Revealing the Dynamic Modulations That Underpin a Resilient Neural Network for Semantic Cognition: An fMRI Investigation in Patients With Anterior Temporal Lobe Resection

Functional integration and segregation during semantic cognition: Evidence across age groups

Semantic cognition is underpinned by ventral anterior temporal lobe (vATL) which encodes knowledge representations and inferior frontal gyrus (IFG), which controls activation of knowledge based on the needs of the current context. This core semantic network has been validated in substantial empirical findings in the past. However, it remains unclear how these core semantic areas dynamically communicate with each other, and with other neural networks, to achieve successful semantic processing. Here, we investigated this question by testing functional connectivity in the core semantic network during semantic tasks and whether these connections were affected by cognitive ageing. Compared to a non-semantic task, semantic tasks increased the connectivity between left and right IFGs, indicating a bilateral semantic control system. Strengthened connectivity was also found between left IFG and left vATL, and this effect was stronger in the young group. At a whole-brain scale, IFG and vATL increased their coupling with multiple-demand regions during semantic tasks, even though these areas were deactivated relative to non-semantic tasks. This suggests that the domain-general executive network contributes to semantic processing. In contrast, IFG and vATL decreased their interaction with default mode network (DMN) areas during semantic tasks, even though these areas were positively activated by the task. This suggests that DMN areas do not contribute to all semantic tasks: their activation may sometimes reflect automatic retrieval of task-irrelevant memories and associations. Taken together, our study characterizes a dynamic connectivity mechanism supporting semantic cognition within and beyond core semantic regions.

Drawing from name in semantic dementia reveals graded object knowledge representations in anterior temporal lobe

Semantic dementia (SD) is characterized by progressive impairment in conceptual knowledge due to anterior temporal lobe (ATL) neurodegeneration. Extended neuropsychological assessments can quantitatively demonstrate the semantic impairment, but this graded loss of knowledge can also be readily observed in the qualitative observation of patients' recall of single concepts. Here, we present the results of a simple task of object drawing-from-name, by patients with SD (N = 19), who have isolated atrophy of the ATL bilaterally. Both cross-sectionally and longitudinally, patient drawings demonstrated a pattern of degradation in which rare and distinctive features (such as the hump on a camel) were lost earliest in disease course, and there was an increase in the intrusion of prototypical features (such as the typical small ears of most mammals on an elephant) with more advanced disease. Crucially, patient drawings showed a continuum of conceptual knowledge loss rather than a binary 'present' or 'absent' state. Overall, we demonstrate that qualitative evaluation of line drawings of animals and objects provides fascinating insights into the transmodal semantic deficit in SD. Our results are consistent with a distributed-plus-hub model of semantic memory. The graded nature of the deficit in semantic performance observed in our subset of longitudinally observed patients suggests that the temporal lobe binds feature-based semantic attributes in its central convergence zone.

Age differences in the neural processing of semantics, within and beyond the core semantic network

Aging is associated with functional activation changes in domain-specific regions and large-scale brain networks. This preregistered Functional magnetic resonance imaging (fMRI) study investigated these effects within the domain of semantic cognition. Participants completed 1 nonsemantic and 2 semantic tasks. We found no age differences in semantic activation in core semantic regions. However, the right inferior frontal gyrus showed difficulty-related increases in both age groups. This suggests that age-related upregulation of this area may be a compensatory response to increased processing demands. At a network level, older people showed more engagement in the default mode network and less in the executive multiple-demand network, aligning with older people's greater knowledge reserves and executive declines. In contrast, activation was age-invariant in semantic control regions. Finally, older adults showed reduced demand-related modulation of multiple-demand network activation in the nonsemantic task but not the semantic tasks. These findings provide a new perspective on the neural basis of semantic cognition in aging, suggesting that preserved function in specialized semantic networks may help to maintain semantic cognition in later life.

