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Stockbridge MD, Keser Z, Bonilha L, Hillis AE. Microstructural properties in subacute aphasia: concurrent and prospective relationships underpinning recovery. Brain Struct Funct 2024:10.1007/s00429-024-02826-z. [PMID: 38969934 DOI: 10.1007/s00429-024-02826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Few investigations examined the relationship between microstructural white matter integrity and subacute post-stroke linguistic performance or the relationship between microstructural integrity and the recovery of language function. We examined two key questions: (1) How does subacute language performance, measured in single words and discourse, relate to the microstructural integrity of key white matter regions of interest in the language network? and (2) Does the integrity of these regions before treatment predict the improvement or resolution of linguistic symptoms immediately and chronically following treatment? METHODS 58 participants within the first three months of stroke were enrolled in a randomized, single-center, double-blind, sham-controlled, study of anodal transcranial direct current stimulation combined with a computer-delivered speech and language naming therapy for subacute aphasia and were asked to complete magnetic resonance imaging at enrollment. Microstructural integrity was evaluated using diffusion tensor imaging processed with atlas-based segmentation. Regression and correlation analyses were conducted. RESULTS A subset of 22 participants received diffusion tensor imaging. Picture naming accuracy significantly correlated with lower mean diffusivity (higher microstructural integrity) in the left posterior inferior temporal gyrus. Recovery of naming performance was predicted by days since stroke and baseline microstructural integrity of the left posterior middle temporal gyrus, arcuate fasciculus, and superior longitudinal fasciculus. Recovery of discourse efficiency was significantly predicted by the same model. CONCLUSIONS This study demonstrates an association between picture naming and discourse and microstructural integrity of the key regions in the language network for patients with subacute post-stroke aphasia. Baseline microstructural integrity significantly predicts language recovery.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street Phipps 4, Suite 446, Baltimore, MD, 21287, USA.
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street Phipps 4, Suite 446, Baltimore, MD, 21287, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Leonardo Bonilha
- Department of Neurology, University of South Carolina School of Medicine Columbia, Columbia, SC, 29209, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street Phipps 4, Suite 446, Baltimore, MD, 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, 21218, USA
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2
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Ross ED. Affective Prosody and Its Impact on the Neurology of Language, Depression, Memory and Emotions. Brain Sci 2023; 13:1572. [PMID: 38002532 PMCID: PMC10669595 DOI: 10.3390/brainsci13111572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Based on the seminal publications of Paul Broca and Carl Wernicke who established that aphasic syndromes (disorders of the verbal-linguistic aspects of communication) were predominantly the result of focal left-hemisphere lesions, "language" is traditionally viewed as a lateralized function of the left hemisphere. This, in turn, has diminished and delayed the acceptance that the right hemisphere also has a vital role in language, specifically in modulating affective prosody, which is essential for communication competency and psychosocial well-being. Focal lesions of the right hemisphere may result in disorders of affective prosody (aprosodic syndromes) that are functionally and anatomically analogous to the aphasic syndromes that occur following focal left-hemisphere lesions. This paper will review the deductive research published over the last four decades that has elucidated the neurology of affective prosody which, in turn, has led to a more complete and nuanced understanding of the neurology of language, depression, emotions and memory. In addition, the paper will also present the serendipitous clinical observations (inductive research) and fortuitous inter-disciplinary collaborations that were crucial in guiding and developing the deductive research processes that culminated in the concept that primary emotions and related display behaviors are a lateralized function of the right hemisphere and social emotions, and related display behaviors are a lateralized function of the left hemisphere.
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Affiliation(s)
- Elliott D. Ross
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA; or
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA
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3
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Ivanova MV, Pappas I, Inglis B, Pracar AL, Herron TJ, Baldo JV, Kayser AS, D’Esposito M, Dronkers NF. Cerebral perfusion in post-stroke aphasia and its relationship to residual language abilities. Brain Commun 2023; 6:fcad252. [PMID: 38162898 PMCID: PMC10757451 DOI: 10.1093/braincomms/fcad252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/26/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024] Open
Abstract
Stroke alters blood flow to the brain resulting in damaged tissue and cell death. Moreover, the disruption of cerebral blood flow (perfusion) can be observed in areas surrounding and distal to the lesion. These structurally preserved but suboptimally perfused regions may also affect recovery. Thus, to better understand aphasia recovery, the relationship between cerebral perfusion and language needs to be systematically examined. In the current study, we aimed to evaluate (i) how stroke affects perfusion outside of lesioned areas in chronic aphasia and (ii) how perfusion in specific cortical areas and perilesional tissue relates to language outcomes in aphasia. We analysed perfusion data from a large sample of participants with chronic aphasia due to left hemisphere stroke (n = 43) and age-matched healthy controls (n = 25). We used anatomically defined regions of interest that covered the frontal, parietal, and temporal areas of the perisylvian cortex in both hemispheres, areas typically known to support language, along with several control regions not implicated in language processing. For the aphasia group, we also looked at three regions of interest in the perilesional tissue. We compared perfusion levels between the two groups and investigated the relationship between perfusion levels and language subtest scores while controlling for demographic and lesion variables. First, we observed that perfusion levels outside the lesioned areas were significantly reduced in frontal and parietal regions in the left hemisphere in people with aphasia compared to the control group, while no differences were observed for the right hemisphere regions. Second, we found that perfusion in the left temporal lobe (and most strongly in the posterior part of both superior and middle temporal gyri) and inferior parietal areas (supramarginal gyrus) was significantly related to residual expressive and receptive language abilities. In contrast, perfusion in the frontal regions did not show such a relationship; no relationship with language was also observed for perfusion levels in control areas and all right hemisphere regions. Third, perilesional perfusion was only marginally related to language production abilities. Cumulatively, the current findings demonstrate that blood flow is reduced beyond the lesion site in chronic aphasia and that hypoperfused neural tissue in critical temporoparietal language areas has a negative impact on behavioural outcomes. These results, using perfusion imaging, underscore the critical and general role that left hemisphere posterior temporal regions play in various expressive and receptive language abilities. Overall, the study highlights the importance of exploring perfusion measures in stroke.
