The left superior temporal gyrus is a shared substrate for auditory short-term memory and speech comprehension: evidence from 210 patients with stroke

Verbal short term memory contribution to sentence comprehension decreases with increasing syntactic complexity in people with aphasia

Sentence comprehension requires the integration of linguistic units presented in a temporal sequence based on a non-linear underlying syntactic structure. While it is uncontroversial that storage is mandatory for this process, there are opposing views regarding the relevance of general short-term-/working-memory capacities (STM/WM) versus language specific resources. Here we report results from 43 participants with an acquired brain lesion in the extended left hemispheric language network and resulting language deficits, who performed a sentence-to-picture matching task and an experimental task assessing phonological short-term memory. The sentence task systematically varied syntactic complexity (embedding depth and argument order) while lengths, number of propositions and plausibility were kept constant. Clinical data including digit-/ block-spans and lesion size and site were additionally used in the analyses. Correlational analyses confirm that performance on STM/WM-tasks (experimental task and digit-span) are the only two relevant predictors for correct sentence-picture-matching, while reaction times only depended on age and lesion size. Notably increasing syntactic complexity reduced the correlational strength speaking for the additional recruitment of language specific resources independent of more general verbal STM/WM capacities, when resolving complex syntactic structure. The complementary lesion-behaviour analysis yielded different lesion volumes correlating with either the sentence-task or the STM-task. Factoring out STM measures lesions in the anterior temporal lobe correlated with a larger decrease in accuracy with increasing syntactic complexity. We conclude that overall sentence comprehension depends on STM/WM capacity, while increases in syntactic complexity tax another independent cognitive resource.

Causal Roles of Ventral and Dorsal Neural Systems for Automatic and Control Self-Reference Processing: A Function Lesion Mapping Study

Background: Humans perceive and interpret the world through the lens of self-reference processes, typically facilitating enhanced performance for the task at hand. However, this research has predominantly emphasized the automatic facet of self-reference processing, overlooking how it interacts with control processes affecting everyday situations. Methods: We investigated this relationship between automatic and control self-reference processing in neuropsychological patients performing self-face perception tasks and the Birmingham frontal task measuring executive functions. Results: Principal component analysis across tasks revealed two components: one loaded on familiarity/orientation judgments reflecting automatic self-reference processing, and the other linked to the cross task and executive function indicating control processing requirements. Voxel-based morphometry and track-wise lesion-mapping analyses showed that impairments in automatic self-reference were associated with reduced grey matter in the ventromedial prefrontal cortex and right inferior temporal gyrus, and white matter damage in the right inferior fronto-occipital fasciculus. Deficits in executive control were linked to reduced grey matter in the bilateral inferior parietal lobule and left anterior insula, and white matter disconnections in the left superior longitudinal fasciculus and arcuate fasciculus. Conclusions: The causal evidence suggests that automatic and control facets of self-reference processes are subserved by distinct yet integrated ventral prefrontal-temporal and dorsal frontal-parietal networks, respectively.

Episodic memory network characteristics in patients with amnestic mild cognitive impairment accompanied by executive function impairment

OBJECTIVE

To explore the functional connectivity (FC) characteristics of the episodic memory network (EMN) in amnestic mild cognitive impairment (aMCI) patients with different levels of executive function (EF).

METHODS

This study included 76 participants from the Alzheimer's Disease Neuroimaging Initiative database, comprising 23 healthy controls (HCs) and 53 aMCI patients. Based on EF levels, aMCI patients were categorized into aMCI-highEF and aMCI-lowEF groups. Cognitive function scores, pathological markers (cerebrospinal fluid β-amyloid, total tau protein, phosphorylated tau protein, AV45-PET, and FDG-PET), and functional magnetic resonance imaging were collected and compared among the three groups. Seed-based FC analysis was used to examine differences in the EMN among the groups, and partial correlation analysis was employed to investigate the relationship between changes in FC and cognitive function scores as well as pathological markers.

RESULTS

Compared to the aMCI-highEF group, the aMCI-lowEF group exhibited more severe cognitive impairment, decreased cerebral glucose metabolism, and elevated AV45 levels. Significant FC differences in the left superior temporal gyrus (STG) of the EMN were observed among the three groups. Post hoc analysis revealed that the aMCI-lowEF group had increased FC in the left STG compared to the HCs and aMCI-highEF groups, with statistically significant differences. Correlation analysis showed a significant negative correlation between the differences in FC in the left STG of aMCI-highEF and aMCI-lowEF groups and Rey Auditory Verbal Learning Test forgetting scores. Receiver operator characteristic curve analysis indicated an area under the curve of 0.741 for distinguishing between aMCI-highEF and aMCI-lowEF groups based on FC of left STG, with a sensitivity of 0.808 and a specificity of 0.667.

CONCLUSION

aMCI-lowEF exhibits characteristic changes in FC within the EMN, providing theoretical support for the role of EF in mediating EMN alterations and, consequently, impacting episodic memory function.

The association between glymphatic system dysfunction and alterations in cerebral function and structure in patients with white matter hyperintensities

The objective of this study is to explore the relationship between the glymphatic system and alterations in the structure and function of the brain in white matter hyperintensity (WMH) patients. MRI data were collected from 27 WMH patients and 23 healthy controls. We calculated the along perivascular space (ALPS) indices, the anterior corner distance of the lateral ventricle, and the width of the third ventricle for each subject. The DPABISurf tool was used to calculate the cortical thickness and cortical area. In addition, data processing assistant for resting-state fMRI was used to calculate regional homogeneity, degree centrality, amplitude low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), and voxel-mirrored homotopic connectivity (VMHC). In addition, each WMH patient was evaluated on the Fazekas scale. Finally, the correlation analysis of structural indicators and functional indicators with bilateral ALPS indices was investigated using Spearman correlation analysis. The ALPS indices of WMH patients were lower than those of healthy controls (left: t = -4.949, P < 0.001; right: t = -3.840, P < 0.001). This study found that ALFF, fALFF, regional homogeneity, degree centrality, and VMHC values in some brain regions of WMH patients were alternated (AlphaSim corrected, P < 0.005, cluster size > 26 voxel, rmm value = 5), and the cortical thickness and cortical area of WMH patients showed trend changes (P < 0.01, cluster size > 20 mm2, uncorrected). Interestingly, we found significantly positive correlations between the left ALPS indices and degree centrality values in the superior temporal gyrus (r = 0.494, P = 0.009, P × 5 < 0.05, Bonferroni correction). Our results suggest that glymphatic system impairment is related to the functional centrality of local connections in patients with WMH. This provides a new perspective for understanding the pathological mechanisms of cognitive impairment in the WMH population.

Creative flow as optimized processing: Evidence from brain oscillations during jazz improvisations by expert and non-expert musicians

Using a creative production task, jazz improvisation, we tested alternative hypotheses about the flow experience: (A) that it is a state of domain-specific processing optimized by experience and characterized by minimal interference from task-negative default-mode network (DMN) activity versus (B) that it recruits domain-general task-positive DMN activity supervised by the fronto-parietal control network (FPCN) to support ideation. We recorded jazz guitarists' electroencephalograms (EEGs) while they improvised to provided chord sequences. Their flow-states were measured with the Core Flow State Scale. Flow-related neural sources were reconstructed using SPM12. Over all musicians, high-flow (relative to low-flow) improvisations were associated with transient hypofrontality. High-experience musicians' high-flow improvisations showed reduced activity in posterior DMN nodes. Low-experience musicians showed no flow-related DMN or FPCN modulation. High-experience musicians also showed modality-specific left-hemisphere flow-related activity while low-experience musicians showed modality-specific right-hemisphere flow-related deactivations. These results are consistent with the idea that creative flow represents optimized domain-specific processing enabled by extensive practice paired with reduced cognitive control.

Comparative efficacy of non-invasive brain stimulation for post-stroke cognitive impairment: a network meta-analysis

BACKGROUND

Non-invasive brain stimulation (NIBS) is a burgeoning approach with the potential to significantly enhance cognition and functional abilities in individuals who have undergone a stroke. However, the current evidence lacks robust comparisons and rankings of various NIBS methods concerning the specific stimulation sites and parameters used. To address this knowledge gap, this systematic review and meta-analysis seek to offer conclusive evidence on the efficacy and safety of NIBS in treating post-stroke cognitive impairment.

METHODS

A systematic review of randomized control trials (RCT) was performed using Bayesian network meta-analysis. We searched RCT in the following databases until June 2022: Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and EMBASE. We compared any active NIBS to control in terms of improving cognition function and activities of daily living (ADL) capacity following stroke.

