclear paralysis and the corticobasal ganglionic degeneration. A causal therapy does not exist and medical treatment is directed at the patient's key symptoms. Different agents such as serotonin reuptake inhibitors, tricyclic antidepressants, atypical neuroleptics, carbamazepine, valproate, lamotrigine and when indicated also acetylcholinesterase inhibitors are potentially helpful. All together, theses medical treatments have a low level of evidence. Non-pharmacological therapies such as physiotherapy, occupational therapy, speech therapy and disease-specific education of the patient and their relatives are important to ensure a safe residential environment and daily routine.

Individual differences in skilled adult readers reveal dissociable patterns of neural activity associated with component processes of reading

We used fMRI to examine patterns of brain activity associated with component processes of visual word recognition and their relationships to individual differences in reading skill. We manipulated both the judgments adults made on written stimuli and the characteristics of the stimuli. Phonological processing led to activation in left inferior frontal and temporal regions whereas semantic processing was associated with bilateral middle frontal activation. Individual differences in reading subskills were reflected in differences in the degree to which cortical regions were engaged during reading. Variation in sight word reading efficiency was associated with degree of activation in visual cortex. Increased phonological decoding skill was associated with greater activation in left temporo-parietal cortex. Greater reading comprehension ability was associated with decreased activation in anterior cingulate and temporal regions. Notably, associations between reading ability and neural activation indicate that brain/behavior relationships among skilled readers differ from patterns associated with dyslexia and reading development.

The function of the anterior temporal lobe: a review of the empirical evidence

Recent work on the anterior temporal lobe (ATL) has lead to substantively different theoretical branches, of its putative functions, that have in some part developed independently of one another. The ATL has dense connectivity with a number of sensory modalities. This has resulted in empirical evidence that supports different functionality dependent upon the variables under investigation. The main bodies of evidence have implicated the ATL as a domain-general semantic hub, whilst other evidence points to a domain-specific role in social or 'person-related' processing. A third body of evidence suggests that the ATLs underlie processing of unique entities. Primarily, research of the ATL has been based on lesion studies and from clinical populations such as semantic dementia or temporal lobe epilepsy patients. Although important, this neuropsychological evidence has a number of confounds, therefore techniques such as functional neuroimaging on healthy participants and the relatively novel use of non-invasive brain stimulation may be more useful to isolate specific variables that can discriminate between these different theories concerning 'normal' function. This review focuses on these latter types of studies and considers the empirical evidence for each perspective. The overall literature is integrated in an attempt to formulate a unifying theory and the functional sub-regions within the ATL are explored. It is concluded that a holistic integration of the theories is feasible in that the ATLs could process domain-general semantic knowledge but with a bias towards social information or stimuli that is personally relevant. Thus, it may be the importance of social/emotional information that gives it priority of processing in the ATL not an inherent property of the structure itself.

Comprehension of concrete and abstract words in patients with selective anterior temporal lobe resection and in patients with selective amygdalo-hippocampectomy

The role of the anterior temporal lobe (ATL) in semantic memory is now firmly established. There is still controversy, however, regarding the specific role of this region in processing various types of concepts. There have been reports of patients suffering from semantic dementia (SD), a neurodegenerative condition in which the ATL is damaged bilaterally, who present with greater semantic impairment for concrete concepts than for abstract concepts, an effect known as reversal of the concreteness effect. This effect has previously been interpreted as reflecting degraded visual-perceptual features of objects due to damage to the inferior temporal lobes such as is observed in SD. Temporal lobe atrophy in SD, however, is bilateral even if it usually predominates to the left ATL, and it has been found to extend beyond the ATL, throughout the temporal lobes including medial and posterior temporal lobe regions. The question therefore remains whether greater impairment for concrete concepts results from damage to the ATL or from damage to the visual association cortex, and if unilateral damage can produce such a deficit. The aim of the present study was to investigate the processing of concrete and abstract words in rare patients who underwent a selective ATL surgical resection, and to compare their performance with that of patients with selective medial temporal lobe damage sparing the ATL region. Seven patients with a selective unilateral anterior temporal resection (ATL), 15 patients with a selective unilateral amygdalo-hippocampectomy (SeAH), and 15 healthy age- and education-matched controls underwent detailed neuropsychological assessment and carried out a semantic similarity judgment task evaluating their comprehension of concrete and abstract words. Results showed that both ATL and SeAH groups were significantly impaired on the semantic task relative to the control group. Within the patient groups, however, comprehension of concrete words was significantly more impaired than that of abstract words in the ATL group, while comprehension of abstract and concrete words was equally affected in the SeAH group. Results of this study suggest that the ATL region may play a critical role in processing concrete concepts, and that the reversal of the concreteness effect observed in ATL patients may result from damage to a categorical organization underlying the representation of concrete concepts.

