Predictability effect on N400 reflects the severity of reading comprehension deficits in aphasia

Exploring neural tracking of acoustic and linguistic speech representations in individuals with post-stroke aphasia

Aphasia is a communication disorder that affects processing of language at different levels (e.g., acoustic, phonological, semantic). Recording brain activity via Electroencephalography while people listen to a continuous story allows to analyze brain responses to acoustic and linguistic properties of speech. When the neural activity aligns with these speech properties, it is referred to as neural tracking. Even though measuring neural tracking of speech may present an interesting approach to studying aphasia in an ecologically valid way, it has not yet been investigated in individuals with stroke-induced aphasia. Here, we explored processing of acoustic and linguistic speech representations in individuals with aphasia in the chronic phase after stroke and age-matched healthy controls. We found decreased neural tracking of acoustic speech representations (envelope and envelope onsets) in individuals with aphasia. In addition, word surprisal displayed decreased amplitudes in individuals with aphasia around 195 ms over frontal electrodes, although this effect was not corrected for multiple comparisons. These results show that there is potential to capture language processing impairments in individuals with aphasia by measuring neural tracking of continuous speech. However, more research is needed to validate these results. Nonetheless, this exploratory study shows that neural tracking of naturalistic, continuous speech presents a powerful approach to studying aphasia.

Electrophysiological evidence of lexical processing impacted by foreign language reading anxiety

Extensive studies have been conducted on the impact of foreign language reading anxiety on reading, primarily focusing on pedagogy and behavior but lacking electrophysiological evidence. The current study aimed to investigate the influence of foreign language reading anxiety on reading and its underlying mechanisms. The results revealed a negative correlation between foreign language reading anxiety and foreign language reading performance, irrespective of the native language. Adults with low levels of foreign language reading anxiety (LFLRA) demonstrated a significant difference in early lexical component N170 amplitude between foreign and native languages. However, this effect was not observed in adults with high levels of foreign language reading anxiety (HFLRA). In terms of N170 latency, HFLRA showed a longer N170 for the foreign language compared to the native language. Furthermore, the N170 effects were predominantly localized over the left occipitotemporal electrodes. Regarding N400 latency, a significant difference was found in LFLRA individuals between foreign and native language processing, while HFLRA individuals did not exhibit this difference. These findings suggest that HFLRA individuals experience inefficient lexical processing (such as orthography or semantics) during reading in foreign language.

Prolonged intermittent theta burst stimulation for post-stroke aphasia: protocol of a randomized, double-blinded, sham-controlled trial

Background

Post-stroke aphasia (PSA) is one of the most devastating symptoms after stroke, yet limited treatment options are available. Prolonged intermittent theta burst stimulation (piTBS) is a promising therapy for PSA. However, its efficacy remains unclear. Therefore, we aim to investigate the efficacy of piTBS over the left supplementary motor area (SMA) in improving language function for PSA patients and further explore the mechanism of language recovery.

Methods

This is a randomized, double-blinded, sham-controlled trial. A total of 30 PSA patients will be randomly allocated to receive either piTBS stimulation or sham stimulation for 15 sessions over a period of 3 weeks. The primary outcome is the Western Aphasia Battery Revised (WAB-R) changes after treatment. The secondary outcomes include The Stroke and Aphasia Quality of Life Scale (SAQOL-39 g), resting-state electroencephalogram (resting-state EEG), Event-related potentials (ERP), brain derived neurotrophic factor (BDNF). These outcome measures are assessed before treatment, after treatment, and at 4-weeks follow up. This study was registered in Chinese Clinical Trial Registry (No. ChiCTR23000203238).

Discussion

This study protocol is promising for improving language in PSA patients. Resting-state EEG, ERP, and blood examination can be used to explore the neural mechanisms of PSA treatment with piTBS.

Clinical trial registration

https://www.chictr.org.cn/index.html, ChiCTR2300074533.