RESULTS

After reviewing 1577 retrieved citations, a total of 26 RCTs were included. High-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (mean difference 2.25 [95% credible interval 0.77, 3.66]) was identified as a recommended approach for alleviating the global severity of cognition. Dual-rTMS (27.61 [25.66, 29.57]) emerged as a favorable technique for enhancing ADL function. In terms of stimulation targets, the dorsolateral prefrontal cortex exhibited a higher ranking in relation to the global severity of cognition.

CONCLUSIONS

Among various NIBS techniques, HF-rTMS stands out as the most promising intervention for enhancing cognitive function. Meanwhile, Dual-rTMS is highly recommended for improving ADL capacity.

Reading text aloud benefits memory but not comprehension

The production effect-that reading aloud leads to better memory than does reading silently-has been defined narrowly with reference to memory; it has been explored largely using word lists as the material to be read and remembered. But might the benefit of production extend beyond memory and beyond individual words? In a series of four experiments, passages from reading comprehension tests served as the study material. Participants read some passages aloud and others silently. After each passage, they completed multiple-choice questions about that passage. Separating the multiple-choice questions into memory-focused versus comprehension-focused questions, we observed a consistent production benefit only for the memory-focused questions. Production clearly improves memory for text, not just for individual words, and also extends to multiple-choice testing. The overall pattern of findings fits with the distinctiveness account of production-that information read aloud stands out at study and at test from information read silently. Only when the tested information is a very close match to the studied information, as is the case for memory questions but not for comprehension questions, does production improve accuracy.

Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies

The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.

Unraveling the Thread of Aphasia Rehabilitation: A Translational Cognitive Perspective

Translational neuroscience is a multidisciplinary field that aims to bridge the gap between basic science and clinical practice. Regarding aphasia rehabilitation, there are still several unresolved issues related to the neural mechanisms that optimize language treatment. Although there are studies providing indications toward a translational approach to the remediation of acquired language disorders, the incorporation of fundamental neuroplasticity principles into this field is still in progress. From that aspect, in this narrative review, we discuss some key neuroplasticity principles, which have been elucidated through animal studies and which could eventually be applied in the context of aphasia treatment. This translational approach could be further strengthened by the implementation of intervention strategies that incorporate the idea that language is supported by domain-general mechanisms, which highlights the impact of non-linguistic factors in post-stroke language recovery. Here, we highlight that translational research in aphasia has the potential to advance our knowledge of brain-language relationships. We further argue that advances in this field could lead to improvement in the remediation of acquired language disturbances by remodeling the rationale of aphasia-therapy approaches. Arguably, the complex anatomy and phenomenology of aphasia dictate the need for a multidisciplinary approach with one of its main pillars being translational research.

The functional connectome of 3,4-methyldioxymethamphetamine-related declarative memory impairments

The chronic intake of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") bears a strong risk for sustained declarative memory impairments. Although such memory deficits have been repeatedly reported, their neurofunctional origin remains elusive. Therefore, we here investigate the neuronal basis of altered declarative memory in recurrent MDMA users at the level of brain connectivity. We examined a group of 44 chronic MDMA users and 41 demographically matched controls. Declarative memory performance was assessed by the Rey Auditory Verbal Learning Test and a visual associative learning test. To uncover alterations in the whole brain connectome between groups, we employed a data-driven multi-voxel pattern analysis (MVPA) approach on participants' resting-state functional magnetic resonance imaging data. Recent MDMA use was confirmed by hair analyses. MDMA users showed lower performance in delayed recall across tasks compared to well-matched controls with moderate-to-strong effect sizes. MVPA revealed a large cluster located in the left postcentral gyrus of global connectivity differences between groups. Post hoc seed-based connectivity analyses with this cluster unraveled hypoconnectivity to temporal areas belonging to the auditory network and hyperconnectivity to dorsal parietal regions belonging to the dorsal attention network in MDMA users. Seed-based connectivity strength was associated with verbal memory performance in the whole sample as well as with MDMA intake patterns in the user group. Our findings suggest that functional underpinnings of MDMA-related memory impairments encompass altered patterns of multimodal sensory integration within auditory processing regions to a functional heteromodal connector hub, the left postcentral gyrus. In addition, hyperconnectivity in regions of a cognitive control network might indicate compensation for degraded sensory processing.

A personalized classification of behavioral severity of autism spectrum disorder using a comprehensive machine learning framework

Autism Spectrum Disorder (ASD) is characterized as a neurodevelopmental disorder with a heterogeneous nature, influenced by genetics and exhibiting diverse clinical presentations. In this study, we dissect Autism Spectrum Disorder (ASD) into its behavioral components, mirroring the diagnostic process used in clinical settings. Morphological features are extracted from magnetic resonance imaging (MRI) scans, found in the publicly available dataset ABIDE II, identifying the most discriminative features that differentiate ASD within various behavioral domains. Then, each subject is categorized as having severe, moderate, or mild ASD, or typical neurodevelopment (TD), based on the behavioral domains of the Social Responsiveness Scale (SRS). Through this study, multiple artificial intelligence (AI) models are utilized for feature selection and classifying each ASD severity and behavioural group. A multivariate feature selection algorithm, investigating four different classifiers with linear and non-linear hypotheses, is applied iteratively while shuffling the training-validation subjects to find the set of cortical regions with statistically significant association with ASD. A set of six classifiers are optimized and trained on the selected set of features using 5-fold cross-validation for the purpose of severity classification for each behavioural group. Our AI-based model achieved an average accuracy of 96%, computed as the mean accuracy across the top-performing AI models for feature selection and severity classification across the different behavioral groups. The proposed AI model has the ability to accurately differentiate between the functionalities of specific brain regions, such as the left and right caudal middle frontal regions. We propose an AI-based model that dissects ASD into behavioral components. For each behavioral component, the AI-based model is capable of identifying the brain regions which are associated with ASD as well as utilizing those regions for diagnosis. The proposed system can increase the speed and accuracy of the diagnostic process and result in improved outcomes for individuals with ASD, highlighting the potential of AI in this area.

Lateralized grey matter volume changes in adolescents versus adults with major depression: SDM-PSI meta-analysis

The current study is the first meta-analysis to examine grey matter volume (GMV) changes in adolescents and across the lifespan in major depressive disorder (MDD). Seed-based d mapping-with permutation of subject images (SDM-PSI) has advantages over previous coordinate-based meta-analytical methods (CBMA), such as reducing bias (via the MetaNSUE algorithm) and including non-statistically significant unreported effects. SDM-PSI was used to analyze 105 whole-brain GMV voxel-based morphometry (VBM) studies comparing 6,530 individuals with MDD versus 6,821 age-matched healthy controls (HC). A laterality effect was observed in which adults with MDD showed lower GMV than adult HC in left fronto-temporo-parietal structures (superior temporal gyrus, insula, Rolandic operculum, and inferior frontal gyrus). However, these abnormalities were not statistically significant for adolescent MDD versus adolescent HC. Instead, adolescent MDD showed lower GMV than adult MDD in right temporo-parietal structures (angular gyrus and middle temporal gyrus). These regional differences may be used as potential biomarkers to predict and monitor treatment outcomes as well as to choose the most effective treatments in adolescents versus adults. Finally, due to the paucity of youth, older adult, and longitudinal studies, future studies should attempt to replicate these GMV findings and examine whether they correlate with treatment response and illness severity.

Memory Deficits in Parkinson's Disease Are Associated with Impaired Attentional Filtering and Memory Consolidation Processes

The present study examined mechanisms underlying memory deficits in Parkinson's disease (PD) and their associations with brain structural metrics. Nineteen PD patients and twenty-two matched controls underwent two memory experiments. In Experiment 1 (delayed memory task), subjects were asked to remember an array of colored rectangles with varying memory set sizes (Low-Load (2 items), Low-Load (relevant 2 items) with Distractor (irrelevant 3 items), and High-Load (5 items)). After a 7 s delay period, they reported whether the orientation of any relevant figures had changed (test period). In Experiment 2 (working memory task), memory arrays were presented in varying set sizes (2 to 6 items) without distractors, followed by a 2 s delay period and a subsequent test period. Brain MRI data were acquired to assess structural differences (volumes and cortical thickness) in areas related to attention, working memory storage capacity, and episodic memory. Multivariate analyses of covariance revealed that, compared with controls, PD patients had lower memory capacity scores in all memory load conditions for Experiment 1 (p < 0.021), whereas there were no group differences in any memory load conditions for Experiment 2 (p > 0.06). In addition, PD patients had lower cortical thickness in the left superior temporal gyrus (p = 0.02), a region related to the ventral attentional system. Moreover, regression analyses revealed that lower cortical thickness values in the left superior temporal gyrus significantly predicted lower memory scores of Low-Load and Low-Load with Distractor conditions in Experiment 1 (p < 0.044) and lower scores of memory load conditions of 4 and 5 items in Experiment 2 (p < 0.012). These findings suggest that memory deficits in PD may partly be due to impaired attentional filtering and memory consolidation processes that may be related to superior temporal neurodegeneration. Future studies are warranted to confirm the current findings to guide the development of effective treatments for memory deficits in PD.