The differential contributions of pFC and temporo-parietal cortex to multimodal semantic control: exploring refractory effects in semantic aphasia

Aphasic patients with multimodal semantic impairment following pFC or temporo-parietal (TP) cortex damage (semantic aphasia [SA]) have deficits characterized by poor control of semantic activation/retrieval, as opposed to loss of semantic knowledge per se. In line with this, SA patients show "refractory effects"; that is, declining accuracy in cyclical word-picture matching tasks when semantically related sets are presented rapidly and repeatedly. This is argued to follow a build-up of competition between targets and distractors. However, the link between poor semantic control and refractory effects is still controversial for two reasons. (1) Some theories propose that refractory effects are specific to verbal or auditory tasks, yet SA patients show poor control over semantic processing in both word and picture semantic tasks. (2) SA can result from lesions to either the left pFC or TP cortex, yet previous work suggests that refractory effects are specifically linked to the left inferior frontal cortex. For the first time, verbal, visual, and nonverbal auditory refractory effects were explored in nine SA patients who had pFC (pFC+) or TP cortex (TP-only) lesions. In all modalities, patient accuracy declined significantly over repetitions. This refractory effect at the group level was driven by pFC+ patients and was not shown by individuals with TP-only lesions. These findings support the theory that SA patients have reduced control over multimodal semantic retrieval and, additionally, suggest there may be functional specialization within the posterior versus pFC elements of the semantic control network.

Executive semantic processing is underpinned by a large-scale neural network: revealing the contribution of left prefrontal, posterior temporal, and parietal cortex to controlled retrieval and selection using TMS

To understand the meanings of words and objects, we need to have knowledge about these items themselves plus executive mechanisms that compute and manipulate semantic information in a task-appropriate way. The neural basis for semantic control remains controversial. Neuroimaging studies have focused on the role of the left inferior frontal gyrus (LIFG), whereas neuropsychological research suggests that damage to a widely distributed network elicits impairments of semantic control. There is also debate about the relationship between semantic and executive control more widely. We used TMS in healthy human volunteers to create "virtual lesions" in structures typically damaged in patients with semantic control deficits: LIFG, left posterior middle temporal gyrus (pMTG), and intraparietal sulcus (IPS). The influence of TMS on tasks varying in semantic and nonsemantic control demands was examined for each region within this hypothesized network to gain insights into (i) their functional specialization (i.e., involvement in semantic representation, controlled retrieval, or selection) and (ii) their domain dependence (i.e., semantic or cognitive control). The results revealed that LIFG and pMTG jointly support both the controlled retrieval and selection of semantic knowledge. IPS specifically participates in semantic selection and responds to manipulations of nonsemantic control demands. These observations are consistent with a large-scale semantic control network, as predicted by lesion data, that draws on semantic-specific (LIFG and pMTG) and domain-independent executive components (IPS).

Lexicality Effects in Word and Nonword Recall of Semantic Dementia and Progressive Nonfluent Aphasia

BACKGROUND

Verbal working memory is an essential component of many language functions, including sentence comprehension and word learning. As such, working memory has emerged as a domain of intense research interest both in aphasiology and in the broader field of cognitive neuroscience. The integrity of verbal working memory encoding relies on a fluid interaction between semantic and phonological processes. That is, we encode verbal detail using many cues related to both the sound and meaning of words. Lesion models can provide an effective means of parsing the contributions of phonological or semantic impairment to recall performance.

METHODS AND PROCEDURES

We employed the lesion model approach here by contrasting the nature of lexicality errors incurred during recall of word and nonword sequences by 3individuals with progressive nonfluent aphasia (a phonological dominant impairment) compared to that of 2 individuals with semantic dementia (a semantic dominant impairment). We focused on psycholinguistic attributes of correctly recalled stimuli relative to those that elicited a lexicality error (i.e., nonword → word OR word → nonword).

OUTCOMES AND RESULTS

Patients with semantic dementia showed greater sensitivity to phonological attributes (e.g., phoneme length, wordlikeness) of the target items relative to semantic attributes (e.g., familiarity). Patients with PNFA showed the opposite pattern, marked by sensitivity to word frequency, age of acquisition, familiarity, and imageability.

CONCLUSIONS

We interpret these results in favor of a processing strategy such that in the context of a focal phonological impairment patients revert to an over-reliance on preserved semantic processing abilities. In contrast, a focal semantic impairment forces both reliance upon and hypersensitivity to phonological attributes of target words. We relate this interpretation to previous hypotheses about the nature of verbal short-term memory in progressive aphasia.