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Affiliation(s)
- Maria V Ivanova
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Ioannis Pappas
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA 90033, USA
| | - Ben Inglis
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, CA 94720, USA
| | - Alexis L Pracar
- Department of Psychology, University of California, Berkeley, CA 94720, USA
| | - Timothy J Herron
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Juliana V Baldo
- Research Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Andrew S Kayser
- Division of Neurology, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mark D’Esposito
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Neurology Service, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Depertment of Neurology, University of California, Davis, CA 95817, USA
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Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI. J Clin Med 2023; 12:jcm12041554. [PMID: 36836089 PMCID: PMC9962403 DOI: 10.3390/jcm12041554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Perfusion imaging is preferred for identifying hypoperfusion in the management of acute ischemic stroke, but it is not always feasible/available. An alternative method for quantifying hypoperfusion, using FLAIR-hyperintense vessels (FHVs) in various vascular regions, has been proposed, with evidence of a statistical relationship with perfusion-weighted imaging (PWI) deficits and behavior. However, additional validation is needed to confirm that areas of suspected hypoperfusion (per the location of FHVs) correspond to the location of perfusion deficits in PWI. We examined the association between the location of FHVs and perfusion deficits in PWI in 101 individuals with acute ischemic stroke, prior to the receipt of reperfusion therapies. FHVs and PWI lesions were scored as present/absent in six vascular regions (i.e., the ACA, PCA, and (four sub-regions of) the MCA territories). Chi-square analyses showed a significant relationship between the two imaging techniques for five vascular regions (the relationship in the ACA territory was underpowered). These results suggest that for most areas of the brain, the general location of FHVs corresponds to hypoperfusion in those same vascular territories in PWI. In conjunction with prior work, results support the use of estimating the amount and location of hypoperfusion using FLAIR imaging when perfusion imaging is not available.
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5
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Moro V, Pacella V, Scandola M, Besharati S, Rossato E, Jenkinson P, Fotopoulou A. A fronto-insular-parietal network for the sense of body ownership. Cereb Cortex 2023; 33:512-522. [PMID: 35235644 PMCID: PMC7614133 DOI: 10.1093/cercor/bhac081] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
Neuropsychological disturbances in the sense of limb ownership provide unique opportunities to study the neurocognitive basis of body ownership. Previous small sample studies that showed discrete cortical lesions cannot explain why multisensory, affective, and cognitive manipulations alter disownership symptoms. We tested the novel hypothesis that disturbances in the sense of limb ownership would be associated not only with discrete cortical lesions but also with disconnections of white-matter tracts supporting specific functional networks. We drew on an advanced lesion-analysis and Bayesian statistics approach in 49 right-hemisphere patients (23 with and 26 without limb disownership). Our results reveal that disturbances in the sense of ownership are associated with lesions in the supramarginal gyrus and disconnections of a fronto-insular-parietal network, involving the frontal-insular and frontal inferior longitudinal tracts, confirming previous disconnection hypotheses. Together with previous behavioral and neuroanatomical results, these findings lead us to propose that the sense of body ownership involves the convergence of bottom-up, multisensory integration, and top-down monitoring of sensory salience based on contextual demands.
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Affiliation(s)
- V. Moro
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, 37129 Verona, Italy
| | - V. Pacella
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, 37129 Verona, Italy,Groupe d’Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, CS F-33076 Bordeaux
| | - M. Scandola
- NPSY-Lab.VR, Department of Human Sciences, University of Verona, 37129 Verona, Italy
| | - S. Besharati
- Department of Psychology, School of Human and Community Development, University of Witwatersrand, 2000 Johannesburg, South Africa,CIFAR Azrieli Global Scholars program, CIFAR, Toronto, ON M5G 1M1 Canada
| | - E. Rossato
- Department of Rehabilitation, IRCSS Sacro Cuore Don Calabria, 37024, Negrar, Verona, Italy
| | - P.M. Jenkinson
- Institute for Social Neuroscience, Ivanhoe, Melbourne, Victoria. Australia
| | - A Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College of London, London WC1E 6BT, UK
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6
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Sharif MS, Goldberg EB, Walker A, Hillis AE, Meier EL. The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke. PLoS One 2022; 17:e0275664. [PMID: 36288353 PMCID: PMC9604977 DOI: 10.1371/journal.pone.0275664] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.
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Affiliation(s)
- Massoud S. Sharif
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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7
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Vitti E, Kim G, Stockbridge MD, Hillis AE, Faria AV. Left Hemisphere Bias of NIH Stroke Scale Is Most Severe for Middle Cerebral Artery Strokes. Front Neurol 2022; 13:912782. [PMID: 35775058 PMCID: PMC9237381 DOI: 10.3389/fneur.2022.912782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
NIHSS score is higher for left vs. right hemisphere strokes of equal volumes. However, differences in each vascular territory have not been evaluated yet. We hypothesized that left vs. right differences are driven by the middle cerebral artery (MCA) territory, and there is no difference between hemispheres for other vascular territories. This study is based on data from 802 patients with evidence of acute ischemic stroke in one major arterial territory (MCA, n = 437; PCA, n = 209; ACA, n = 21; vertebrobasilar, n = 46). We examined differences in patients with left or right strokes regarding to lesion volume, NIHSS, and other covariates (age, sex, race). We used linear models to test the effects of these covariates on NIHSS. We looked at the whole sample as well as in the sample stratified by NIHSS (≤5 or >5) and by lesion location (MCA or PCA). Patients with left MCA strokes had significantly higher NIHSS than those with right strokes. Only patients with MCA strokes showed NIHSS score affected by the hemisphere when controlling for stroke volume and patient's age. This difference was driven by the more severe strokes (NIHSS>5). It is important to consider this systematic bias in the NIHSS when using the score for inclusion criteria for treatment or trials. Patients with right MCA stroke may be under-treated and left with disabling deficits that are not captured by the NIHSS.