Filling the gap: Cloze probability and sentence constraint norms for 807 European Portuguese sentences

Sentence processing is affected by the sentence context and word expectancy. To investigate sentence comprehension experimentally, it is useful to have sentence completion norms with both context constraint and word expectancy measures. In this study, two experiments were conducted to collect norms for completion of 807 European Portuguese sentences. Context constraint was measured through type-token ratio and proportion idiosyncratic responses, while word expectancy was assessed by cloze probability. Besides establishing norms for a large sample of sentences, the study investigated the impact of the production procedure and method of analysis. In Experiment 1, a single-production procedure was used, i.e., participants completed each sentence fragment with only a single response, whereas in Experiment 2, a multiple-production procedure was used, i.e., participants have to provide up to three completion words for each sentence fragment. In Experiment 2, the analyses were obtained using two distinct methods: first-response analysis and combined-response analysis. The results showed that cloze and context measures are comparable between production paradigms and that the results from both analysis methods were correlated. The advantages of each production procedure and analysis method are discussed.

Electrophysiological correlates of basic semantic composition in people with aphasia

The neuroanatomical correlates of basic semantic composition have been investigated in previous neuroimaging and lesion studies, but research on the electrophysiology of the involved processes is scarce. A large literature on sentence-level event-related potentials (ERPs) during semantic processing has identified at least two relevant components - the N400 and the P600. Other studies demonstrated that these components are reduced and/or delayed in people with aphasia (PWA). However, it remains to be shown if these findings generalize beyond the sentence level. Specifically, it is an open question if an alteration in ERP responses in PWA can also be observed during basic semantic composition, providing a potential future diagnostic tool. The present study aimed to elucidate the electrophysiological dynamics of basic semantic composition in a group of post-stroke PWA. We included 20 PWA and 20 age-matched controls (mean age 58 years) and measured ERP responses while they performed a plausibility judgment task on two-word phrases that were either meaningful ("anxious horse"), anomalous ("anxious wood") or had the noun replaced by a pseudoword ("anxious gufel"). The N400 effect for anomalous versus meaningful phrases was similar in both groups. In contrast, unlike the control group, PWA did not show an N400 effect between pseudoword and meaningful phrases. Moreover, both groups exhibited a parietal P600 effect towards pseudoword phrases, while PWA showed an additional P600 over frontal electrodes. Finally, PWA showed an inverse correlation between the magnitude of the N400 and P600 effects: PWA exhibiting no or even reversed N400 effects towards anomalous and pseudoword phrases showed a stronger P600 effect. These results may reflect a compensatory mechanism which allows PWA to arrive at the correct interpretation of the phrase. When compositional processing capacities are impaired in the early N400 time-window, PWA may make use of a more elaborate re-analysis process reflected in the P600.

Effects of Healthy Aging and Gender on the Electrophysiological Correlates of Semantic Sentence Comprehension: The Development of Dutch Normative Data

PURPOSE

The clinical use of event-related potentials in patients with language disorders is increasingly acknowledged. For this purpose, normative data should be available. Within this context, healthy aging and gender effects on the electrophysiological correlates of semantic sentence comprehension were investigated.

METHOD

One hundred and ten healthy subjects (55 men and 55 women), divided among three age groups (young, middle aged, and elderly), performed a semantic sentence congruity task in the visual modality during electroencephalographic recording.

RESULTS

The early visual complex was affected by increasing age as shown by smaller P2 amplitudes in the elderly compared to the young. Moreover, the N400 effect in the elderly was smaller than in the young and was delayed compared to latency measures in both middle-aged and young subjects. The topography of age-related amplitude changes of the N400 effect appeared to be gender specific. The late positive complex effect was increased at frontal electrode sites from middle age on, but this was not statistically significant. No gender effects were detected regarding the early P1, N1, and P2, or the late positive complex effect.

CONCLUSION

Especially aging effects were found during semantic sentence comprehension, and this from the level of perceptual processing on. Normative data are now available for clinical use.