Converging functional magnetic resonance imaging evidence for a role of the left inferior frontal lobe in semantic retention during language comprehension

Increasing evidence supports dissociable short-term memory (STM) capacities for semantic and phonological representations. Cognitive neuropsychological data suggest that damage to the left inferior and middle frontal gyri are associated with deficits of semantic STM, while damage to inferior parietal areas is associated with deficits of phonological STM. Patients identified as having semantic STM deficits are also impaired on a number of language comprehension and production paradigms. We used one such comprehension task derived from cognitive neuropsychological data to test predictions with functional magnetic resonance imaging (fMRI) using healthy participants. Using a task that required participants to make semantic anomaly judgements, we found significantly greater activation in areas of the left inferior frontal and middle frontal gyri for phrases that required maintenance of multiple words for eventual integration with a subsequent noun or verb. These data are consistent with our previous patient studies (Hanten & Martin, 2000; R. C. Martin & He, 2004; R. C. Martin & Romani, 1994 ) that suggest that semantic STM is associated with the left inferior and middle frontal gyri and that deficits of semantic STM have particular consequences for comprehension tasks that require maintenance of several word meanings in unintegrated form.

Positive effects of language treatment for the logopenic variant of primary progressive aphasia

Despite considerable recent progress in understanding the underlying neurobiology of primary progressive aphasia (PPA) syndromes, relatively little attention has been directed toward the examination of behavioral interventions that may lessen the pervasive communication problems associated with PPA. In this study, we report on an individual with a behavioral profile and cortical atrophy pattern consistent with the logopenic variant of PPA. At roughly two-and-a-half years post onset, his marked lexical retrieval impairment prompted administration of a semantically based intervention to improve word retrieval. The treatment was designed to improve self-directed efforts to engage the participant's relatively preserved semantic system in order to facilitate word retrieval. His positive response to an intensive (2-week) dose of behavioral treatment was associated with improved lexical retrieval of items within trained categories, and generalized improvement for naming of untrained items that lasted over a 6-month follow-up interval. These findings support the potential value of intensive training to achieve self-directed strategic compensation for lexical retrieval difficulties in logopenic PPA. Additional insight was gained regarding the neural regions that supported improved performance by the administration of a functional magnetic resonance imaging protocol before and after treatment. In the context of a picture-naming task, post-treatment fMRI showed increased activation of left dorsolateral prefrontal regions that have been implicated in functional imaging studies of generative naming in healthy individuals. The increased activation in these frontal regions that were not significantly atrophic in our patient (as determined by voxel-based morphometry) is consistent with the notion that neural plasticity can support compensation for specific language loss, even in the context of progressive neuronal degeneration.

The neurobiology of semantic memory

Semantic memory includes all acquired knowledge about the world and is the basis for nearly all human activity, yet its neurobiological foundation is only now becoming clear. Recent neuroimaging studies demonstrate two striking results: the participation of modality-specific sensory, motor, and emotion systems in language comprehension, and the existence of large brain regions that participate in comprehension tasks but are not modality-specific. These latter regions, which include the inferior parietal lobe and much of the temporal lobe, lie at convergences of multiple perceptual processing streams. These convergences enable increasingly abstract, supramodal representations of perceptual experience that support a variety of conceptual functions including object recognition, social cognition, language, and the remarkable human capacity to remember the past and imagine the future.

MRI patterns of atrophy and hypoperfusion associations across brain regions in frontotemporal dementia

Magnetic Resonance Imaging (MRI) provides various imaging modes to study the brain. We tested the benefits of a joint analysis of multimodality MRI data in combination with a large-scale analysis that involved simultaneously all image voxels using joint independent components analysis (jICA) and compared the outcome to results using conventional voxel-by-voxel unimodality tests. Specifically, we designed a jICA to decompose multimodality MRI data into independent components that explain joint variations between the image modalities as well as variations across brain regions. We tested the jICA design on structural and perfusion-weighted MRI data from 12 patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and 12 cognitively normal elderly individuals. While unimodality analyses showed widespread brain atrophy and hypoperfusion in the patients, jICA further revealed two significant joint components of variations between atrophy and hypoperfusion across brain regions. The 1st joint component revealed associated brain atrophy and hypoperfusion predominantly in the right brain hemisphere in behavioral variant frontotemporal dementia, and the 2nd joint component revealed greater atrophy relative to hypoperfusion affecting predominantly the left hemisphere in behavioral variant frontotemporal dementia. The patterns are consistent with the clinical symptoms of behavioral variant frontotemporal dementia that relate to asymmetric compromises of the left and right brain hemispheres. The joint components also revealed that that structural alterations can be associated with physiological alterations in spatially separated but potentially connected brain regions. Finally, jICA outperformed voxel-by-voxel unimodal tests significantly in terms of an effect size, separating the behavioral variant frontotemporal dementia patients from the controls. Taken together, the results demonstrate the benefit of multimodality MRI in conjunction with jICA for mapping neurodegeneration, which may lead ultimately to an improved diagnosis of behavioral variant frontotemporal dementia and other forms of neurodegenerative diseases.