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Affiliation(s)
- Emilia Vitti
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Ganghyun Kim
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Melissa D. Stockbridge
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Physical Medicine, Rehabilitation, and Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Andreia V. Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Andreia V. Faria
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8
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Abstract
Personal neglect is a disorder in the perception and representation of the body that causes the patients to behave as if the contralesional side of their body does not exist. This clinical condition has not been adequately investigated in the past as it has been considered a symptom of unilateral spatial neglect, which has mainly been studied with reference to extrapersonal space. Only a few studies with small samples have investigated the neuroanatomical correlates of personal neglect, and these have mainly focused on discrete cortical lesions and modular accounts, as well as being based on the hypothesis that this disorder is associated with somatosensory and spatial deficits. In the present study, we tested the novel hypothesis that personal neglect may be associated not only with discrete cortical and subcortical lesions, but also with disconnections of white matter tracts. We performed an advanced lesion analyses in a large sample of 104 right hemisphere damaged patients, 72 of whom were suffering from personal neglect. Results from the analyses of the grey and white matter were controlled for co-occurrent clinical variables such as extrapersonal neglect, anosognosia for hemiplegia and motor deficits, along with other lesion-related variables such as lesion size and the interval from the lesion onset to neuroimaging recordings. Our results reveal that personal neglect is associated with lesions in a medial network which involves the temporal cortex (Heschl's gyrus), the ventro-lateral nuclei of the thalamus and the fornix. This suggests that personal neglect involves a convergence between sensorimotor processes, spatial representation and the processing of self-referred information (episodic memory).
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9
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Bunker LD, Walker A, Meier E, Goldberg E, Leigh R, Hillis AE. Hyperintense vessels on imaging account for neurological function independent of lesion volume in acute ischemic stroke. Neuroimage Clin 2022; 34:102991. [PMID: 35339984 PMCID: PMC8957047 DOI: 10.1016/j.nicl.2022.102991] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Studies have revealed variable significance of FLAIR hyperintense vessels (FHV). We found number and location of FHV are associated with functional deficits. Functional measures correlated with FHV independently of lesion volume.
In acute ischemic stroke, reported relationships between lesion metrics and behavior have largely focused on lesion volume and location. However, hypoperfusion has been shown to correlate with deficits in the acute stage. Hypoperfusion is typically identified using perfusion imaging in clinical settings, which requires contrast. Unfortunately, contrast is contraindicated for some individuals. An alternative method has been proposed to identify hypoperfusion using hyperintense vessels on fluid-attenuated inversion recovery (FLAIR) imaging. This study aimed to validate the clinical importance of considering hypoperfusion when accounting for behavior in acute stroke and demonstrate the clinical utility of scoring the presence of hyperintense vessels to quantify it. One hundred and fifty-three participants with acute ischemic stroke completed a battery of commonly-used neurological and behavioral measures. Clinical MRIs were used to determine lesion volume and to score the presence of hyperintense vessels seen on FLAIR images to estimate severity of hypoperfusion in six different vascular regions. National Institutes of Health Stroke Scale (NIHSS) scores, naming accuracy (left hemisphere strokes), and language content produced during picture description were examined in relation to lesion volume, hypoperfusion, and demographic variables using correlational analyses and multivariable linear regression. Results showed that lesion volume and hypoperfusion, in addition to demographic variables, were independently associated with performance on NIHSS, naming, and content production. Specifically, hypoperfusion in the frontal lobe independently correlated with NIHSS scores, while hypoperfusion in parietal areas independently correlated with naming accuracy and content production. These results correspond to previous reports associating hypoperfusion with function, confirming that hypoperfusion is an important consideration—beyond lesion volume—when accounting for behavior in acute ischemic stroke. Quantifying hypoperfusion using FLAIR hyperintense vessels can be an essential clinical tool when other methods of identifying hypoperfusion are unavailable or time prohibitive.
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Affiliation(s)
- Lisa D Bunker
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Alexandra Walker
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Erin Meier
- Northeastern University Bouvé College of Health Sciences, Department of Communication Sciences and Disorders, Boston, MA 02115, USA
| | - Emily Goldberg
- University of Pittsburgh, Department of Communication Science and Disorders, Pittsburgh, PA 15260, USA
| | - Richard Leigh
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Johns Hopkins University School of Medicine, Department of Neurology and Neuroscience, Baltimore, MD 21287, USA. https://twitter.com/@HopkinsSKSI
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Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review. Neural Plast 2022; 2022:5635596. [PMID: 35494482 PMCID: PMC9050322 DOI: 10.1155/2022/5635596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.