Beyond Broca's and Wernicke's: Functional Mapping of Ancillary Language Centers Prior to Brain Tumor Surgery

Functional MRI is a well-established tool used for pre-surgical planning to help the neurosurgeon have a roadmap of critical functional areas that should be avoided, if possible, during surgery to minimize morbidity for patients with brain tumors (though this also has applications for surgical resection of epileptogenic tissue and vascular lesions). This article reviews the locations of secondary language centers within the brain along with imaging findings to help improve our confidence in our knowledge on language lateralization. Brief overviews of these language centers and their contributions to the language networks will be discussed. These language centers include primary language centers of "Broca's Area" and "Wernicke's Area". However, there are multiple secondary language centers such as the dorsal lateral prefrontal cortex (DLPFC), frontal eye fields, pre- supplemental motor area (pre-SMA), Basal Temporal Language Area (BTLA), along with other areas of activation. Knowing these foci helps to increase self-assurance when discussing the nature of laterality with the neurosurgeon. By knowing secondary language centers for language lateralization, via fMRI, one can feel confident on providing neurosurgeon colleagues with appropriate information on the laterality of language in preparation for surgery.

MRI factors associated with cognitive functioning after acute onset brain injury: Systematic review and meta-analysis

Impairments of memory, attention, and executive functioning are frequently reported after acute onset brain injury. MRI markers hold potential to contribute to identification of patients at risk for cognitive impairments and clarification of mechanisms. The aim of this systematic review was to summarize and value the evidence on MRI markers of memory, attention, and executive functioning after acute onset brain injury. We included ninety-eight studies, on six classes of MRI factors (location and severity of damage (n = 15), volume/atrophy (n = 36), signs of small vessel disease (n = 15), diffusion-weighted imaging measures (n = 36), resting-state functional MRI measures (n = 13), and arterial spin labeling measures (n = 1)). Three measures showed consistent results regarding their association with cognition. Smaller hippocampal volume was associated with worse memory in fourteen studies (pooled correlation 0.58 [95% CI: 0.46-0.68] for whole, 0.11 [95% CI: 0.04-0.19] for left, and 0.34 [95% CI: 0.17-0.49] for right hippocampus). Lower fractional anisotropy in cingulum and fornix was associated with worse memory in six and five studies (pooled correlation 0.20 [95% CI: 0.08-0.32] and 0.29 [95% CI: 0.20-0.37], respectively). Lower functional connectivity within the default-mode network was associated with worse cognition in four studies. In conclusion, hippocampal volume, fractional anisotropy in cingulum and fornix, and functional connectivity within the default-mode network showed consistent associations with cognitive performance in all types of acute onset brain injury. External validation and cut off values for predicting cognitive impairments are needed for clinical implementation.

Baseline Conceptual-Semantic Impairment Predicts Longitudinal Treatment Effects for Anomia in Primary Progressive Aphasia and Alzheimer's Disease

Background

An individual's diagnostic subtype may fail to predict the efficacy of a given type of treatment for anomia. Classification by conceptual-semantic impairment may be more informative.

Aims

This study examined the effects of conceptual-semantic impairment and diagnostic subtype on anomia treatment effects in primary progressive aphasia (PPA) and Alzheimer's disease (AD).

Methods & Procedures

At baseline, the picture and word versions of the Pyramids and Palm Trees and Kissing and Dancing tests were used to measure conceptual-semantic processing. Based on norming that was conducted with unimpaired older adults, participants were classified as being impaired on both the picture and word versions (i.e., modality-general conceptual-semantic impairment), the picture version (Objects or Actions) only (i.e., visual-conceptual impairment), the word version (Nouns or Verbs) only (i.e., lexical-semantic impairment), or neither the picture nor the word version (i.e., no impairment). Following baseline testing, a lexical treatment and a semantic treatment were administered to all participants. The treatment stimuli consisted of nouns and verbs that were consistently named correctly at baseline (Prophylaxis items) and/or nouns and verbs that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at three, seven, eleven, fourteen, eighteen, and twenty-one months.

Outcomes & Results

Compared to baseline naming performance, lexical and semantic treatments both improved naming accuracy for treated Remediation nouns and verbs. For Prophylaxis items, lexical treatment was effective for both nouns and verbs, and semantic treatment was effective for verbs, but the pattern of results was different for nouns -- the effect of semantic treatment was initially nonsignificant or marginally significant, but it was significant beginning at 11 Months, suggesting that the effects of prophylactic semantic treatment may become more apparent as the disorder progresses. Furthermore, the interaction between baseline Conceptual-Semantic Impairment and the Treatment Condition (Lexical vs. Semantic) was significant for verb Prophylaxis items at 3 and 18 Months, and it was significant for noun Prophylaxis items at 14 and 18 Months.

Conclusions

The pattern of results suggested that individuals who have modality-general conceptual-semantic impairment at baseline are more likely to benefit from lexical treatment, while individuals who have unimpaired conceptual-semantic processing at baseline are more likely to benefit from semantic treatment as the disorder progresses. In contrast to conceptual-semantic impairment, diagnostic subtype did not typically predict the treatment effects.

The role of left temporo-parietal and inferior frontal cortex in comprehending syntactically complex sentences: A brain stimulation study

BACKGROUND AND OBJECTIVES

Syntactic competence relies on a left-lateralized network converging on hubs in inferior-frontal and posterior-temporal cortices. We address the question whether anodal transcranial direct current stimulation (a-tDCS) over these hubs can modulate comprehension of sentences, whose syntactic complexity systematically varied along the factors embedding depths and canonicity. Semantic content and length of the sentences were kept identical and forced choice picture matching was required after the full sentence had been presented.

METHODS

We used a single-blind, within-subject, sham-controlled design, applying a-tDCS targeting left posterior tempo-parietal (TP) and left inferior frontal cortex (FC). Stimulation sites were determined by individual neuro-navigation. 20 participants were included of whom 19 entered the analysis. Results were analysed using (generalized) mixed models. In a pilot-experiment in another group of 20 participants we validated the manipulation of syntactic complexity by the two factors embedding depth and argument-order.

RESULTS

Reaction times increased and accuracy decreased with higher embedding depth and non-canonical argument order in both experiments. Notably a-tDCS over TP enhanced sentence-to-picture matching, while FC-stimulation showed no consistent effect. Moreover, the analysis disclosed a session effect, indicating improvements of task performance especially regarding speed.

CONCLUSIONS

We conclude that the posterior 'hub' of the neuronal network affording syntactic analysis represents a 'bottleneck', likely due to working-memory capacity and the challenges of mapping semantic to syntactic information allowing for role assignment. While this does not challenge the role of left inferior-frontal cortex for syntax processing and novel-grammar learning, the application of highly established syntactic rules during sentence comprehension may be considered optimized, thus not augmentable by a-tDCS in the uncompromised network.

SIGNIFICANCE STATEMENT

Anodal transcranial direct current stimulation (a-tDCS) over left temporo-parietal cortex enhances comprehension of complex sentences in uncompromised young speakers. Since a-tDCS over left frontal cortex did not elicit any change, the 'bottleneck' for the understanding of complex sentences seems to be the posterior, temporo-parietal rather than the anterior inferior-frontal 'hub' of language processing. Regarding the attested role of inferior-frontal cortex in syntax processing, we suggest that its function is optimized in competent young speakers, preventing further enhancement by (facilitatory) tDCS. Results shed light on the functional anatomy of syntax processing during sentence comprehension; moreover, they open perspectives for research in the lesioned language network of people with syntactic deficits due to aphasia.