A common neural code for meaning in discourse production and comprehension

How does the brain code the meanings conveyed by language? Neuroimaging studies have investigated this by linking neural activity patterns during discourse comprehension to semantic models of language content. Here, we applied this approach to the production of discourse for the first time. Participants underwent fMRI while producing and listening to discourse on a range of topics. We used a distributional semantic model to quantify the similarity between different speech passages and identified where similarity in neural activity was predicted by semantic similarity. When people produced discourse, speech on similar topics elicited similar activation patterns in a widely distributed and bilateral brain network. This network was overlapping with, but more extensive than, the regions that showed similarity effects during comprehension. Critically, cross-task neural similarities between comprehension and production were also predicted by similarities in semantic content. This result suggests that discourse semantics engages a common neural code that is shared between comprehension and production. Effects of semantic similarity were bilateral in all three RSA analyses, even while univariate activation contrasts in the same data indicated left-lateralised BOLD responses. This indicates that right-hemisphere regions encode semantic properties even when they are not activated above baseline. We suggest that right-hemisphere regions play a supporting role in processing the meaning of discourse during both comprehension and production.

Dynamics of Functional Networks for Syllable and Word-Level Processing

Speech comprehension requires the ability to temporally segment the acoustic input for higher-level linguistic analysis. Oscillation-based approaches suggest that low-frequency auditory cortex oscillations track syllable-sized acoustic information and therefore emphasize the relevance of syllabic-level acoustic processing for speech segmentation. How syllabic processing interacts with higher levels of speech processing, beyond segmentation, including the anatomical and neurophysiological characteristics of the networks involved, is debated. In two MEG experiments, we investigate lexical and sublexical word-level processing and the interactions with (acoustic) syllable processing using a frequency-tagging paradigm. Participants listened to disyllabic words presented at a rate of 4 syllables/s. Lexical content (native language), sublexical syllable-to-syllable transitions (foreign language), or mere syllabic information (pseudo-words) were presented. Two conjectures were evaluated: (i) syllable-to-syllable transitions contribute to word-level processing; and (ii) processing of words activates brain areas that interact with acoustic syllable processing. We show that syllable-to-syllable transition information compared to mere syllable information, activated a bilateral superior, middle temporal and inferior frontal network. Lexical content resulted, additionally, in increased neural activity. Evidence for an interaction of word- and acoustic syllable-level processing was inconclusive. Decreases in syllable tracking (cerebroacoustic coherence) in auditory cortex and increases in cross-frequency coupling between right superior and middle temporal and frontal areas were found when lexical content was present compared to all other conditions; however, not when conditions were compared separately. The data provide experimental insight into how subtle and sensitive syllable-to-syllable transition information for word-level processing is.

Distinct but cooperating brain networks supporting semantic cognition

Semantic cognition is a complex multifaceted brain function involving multiple processes including sensory, semantic, and domain-general cognitive systems. However, it remains unclear how these systems cooperate with each other to achieve effective semantic cognition. Here, we used independent component analysis (ICA) to investigate the functional brain networks that support semantic cognition. We used a semantic judgment task and a pattern-matching control task, each with 2 levels of difficulty, to disentangle task-specific networks from domain-general networks. ICA revealed 2 task-specific networks (the left-lateralized semantic network [SN] and a bilateral, extended semantic network [ESN]) and domain-general networks including the frontoparietal network (FPN) and default mode network (DMN). SN was coupled with the ESN and FPN but decoupled from the DMN, whereas the ESN was synchronized with the FPN alone and did not show a decoupling with the DMN. The degree of decoupling between the SN and DMN was associated with semantic task performance, with the strongest decoupling for the poorest performing participants. Our findings suggest that human higher cognition is achieved by the multiple brain networks, serving distinct and shared cognitive functions depending on task demands, and that the neural dynamics between these networks may be crucial for efficient semantic cognition.