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Stein C, Bunker L, Chu B, Leigh R, Faria A, Hillis AE. Various tests of left neglect are associated with distinct territories of hypoperfusion in acute stroke. Brain Commun 2022; 4:fcac064. [PMID: 35386220 PMCID: PMC8977645 DOI: 10.1093/braincomms/fcac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/18/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Hemispatial neglect is among the most disabling consequences of right hemisphere stroke. However, there is no consensus on the optimal assessments to identify neglect. We hypothesized that different tests for neglect given the same day (i) detect distinct aspects and types of neglect, (ii) are sensitive to different cognitive functions (beyond spatially specific processing) and (iii) are associated with distinct regions of hypoperfusion. We examined data from 135 participants with acute, right-hemispheric ischaemic stroke who received an MRI and neglect testing within 48 h of acute infarct in a cross-sectional study. The volume of infarct was calculated on diffusion-weighted imaging. We also scored severity and location of fluid-attenuated inversion recovery hyperintense vessels in six areas (anterior cerebral artery territory, posterior cerebral artery territory and four within the middle cerebral artery territory) to estimate the volume and location of hypoperfusion in acute stroke. Neglect tests included gap detection, scene copy, line bisection, line cancellation, oral reading and picture description. We found strong correlations between tests that evaluated viewer-centred processing, as well as strong correlations between tests that evaluated stimulus-centred processing. The error rate on different tests was associated with hypoperfusion in different vascular territories, even after controlling for the volume of an infarct. Our results confirm that it is essential to administer a battery of different tests of hemispatial neglect to capture various deficits in attention and spatially specific processing that underlies neglect. Our results also show the potential usefulness of hyperintense vessel ratings as an indication of dysfunction beyond the infarct, as the ratings (and not infarct volume) were highly associated with many clinical deficits. Finally, results underscore that diverse types of neglect are clinically important in acute stroke, as they reflect different areas of hypoperfused tissue, which may be salvageable in the absence of infarct in those areas. As such, neglect batteries may be useful for detecting patients with cortical hypoperfusion who are candidates for reperfusion therapies.
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Affiliation(s)
- Colin Stein
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Bunker
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Chu
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard Leigh
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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12
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Sharma VK, Wong LK. Middle Cerebral Artery Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Williams NL, Suarez A, Negoita S, Hillis AE, Gottesman RF, Johansen MC. Cardiac Structure and Function Is Associated With Hemispatial Neglect Severity. Front Neurol 2021; 12:666257. [PMID: 34025570 PMCID: PMC8134693 DOI: 10.3389/fneur.2021.666257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Hemispatial neglect is a debilitating consequence of right hemispheric ischemic stroke (RIS), with evidence that patient-level factors influence neglect severity. Study objective: Determine if cardiac function is associated with presence and severity of neglect, independent of infarct size. Methods: Two hundred and eighteen non-demented, RIS with cerebral MRI and echocardiography who completed ≥1 of 4 tests evaluating neglect were included. Age- and sex- adjusted Z-scores defined neglect with severity categorized as no neglect, neglect on one or neglect on ≥2 tests. The dependent variable was presence of neglect (multivariable logistic regression), or neglect severity (multinomial logistic regression). The association with left ventricular (LV) structure/function (independent variable) was evaluated using separate nested adjustment models. Results: Patients were on average 61 yo (21–95), female (50%), black (53%), with an ejection fraction of 60% (IQR 20–75%). Fifty eight (27%) had neglect. Each 1 cm increase in LV systolic diameter was associated with a higher relative risk of having neglect on two tests compared to those with no neglect (RRR = 1.83, 95% CI 1.01–3.32), but not after adjusting for education and DWI volume (RRR = 1.68, 95% CI 0.89–3.19). Per 1 cm increase in left atrial (LA) diameter, the relative risk of having neglect on 2 tests vs. no neglect was over two times higher (95% CI 1.04–4.77), but lost significance in the final model (RRR = 1.73, 95% CI 0.76–3.94). Conclusions: We found an association between markers of diastolic dysfunction (enlarging LV, compensatory enlarging LA) and severity of neglect, suggesting that cardiac structure, and function affects not only lesion volume, but also the functional consequences of infarct volume.
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Affiliation(s)
- Nicole L Williams
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adrian Suarez
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Serban Negoita
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michelle C Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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Sheppard SM, Meier EL, Zezinka Durfee A, Walker A, Shea J, Hillis AE. Characterizing subtypes and neural correlates of receptive aprosodia in acute right hemisphere stroke. Cortex 2021; 141:36-54. [PMID: 34029857 DOI: 10.1016/j.cortex.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Speakers naturally produce prosodic variations depending on their emotional state. Receptive prosody has several processing stages. We aimed to conduct lesion-symptom mapping to determine whether damage (core infarct or hypoperfusion) to specific brain areas was associated with receptive aprosodia or with impairment at different processing stages in individuals with acute right hemisphere stroke. We also aimed to determine whether different subtypes of receptive aprosodia exist that are characterized by distinctive behavioral performance patterns. METHODS Twenty patients with receptive aprosodia following right hemisphere ischemic stroke were enrolled within five days of stroke; clinical imaging was acquired. Participants completed tests of receptive emotional prosody, and tests of each stage of prosodic processing (Stage 1: acoustic analysis; Stage 2: analyzing abstract representations of acoustic characteristics that convey emotion; Stage 3: semantic processing). Emotional facial recognition was also assessed. LASSO regression was used to identify predictors of performance on each behavioral task. Predictors entered into each model included 14 right hemisphere regions, hypoperfusion in four vascular territories as measured using FLAIR hyperintense vessel ratings, lesion volume, age, and education. A k-medoid cluster analysis was used to identify different subtypes of receptive aprosodia based on performance on the behavioral tasks. RESULTS Impaired receptive emotional prosody and impaired emotional facial expression recognition were both predicted by greater percent damage to the caudate. The k-medoid cluster analysis identified three different subtypes of aprosodia. One group was primarily impaired on Stage 1 processing and primarily had frontotemporal lesions. The second group had a domain-general emotion recognition impairment and maximal lesion overlap in subcortical areas. Finally, the third group was characterized by a Stage 2 processing deficit and had lesion overlap in posterior regions. CONCLUSIONS Subcortical structures, particularly the caudate, play an important role in emotional prosody comprehension. Receptive aprosodia can result from impairments at different processing stages.