Altered Functional Connectivity Density in Type 2 Diabetes Mellitus with and without Mild Cognitive Impairment

Although disturbed functional connectivity is known to be a factor influencing cognitive impairment, the neuropathological mechanisms underlying the cognitive impairment caused by type 2 diabetes mellitus (T2DM) remain unclear. To characterize the neural mechanisms underlying T2DM-related brain damage, we explored the altered functional architecture patterns in different cognitive states in T2DM patients. Thirty-seven T2DM patients with normal cognitive function (DMCN), 40 T2DM patients with mild cognitive impairment (MCI) (DMCI), and 40 healthy controls underwent neuropsychological assessments and resting-state functional MRI examinations. Functional connectivity density (FCD) analysis was performed, and the relationship between abnormal FCD and clinical/cognitive variables was assessed. The regions showing abnormal FCD in T2DM patients were mainly located in the temporal lobe and cerebellum, but the abnormal functional architecture was more extensive in DMCI patients. Moreover, in comparison with the DMCN group, DMCI patients showed reduced long-range FCD in the left superior temporal gyrus (STG), which was correlated with the Rey auditory verbal learning test score in all T2DM patients. Thus, DMCI patients show functional architecture abnormalities in more brain regions involved in higher-level cognitive function (executive function and auditory memory function), and the left STG may be involved in the neuropathology of auditory memory in T2DM patients. These findings provide some new insights into understanding the neural mechanisms underlying T2DM-related cognitive impairment.

Modulation of auditory temporal processing, speech in noise perception, auditory-verbal memory, and reading efficiency by anodal tDCS in children with dyslexia

Dyslexia is a neurodevelopmental disorder that is prevalent in children. It is estimated that 30-50% of individuals diagnosed with dyslexia also manifest an auditory perceptual deficit characteristic of auditory processing disorder (APD). Some studies suggest that defects in basic auditory processing can lead to phonological defects as the most prominent cause of dyslexia. Thus, in some cases, there may be interrelationships between dyslexia and some of the aspects of central auditory processing. In recent years, transcranial direct current stimulation (tDCS) has been used as a safe method for the modulation of central auditory processing aspects in healthy adults and reading skills in children with dyslexia. Therefore, the objectives of our study were to investigate the effect of tDCS on the modulation of different aspects of central auditory processing, aspects of reading, and the relationship between these two domains in dyslexic children with APD. A within-subjects design was employed to investigate the effect of two electrode arrays (the anode on the left STG (AC)/cathode on the right shoulder and anode on the left STG/cathode on the right STG) on auditory temporal processing; speech-in-noise perception, short-term auditory memory; and high-frequency word, low-frequency word, pseudoword, and text reading. The results of this clinical trial showed the modulation of the studied variables in central auditory processing and the accuracy and speed of reading variables compared to the control and sham statuses in both electrode arrays. Our results also showed that the improvement of the accuracy and speed of text reading, as well as the accuracy of pseudoword reading were related to the improvement of speech in noise perception and temporal processing. The results of this research can be effective in clarifying the basis of the neurobiology of dyslexia and, in particular, the hypothesis of the role of basic auditory processing and subsequently the role of the auditory cortex in dyslexia. These results might provide a framework to facilitate behavioral rehabilitation in dyslexic children with APD.

Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion

BACKGROUND

The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient's performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation.

METHODS

The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman's partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests' corrected scores.

RESULTS

Of the 37 patients enrolled in this study, 29.7% made 3-11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = -0.408, p = 0.013; r = -0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = -0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = -0.468, p = 0.007; r = -0.499, p = 0.003). The orientation also correlated with the TT part III (r = -0.504, p = 0.002).

CONCLUSION

Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory-verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.

Late dominance of the right hemisphere during narrative comprehension

PET and fMRI studies suggest that auditory narrative comprehension is supported by a bilateral multilobar cortical network. The superior temporal resolution of magnetoencephalography (MEG) makes it an attractive tool to investigate the dynamics of how different neuroanatomic substrates engage during narrative comprehension. Using beta-band power changes as a marker of cortical engagement, we studied MEG responses during an auditory story comprehension task in 31 healthy adults. The protocol consisted of two runs, each interleaving 7 blocks of the story comprehension task with 15 blocks of an auditorily presented math task as a control for phonological processing, working memory, and attention processes. Sources at the cortical surface were estimated with a frequency-resolved beamformer. Beta-band power was estimated in the frequency range of 16-24 Hz over 1-sec epochs starting from 400 msec after stimulus onset until the end of a story or math problem presentation. These power estimates were compared to 1-second epochs of data before the stimulus block onset. The task-related cortical engagement was inferred from beta-band power decrements. Group-level source activations were statistically compared using non-parametric permutation testing. A story-math contrast of beta-band power changes showed greater bilateral cortical engagement within the fusiform gyrus, inferior and middle temporal gyri, parahippocampal gyrus, and left inferior frontal gyrus (IFG) during story comprehension. A math-story contrast of beta power decrements showed greater bilateral but left-lateralized engagement of the middle frontal gyrus and superior parietal lobule. The evolution of cortical engagement during five temporal windows across the presentation of stories showed significant involvement during the first interval of the narrative of bilateral opercular and insular regions as well as the ventral and lateral temporal cortex, extending more posteriorly on the left and medially on the right. Over time, there continued to be sustained right anterior ventral temporal engagement, with increasing involvement of the right anterior parahippocampal gyrus, STG, MTG, posterior superior temporal sulcus, inferior parietal lobule, frontal operculum, and insula, while left hemisphere engagement decreased. Our findings are consistent with prior imaging studies of narrative comprehension, but in addition, they demonstrate increasing right-lateralized engagement over the course of narratives, suggesting an important role for these right-hemispheric regions in semantic integration as well as social and pragmatic inference processing.

Specific disruption of the ventral anterior temporo-frontal network reveals key implications for language comprehension and cognition

Recent investigations have raised the question of the role of the anterior lateral temporal cortex in language processing (ventral language network). Here we present the language and overall cognitive performance of a rare male patient with chronic middle cerebral artery cerebrovascular accident with a well-documented lesion restricted to the anterior temporal cortex and its connections via the extreme capsule with the pars triangularis of the inferior frontal gyrus (i.e. Broca’s region). The performance of this unique patient is compared with that of two chronic middle cerebral artery cerebrovascular accident male patients with damage to the classic dorsal posterior temporo-parietal language system. Diffusion tensor imaging is used to reconstruct the relevant white matter tracts of the three patients, which are also compared with those of 10 healthy individuals. The patient with the anterior temporo-frontal lesion presents with flawless and fluent speech, but selective impairment in accessing lexico-semantic information, in sharp contrast to the impairments in speech, sentence comprehension and repetition observed after lesions to the classic dorsal language system. The present results underline the contribution of the ventral language stream in lexico-semantic processing and higher cognitive functions, such as active selective controlled retrieval.

Neuropsychological profiling and clinical DTI of three stroke patients highlight the importance of the ventral language system in normal language comprehension and cognition.

The resting-state topological organization damage of language-related brain regions in post-stroke cognitive impairment

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.

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

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.

The structural changes of gray matter in Parkinson disease patients with mild cognitive impairments

Objectives

Parkinson disease (PD) is associated with cognitive impairments. However, the underlying neural mechanism of cognitive impairments in PD is still not clear. This study aimed to investigate the anatomic alternations of gray matter in PD patients with mild cognitive impairment (MCI) and their associations with neurocognitive measurements.

Methods

T1-weighted magnetic resonance imaging (MRI) data were acquired from 23 PD patients with MCI, 23 PD patients without MCI, and 23 matched healthy controls. The MRI data were analyzed using voxel-based morphometry (VBM) and surfaced-based morphometry (SBM) methods to assess the structural changes in gray matter volume and cortical thickness respectively. Receiver operating characteristic (ROC) analysis was used to examine the diagnostic accuracies of the indexes of interest. The correlations between the structural metrics and neurocognitive assessments (e.g., Montreal cognitive assessment, MOCA; Mini-mental state examination, MMSE) were further examined.

Results

PD patients with MCI showed reduced gray matter volume (GMV) in the frontal cortex (e.g., right inferior frontal gyrus and middle frontal gyrus) and extended to insula as well as cerebellum compared with the healthy controls and PD patients without MIC. Thinner of cortical thickens in the temporal lobe (e.g., left middle temporal gyrus and right superior temporal gyrus) extending to parietal cortex (e.g., precuneus) were found in the PD patients with MCI relative to the healthy controls and PD patients without MCI.ROC analysis indicated that the area under the ROC curve (AUC) values in the frontal, temporal, and subcortical structures (e.g., insula and cerebellum) could differentiate the PD patients with MCI and without MCI and healthy controls. Furthermore, GMV of the right middle frontal gyrus and cortical thickness of the right superior temporal gyrus were correlated with neurocognitive dysfunctions (e.g., MOCA and MMSE) in PD patients with MCI.

Conclusion

This study provided further evidence that PD with MCI was associated with structural alternations of brain. Morphometric analysis focusing on the cortical and subcortical regions could be biomarkers of cognitive impairments in PD patients.