The multidimensional nature of aphasia recovery post-stroke

Language is not a single function, but instead results from interactions between neural representations and computations that can be damaged independently of each other. Although there is now clear evidence that the language profile in post-stroke aphasia reflects graded variations along multiple underlying dimensions ('components'), it is still entirely unknown if these distinct language components have different recovery trajectories and rely on the same, or different, neural regions during aphasia recovery. Accordingly, this study examined whether language components in the subacute stage: (i) mirror those observed in the chronic stage; (ii) recover together in a homogeneous manner; and (iii) have recovery trajectories that relate to changing activation in distinct or overlapping underlying brain regions. We analysed longitudinal data from 26 individuals with mild-moderate aphasia following left hemispheric infarct who underwent functional MRI and behavioural testing at ∼2 weeks and ∼4 months post-stroke. The language profiles in early post-stroke aphasia reflected three orthogonal principal components consisting of fluency, semantic/executive function and phonology. These components did not recover in a singular, homogeneous manner; rather, their longitudinal trajectories were uncorrelated, suggesting that aphasia recovery is heterogeneous and multidimensional. Mean regional brain activation during overt speech production in unlesioned areas was compared with patient scores on the three principal components of language at both the early and late time points. In addition, the change in brain activation over time was compared with the change on each of the principal component scores, both before and after controlling for baseline scores. We found that different language components were associated with changing activation in multiple, non-overlapping bilateral brain regions during aphasia recovery. Specifically, fluency recovery was associated with increasing activation in bilateral middle frontal gyri and right temporo-occipital middle temporal gyrus; semantic/executive recovery was associated with reducing activation in bilateral anterior temporal lobes; while phonology recovery was associated with reducing activation in bilateral precentral gyri, dorso-medial frontal poles and the precuneus. Overlapping clusters in the ventromedial prefrontal cortex were positively associated with fluency recovery but negatively associated with semantic/executive and phonology recovery. This combination of detailed behavioural and functional MRI data provides novel insights into the neural basis of aphasia recovery. Because different aspects of language seem to rely on different neural regions for recovery, treatment strategies that target the same neural region in all stroke survivors with aphasia might be entirely ineffective or even impair recovery, depending on the specific language profile of each individual patient.

Structure and function of language networks in temporal lobe epilepsy

Individuals with temporal lobe epilepsy (TLE) may have significant language deficits. Language capabilities may further decline following temporal lobe resections. The language network, comprising dispersed gray matter regions interconnected with white matter fibers, may be atypical in individuals with TLE. This review explores the structural changes to the language network and the functional reorganization of language abilities in TLE. We discuss the importance of detailed reporting of patient's characteristics, such as, left- and right-sided focal epilepsies as well as lesional and nonlesional pathological subtypes. These factors can affect the healthy functioning of gray and/or white matter. Dysfunction of white matter and displacement of gray matter function could concurrently impact their ability, in turn, producing an interactive effect on typical language organization and function. Surgical intervention can result in impairment of function if the resection includes parts of this structure-function network that are critical to language. In addition, impairment may occur if language function has been reorganized and is included in a resection. Conversely, resection of an epileptogenic zone may be associated with recovery of cortical function and thus improvement in language function. We explore the abnormality of functional regions in a clinically applicable framework and highlight the differences in the underlying language network. Avoidance of language decline following surgical intervention may depend on tailored resections to avoid critical areas of gray matter and their white matter connections. Further work is required to elucidate the plasticity of the language network in TLE and to identify sub-types of language representation, both of which will be useful in planning surgery to spare language function.

Age-specificity and generalization of behavior-associated structural and functional networks and their relevance to behavioral domains

Behavior-associated structural connectivity (SC) and resting-state functional connectivity (rsFC) networks undergo various changes in aging. To study these changes, we proposed a continuous dimension where at one end networks generalize well across age groups in terms of behavioral predictions (age-general) and at the other end, they predict behaviors well in a specific age group but fare poorly in another age group (age-specific). We examined how age generalizability/specificity of multimodal behavioral associated brain networks varies across behavioral domains and imaging modalities. Prediction models consisting of SC and/or rsFC networks were trained to predict a diverse range of 75 behavioral outcomes in a young adult sample (N = 92). These models were then used to predict behavioral outcomes in unseen young (N = 60) and old (N = 60) subjects. As expected, behavioral prediction models derived from the young age group, produced more accurate predictions in the unseen young than old subjects. These behavioral predictions also differed significantly across behavioral domains, but not imaging modalities. Networks associated with cognitive functions, except for a few mostly relating to semantic knowledge, fell toward the age-specific end of the spectrum (i.e., poor young-to-old generalizability). These findings suggest behavior-associated brain networks are malleable to different degrees in aging; such malleability is partly determined by the nature of the behavior.