Premorbid expertise produces category-specific impairment in a domain-general semantic disorder

For decades, category-specific semantic impairment - i.e., better comprehension of items from one semantic category than another - has been the driving force behind many claims about the organisation of conceptual knowledge in the brain. Double dissociations between patients with category-specific disorders are widely interpreted as showing that different conceptual domains are necessarily supported by functionally independent systems. We show that, to the contrary, even strong or classical dissociations can also arise from individual differences in premorbid expertise. We examined two patients with global and progressive semantic degradation who, unusually, had known areas of premorbid expertise. Patient 1, a former automotive worker, showed selective preservation of car knowledge, whereas Patient 2, a former botanist, showed selective preservation of information about plants. In non-expert domains, these patients showed the typical pattern: i.e., an inability to differentiate between highly similar concepts (e.g., rose and daisy), but retention of broader distinctions (e.g., between rose and cat). Parallel distributed processing (PDP) models of semantic cognition show that expertise in a particular domain increases the differentiation of specific-level concepts, such that the semantic distance between these items resembles non-expert basic-level distinctions. We propose that these structural changes interact with global semantic degradation, particularly when expert knowledge is acquired early and when exposure to expert concepts continues during disease progression. Therefore, category-specific semantic impairment can arise from at least two distinct mechanisms: damage to representations that are critical for a particular category (e.g., knowledge of hand shape and action for the category 'tools') and differences in premorbid experience.

Differential Contributions of Bilateral Ventral Anterior Temporal Lobe and Left Anterior Superior Temporal Gyrus to Semantic Processes

Studies of semantic dementia and repetitive TMS have suggested that the bilateral anterior temporal lobes (ATLs) underpin a modality-invariant representational hub within the semantic system. However, it is not clear whether all ATL subregions contribute in the same way. We utilized distortion-corrected fMRI to investigate the pattern of activation in the left and right ATL when participants performed a semantic decision task on auditory words, environmental sounds, or pictures. This showed that the ATL is not functionally homogeneous but is more graded. Both left and right ventral ATL (vATL) responded to all modalities in keeping with the notion that this region underpins multimodality semantic processing. In addition, there were graded differences across the hemispheres. Semantic processing of both picture and environmental sound stimuli was associated with equivalent bilateral vATL activation, whereas auditory words generated greater activation in left than right vATL. This graded specialization for auditory stimuli would appear to reflect the input from the left superior ATL, which responded solely to semantic decisions on the basis of spoken words and environmental sounds, suggesting that this region is specialized to auditory stimuli. A final noteworthy result was that these regions were activated for domain level decisions to singly presented stimuli, which appears to be incompatible with the hypotheses that the ATL is dedicated (a) to the representation of specific entities or (b) for combinatorial semantic processes.

Biomarkers in frontotemporal lobar degeneration

PURPOSE OF REVIEW

Recent findings assessing the utility of neuroimaging and biofluid biomarkers are reviewed that help identify patients with frontotemporal lobar degeneration (FTLD) spectrum abnormality.

RECENT FINDINGS

Neuroimaging studies using T1 structural MRI and diffusion tensor imaging (DTI) distinguish between patients with FTLD and Alzheimer's disease, although the reliability of these group-level findings in individual patients has been assessed only rarely. However, innovative analyses such as support vector machine approaches are able to integrate T1 and DTI imaging results and to identify specific MRI profiles that distinguish between individual patients with FTLD and Alzheimer's disease. Novel radioligand positron emission tomography assessments also can recognize Alzheimer's disease patients with a clinical phenotype resembling that seen in FTLD. Biofluid studies identify about 15% of patients with FTLD due to a genetic mutation that is associated with the specific histopathologic features of TDP-43 or a tauopathy. Other genetically-based risk factors and targeted proteomic searches of plasma and cerebrospinal fluid have suggested additional markers in sporadic cases of FTLD that will lead to the identification of patients with TDP-43 or tau histopathology.

SUMMARY

Great progress has been made in developing biomarkers for FTLD, but additional work is needed to extend these advances so that the histopathologic abnormality causing FTLD can be specified in an individual patient.

Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship

Primary progressive aphasia (PPA), typically resulting from a neurodegenerative disease such as frontotemporal dementia/Pick Complex or Alzheimer's disease, is a heterogeneous clinical condition characterized by a progressive loss of specific language functions with initial sparing of other cognitive domains. Based on the constellation of symptoms, PPA has been classified into a nonfluent, semantic, or logopenic variant. This review of the literature aims to characterize the speech and language impairment, cognition, neuroimaging, pathology, genetics, and epidemiology associated with each of these variants. Some therapeutic recommendations, theoretical implications, and directions for future research have been also provided.