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Affiliation(s)
- Shannon M Sheppard
- Department of Communication Sciences & Disorders, Chapman University, Irvine, CA, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Erin L Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Alex Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Shea
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
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15
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Alves PN, Fonseca AC, Silva DP, Andrade MR, Pinho-E-Melo T, Thiebaut de Schotten M, Martins IP. Unravelling the Neural Basis of Spatial Delusions After Stroke. Ann Neurol 2021; 89:1181-1194. [PMID: 33811370 DOI: 10.1002/ana.26079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Knowing explicitly where we are is an interpretation of our spatial representations. Reduplicative paramnesia is a disrupting syndrome in which patients present a firm belief of spatial mislocation. Here, we studied the largest sample of patients with delusional misidentifications of space (ie, reduplicative paramnesia) after stroke to shed light on their neurobiology. METHODS In a prospective, cumulative, case-control study, we screened 400 patients with acute right-hemispheric stroke. We included 64 cases and 233 controls. First, lesions were delimited and normalized. Then, we computed structural and functional disconnection maps using methods of lesion-track and network-mapping. The maps were compared, controlling for confounders. Second, we built a multivariate logistic model, including clinical, behavioral, and neuroimaging data. Finally, we performed a nested cross-validation of the model with a support-vector machine analysis. RESULTS The most frequent misidentification subtype was confabulatory mislocation (56%), followed by place reduplication (19%), and chimeric assimilation (13%). Our results indicate that structural disconnection is the strongest predictor of the syndrome and included 2 distinct streams, connecting right fronto-thalamic and right occipitotemporal structures. In the multivariate model, the independent predictors of reduplicative paramnesia were the structural disconnection map, lesion sparing of right dorsal fronto-parietal regions, age, and anosognosia. Good discrimination accuracy was demonstrated (area under the curve = 0.80 [0.75-0.85]). INTERPRETATION Our results localize the anatomic circuits that may have a role in the abnormal spatial-emotional binding and in the defective updating of spatial representations underlying reduplicative paramnesia. This novel data may contribute to better understand the pathophysiology of delusional syndromes after stroke. ANN NEUROL 2021;89:1181-1194.
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Affiliation(s)
- Pedro N Alves
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Ana C Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela P Silva
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Matilde R Andrade
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, University of London, London, UK
| | - Teresa Pinho-E-Melo
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France.,Groupe d'Imagerie Neurofonctionnelle, CEA, Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Isabel P Martins
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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16
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Stockert A, Wawrzyniak M, Klingbeil J, Wrede K, Kümmerer D, Hartwigsen G, Kaller CP, Weiller C, Saur D. Dynamics of language reorganization after left temporo-parietal and frontal stroke. Brain 2020; 143:844-861. [PMID: 32068789 DOI: 10.1093/brain/awaa023] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
The loss and recovery of language functions are still incompletely understood. This longitudinal functional MRI study investigated the neural mechanisms underlying language recovery in patients with post-stroke aphasia putting particular emphasis on the impact of lesion site. To identify patterns of language-related activation, an auditory functional MRI sentence comprehension paradigm was administered to patients with circumscribed lesions of either left frontal (n = 17) or temporo-parietal (n = 17) cortex. Patients were examined repeatedly during the acute (≤1 week, t1), subacute (1-2 weeks, t2) and chronic phase (>6 months, t3) post-stroke; healthy age-matched control subjects (n = 17) were tested once. The separation into two patient groups with circumscribed lesions allowed for a direct comparison of the contributions of distinct lesion-dependent network components to language reorganization between both groups. We hypothesized that activation of left hemisphere spared and perilesional cortex as well as lesion-homologue cortex in the right hemisphere varies between patient groups and across time. In addition, we expected that domain-general networks serving cognitive control independently contribute to language recovery. First, we found a global network disturbance in the acute phase that is characterized by reduced functional MRI language activation including areas distant to the lesion (i.e. diaschisis) and subsequent subacute network reactivation (i.e. resolution of diaschisis). These phenomena were driven by temporo-parietal lesions. Second, we identified a lesion-independent sequential activation pattern with increased activity of perilesional cortex and bilateral domain-general networks in the subacute phase followed by reorganization of left temporal language areas in the chronic phase. Third, we observed involvement of lesion-homologue cortex only in patients with frontal but not temporo-parietal lesions. Fourth, irrespective of lesion location, language reorganization predominantly occurred in pre-existing networks showing comparable activation in healthy controls. Finally, we detected different relationships of performance and activation in language and domain-general networks demonstrating the functional relevance for language recovery. Our findings highlight that the dynamics of language reorganization clearly depend on lesion location and hence open new perspectives for neurobiologically motivated strategies of language rehabilitation, such as individually-tailored targeted application of neuro-stimulation.
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Affiliation(s)
- Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Katrin Wrede
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Dorothee Kümmerer
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group, Cognition and Plasticity, Max Planck Institute of Human and Cognitive Brain Sciences, 04103 Leipzig, Germany
| | - Christoph P Kaller
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
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17
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Hillis AE. In Memoriam: Robert J. Wityk. Stroke 2020; 51:1916-1917. [PMID: 32568645 DOI: 10.1161/strokeaha.120.030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Argye E Hillis
- Departments of Neurology and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine (A.E.H.).,Department of Cognitive Science, Johns Hopkins University (A.E.H.)
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18
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Pacella V, Foulon C, Jenkinson PM, Scandola M, Bertagnoli S, Avesani R, Fotopoulou A, Moro V, Thiebaut de Schotten M. Anosognosia for hemiplegia as a tripartite disconnection syndrome. eLife 2019; 8:e46075. [PMID: 31383259 PMCID: PMC6684265 DOI: 10.7554/elife.46075] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/20/2019] [Indexed: 11/26/2022] Open
Abstract
The syndrome of Anosognosia for Hemiplegia (AHP) can provide unique insights into the neurocognitive processes of motor awareness. Yet, prior studies have only explored predominately discreet lesions. Using advanced structural neuroimaging methods in 174 patients with a right-hemisphere stroke, we were able to identify three neural systems that contribute to AHP, when disconnected or directly damaged: the (i) premotor loop (ii) limbic system, and (iii) ventral attentional network. Our results suggest that human motor awareness is contingent on the joint contribution of these three systems.