Phonological Working Memory Representations in the Left Inferior Parietal Lobe in the Face of Distraction and Neural Stimulation

The neural basis of phonological working memory (WM) was investigated through an examination of the effects of irrelevant speech distractors and disruptive neural stimulation from transcranial magnetic stimulation (TMS). Embedded processes models argue that the same regions involved in speech perception are used to support phonological WM whereas buffer models assume that a region separate from speech perception regions is used to support WM. Thus, according to the embedded processes approach but not the buffer approach, irrelevant speech and TMS to the speech perception region should disrupt the decoding of phonological WM representations. According to the buffer account, decoding of WM items should be possible in the buffer region despite distraction and should be disrupted with TMS to this region. Experiment 1 used fMRI and representational similarity analyses (RSA) with a delayed recognition memory paradigm using nonword stimuli. Results showed that decoding of memory items in the speech perception regions (superior temporal gyrus, STG) was possible in the absence of distractors. However, the decoding evidence in the left STG was susceptible to interference from distractors presented during the delay period whereas decoding in the proposed buffer region (supramarginal gyrus, SMG) persisted. Experiment 2 examined the causal roles of the speech processing region and the buffer region in phonological WM performance using TMS. TMS to the SMG during the early delay period caused a disruption in recognition performance for the memory nonwords, whereas stimulations at the STG and an occipital control region did not affect WM performance. Taken together, results from the two experiments are consistent with predictions of a buffer model of phonological WM, pointing to a critical role of the left SMG in maintaining phonological representations.

Altered Coupling Between Cerebral Blood Flow and Voxel-Mirrored Homotopic Connectivity Affects Stroke-Induced Speech Comprehension Deficits

The neurophysiological basis of the association between interhemispheric connectivity and speech comprehension processing remains unclear. This prospective study examined regional cerebral blood flow (CBF), homotopic functional connectivity, and neurovascular coupling, and their effects on comprehension performance in post-stroke aphasia. Multimodal imaging data (including data from functional magnetic resonance imaging and arterial spin labeling imaging) of 19 patients with post-stroke aphasia and 22 healthy volunteers were collected. CBF, voxel-mirrored homotopic connectivity (VMHC), CBF-VMHC correlation, and CBF/VMHC ratio maps were calculated. Between-group comparisons were performed to identify neurovascular changes, and correlation analyses were conducted to examine their relationship with the comprehension domain. The correlation between CBF and VMHC of the global gray matter decreased in patients with post-stroke aphasia. The total speech comprehension score was significantly associated with VMHC in the peri-Wernicke area [posterior superior temporal sulcus (pSTS): r = 0.748, p = 0.001; rostroventral area 39: r = 0.641, p = 0.008]. The decreased CBF/VMHC ratio was also mainly associated with the peri-Wernicke temporoparietal areas. Additionally, a negative relationship between the mean CBF/VMHC ratio of the cingulate gyrus subregion and sentence-level comprehension was observed (r = −0.658, p = 0.006). These findings indicate the contribution of peri-Wernicke homotopic functional connectivity to speech comprehension and reveal that abnormal neurovascular coupling of the cingulate gyrus subregion may underly comprehension deficits in patients with post-stroke aphasia.

Altered processing of communication signals in the subcortical auditory sensory pathway in autism

Autism spectrum disorder (ASD) is characterised by social communication difficulties. These difficulties have been mainly explained by cognitive, motivational, and emotional alterations in ASD. The communication difficulties could, however, also be associated with altered sensory processing of communication signals. Here, we assessed the functional integrity of auditory sensory pathway nuclei in ASD in three independent functional magnetic resonance imaging experiments. We focused on two aspects of auditory communication that are impaired in ASD: voice identity perception, and recognising speech-in-noise. We found reduced processing in adults with ASD as compared to typically developed control groups (pairwise matched on sex, age, and full-scale IQ) in the central midbrain structure of the auditory pathway (inferior colliculus [IC]). The right IC responded less in the ASD as compared to the control group for voice identity, in contrast to speech recognition. The right IC also responded less in the ASD as compared to the control group when passively listening to vocal in contrast to non-vocal sounds. Within the control group, the left and right IC responded more when recognising speech-in-noise as compared to when recognising speech without additional noise. In the ASD group, this was only the case in the left, but not the right IC. The results show that communication signal processing in ASD is associated with reduced subcortical sensory functioning in the midbrain. The results highlight the importance of considering sensory processing alterations in explaining communication difficulties, which are at the core of ASD.

Canonical Sentence Processing and the Inferior Frontal Cortex: Is There a Connection?

The role of left inferior frontal cortex (LIFC) in canonical sentence comprehension is controversial. Many studies have found involvement of LIFC in sentence production or complex sentence comprehension, but negative or mixed results are often found in comprehension of simple or canonical sentences. We used voxel-, region-, and connectivity-based lesion symptom mapping (VLSM, RLSM, CLSM) in left-hemisphere chronic stroke survivors to investigate canonical sentence comprehension while controlling for lexical-semantic, executive, and phonological processes. We investigated how damage and disrupted white matter connectivity of LIFC and two other language-related regions, the left anterior temporal lobe (LATL) and posterior temporal-inferior parietal area (LpT-iP), affected sentence comprehension. VLSM and RLSM revealed that LIFC damage was not associated with canonical sentence comprehension measured by a sensibility judgment task. LIFC damage was associated instead with impairments in a lexical semantic similarity judgment task with high semantic/executive demands. Damage to the LpT-iP, specifically posterior middle temporal gyrus (pMTG), predicted worse sentence comprehension after controlling for visual lexical access, semantic knowledge, and auditory-verbal short-term memory (STM), but not auditory single-word comprehension, suggesting pMTG is vital for auditory language comprehension. CLSM revealed that disruption of left-lateralized white-matter connections from LIFC to LATL and LpT-iP was associated with worse sentence comprehension, controlling for performance in tasks related to lexical access, auditory word comprehension, and auditory-verbal STM. However, the LIFC connections were accounted for by the lexical semantic similarity judgment task, which had high semantic/executive demands. This suggests that LIFC connectivity is relevant to canonical sentence comprehension when task-related semantic/executive demands are high.

Lesion correlates of auditory sentence comprehension deficits in post-stroke aphasia

Auditory sentence comprehension requires coordination of multiple levels of processing: auditory-phonological perception, lexical-semantic comprehension, syntactic parsing and discourse construction, as well as executive functions such as verbal working memory (WM) and cognitive control. This study examined the lesion correlates of sentence comprehension deficits in post-stroke aphasia, building on prior work on this topic by using a different and clinically-relevant measure of sentence comprehension (the Token Test) and multivariate (SCCAN) and connectome-based lesion-symptom mapping methods. The key findings were that lesions in the posterior superior temporal lobe and inferior frontal gyrus (pars triangularis) were associated with sentence comprehension deficits, which was observed in both mass univariate and multivariate lesion-symptom mapping. Graph theoretic measures of connectome disruption were not statistically significantly associated with sentence comprehension deficits after accounting for overall lesion size.

Altered Spontaneous Brain Activity and Network Property in Patients With Congenital Monocular Blindness

Individuals with congenital monocular blindness may have specific brain changes since the brain is prenatally deprived of half the normal visual input. To explore characteristic brain functional changes of congenital monocular blindness, we analyzed resting-state functional MRI (rs-fMRI) data of 16 patients with unilateral congenital microphthalmia and 16 healthy subjects with normal vision to compare intergroup differences of amplitude of low frequency fluctuations (ALFFs), functional connectivity (FC), and network topolgoical properties. Compared with controls, patients with microphthalmia exhibited significantly lower ALFF values in the left inferior occipital and temporal gyri, superior temporal gyrus, inferior parietal lobe and post-central gyrus, whereas higher ALFF in the right middle and inferior temporal gyri, middle and superior frontal gyri, left superior frontal, and temporal gyri, such as angular gyrus. Meanwhile, FC between left medial superior frontal gyrus and angular gyrus, FC between left superior temporal gyrus and inferior parietal lobe and post-central gyrus decreased in the patients with congenital microphthalmia. In addition, a graph theory-analysis revealed increased regional network metrics (degree centrality and nodal efficiency) in the middle and inferior temporal gyri and middle and superior frontal gyri, while decreased values in the inferior occipital and temporal gyri, inferior parietal lobule, post-central gyrus, and angular gyrus. Taken together, patients with congenital microphthalmia had widespread abnormal activities within neural networks involving the vision and language and language-related regions played dominant roles in their brain networks. These findings may provide clues for functional reorganization of vision and language networks induced by the congenital monocular blindness.

The Cerebrovascular Reactivity-Adjusted Spontaneous Brain Activity Abnormalities in White Matter Hyperintensities Related Cognitive Impairment: A Resting-State Functional MRI Study

BACKGROUND

The BOLD signal is regulated by neuronal activity and vascular physiology. The evolution pattern of brain activities after modulating the vascular factors in white matter hyperintensities (WMHs) related cognitive impairment (CI) was unknown.