Magnetoencephalography of frontotemporal dementia: spatiotemporally localized changes during semantic decisions

Behavioural variant frontotemporal dementia is a neurodegenerative disorder with dysfunction and atrophy of the frontal lobes leading to changes in personality, behaviour, empathy, social conduct and insight, with relative preservation of language and memory. As novel treatments begin to emerge, biomarkers of frontotemporal dementia will become increasingly important, including functionally relevant neuroimaging indices of the neurophysiological basis of cognition. We used magnetoencephalography to examine behavioural variant frontotemporal dementia using a semantic decision task that elicits both frontal and temporal activity in healthy people. Twelve patients with behavioural variant frontotemporal dementia (age 50-75) and 16 matched controls made categorical semantic judgements about 400 pictures during continuous magnetoencephalography. Distributed source analysis was used to compare patients and controls. The patients had normal early responses to picture confrontation, indicating intact visual processing. However, a predominantly posterior set of regions including temporoparietal cortex showed reduced source activity 250-310 ms after stimulus onset, in proportion to behavioural measures of semantic association. In contrast, a left frontoparietal network showed reduced source activity at 550-650 ms, proportional to patients' deficits in attention and orientation. This late deficit probably reflects impairment in the neural substrate of goal-oriented decision making. The results demonstrate behaviourally relevant neural correlates of semantic processing and decision making in behavioural variant frontotemporal dementia, and show for the first time that magnetoencephalography can be used to study cognitive systems in the context of frontotemporal dementia.

Neuropathological background of phenotypical variability in frontotemporal dementia

Frontotemporal lobar degeneration (FTLD) is the umbrella term encompassing a heterogeneous group of pathological disorders. With recent discoveries, the FTLDs have been show to classify nicely into three main groups based on the major protein deposited in the brain: FTLD-tau, FTLD-TDP and FTLD-FUS. These pathological groups, and their specific pathologies, underlie a number of well-defined clinical syndromes, including three frontotemporal dementia (FTD) variants [behavioral variant frontotemporal dementia (bvFTD), progressive non-fluent aphasia, and semantic dementia (SD)], progressive supranuclear palsy syndrome (PSPS) and corticobasal syndrome (CBS). Understanding the neuropathological background of the phenotypic variability in FTD, PSPS and CBS requires large clinicopathological studies. We review current knowledge on the relationship between the FTLD pathologies and clinical syndromes, and pool data from a number of large clinicopathological studies that collectively provide data on 544 cases. Strong relationships were identified as follows: FTD with motor neuron disease and FTLD-TDP; SD and FTLD-TDP; PSPS and FTLD-tau; and CBS and FTLD-tau. However, the relationship between some of these clinical diagnoses and specific pathologies is not so clear cut. In addition, the clinical diagnosis of bvFTD does not have a strong relationship to any FTLD subtype or specific pathology and therefore remains a diagnostic challenge. Some evidence suggests improved clinicopathological association of bvFTD by further refining clinical characteristics. Unlike FTLD-tau and FTLD-TDP, FTLD-FUS has been less well characterized, with only 69 cases reported. However, there appears to be some associations between clinical phenotypes and FTLD-FUS pathologies. Clinical diagnosis is therefore promising in predicting molecular pathology.

Biomarkers to identify the pathological basis for frontotemporal lobar degeneration

Recent findings assessing the utility of biomarkers are reviewed that help identify the basis for disease in patients with frontotemporal lobar degeneration (FTLD) spectrum pathology. Biofluid studies identify about 15% of patients with FTLD due to a genetic mutation that is associated with the specific histopathologic features of TDP-43 or a tauopathy. Other genetically based risk factors and targeted proteomic searches of plasma and cerebrospinal fluid have suggested additional markers that may be useful in sporadic cases of FTLD. While progress has been made in developing biomarkers for FTLD, additional work is needed to extend these advances so that the histopathologic abnormality causing FTLD can be specified in an individual patient.

Episodic and semantic memory in children with mesial temporal sclerosis

The aim of this study was to analyze semantic and episodic memory deficits in children with mesial temporal sclerosis (MTS) and their correlation with clinical epilepsy variables. For this purpose, 19 consecutive children and adolescents with MTS (8 to 16 years old) were evaluated and their performance on five episodic memory tests (short- and long-term memory and learning) and four semantic memory tests was compared with that of 28 healthy volunteers. Patients performed worse on tests of immediate and delayed verbal episodic memory, visual episodic memory, verbal and visual learning, mental scanning for semantic clues, object naming, word definition, and repetition of sentences. Clinical variables such as early age at seizure onset, severity of epilepsy, and polytherapy impaired distinct types of memory. These data confirm that children with MTS have episodic memory deficits and add new information on semantic memory. The data also demonstrate that clinical variables contribute differently to episodic and semantic memory performance.