A tale of two gradients: differences between the left and right hemispheres predict semantic cognition

Decomposition of whole-brain functional connectivity patterns reveals a principal gradient that captures the separation of sensorimotor cortex from heteromodal regions in the default mode network (DMN). Functional homotopy is strongest in sensorimotor areas, and weakest in heteromodal cortices, suggesting there may be differences between the left and right hemispheres (LH/RH) in the principal gradient, especially towards its apex. This study characterised hemispheric differences in the position of large-scale cortical networks along the principal gradient, and their functional significance. We collected resting-state fMRI and semantic, working memory and non-verbal reasoning performance in 175 + healthy volunteers. We then extracted the principal gradient of connectivity for each participant, tested which networks showed significant hemispheric differences on the gradient, and regressed participants’ behavioural efficiency in tasks outside the scanner against interhemispheric gradient differences for each network. LH showed a higher overall principal gradient value, consistent with its role in heteromodal semantic cognition. One frontotemporal control subnetwork was linked to individual differences in semantic cognition: when it was nearer heteromodal DMN on the principal gradient in LH, participants showed more efficient semantic retrieval—and this network also showed a strong hemispheric difference in response to semantic demands but not working memory load in a separate study. In contrast, when a dorsal attention subnetwork was closer to the heteromodal end of the principal gradient in RH, participants showed better visual reasoning. Lateralization of function may reflect differences in connectivity between control and heteromodal regions in LH, and attention and visual regions in RH.

The neural bases of resilient semantic system: evidence of variable neuro-displacement in cognitive systems

The purpose of this study was to explore an important research goal in cognitive and clinical neuroscience: What are the neurocomputational mechanisms that make cognitive systems "well engineered" and thus resilient across a range of performance demands and to mild levels of perturbation or even damage? A new hypothesis called 'variable neuro-displacement' suggests that cognitive systems are formed with dynamic, spare processing capacity, which balances energy consumption against performance requirements and can be resilient to changes in performance demands. Here, we tested this hypothesis by investigating the neural dynamics of the semantic system by manipulating performance demand. The performance demand was manipulated with two levels of task difficulty (easy vs. hard) in two different ways (stimulus type and response timing). We found that the demanding semantic processing increased regional activity in both the domain-specific semantic representational system (anterior temporal lobe) and the parallel executive control networks (prefrontal, posterior temporal, and parietal regions). Functional connectivity between these regions was also increased during demanding semantic processing and these increases were related to better semantic task performance. Our results suggest that semantic cognition is made resilient by flexible, dynamic changes including increased regional activity and functional connectivity across both domain-specific and domain-general systems. It reveals the intrinsic resilience-related mechanisms of semantic cognition, mimicking alterations caused by perturbation or brain damage. Our findings provide a strong implication that the intrinsic mechanisms of a well-engineered semantic system might be attributed to the compensatory functional alterations in the impaired brain.

Implicit, automatic semantic word categorisation in the left occipito-temporal cortex as revealed by fast periodic visual stimulation

Conceptual knowledge allows the categorisation of items according to their meaning beyond their physical similarities. This ability to respond to different stimuli (e.g., a leek, a cabbage, etc.) based on similar semantic representations (e.g., belonging to the vegetable category) is particularly important for language processing, because word meaning and the stimulus form are unrelated. The neural basis of this core human ability is debated and is complicated by the strong reliance of most neural measures on explicit tasks, involving many non-semantic processes. Here we establish an implicit method, i.e., fast periodic visual stimulation (FPVS) coupled with electroencephalography (EEG), to study neural conceptual categorisation processes with written word stimuli. Fourteen neurotypical participants were presented with different written words belonging to the same semantic category (e.g., different animals) alternating at 4 Hz rate. Words from a different semantic category (e.g., different cities) appeared every 4 stimuli (i.e., at 1 Hz). Following a few minutes of recording, objective electrophysiological responses at 1 Hz, highlighting the human brain’s ability to implicitly categorize stimuli belonging to distinct conceptual categories, were found over the left occipito-temporal region. Topographic differences were observed depending on whether the periodic change involved living items, associated with relatively more ventro-temporal activity as compared to non-living items associated with relatively more dorsal posterior activity. Overall, this study demonstrates the validity and high sensitivity of an implicit frequency-tagged marker of word-based semantic memory abilities.