OBJECTIVE

To explore the "pure" low-frequency fluctuation (ALFF) alterations after adjusting the cerebrovascular reactivity (CVR) factor.

METHODS

In this study, 111 WMHs subjects including 55 with CI (WMH-CI) and 56 without CI (WMH-no-CI), and 72 normal controls (NCs) underwent resting-state fMRI. The CVR and ALFF maps were derived using BOLD data. A voxel-wise Pearson analysis was performed to detect the relationship between CVR and ALFF maps. The ANCOVA analysis with and without CVR as a covariate was conducted to explore the effect of CVR on ALFF analysis. Correlation between the ALFF alterations and cognitive performance was conducted in WMH-CI subjects. The receiver operating characteristic curve was constructed to assess the diagnostic performance of ALFF indexes to determine the occurrence of CI.

RESULTS

There was a significant widespread correlation between the CVR and ALFF maps. The ALFF alterations between the WMH groups and NC group with CVR as covariate were more than those without CVR as covariate. WMH-CI subjects showed further ALFF alterations when compared with WMH-no-CI subjects. The abnormal ALFF values were significantly associated with poor performance. The combination of inferior frontal gyrus and middle frontal gyrus to PCC provided an incremental contribution to the occurrence of CI.

CONCLUSION

More areas with abnormal ALFF values which were specific to the WMHs related cognitive dysfunction were detected when considering the impact of CVR.

Components of language processing and their long-term and working memory storage in the brain

There is a consensus that the temporal lobes are involved in representing various types of information critical for language processing, including phonological (i.e., speech sound), semantic (meaning), and orthographic (spelling) representations. An important question is whether the same regions that represent our long-term knowledge of phonology, semantics, and orthography are used to support the maintenance of these types of information in working memory (WM) (for instance, maintaining semantic information during sentence comprehension), or whether regions outside the temporal lobes provide the neural basis for WM maintenance in these domains. This review focuses on the issue of whether temporal lobe regions support WM for phonological information, with a brief discussion of related findings in the semantic and orthographic domains. Across all three domains, evidence from lesion-symptom mapping and functional neuroimaging indicates that parietal or frontal regions are critical for supporting WM, with different regions supporting WM in the three domains. The distinct regions in different domains argue against these regions as playing a general attentional role. The findings imply an interaction between the temporal lobe regions housing the long-term memory representations in these domains and the frontal and parietal regions needed to maintain these representations over time.

Gray matter asymmetry in asymptomatic carotid stenosis

Even clinically “asymptomatic” carotid stenosis is associated with multidomain cognitive impairment, gray matter (GM) atrophy, and silent lesion. However, the links between them remain unclear. Using structural MRI data, we examined GM asymmetry index (AI) and white matter hyperintensity (WMH) in 24 patients with severe asymptomatic carotid stenosis (SACS), 24 comorbidity‐matched controls, and independent samples of 84 elderly controls and 22 young adults. As compared to controls, SACS patients showed worse verbal memories, higher WMH burden, and right‐lateralized GM in posterior middle temporal and mouth‐somatomotor regions. These clusters extended to pars triangularis, lateral temporal, and cerebellar regions, when compared with young adults. Further, a full‐path of WMH burden (X), GM volume (atrophy, M1), AI (asymmetry, M2), and neuropsychological variables (Y) through a serial mediation model was analyzed. This analysis identified that left‐dominated GM atrophy and right‐lateralized asymmetry in the posterior middle temporal cortex mediated the relationship between WMH burden and recall memory in SACS patients. These results suggest that the unbalanced hemispheric atrophy in the posterior middle temporal cortex is crucial to mediating relationship between WMH burden and verbal recall memories, which may underlie accelerated aging and cognitive deterioration in patients with SACS and other vascular cognitive impairment.

Aberrant Changes in Cortical Complexity in Right-Onset Versus Left-Onset Parkinson's Disease in Early-Stage

There is increasing evidence to show that motor symptom lateralization in Parkinson’s disease (PD) is linked to non-motor features, progression, and prognosis of the disease. However, few studies have reported the difference in cortical complexity between patients with left-onset of PD (LPD) and right-onset of PD (RPD). This study aimed to investigate the differences in the cortical complexity between early-stage LPD and RPD. High-resolution T1-weighted magnetic resonance images of the brain were acquired in 24 patients with LPD, 34 patients with RPD, and 37 age- and sex-matched healthy controls (HCs). Cortical complexity including gyrification index, fractal dimension (FD), and sulcal depth was analyzed using surface-based morphometry via CAT12/SPM12. Familywise error (FWE) peak-level correction at p < 0.05 was performed for significance testing. In patients with RPD, we found decreased mean FD and mean sulcal depth in the banks of the left superior temporal sulcus (STS) compared with LPD and HCs. The mean FD in the left superior temporal gyrus (STG) was decreased in RPD compared with HCs. However, in patients with LPD, we did not identify significantly abnormal cortical complex change compared with HCs. Moreover, we observed that the mean FD in STG was negatively correlated with the 17-item Hamilton Depression Scale (HAMD) among the three groups. Our findings support the specific influence of asymmetrical motor symptoms in cortical complexity in early-stage PD and reveal that the banks of left STS and left STG might play a crucial role in RPD.

Associated functional network development and language abilities in children

During childhood, the brain is gradually converging to the efficient functional architecture observed in adults. How the brain's functional architecture evolves with age, particularly in young children, is however, not well understood. We examined the functional connectivity of the core language regions, in association with cortical growth and language abilities, in 175 young children in the age range of 4 to 9 years. We analyzed the brain's developmental changes using resting-state functional and T1-weighted structural magnetic resonance imaging data. The results showed increased functional connectivity strength with age between the pars triangularis of the left inferior frontal gyrus and left temporoparietal regions (cohen's d = 0.54, CI: 0.24 - 0.84), associated with children's language abilities. Stronger functional connectivity between bilateral prefrontal and temporoparietal regions was associated with better language abilities regardless of age. In addition, the stronger functional connectivity between the left inferior frontal and temporoparietal regions was associated with larger surface area and thinner cortical thickness in these regions, which in turn was associated with superior language abilities. Thus, using functional and structural brain indices, coupled with behavioral measures, we elucidate the association of functional language network development, language ability, and cortical growth, thereby adding to our understanding of the neural basis of language acquisition in young children.

Distinct mechanisms for talker adaptation operate in parallel on different timescales

The mapping between speech acoustics and phonemic representations is highly variable across talkers, and listeners are slower to recognize words when listening to multiple talkers compared with a single talker. Listeners' speech processing efficiency in mixed-talker settings improves when given time to reorient their attention to each new talker. However, it remains unknown how much time is needed to fully reorient attention to a new talker in mixed-talker settings so that speech processing becomes as efficient as when listening to a single talker. In this study, we examined how speech processing efficiency improves in mixed-talker settings as a function of the duration of continuous speech from a talker. In single-talker and mixed-talker conditions, listeners identified target words either in isolation or preceded by a carrier vowel of parametrically varying durations from 300 to 1,500 ms. Listeners' word identification was significantly slower in every mixed-talker condition compared with the corresponding single-talker condition. The costs associated with processing mixed-talker speech declined significantly as the duration of the speech carrier increased from 0 to 600 ms. However, increasing the carrier duration beyond 600 ms did not achieve further reduction in talker variability-related processing costs. These results suggest that two parallel mechanisms support processing talker variability: A stimulus-driven mechanism that operates on short timescales to reorient attention to new auditory sources, and a top-down mechanism that operates over longer timescales to allocate the cognitive resources needed to accommodate uncertainty in acoustic-phonemic correspondences during contexts where speech may come from multiple talkers.

Altered Gray Matter Volume, Functional Connectivity, and Degree Centrality in Early-Onset Type 2 Diabetes Mellitus

Background: Structural and functional brain alterations that underlie cognitive decline have been observed in elderly adults with type 2 diabetes mellitus (T2DM); however, whether these alterations can be observed in patients with early-onset T2DM remains unclear. Therefore, we aimed to describe the abnormalities in brain volume and functional patterns in patients with early-onset T2DM in the present study.

Methods: We enrolled 20 patients with early-onset T2DM and 20 healthy controls (HCs). Changes in brain volume were assessed using voxel-based morphology (VBM), while changes in brain function were assessed using degree centrality (DC) and functional connectivity (FC).