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Affiliation(s)
- Valentina Pacella
- Social and Cognitive Neuroscience Laboratory, Department of PsychologySapienza University of RomeRomeItaly
- NPSY.Lab-VR, Department of Human SciencesUniversity of VeronaVeronaItaly
| | - Chris Foulon
- Brain Connectivity and Behaviour LaboratorySorbonne UniversitiesParisFrance
- Frontlab, Institut du Cerveau et de la Moelle épinière (ICM)UPMC UMRS 1127, Inserm U 1127, CNRS UMR 7225ParisFrance
- Computational Neuroimaging Laboratory, Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinUnited States
| | - Paul M Jenkinson
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUnited Kingdom
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human SciencesUniversity of VeronaVeronaItaly
| | - Sara Bertagnoli
- NPSY.Lab-VR, Department of Human SciencesUniversity of VeronaVeronaItaly
| | - Renato Avesani
- Department of RehabilitationIRCSS Sacro Cuore-Don Calabria HospitalVeronaItaly
| | - Aikaterini Fotopoulou
- Clinical, Educational and Health Psychology, Division of Psychology and Language SciencesUniversity College LondonLondonUnited Kingdom
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human SciencesUniversity of VeronaVeronaItaly
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour LaboratorySorbonne UniversitiesParisFrance
- Frontlab, Institut du Cerveau et de la Moelle épinière (ICM)UPMC UMRS 1127, Inserm U 1127, CNRS UMR 7225ParisFrance
- Groupe d’Imagerie NeurofonctionnelleInstitut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of BordeauxBordeauxFrance
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19
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Roxbury T, McMahon K, Wong A, Farrell A, Burfein P, Taubert S, O'Brien K, Read S, Coulthard A, Copland D. Brain activity during spoken word recognition in subacute aphasia. BRAIN AND LANGUAGE 2019; 195:104630. [PMID: 31220584 DOI: 10.1016/j.bandl.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/01/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Tracy Roxbury
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Katie McMahon
- School of Clinical Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Herston Imaging Research Facility, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Andrew Wong
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Anna Farrell
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Penni Burfein
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Shana Taubert
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Kate O'Brien
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Stephen Read
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Alan Coulthard
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - David Copland
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.
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20
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Resting-state functional connectivity: An emerging method for the study of language networks in post-stroke aphasia. Brain Cogn 2019; 131:22-33. [DOI: 10.1016/j.bandc.2017.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/15/2022]
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21
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Abstract
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery. In this review, we discuss the recent evidence of the contribution of infarct location to patient management decisions and functional outcomes after acute ischemic stroke.
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Affiliation(s)
- Mark R Etherton
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia S Rost
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ona Wu
- 1 Harvard Medical School, Boston, MA, USA.,3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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22
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2018; 31:864-876. [PMID: 29233071 DOI: 10.1177/1545968317732680] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, France; AP-HP, Stroke Unit, Pitié-Salpêtrière Hospital, France
| | - Rebecca J Fisher
- 6 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 7 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 8 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 9 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 10 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 11 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 12 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 13 Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 14 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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23
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Forkel SJ, Catani M. Lesion mapping in acute stroke aphasia and its implications for recovery. Neuropsychologia 2018; 115:88-100. [PMID: 29605593 PMCID: PMC6018610 DOI: 10.1016/j.neuropsychologia.2018.03.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022]
Abstract
Patients with stroke offer a unique window into understanding human brain function. Mapping stroke lesions poses several challenges due to the complexity of the lesion anatomy and the mechanisms causing local and remote disruption on brain networks. In this prospective longitudinal study, we compare standard and advanced approaches to white matter lesion mapping applied to acute stroke patients with aphasia. Eighteen patients with acute left hemisphere stroke were recruited and scanned within two weeks from symptom onset. Aphasia assessment was performed at baseline and six-month follow-up. Structural and diffusion MRI contrasts indicated an area of maximum overlap in the anterior external/extreme capsule with diffusion images showing a larger overlap extending into posterior perisylvian regions. Anatomical predictors of recovery included damage to ipsilesional tracts (as shown by both structural and diffusion images) and contralesional tracts (as shown by diffusion images only). These findings indicate converging results from structural and diffusion lesion mapping methods but also clear differences between the two approaches in their ability to identify predictors of recovery outside the lesioned regions.
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Affiliation(s)
- Stephanie J Forkel
- Natbrainlab, King's College London, Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), De Crespigny Park, London SE5 8AF, United Kingdom; Natbrainlab, Department of Forensic and Neurodevelopmental Sciences and Sackler Institute of Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Marco Catani
- Natbrainlab, King's College London, Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), De Crespigny Park, London SE5 8AF, United Kingdom; Natbrainlab, Department of Forensic and Neurodevelopmental Sciences and Sackler Institute of Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London De Crespigny Park, London SE5 8AF, United Kingdom.