Language networks in aphasia and health: A 1000 participant activation likelihood estimation meta-analysis

Aphasia recovery post-stroke is classically and most commonly hypothesised to rely on regions that were not involved in language premorbidly, through 'neurocomputational invasion' or engagement of 'quiescent homologues'. Contemporary accounts have suggested, instead, that recovery might be supported by under-utilised areas of the premorbid language network, which are downregulated in health to save neural resources ('variable neurodisplacement'). Despite the importance of understanding the neural bases of language recovery clinically and theoretically, there is no consensus as to which specific regions are more likely to be activated in post-stroke aphasia (PSA) than healthy individuals. Accordingly, we performed an Activation Likelihood Estimation (ALE) meta-analysis of language functional neuroimaging studies in PSA. We obtained coordinate-based functional neuroimaging data for 481 individuals with aphasia following left-hemisphere stroke and 530 linked controls from 33 studies that met predefined inclusion criteria. ALE identified regions of consistent, above-chance spatial convergence of activation, as well as regions of significantly different activation likelihood, between participant groups and language tasks. Overall, these findings dispute the prevailing theory that aphasia recovery involves recruitment of novel right hemisphere territory into the language network post-stroke. Instead, multiple regions throughout both hemispheres were consistently activated during language tasks in both PSA and controls. Regions of the right anterior insula, frontal operculum and inferior frontal gyrus (IFG) pars opercularis were more likely to be activated across all language tasks in PSA than controls. Similar regions were more likely to be activated during higher than lower demand comprehension or production tasks, consistent with them representing enhanced utilisation of spare capacity within right hemisphere executive-control related regions. This provides novel evidence that 'variable neurodisplacement' underlies language network changes that occur post-stroke. Conversely, multiple undamaged regions were less likely to be activated across all language tasks in PSA than controls, including domain-general regions of medial superior frontal and paracingulate cortex, right IFG pars triangularis and temporal pole. These changes might represent functional diaschisis, and demonstrate that there is not global, undifferentiated upregulation of all domain-general neural resources during language in PSA. Such knowledge is essential if we are to design neurobiologically-informed therapeutic interventions to facilitate language recovery.

Category-selective deficits are the exception and not the rule: Evidence from a case-series of 64 patients with ventral occipito-temporal cortex damage

The organisational principles of the visual ventral stream are still highly debated, particularly the relative association/dissociation between word and face recognition and the degree of lateralisation of the underlying processes. Reports of dissociations between word and face recognition stem from single case-studies of category selective impairments, and neuroimaging investigations of healthy participants. Despite the historical reliance on single case-studies, more recent group studies have highlighted a greater commonality between word and face recognition. Studying individual patients with rare selective deficits misses (a) important variability between patients, (b) systematic associations between task performance, and (c) patients with mild, severe and/or non-selective impairments; meaning that the full spectrum of deficits is unknown. The Back of the Brain project assessed the range and specificity of visual perceptual impairment in 64 patients with posterior cerebral artery stroke recruited based on lesion localization and not behavioural performance. Word, object, and face processing were measured with comparable tests across different levels of processing to investigate associations and dissociations across domains. We present two complementary analyses of the extensive behavioural battery: (1) a data-driven analysis of the whole patient group, and (2) a single-subject case-series analysis testing for deficits and dissociations in each individual patient. In both analyses, the general organisational principle was of associations between words, objects, and faces even following unilateral lesions. The majority of patients either showed deficits across all domains or in no domain, suggesting a spectrum of visuo-perceptual deficits post stroke. Dissociations were observed, but they were the exception and not the rule: Category-selective impairments were found in only a minority of patients, all of whom showed disproportionate deficits for words. Interestingly, such selective word impairments were found following both left and right hemisphere lesions. This large-scale investigation of posterior cerebral artery stroke patients highlights the bilateral representation of visual perceptual function.