Results: Compared to HCs, patients with early-onset T2DM exhibited gray matter reductions in the left orbital superior, middle, and inferior frontal gyri as well as the right superior frontal gyrus. The gray matter reductions in the right superior frontal gyrus were negatively associated with the urine albumin to creatinine ratio. Furthermore, increased DC values were observed in the left superior temporal gyrus, left Heschl gyrus, and left hippocampus in patients with early-onset T2DM. An FC analysis of these regions revealed elevated connectivity in the right precuneus, left inferior parietal gyrus, left Heschl gyrus, bilateral post-central gyrus, bilateral insula, bilateral superior temporal gyrus, and bilateral medial and paracingulate gyrus. Furthermore, the FC of the hubs to the superior temporal gyrus, insula, and Heschl gyrus was increased and positively correlated with trail making test-B.

Conclusion: Decreased local gray matter volume and increased DC and FC may represent the neurobiological mechanism underlying cognitive dysfunction in patients with early-onset T2DM.

The Impact of Primary Progressive Aphasia on Picture Naming and General Language Ability

BACKGROUND

Primary progressive aphasia (PPA) is a clinical syndrome that is characterized by progressive deterioration of language while other cognitive domains remain relatively intact. The extent to which print exposure and cortical volume atrophy jointly influence picture naming and general language ability in individuals with PPA remains underexplored.

OBJECTIVE

To investigate the language performance of individuals with the nonfluent variant of primary progressive aphasia (nfvPPA) and to explore the impact of print exposure and cortical volume atrophy on their language ability.

METHOD

We compared 14 Greek individuals with nfvPPA and similar age, education, disease duration, and cognitive ability with age-, gender- and education-matched Greek controls on picture naming and on language tasks of the Boston Diagnostic Aphasia Examination-Short Form, including oral word reading, word and sentence repetition, complex ideational material, and reading comprehension. The effects of print exposure and left-hemisphere cortical volume on the individuals' language performance were estimated through stepwise regression models.

RESULTS

The language performance of the individuals with nfvPPA was affected by print exposure and cortical volume atrophy. Picture naming and word reading were affected by print exposure. The highest contributions of cortical volume atrophy were found for the repetition, complex ideational material, and reading comprehension tasks.

CONCLUSION

Print exposure and cortical volume atrophy may help explain variability in the language performance of nfvPPA individuals with similar age, education, disease duration, and cognitive ability.

rsfMRI based evidence for functional connectivity alterations in adults with developmental stuttering

Persistent developmental stuttering (PDS) is defined as a speech disorder mainly characterized by intermittent involuntary disruption in normal fluency, time patterning, and rhythm of speech. Although extensive functional neuroimaging studies have explored brain activation alterations in stuttering, the main affected brain regions/networks in PDS still remain unclear. Here, using functional magnetic resonance imaging (fMRI), we investigated resting-state whole-brain functional connectivity of 15 adults who stutter (PDS group) and 15 age-matched control individuals to reveal the connectivity abnormalities associated with stuttering. We were also interested in exploring how the severity of stuttering varies across individuals to understand the compensatory mechanism of connectivity pattern in patients showing less symptoms. Our results revealed decreased connectivity of left frontal pole and left middle frontal gyrus (MidFG) with right precentral/postcentral gyrus in stuttering individuals compared with control participants, while less symptomatic PDS individuals showed greater functional connectivity between left MidFG and left caudate. Additionally, our finding indicated reduced connectivity in the PDS group between the left superior temporal gyrus (STG) and several brain regions including the right limbic lobe, right fusiform, and right cerebellum, as well as the left middle temporal gyrus (MTG). We also observed that PDS individuals with less severe symptoms had stronger connectivity between right MTG and several left hemispheric regions including inferior frontal gyrus (IFG) and STG. The connectivity between right fronto-orbital and right MTG was also negatively correlated with stuttering severity. These findings may suggest the involvement of right MTG and left MidFG in successful compensatory mechanisms in more fluent stutterers.

Dissociable Mechanisms of Verbal Working Memory Revealed through Multivariate Lesion Mapping

Two maintenance mechanisms with separate neural systems have been suggested for verbal working memory: articulatory-rehearsal and non-articulatory maintenance. Although lesion data would be key to understanding the essential neural substrates of these systems, there is little evidence from lesion studies that the two proposed mechanisms crucially rely on different neuroanatomical substrates. We examined 39 healthy adults and 71 individuals with chronic left-hemisphere stroke to determine if verbal working memory tasks with varying demands would rely on dissociable brain structures. Multivariate lesion-symptom mapping was used to identify the brain regions involved in each task, controlling for spatial working memory scores. Maintenance of verbal information relied on distinct brain regions depending on task demands: sensorimotor cortex under higher demands and superior temporal gyrus (STG) under lower demands. Inferior parietal cortex and posterior STG were involved under both low and high demands. These results suggest that maintenance of auditory information preferentially relies on auditory-phonological storage in the STG via a nonarticulatory maintenance when demands are low. Under higher demands, sensorimotor regions are crucial for the articulatory rehearsal process, which reduces the reliance on STG for maintenance. Lesions to either of these regions impair maintenance of verbal information preferentially under the appropriate task conditions.

Brain metabolic characteristics distinguishing typical and atypical benign epilepsy with centro-temporal spikes

OBJECTIVES

Atypical benign epilepsy with centro-temporal spikes (BECTS) have less favorable outcomes than typical BECTS, and thus should be accurately identified for adequate treatment. We aimed to investigate the glucose metabolic differences between typical and atypical BECTS using ¹⁸F-fluorodeoxyglucose positron emission tomography ([¹⁸F]FDG PET) imaging, and explore whether these differences can help distinguish.

METHODS

Forty-six patients with typical BECTS, 31 patients with atypical BECTS and 23 controls who underwent [¹⁸F]FDG PET examination were retrospectively involved. Absolute asymmetry index (|AI|) was applied to evaluate the severity of metabolic abnormality. Glucose metabolic differences were investigated among typical BECTS, atypical BECTS, and controls by using statistical parametric mapping (SPM). Logistic regression analyses were performed based on clinical, PET, and hybrid features.

RESULTS

The |AI| was found significantly higher in atypical BECTS than in typical BECTS (p = 0.040). Atypical BECTS showed more hypo-metabolism regions than typical BECTS, mainly located in the fronto-temporo-parietal cortex. The PET model had significantly higher area under the curve (AUC) than the clinical model (0.91 vs. 0.70, p = 0.006). The hybrid model had the highest sensitivity (0.90), specificity (0.85), and accuracy (0.87) of all three models.

CONCLUSIONS

Atypical BECTS showed more widespread and severe hypo-metabolism than typical BECTS, depending on which the two groups can be well distinguished. The combination of metabolic characteristics and clinical variables has the potential to be used clinically to distinguish between typical and atypical BECTS.

KEY POINTS

• Distinguishing between typical and atypical BECTS is very important for the formulation of treatment regimens in clinical practice. • Atypical BECTS showed more widespread and severe hypo-metabolism than typical BECTS, mainly located in the fronto-temporo-parietal cortex. • The logistic regression model based on PET outperformed that based on clinical characteristics in classification of typical and atypical BECTS, and the hybrid model achieved the best classification performance.

Neural regions underlying object and action naming: Complementary evidence from acute stroke and primary progressive aphasia

BACKGROUND

Naming impairment is commonly noted in individuals with aphasia. However, object naming receives more attention than action naming. Furthermore, most studies include participants with aphasia due to only one aetiology, commonly stroke. We developed a new assessment, the Hopkins Action Naming Assessment (HANA), to evaluate action naming impairments.

AIMS

Our aims were to show that the HANA is a useful tool that can (1) identify action naming impairments and (2) be used to investigate the neural substrates underlying naming. We paired the HANA with the Boston Naming Test (BNT) to compare action and object naming. We considered participants with aphasia due to primary progressive aphasia (PPA) or acute left hemisphere stroke to provide a more comprehensive picture of brain-behaviour relationships critical for naming. Behaviourally, we hypothesised that there would be a double dissociation between object and action naming performance. Neuroanatomically, we hypothesised that different neural substrates would be implicated in object vs. action naming and that different lesion-deficit associations would be identified in participants with PPA vs. acute stroke.

METHODS & PROCEDURES

Participants (N=138 with PPA, N=37 with acute stroke) completed the BNT and HANA. Behavioural performance was compared. A subset of participants (N=31 with PPA, N=37 with acute stroke) provided neuroimaging data. The whole brain was automatically segmented into regions of interest (ROIs). For participants with PPA, the image variables were the ROI volumes, normalised by the brain volume. For participants with acute stroke, the image variables were the percentage of each ROI affected by the lesion. The relationship between ROIs likely to be involved in naming performance was modelled with LASSO regression.