Speech comprehension in noisy environments: Evidence from the predictability effects on the N400 and LPC

Introduction

Speech comprehension involves context-based lexical predictions for efficient semantic integration. This study investigated how noise affects the predictability effect on event-related potentials (ERPs) such as the N400 and late positive component (LPC) in speech comprehension.

Methods

Twenty-seven listeners were asked to comprehend sentences in clear and noisy conditions (hereinafter referred to as "clear speech" and "noisy speech," respectively) that ended with a high-or low-predictability word during electroencephalogram (EEG) recordings.

Results

The study results regarding clear speech showed the predictability effect on the N400, wherein low-predictability words elicited a larger N400 amplitude than did high-predictability words in the centroparietal and frontocentral regions. Noisy speech showed a reduced and delayed predictability effect on the N400 in the centroparietal regions. Additionally, noisy speech showed a predictability effect on the LPC in the centroparietal regions.

Discussion

These findings suggest that listeners achieve comprehension outcomes through different neural mechanisms according to listening conditions. Noisy speech may be comprehended with a second-pass process that possibly functions to recover the phonological form of degraded speech through phonetic reanalysis or repair, thus compensating for decreased predictive efficiency.

Electrophysiology reveals cognitive-linguistic alterations after concussion

Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.

The electrophysiology of aphasia: A scoping review

OBJECTIVE

To systematically assess the body of literature using N400 and P600 as they relate to people with aphasia. The primary aim was to reveal patterns in the literature which could be used to direct future research in the development of clinically relevant Event-Related Potentials (ERPs) for language assessment, while also identifying gaps in existing knowledge and highlight areas of further inquiry.

METHODS

A literature search was performed on studies published before May 2021. Relevant studies on aphasia and the two ERPs of interest were assessed for quality, and the relationship between aphasia and these ERPs was explored.

RESULTS

A total of 721 articles were identified, with 30 meeting inclusion criteria. Although there is significant variation in the literature, this scoping review revealed people with aphasia show reduced amplitude, delayed latency and different distribution compared to controls, and that ERPs are modulated by severity of aphasia.

CONCLUSIONS

To develop a relevant clinical tool for the management of aphasia, future research must strive to improve consistency within ERP methodology, with a greater number of diverse aphasia subtypes included in research.

SIGNIFICANCE

This scoping review reveals N400 and P600 represent promising potential biomarkers for the diagnosis and ongoing management of aphasia.

The role and use of event-related potentials in aphasia: A scoping review

Event-related potentials (ERPs) can provide important insights into underlying language processes in both unimpaired and neurologically impaired populations and may be particularly useful in aphasia. This scoping review was conducted to provide a comprehensive summary of how ERPs have been used with people with aphasia (PWA), with the goal of exploring the potential clinical application of ERPs in aphasia assessment and treatment. We identified 117 studies that met inclusionary criteria, reflecting six thematic domains of inquiry that relate to understanding both unimpaired and aphasic language processing and the use of ERPs with PWA. In these studies, a wide variety of ERP components were reported. Inconsistencies in reporting of participant characteristics and study protocols limit our ability to generalize beyond the individual studies and understand implications for clinical applicability. We discuss the potential roles of ERPs in aphasia management and make recommendations for further developing ERPs for clinical utility in PWA.

The Role of Glutamate in Language and Language Disorders - Evidence from ERP and Pharmacologic Studies

Current models of language processing do not address mechanisms at the neurotransmitter level, nor how pharmacologic agents may improve language function(s) in seemingly disparate disorders. L-Glutamate, the primary excitatory neurotransmitter in the human brain, is extensively involved in various higher cortical functions. We postulate that the physiologic role of L-Glutamate neurotransmission extends to the regulation of language access, comprehension, and production, and that disorders in glutamatergic transmission and circuitry contribute to the pathogenesis of neurodegenerative diseases and sporadic-onset language disorders such as the aphasic stroke syndromes. We start with a review of basic science data pertaining to various glutamate receptors in the CNS and ways that they may influence the physiological processes of language access and comprehension. We then focus on the dysregulation of glutamate neurotransmission in three conditions in which language dysfunction is prominent: Alzheimer's Disease, Fragile X-associated Tremor/Ataxia Syndrome, and Aphasic Stroke Syndromes. Finally, we review the pharmacologic and electrophysiologic (event related brain potential or ERP) data pertaining to the role glutamate neurotransmission plays in language processing and disorders.