Homotopic redistribution of functional connectivity in insula-centered diffuse low-grade glioma

OBJECTIVE

In the event of neural injury, the homologous contralateral brain areas may play a compensatory role to avoid or limit the functional loss. However, this dynamic strategy of functional redistribution is not clearly established, especially in the pathophysiological context of diffuse low-grade glioma. Our aim here was to assess the extent to which unilateral tumor infiltration of the insula dynamically modulates the functional connectivity of the contralesional one.

METHODS

Using resting-state functional connectivity MRI, a seed-to-ROI approach was employed in 52 insula-centered glioma patients (n = 30 left and 22 right) compared with 19 age-matched healthy controls.

RESULTS

Unsurprisingly, a significant decrease of the inter-insular connectivity was observed in both patient groups. More importantly, the analyses revealed a significant increase of the contralesional insular connectivity towards both cerebral hemispheres, especially in cortical areas forming the visual and the sensorimotor networks. This functional redistribution was not identified when the analyses were performed on three control regions for which the homologous area was not impaired by the tumor. This overall pattern of results indicates that massive infiltration of the insular cortex causes a significant redeployment of the contralesional functional connectivity.

CONCLUSION

This general finding suggests that the undamaged insula plays a role in the functional compensation usually observed in this patient population, and thus provides compelling support for the concept of homotopic functional plasticity in brain-damaged patients.

Intrinsic connectivity of anterior temporal lobe relates to individual differences in semantic retrieval for landmarks

Contemporary neuroscientific accounts suggest that ventral anterior temporal lobe (ATL) acts as a bilateral heteromodal semantic hub, which is particularly critical for the specific-level knowledge needed to recognise unique entities, such as familiar landmarks and faces. There may also be graded functional differences between left and right ATL, relating to effects of modality (linguistic versus non-linguistic) and category (e.g., knowledge of people and places). Individual differences in intrinsic connectivity from left and right ATL might be associated with variation in semantic categorisation performance across these categories and modalities. We recorded resting-state fMRI in 74 individuals and, in a separate session, examined semantic categorisation. People with greater connectivity between left and right ATL were more efficient at categorising landmarks (e.g., Eiffel Tower), especially when these were presented visually. In addition, participants who showed stronger connectivity from right than left ATL to medial occipital cortex showed more efficient semantic categorisation of landmarks regardless of modality of presentation. These results can be interpreted in terms of graded differences in the patterns of connectivity across left and right ATL, which give rise to a bilateral yet partially segregated semantic 'hub'. More specifically, right ATL connectivity supports the efficient semantic categorisation of landmarks.

Regional and hemispheric susceptibility of the temporal lobe to FTLD-TDP type C pathology

Post-mortem studies show that focal anterior temporal lobe (ATL) neurodegeneration is most often caused by frontotemporal lobar degeneration TDP-43 type C pathology. Clinically, these patients are described with different terms, such as semantic variant primary progressive aphasia (svPPA), semantic dementia (SD), or right temporal variant frontotemporal dementia (FTD) depending on whether the predominant symptoms affect language, semantic knowledge for object or people, or socio-emotional behaviors. ATL atrophy presents with various degrees of lateralization, with right-sided cases considered rarer even though estimation of their prevalence is hampered by the paucity of studies on well-characterized, pathology-proven cohorts. Moreover, it is not clear whether left and right variants show a similar distribution of atrophy within the ATL cross-sectionally and longitudinally. Here we study the largest cohort to-date of pathology-proven TDP-43-C cases diagnosed during life as svPPA, SD or right temporal variant FTD. We analyzed clinical, cognitive, and neuroimaging data from 30 cases, a subset of which was followed longitudinally. Guided by recent structural and functional parcellation studies, we constructed four bilateral ATL regions of interest (ROIs). The computation of an atrophy lateralization index allowed the comparison of atrophy patterns between the two hemispheres. This led to an automatic, imaging-based classification of the cases as left-predominant or right-predominant. We then compared the two groups in terms of regional atrophy patterns within the ATL ROIs (cross-sectionally) and atrophy progression (longitudinally). Results showed that 40% of pathology proven cases of TDP-43-C diagnosed with a temporal variant presented with right-lateralized atrophy. Moreover, the findings of our ATL ROI analysis indicated that, irrespective of atrophy lateralization, atrophy distribution within both ATLs follows a medial-to-lateral gradient. Finally, in both left and right cases, atrophy appeared to progress to the contralateral ATL, and from the anterior temporal pole to posterior temporal and orbitofrontal regions. Taken together, our findings indicate that incipient right predominant ATL atrophy is common in TDP-43-C pathology, and that distribution of damage within the ATLs appears to be the same in left- and right- sided variants. Thus, regardless of differences in clinical phenotype and atrophy lateralization, both temporal variants of FTD should be viewed as a spectrum presentation of the same disease.