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24
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:480-493. [PMID: 28697711 DOI: 10.1177/1747493017714176] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rebecca J Fisher
- 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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Sebastian R, Breining BL. Contributions of Neuroimaging to Understanding Language Deficits in Acute Stroke. Semin Speech Lang 2018; 39:66-78. [PMID: 29359306 PMCID: PMC5840876 DOI: 10.1055/s-0037-1608854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in structural and functional imaging techniques have provided new insights into our understanding of brain and language relationships. In this article, we review the various structural and functional imaging methods currently used to study language deficits in acute stroke. We also discuss the advantages and the limitations of each imaging modality and the applications of each modality in the clinical and research settings in the study of language deficits.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Adapting the concepts of brain and cognitive reserve to post-stroke cognitive deficits: Implications for understanding neglect. Cortex 2017; 97:327-338. [DOI: 10.1016/j.cortex.2016.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/03/2016] [Accepted: 12/04/2016] [Indexed: 01/17/2023]
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Hillis AE, Rorden C, Fridriksson J. Brain regions essential for word comprehension: Drawing inferences from patients. Ann Neurol 2017; 81:759-768. [PMID: 28445916 DOI: 10.1002/ana.24941] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 04/22/2017] [Accepted: 04/22/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Argye E Hillis
- Departments of Neurology, Physical Medicine & Rehabilitation, and Cognitive Science, Johns Hopkins University, Baltimore, MD
| | | | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia, SC
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Faulkner J, Stoner L, Grigg R, Fryer S, Stone K, Lambrick D. Acute effects of exercise posture on executive function in transient ischemic attack patients. Psychophysiology 2017; 54:1239-1248. [DOI: 10.1111/psyp.12868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- James Faulkner
- Department of Sport and Exercise; University of Winchester; Winchester United Kingdom
| | - Lee Stoner
- School of Sport and Exercise; Massey University; Wellington New Zealand
- Department of Exercise and Sport Science; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Rebecca Grigg
- School of Sport and Exercise; Massey University; Wellington New Zealand
| | - Simon Fryer
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Keeron Stone
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Danielle Lambrick
- School of Health and Life Sciences; University of Southampton; Southampton United Kingdom
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Ni L, Li J, Li W, Zhou F, Wang F, Schwarz CG, Liu R, Zhao H, Wu W, Zhang X, Li M, Yu H, Zhu B, Villringer A, Zang Y, Zhang B, Lv Y, Xu Y. The value of resting-state functional MRI in subacute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced perfusion MRI. Sci Rep 2017; 7:41586. [PMID: 28139701 PMCID: PMC5282488 DOI: 10.1038/srep41586] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/21/2016] [Indexed: 11/09/2022] Open
Abstract
To evaluate the potential clinical value of the time-shift analysis (TSA) approach for resting-state fMRI (rs-fMRI) blood oxygenation level-dependent (BOLD) data in detecting hypoperfusion of subacute stroke patients through comparison with dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI). Forty patients with subacute stroke (3–14 days after neurological symptom onset) underwent MRI examination. Cohort A: 31 patients had MRA, DSC-PWI and BOLD data. Cohort B: 9 patients had BOLD and MRA data. The time delay between the BOLD time course in each voxel and the mean signal of global and contralateral hemisphere was calculated using TSA. Time to peak (TTP) was employed to detect hypoperfusion. Among cohort A, 14 patients who had intracranial large-vessel occlusion/stenosis with sparse collaterals showed hypoperfusion by both of the two approaches, one with abundant collaterals showed neither TTP nor TSA time delay. The remaining 16 patients without obvious MRA lesions showed neither TTP nor TSA time delay. Among cohort B, eight patients showed time delay areas. The TSA approach was a promising alternative to DSC-PWI for detecting hypoperfusion in subacute stroke patients who had obvious MRA lesions with sparse collaterals, those with abundant collaterals would keep intact local perfusion.
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Affiliation(s)
- Ling Ni
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Jingwei Li
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiping Li
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Fei Zhou
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing Medical University, Nanjing, China
| | - Fangfang Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | | | - Renyuan Liu
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Hui Zhao
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenbo Wu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Xin Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Ming Li
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Haiping Yu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Bin Zhu
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Yufeng Zang
- Center for Cognition and Brain Disorders, Affiliated Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, University of Nanjing, Nanjing, China
| | - Yating Lv
- Center for Cognition and Brain Disorders, Affiliated Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Yun Xu
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Let thy left brain know what thy right brain doeth: Inter-hemispheric compensation of functional deficits after brain damage. Neuropsychologia 2016; 93:407-412. [DOI: 10.1016/j.neuropsychologia.2016.06.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/06/2016] [Accepted: 06/12/2016] [Indexed: 12/18/2022]
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31
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Dunn LE, Schweber AB, Manson DK, Lendaris A, Herber C, Marshall RS, Lazar RM. Variability in Motor and Language Recovery during the Acute Stroke Period. Cerebrovasc Dis Extra 2016; 6:12-21. [PMID: 27099611 PMCID: PMC4836126 DOI: 10.1159/000444149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset. Methods Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period. Results Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains. Conclusions Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.
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Affiliation(s)
| | - Adam B Schweber
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Daniel K Manson
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Andrea Lendaris
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Charlotte Herber
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Randolph S Marshall
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Ronald M Lazar
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
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Abstract
The sequelae of post-stroke aphasia are considerable, with implications at the societal and personal levels. An understanding of the mechanisms of recovery of cognitive and language processes after stroke and the factors associated with increased risk of post-stroke language and cognitive deficits is vital in providing optimal care of individuals with aphasia and in counseling to their families and caregivers. Advances in neuroimaging facilitate the identification of dysfunctional or damaged brain tissue responsible for these cognitive/language deficits and contribute insights regarding the functional neuroanatomy of language. Evidence-based person-centered behavioral therapy remains the mainstay for rehabilitation of aphasia, although emerging evidence shows that neuromodulation is a promising adjunct to traditional therapy. These topics are discussed in this review, illustrating with recent studies from the Stroke Cognitive Outcomes and REcovery (SCORE) lab.