White matter damage in primary progressive aphasias: a diffusion tensor tractography study

Primary progressive aphasia is a clinical syndrome that encompasses three major phenotypes: non-fluent/agrammatic, semantic and logopenic. These clinical entities have been associated with characteristic patterns of focal grey matter atrophy in left posterior frontoinsular, anterior temporal and left temporoparietal regions, respectively. Recently, network-level dysfunction has been hypothesized but research to date has focused largely on studying grey matter damage. The aim of this study was to assess the integrity of white matter tracts in the different primary progressive aphasia subtypes. We used diffusion tensor imaging in 48 individuals: nine non-fluent, nine semantic, nine logopenic and 21 age-matched controls. Probabilistic tractography was used to identify bilateral inferior longitudinal (anterior, middle, posterior) and uncinate fasciculi (referred to as the ventral pathway); and the superior longitudinal fasciculus segmented into its frontosupramarginal, frontoangular, frontotemporal and temporoparietal components, (referred to as the dorsal pathway). We compared the tracts' mean fractional anisotropy, axial, radial and mean diffusivities for each tract in the different diagnostic categories. The most prominent white matter changes were found in the dorsal pathways in non-fluent patients, in the two ventral pathways and the temporal components of the dorsal pathways in semantic variant, and in the temporoparietal component of the dorsal bundles in logopenic patients. Each of the primary progressive aphasia variants showed different patterns of diffusion tensor metrics alterations: non-fluent patients showed the greatest changes in fractional anisotropy and radial and mean diffusivities; semantic variant patients had severe changes in all metrics; and logopenic patients had the least white matter damage, mainly involving diffusivity, with fractional anisotropy altered only in the temporoparietal component of the dorsal pathway. This study demonstrates that both careful dissection of the main language tracts and consideration of all diffusion tensor metrics are necessary to characterize the white matter changes that occur in the variants of primary progressive aphasia. These results highlight the potential value of diffusion tensor imaging as a new tool in the multimodal diagnostic evaluation of primary progressive aphasia.

Support for anterior temporal involvement in semantic error production in aphasia: new evidence from VLSM

Semantic errors in aphasia (e.g., naming a horse as "dog") frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were found in the left anterior temporal lobe (L-ATL), in the mid- to anterior MTG region. The absence of findings in Wernicke's area was surprising, as were indications that ATL voxels made an essential contribution to the post-semantic stage of lexical access. In this follow-up study, we sought to validate these results by re-defining semantic errors in a manner that was less theory dependent and more consistent with prior lesion studies. As this change also increased the robustness of the dependent variable, it made it possible to perform additional statistical analyses that further refined the interpretation. The results strengthen the evidence for a causal relationship between ATL damage and lexically-based semantic errors in naming and lend confidence to the conclusion that chronic lesions in Wernicke's area are not causally implicated in semantic error production.

Neural correlates of lexical-semantic memory: A voxel-based morphometry study in mild AD, aMCI and normal aging

Neuroanatomical correlations of naming and lexical-semantic memory are not yet fully understood. The most influential approaches share the view that semantic representations reflect the manner in which information has been acquired through perception and action, and that each brain area processes different modalities of semantic representations. Despite these anatomical differences in semantic processing, generalization across different features that have similar semantic significance is one of the main characteristics of human cognition.

Neuroimaging findings in frontotemporal lobar degeneration spectrum of disorders

Frontotemporal lobar degeneration (FTLD) is a clinically and pathologically heterogeneous spectrum of disorders. In the last few years, neuroimaging has contributed to the phenotypic characterisation of these patients. Complementary to the clinical and neuropsychological evaluations, structural magnetic resonance imaging (MRI) and functional techniques provide important pieces of information for the diagnosis of FTLD. They also appear to be useful in distinguishing FTLD from patients with Alzheimer's disease (AD). Preliminary studies in pathologically proven cases suggested that distinct patterns of tissue loss could assist in predicting in vivo the pathological subtype. Recent years have also witnessed impressive advances in the development of novel imaging approaches. Diffusion tensor MRI and functional MRI have improved our understanding of the pathophysiology of the disease, and this should lead to the identification of additional useful markers of disease progression. This reviews discusses comprehensively the state-of-the-art of neuroimaging in the study of FTLD spectrum of disorders, and attempts to envisage which will be new neuroimaging biomarkers that could serve as surrogate measures of the underlying pathology. This will be central in the design of treatment trials of experimental drugs, which are likely to emerge in the near future, to target the pathological processes associated with this condition.