Impaired naming performance in temporal lobe epilepsy: language fMRI responses are modulated by disease characteristics

OBJECTIVE

To investigate alterations of language networks and their relation to impaired naming performance in temporal lobe epilepsy (TLE) using functional MRI.

METHODS

Seventy-two adult TLE patients (41 left) and 36 controls were studied with overt auditory and picture naming fMRI tasks to assess temporal lobe language areas, and a covert verbal fluency task to probe frontal lobe language regions. Correlation of fMRI activation with clinical naming scores, and alteration of language network patterns in relation to epilepsy duration, age at onset and seizure frequency, were investigated with whole-brain multiple regression analyses.

RESULTS

Auditory and picture naming fMRI activated the left posterior temporal lobe, and stronger activation correlated with better clinical naming scores. Verbal fluency MRI mainly activated frontal lobe regions. In left and right TLE, a later age of epilepsy onset related to stronger temporal lobe activations, while earlier age of onset was associated with impaired deactivation of extratemporal regions. In left TLE patients, longer disease duration and higher seizure frequency were associated with reduced deactivation. Frontal lobe language networks were unaffected by disease characteristics.

CONCLUSIONS

While frontal lobe language regions appear spared, temporal lobe language areas are susceptible to dysfunction and reorganisation, particularly in left TLE. Early onset and long duration of epilepsy, and high seizure frequency, were associated with compromised activation and deactivation patterns of task-associated regions, which might account for impaired naming performance in individuals with TLE.

"Looks familiar, but I do not know who she is": The role of the anterior right temporal lobe in famous face recognition

Processing a famous face involves a cascade of steps including detecting the presence of a face, recognizing it as familiar, accessing semantic/biographical information about the person, and finally, if required, production of the proper name. Decades of neuropsychological and neuroimaging studies have identified a network of occipital and temporal brain regions ostensibly comprising the 'core' system for face processing. Recent research has also begun to elucidate upon an 'extended' network, including anterior temporal and frontal regions. However, there is disagreement about which brain areas are involved in each step, as many aspects of face processing occur automatically in healthy individuals and rarely dissociate in patients. Moreover, some common phenomena are not easily induced in an experimental setting, such as having a sense of familiarity without being able to recall who the person is. Patients with the semantic variant of Primary Progressive Aphasia (svPPA) often recognize a famous face as familiar, even when they cannot specifically recall the proper name or biographical details. In this study, we analyzed data from a large sample of 105 patients with neurodegenerative disorders, including 43 svPPA, to identify the neuroanatomical substrates of three different steps of famous face processing. Using voxel-based morphometry, we correlated whole-brain grey matter volumes with scores on three experimental tasks that targeted familiarity judgment, semantic/biographical information retrieval, and naming. Performance in naming and semantic association significantly correlates with grey matter volume in the left anterior temporal lobe, whereas familiarity judgment with integrity of the right anterior middle temporal gyrus. These findings shed light on the neuroanatomical substrates of key components of overt face processing, addressing issues of functional lateralization, and deepening our understanding of neural substrates of semantic knowledge.