Semantic Processing in Healthy Aging and Alzheimer's Disease: A Systematic Review of the N400 Differences

Semantic deficits are common in individuals with Alzheimer’s disease (AD). These deficits notably impact the ability to understand words. In healthy aging, semantic knowledge increases but semantic processing (i.e., the ability to use this knowledge) may be impaired. This systematic review aimed to investigate semantic processing in healthy aging and AD through behavioral responses and the N400 brain event-related potential. The results of the quantitative and qualitative analyses suggested an overall decrease in accuracy and increase in response times in healthy elderly as compared to young adults, as well as in individuals with AD as compared to age-matched controls. The influence of semantic association, as measured by N400 effect amplitudes, appears smaller in healthy aging and even more so in AD patients. Thus, semantic processing differences may occur in both healthy and pathological aging. The establishment of norms of healthy aging for these outcomes that vary between normal and pathological aging could eventually help early detection of AD.

N400 extraction from a few trials of EEG data using spatial and temporal-frequency pattern analysis

OBJECTIVE

N400 plays an important role in the studies of cognitive science and clinical neuropsychology diseases. However, it is still a challenge to extract the N400 component from a few trials of electroencephalogram (EEG) data.

APPROACH

A method was proposed to analyze the spatial and temporal-frequency patterns of N400 in this study. First, resampling-average difference was used to enhance the signal-to-noise ratio (SNR) of N400 in EEG samples. Next, dictionary learning was utilized to adaptively select the wavelet bases corresponding to event-related potentials (ERPs) rather than spontaneous EEG activities and obtain the temporal-frequency patterns of ERPs. Finally, the low-rank constrained sparse decomposition was exploited to remove the spontaneous EEG activities and to learn the ERP spatial patterns, and the number of ERPs was also automatically determined. Simulation N400 datasets with different SNR levels and real N400 datasets of 15 subjects were used to evaluate the performance of the proposed method.

MAIN RESULTS

The results indicated that the proposed method accurately extracted the N400 component from a few trials of EEG data, and a significant difference of extracted N400 waveforms was observed between two experiment conditions.

SIGNIFICANCE

In the proposed method, the resampling-average difference significantly enhanced the SNR of EEG samples. Combined with the dictionary learning, the low-rank constrained sparse decomposition effectively removed the spontaneous EEG activities and automatically selected the correct ERP components.

Language-Related Brain Potentials in Patients With Disorders of Consciousness: A Follow-up Study to Detect “Covert” Language Disorders

Background. Language disorders may occur in patients with disorders of consciousness (DoCs), and they could interfere with the behavioral assessment of consciousness and responsiveness. Objective. In this study, we retrospectively explored whether ERP N400 was eventually associated with the presence of aphasia diagnosed in those patients who had evolved into Exit-Minimally Conscious State (E-MCS) at the clinical follow-up. Methods. In this retrospective cohort study, the ERPs elicited by an auditory sentences task were retrospectively examined in a sample of 15 DoC patients diagnosed according to the Coma Recovery Scale–Revised (CRS-R). All these 15 DoC patients underwent a (at least) 1-year clinical follow-up, which included a neuropsychological evaluation to assess language function among other cognitive functions. Ten healthy individuals also underwent the same paradigm to investigate the variability of ERPs characteristics. Results. The N400 ERP component with centroparietal topography was found in 9 of 10 healthy controls in response to the ill-formed sentences. Analysis of patients’ data revealed that (1) a significant N400 component could be detected in 64% (9 of 14 patients) of the DoC patients regardless of the type of DoC; (2) no significant N400 ERP component was retrospectively detected in those E-MCS patients who showed aphasia at the follow-up; and (3) the presence/absence of the N400-ERP component was consistent with the brain lesion side and significantly predict the recovery. Conclusion. These preliminary findings indicate that the absence of N400 was significantly associated with the presence of aphasia diagnosed at the clinical follow-up in E-MCS patients.