Low-frequency repetitive transcranial magnetic stimulation of the anterior temporal lobes does not dissociate social versus nonsocial semantic knowledge

Social conceptual knowledge is imperative to communicate with, interact with, and interpret human society; however, little is known about the neural basis of social concepts. Previous research has predominantly suggested that the right anterior temporal lobe (ATL) may specifically represent social conceptual knowledge, whereas the left ATL is necessary for general semantic processing. However, this view has not always been supported by empirical studies. Employing a lateralized design and two different semantic tasks and a nonsemantic control task, we aimed to clarify some of these ambiguities by potentially dissociating left from right functionality and social from nonsocial concepts, using inhibitory repetitive transcranial magnetic stimulation (rTMS) coupled with a sham and control site stimulation ( N = 56). The results showed that stimulation of the left ATL led to overall faster processing times without affecting accuracy, whilst the right ATL and control groups did not significantly change in reaction times or accuracy. No difference occurred between social and nonsocial concepts after stimulation. This study is the first to show that inhibition of the left temporal lobe may improve performance on a semantic task and provides evidence that the ATLs may be lateralized in conceptual processing. The results do not confirm that the right temporal lobe is crucial for social conceptual processing, as inhibition did not significantly affect performance for social concepts.

Deregulated Semantic Cognition Follows Prefrontal and Temporo-parietal Damage: Evidence from the Impact of Task Constraint on Nonverbal Object Use

Semantic cognition, which encompasses all conceptually based behavior, is dependent on the successful interaction of two key components: conceptual representations and regulatory control. Qualitatively distinct disorders of semantic knowledge follow damage to the different parts of this system. Previous studies have shown that patients with multimodal semantic impairment following CVA—a condition referred to as semantic aphasia (SA)—perform poorly on a range of conceptual tasks due to a failure of executive control following prefrontal and/or temporo-parietal infarction [Jefferies, E., & Lambon Ralph, M. A. Semantic impairment in stroke aphasia versus semantic dementia: A case-series comparison. Brain, 129, 2132–2147, 2006]. Although a deficit of core semantic control would be expected to impair all modalities in parallel, most research exploring this condition has focused on tasks in the verbal domain. In a novel exploration of semantic control in the nonverbal domain, therefore, we assessed eight patients with SA on two experiments that examined object use knowledge under different levels of task constraint. Patients exhibited three key characteristics of semantic deregulation: (a) difficulty using conceptual knowledge flexibly to support the noncanonical uses of everyday objects; (b) poor inhibition of semantically related distractor items; and (c) improved object use with the provision of more tightly constraining task conditions following verbal and pictorial cues. Our findings are consistent with the notion that a neural network incorporating the left inferior prefrontal and temporo-parietal areas (damaged in SA) underpins regulation of semantic activation across both verbal and nonverbal modalities.

Semantic dementia and persisting Wernicke's aphasia: linguistic and anatomical profiles

Few studies have directly compared the clinical and anatomical characteristics of patients with progressive aphasia to those of patients with aphasia caused by stroke. In the current study we examined fluent forms of aphasia in these two groups, specifically semantic dementia (SD) and persisting Wernicke's aphasia (WA) due to stroke. We compared 10 patients with SD to 10 age- and education-matched patients with WA in three language domains: language comprehension (single words and sentences), spontaneous speech and visual semantics. Neuroanatomical involvement was analyzed using disease-specific image analysis techniques: voxel-based morphometry (VBM) for patients with SD and overlays of lesion digitized lesion reconstructions in patients with WA. Patients with SD and WA were both impaired on tasks that involved visual semantics, but patients with SD were less impaired in spontaneous speech and sentence comprehension. The anatomical findings showed that different regions were most affected in the two disorders: the left anterior temporal lobe in SD and the left posterior middle temporal gyrus in chronic WA. This study highlights that the two syndromes classically associated with language comprehension deficits in aphasia due to stroke and neurodegenerative disease are clinically distinct, most likely due to distinct distributions of damage in the temporal lobe.

Phonological learning in semantic dementia

Patients with semantic dementia (SD) have anterior temporal lobe (ATL) atrophy that gives rise to a highly selective deterioration of semantic knowledge. Despite pronounced anomia and poor comprehension of words and pictures, SD patients have well-formed, fluent speech and normal digit span. Given the intimate connection between phonological STM and word learning revealed by both neuropsychological and developmental studies, SD patients might be expected to show good acquisition of new phonological forms, even though their ability to map these onto meanings is impaired. In contradiction of these predictions, a limited amount of previous research has found poor learning of new phonological forms in SD. In a series of experiments, we examined whether SD patient, GE, could learn novel phonological sequences and, if so, under which circumstances. GE showed normal benefits of phonological knowledge in STM (i.e., normal phonotactic frequency and phonological similarity effects) but reduced support from semantic memory (i.e., poor immediate serial recall for semantically degraded words, characterised by frequent item errors). Next, we demonstrated normal learning of serial order information for repeated lists of single-digit number words using the Hebb paradigm: these items were well-understood allowing them to be repeated without frequent item errors. In contrast, patient GE showed little learning of nonsense syllable sequences using the same Hebb paradigm. Detailed analysis revealed that both GE and the controls showed a tendency to learn their own errors as opposed to the target items. Finally, we showed normal learning of phonological sequences for GE when he was prevented from repeating his errors. These findings confirm that the ATL atrophy in SD disrupts phonological processing for semantically degraded words but leaves the phonological architecture intact. Consequently, when item errors are minimised, phonological STM can support the acquisition of new phoneme sequences in patients with SD.