OUTCOMES & RESULTS

Behavioural results showed a double dissociation in performance: in each group, some participants displayed intact performance relative to healthy controls on actions but not objects and/or significantly better performance on actions than objects, while others showed the opposite pattern. These results support the need to assess both objects and actions when evaluating naming deficits. Neuroimaging results identified different regions associated with object vs. action naming, implicating overlapping but distinct networks of regions. Furthermore, results differed for participants with PPA vs. acute stroke, indicating that critical information may be missed when only one aetiology is considered.

CONCLUSIONS

Overall, the study provides a more comprehensive picture of the neural bases of naming, underscoring the importance of assessing both objects and actions and considering different aetiologies of damage. It demonstrates the utility of the HANA.

Lesions that do or do not impair digit span: a study of 816 stroke survivors

Prior studies have reported inconsistency in the lesion sites associated with verbal short-term memory impairments. Here we asked: How many different lesion sites can account for selective impairments in verbal short-term memory that persist over time, and how consistently do these lesion sites impair verbal short-term memory? We assessed verbal short-term memory impairments using a forward digit span task from the Comprehensive Aphasia Test. First, we identified the incidence of digit span impairments in a sample of 816 stroke survivors (541 males/275 females; age at stroke onset 56 ± 13 years; time post-stroke 4.4 ± 5.2 years). Second, we studied the lesion sites in a subgroup of these patients (n = 39) with left hemisphere damage and selective digit span impairment-defined as impaired digit span with unimpaired spoken picture naming and spoken word comprehension (tests of speech production and speech perception, respectively). Third, we examined how often these lesion sites were observed in patients who either had no digit span impairments or digit span impairments that co-occurred with difficulties in speech perception and/or production tasks. Digit span impairments were observed in 222/816 patients. Almost all (199/222 = 90%) had left hemisphere damage to five small regions in basal ganglia and/or temporo-parietal areas. Even complete damage to one or more of these five regions was not consistently associated with persistent digit span impairment. However, when the same regions were spared, only 5% (23/455) presented with digit span impairments. These data suggest that verbal short-term memory impairments are most consistently associated with damage to left temporo-parietal and basal ganglia structures. Sparing of these regions very rarely results in persistently poor verbal short-term memory. These findings have clinical implications for predicting recovery of verbal short-term memory after stroke.

Maintaining verbal short-term memory representations in non-perceptual parietal regions

Buffer accounts of verbal short-term memory (STM) assume dedicated buffers for maintaining different types of information (e.g., phonological, visual) whereas embedded processes accounts argue against the existence of buffers and claim that STM consists of the activated portion of long-term memory (LTM). We addressed this debate by determining whether STM recruits the same neural substrate as LTM, or whether additional regions are involved in short-term storage. Using fMRI with representational similarity analysis (RSA), we examined the representational correspondence of multi-voxel neural activation patterns with the theoretical predictions for the maintenance of both phonological and semantic codes in STM. We found that during the delay period of a phonological STM task, phonological representations could be decoded in the left supramarginal gyrus (SMG) but not the superior temporal gyrus (STG), a speech processing region, for word stimuli. Whereas the pattern in the SMG was specific to phonology, a different region in the left angular gyrus showed RSA decoding evidence for the retention of either phonological or semantic codes, depending on the task context. Taken together, the results provide clear support for a dedicated buffer account of phonological STM, although evidence for a semantic buffer is equivocal.

Working Memory Capacities Neurally Dissociate: Evidence from Acute Stroke

Substantial behavioral evidence implies the existence of separable working memory (WM) components for maintaining phonological and semantic information. In contrast, only a few studies have addressed the neural basis of phonological versus semantic WM using functional neuroimaging and none has used a lesion-symptom mapping (LSM) approach. Here, we address this gap, reporting a multivariate LSM study of phonological and semantic WM for 94 individuals at the acute stage of left hemisphere stroke. Testing at the acute stage avoids issues of brain reorganization and the adoption of patient strategies for task performance. The LSM analyses for each WM component controlled for the other WM component and semantic and phonological knowledge at the single word level. For phonological WM, the regions uncovered included the supramarginal gyrus, argued to be the site of phonological storage, and several cortical and subcortical regions plausibly related to inner rehearsal. For semantic WM, inferior frontal regions and the angular gyrus were uncovered. The findings thus provide converging evidence for separable systems for phonological and semantic WM that are distinguished from the systems supporting long-term knowledge representations in those domains.

The Protective Influence of Bilingualism on the Recovery of Phonological Input Processing in Aphasia After Stroke

Language-related potentials are increasingly used to objectify (mal)adaptive neuroplasticity in stroke-related aphasia recovery. Using preattentive [mismatch negativity (MMN)] and attentive (P300) phonologically related paradigms, neuroplasticity in sensory memory and cognitive functioning underlying phonological processing can be investigated. In aphasic patients, MMN amplitudes are generally reduced for speech sounds with a topographic source distribution in the right hemisphere. For P300 amplitudes and latencies, both normal and abnormal results have been reported. The current study investigates the preattentive and attentive phonological discrimination ability in 17 aphasic patients (6 monolinguals and 11 bilinguals, aged 41–71 years) at two timepoints during aphasia recovery. Between the two timepoints, a significant improvement of behavioral language performance in both languages is observed in all patients with the MMN latency at timepoint 1 as a predictive factor for aphasia recovery. In contrast to monolinguals, bilingual aphasic patients have a higher probability to improve their processing speed during rehabilitation, resulting in a shortening of the MMN latency over time, which sometimes progresses toward the normative values.

Working memory training in post-stroke aphasia: Near and far transfer effects

PURPOSE

Individuals with aphasia (IWA) show various impairments in speech, language, and cognitive functions. Working memory (WM), a cognitive system that functions to hold and manipulate information in support of complex, goal-directed behaviors, is one of the impaired cognitive domains in aphasia. The present study intended to examine the effects of a WM training program on both memory and language performance in IWA.

METHOD

This quasi-experimental study with an active control group was performed on 25 people with mild or moderate Broca's aphasia aged 29-61 years resulting from left hemisphere damage following ischemic stroke. Participants were assigned into two groups, including a training group (n = 13) and a control group (n = 12). The treatment and control groups received WM training and routine speech therapy, respectively. Two separate lists of WM tests, including one list for both pre-training assessment and training program and a second list for the post-training assessment, were used in this study.

RESULTS

The treatment group showed significant improvements in both trained and non-trained WM tasks (near transfer effect) and language performance (far transfer effect) compared to the control group.

CONCLUSION

Given the good generalizability of the WM training program on both WM and language performance, WM training is suggested as part of the rehabilitation program in aphasia.

Hearing loss is associated with gray matter differences in older adults at risk for and with Alzheimer's disease

Using data from the COMPASS-ND study we investigated associations between hearing loss and hippocampal volume as well as cortical thickness in older adults with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's dementia (AD). SCD participants with greater pure-tone hearing loss exhibited lower hippocampal volume, but more cortical thickness in the left superior temporal gyrus and right pars opercularis. Greater speech-in-noise reception thresholds were associated with lower cortical thickness bilaterally across much of the cortex in AD. The AD group also showed a trend towards worse speech-in-noise thresholds compared to the SCD group.

Working Memory in Aphasia: The Role of Temporal Information Processing

Aphasia is an acquired impairment of language functions resulting from a brain lesion. It is usually accompanied by deficits in non-linguistic cognitive processes. This study aimed to investigate in patients with aphasia the complex interrelationships between selected cognitive functions: auditory speech comprehension, working memory (WM), and temporal information processing (TIP) in the millisecond time range. Thirty right-handed subjects (20 males) aged from 27 to 82 years suffering from post-stroke aphasia participated in the study. Verbal working memory (VWM) and spatial working memory (SWM) were assessed with: (1) a receptive verbal test and (2) the Corsi Block-Tapping Test, respectively. Both these WM tests used the forward tasks (mainly engaging maintenance processes, i.e., storing, monitoring, and matching information) and backward tasks (engaging both maintenance and manipulation processes, i.e., reordering and updating information). Auditory comprehension was assessed by receptive language tests, and TIP efficiency was assessed by auditory perception of temporal order in the millisecond time range. We observed better performance of forward WM tasks than backward ones, independently of the type of material used. Furthermore, the severity of auditory comprehension impairment correlated with the efficiency on both forward and backward VWM tasks and the backward SWM task. Further analysis revealed that TIP plays a crucial role only in the latter task. These results indicate the divergent pattern of interactions between WM and TIP depending on the type of WM tasks. Level of verbal competency appeared to play an important role in both VWM tasks, whereas TIP (which is associated with manipulation processes) appeared to be important for SWM, but only on the backward task.