ERP evidence of semantic processing in children with ASD

25% of children with autism spectrum disorder (ASD) remain minimally verbal (MV), despite intervention. Electroencephalography can reveal neural mechanisms underlying language impairment in ASD, potentially improving our ability to predict language outcomes and target interventions. Verbal (V) and MV children with ASD, along with an age-matched typically developing (TD) group participated in a semantic congruence ERP paradigm, during which pictures were displayed followed by the expected or unexpected word. An N400 effect was evident in all groups, with a shorter latency in the TD group. A late negative component (LNC) also differentiated conditions, with a group by condition by region interaction. Post hoc analyses revealed that the LNC was present across multiple regions in the TD group, in the mid-frontal region in MVASD, and not present in the VASD group. Cluster analysis identified subgroups within the ASD participants. Two subgroups showed markedly atypical patterns of processing, one with reversed but robust differentiation of conditions, and the other with initially reversed followed by typical differentiation. Findings indicate that children with ASD, including those with minimal language, showed EEG evidence of semantic processing, but it was characterized by delayed speed of processing and limited integration with mental representations.

Considerations for the Use of Neuroimaging Technologies for Predicting Recovery of Speech and Language in Aphasia

PURPOSE

The number of research articles aimed at identifying neuroimaging biomarkers for predicting recovery from aphasia continues to grow. Although the clinical use of these biomarkers to determine prognosis has been proposed, there has been little discussion of how this would be accomplished. This is an important issue because the best translational science occurs when translation is considered early in the research process. The purpose of this clinical focus article is to present a framework to guide the discussion of how neuroimaging biomarkers for recovery from aphasia could be implemented clinically.

METHOD

The genomics literature reveals that implementing genetic testing in the real-world poses both opportunities and challenges. There is much similarity between these opportunities and challenges and those related to implementing neuroimaging testing to predict recovery in aphasia. Therefore, the Center for Disease Control's model list of questions aimed at guiding the review of genetic testing has been adapted to guide the discussion of using neuroimaging biomarkers as predictors of recovery in aphasia.

CONCLUSION

The adapted model list presented here is a first and useful step toward initiating a discussion of how neuroimaging biomarkers of recovery could be employed clinically to provide improved quality of care for individuals with aphasia.

The Acquisition of Orthographic Knowledge: Evidence from the Lexicality Effects on N400

This study aimed to understand how reading ability shapes the lexicality effects on N400. Fifty-three typical developing children from the second to the sixth grades were asked to perform the pronounceability judgment task on a set of Chinese real characters (RC), pseudocharacters (PC) and non-characters (NC), as ERPs were recorded. The cluster-based permutation analysis revealed that children with low- to medium-reading ability showed greater negativity to NCs than to RCs and PCs in frontal sites from 300 to 450 ms, while children with high ability group showed a greater positivity to NCs than both RCs and PCs at central to posterior sites. Furthermore, the linear mixed model (LMM) analysis was applied to investigate the relationship between lexicality effects on N400 and reading-related behavioral assessments on a set of standardized tests (including character recognition, vocabulary size, phonological awareness, and working memory). The results found that in children with lower reading ability, the N400 elicited by NCs becomes more negative in the frontal sites. For children with higher reading ability, the N400 elicited by NCs became more positive than that elicited by RCs or PCs in the posterior sites. These findings demonstrate the developmental changes in the lexicality effects on N400 as children become more advanced readers and suggested that the lexicality effects on N400 can serve as neural markers for the evaluation of orthographic proficiency in reading development.