Different roles of lateral anterior temporal lobe and inferior parietal lobule in coding function and manipulation tool knowledge: evidence from an rTMS study

A remarkable cognitive ability in humans is the competency to use a wide variety of different tools. Two cortical regions, the anterior temporal lobes (ATL) and left inferior parietal lobule (IPL), have been proposed to make differential contributions to two kinds of knowledge about tools - function vs. manipulation. We used repetitive transcranial magnetic stimulation (rTMS) and two semantic decision tasks to assess the role of these regions in healthy participants. Participants made semantic decisions about the function (what for) or manipulation (how) of tools used in daily life. The stimulation of ATL resulted in longer responses for the "function" judgments, whilst stimulation of IPL yielded longer responses for the "manipulation" judgments. In line with the neuropsychological literature, these results are discussed within hub-and-spoke framework of semantic memory.

Perception and conception: temporal lobe activity during complex discriminations of familiar and novel faces and objects

Recent studies indicate that medial-temporal lobe (MTL) damage, either from focal lesions or neurodegenerative disease (e.g., semantic dementia), impairs perception as well as long-term declarative memory. Notably, however, these two patient groups show different performance for meaningful versus unfamiliar stimuli. In amnesics with nonprogressive MTL lesions, the use of meaningful stimuli, compared with unfamiliar items, boosted discrimination performance. In semantic dementia, a condition characterized by progressive deterioration of conceptual knowledge in the context of anterolateral temporal lobe damage, performance for meaningful stimuli was equivalent to that for unfamiliar items. To further investigate these findings, we scanned healthy volunteers while they performed odd-one-out discriminations involving familiar (i.e., meaningful/famous) and unfamiliar (i.e., novel) objects and faces and a baseline task of size oddity. Outside the scanner, volunteers' recognition memory was assessed. We found above baseline activity in the perirhinal cortex and hippocampus for all object and face discriminations and above baseline activity in the temporal pole for all face discriminations. The comparison of meaningful, relative to novel, faces and objects, revealed increased activity in the perirhinal cortex and hippocampus. In the temporal pole, we also found activity related to meaningfulness for faces but not for objects. Importantly, these meaningfulness effects were evident even for discriminations that were not subsequently well remembered, suggesting that the difference between meaningful and novel stimuli reflects perceptual or conceptual processes rather than solely incidental encoding into long-term memory. The results provide further evidence that the MTL is recruited during complex perceptual discrimination and additionally suggest that these structures are recruited in semantic processing of objects and faces.

Facilitate insight by non-invasive brain stimulation

Our experiences can blind us. Once we have learned to solve problems by one method, we often have difficulties in generating solutions involving a different kind of insight. Yet there is evidence that people with brain lesions are sometimes more resistant to this so-called mental set effect. This inspired us to investigate whether the mental set effect can be reduced by non-invasive brain stimulation. 60 healthy right-handed participants were asked to take an insight problem solving task while receiving transcranial direct current stimulation (tDCS) to the anterior temporal lobes (ATL). Only 20% of participants solved an insight problem with sham stimulation (control), whereas 3 times as many participants did so (p = 0.011) with cathodal stimulation (decreased excitability) of the left ATL together with anodal stimulation (increased excitability) of the right ATL. We found hemispheric differences in that a stimulation montage involving the opposite polarities did not facilitate performance. Our findings are consistent with the theory that inhibition to the left ATL can lead to a cognitive style that is less influenced by mental templates and that the right ATL may be associated with insight or novel meaning. Further studies including neurophysiological imaging are needed to elucidate the specific mechanisms leading to the enhancement.

The importance of multiple assessments of object knowledge in semantic dementia: the case of the familiar objects task

Semantic dementia (SD) is characterized by a dramatic loss of conceptual knowledge about the meaning of words and the identity of objects. Previous research has suggested that SD patients' knowledge is differentially influenced by the disease and may decline at different degrees depending on a patient's everyday familiarity with certain items. However, no study has examined (a) semantic knowledge deterioration and (b) the potential significance of autobiographical experience for the maintenance of object concepts in the same cohort of SD patients by using comprehensive assessments of different aspects of object knowledge across an experience-based, distributed semantic memory network. Here, we tested four SD patients and three Alzheimer's disease (AD) control patients using a range of tasks - including naming, gesture generation, and autobiographical knowledge - with personally familiar objects or perceptually similar or different object analogs. Our results showed dissociations between performance on naming relative to other assessments of object knowledge between SD and AD patients, though we did not observe a reliable familiar objects advantage. We discuss different factors that may account for these findings, as well as their implications for research on SD.