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Affiliation(s)
- Donna C. Tippett
- Department of Neurology, Department of Physical Medicine and Rehabilitation, and Department of Otolaryngology—Head and Neck Surgery Johns Hopkins University School of Medicine6th Floor, Johns Hopkins Outpatient Center, 601 North Caroline StreetBaltimoreMD21287-0910USA
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Lau JKL, Humphreys GW, Douis H, Balani A, Bickerton WL, Rotshtein P. The relation of object naming and other visual speech production tasks: a large scale voxel-based morphometric study. Neuroimage Clin 2015; 7:463-75. [PMID: 25685713 PMCID: PMC4325087 DOI: 10.1016/j.nicl.2015.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 01/09/2023]
Abstract
We report a lesion-symptom mapping analysis of visual speech production deficits in a large group (280) of stroke patients at the sub-acute stage (<120 days post-stroke). Performance on object naming was evaluated alongside three other tests of visual speech production, namely sentence production to a picture, sentence reading and nonword reading. A principal component analysis was performed on all these tests' scores and revealed a 'shared' component that loaded across all the visual speech production tasks and a 'unique' component that isolated object naming from the other three tasks. Regions for the shared component were observed in the left fronto-temporal cortices, fusiform gyrus and bilateral visual cortices. Lesions in these regions linked to both poor object naming and impairment in general visual-speech production. On the other hand, the unique naming component was potentially associated with the bilateral anterior temporal poles, hippocampus and cerebellar areas. This is in line with the models proposing that object naming relies on a left-lateralised language dominant system that interacts with a bilateral anterior temporal network. Neuropsychological deficits in object naming can reflect both the increased demands specific to the task and the more general difficulties in language processing.
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Affiliation(s)
| | - Glyn W. Humphreys
- School of Psychology, University of Birmingham, Birmingham, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hassan Douis
- School of Psychology, University of Birmingham, Birmingham, UK
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Alex Balani
- School of Psychology, University of Birmingham, Birmingham, UK
- Department of Psychology, Edge Hill University, Lancashire, UK
| | | | - Pia Rotshtein
- School of Psychology, University of Birmingham, Birmingham, UK
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35
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Yan Y, Yuan Y, Liang L, Chen T, Shen Y, Zhong C. Influence of carotid artery stenting on cognition of elderly patients with severe stenosis of the internal carotid artery. Med Sci Monit 2014; 20:1461-8. [PMID: 25129549 PMCID: PMC4144945 DOI: 10.12659/msm.890847] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the influence of carotid artery stenting (CAS) on the cognition and quality of life of elderly patients with severe stenosis of the internal carotid artery. Material/Methods 65 elderly patients with symptomatic severe stenosis of internal carotid artery were recruited into 2 groups: the pharmacotherapy group (n=29) and the CAS group (n=36). Before surgery and 1, 3, 6, and 12 months after surgery, Montreal cognitive assessment (MoCA) was used for the evaluation of cognition and WHOQOL-BREF was used for the assessment of quality of life. Results At 12 months after surgery, total MoCA score and WHOQOL-BREF score in the pharmacotherapy group was significantly reduced when compared with those before surgery (P<0.05). In the CAS group, the total MoCA score, scores of attention and delayed recall, and WHOQOL-BREF score increased significantly at different time points after surgery when compared with those before surgery (P<0.05). Moreover, in CAS group, the MoCA score and WHOQOL-BREF markedly increased gradually over time (P<0.05). Compared with the pharmacotherapy group, cognition and quality of life in the CAS group were improved dramatically during the follow-up period (P<0.05). Conclusions Severe stenosis of the internal carotid artery is a cause of cognition impairment, and CAS may improve cognition and quality of life.
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Affiliation(s)
- Yongxing Yan
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
| | - Yanrong Yuan
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
| | - Lizhen Liang
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
| | - Tao Chen
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
| | - Yonghui Shen
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
| | - Changyang Zhong
- Department of Neurology, Third People's Hospital of Hangzhou, Hangzhou, China (mainland)
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Yan Y, Liang L, Yuan Y, Chen T, Shen Y, Zhong C. Influence of stent-assisted angioplasty on cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis. Med Sci Monit 2014; 20:1129-36. [PMID: 24990175 PMCID: PMC4095702 DOI: 10.12659/msm.890592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to investigate cognitive function and affective disorder in elderly patients with symptomatic vertebrobasilar artery stenosis (SVAS) after stent-assisted angioplasty (SAA) and to explore the potential mechanism. MATERIAL AND METHODS The study subjects were 26 elderly SVAS patients who were non-responsive to pharmacotherapy and received SAA (study group) and 30 patients receiving intracoronary stent implantation (control group). Montreal cognitive assessment (MoCA), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were used. RESULTS The total MoCA score, scores of line connection, copying cube, drawing clock, and delayed recall increased significantly in the study group after surgery (P<0.05, P<0.01). In addition, the MoCA score increased over time and the total MoCA score at 12 months was markedly higher than that at 1 month (P<0.05). The scores of HAMD and HAMA decreased dramatically after surgery compared with before surgery in these patients (P<0.01). A comparison at the corresponding period was performed between study group and control group, and it was found that the differences in total MoCA scores and scores of line connection, copying cube, drawing clock, and delayed recall before surgery and at 1 month after surgery were significant (P<0.05, P<0.01). CONCLUSIONS SAA may improve the visuospatial/executive abilities and delayed recall, as well as the depression and anxiety in patients with SVAS. Larger and controlled trails are needed to investigate the effect of SAA on cognition and affection in these patients.
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Affiliation(s)
- Yongxing Yan
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Lizhen Liang
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Yanrong Yuan
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Tao Chen
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Yonghui Shen
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
| | - Changyang Zhong
- Department of Neurology, Third People's Hospital, Hangzhou, China (mainland)
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Umarova RM, Reisert M, Beier TU, Kiselev VG, Klöppel S, Kaller CP, Glauche V, Mader I, Beume L, Hennig J, Weiller C. Attention-network specific alterations of structural connectivity in the undamaged white matter in acute neglect. Hum Brain Mapp 2014; 35:4678-92. [PMID: 24668692 DOI: 10.1002/hbm.22503] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/30/2014] [Accepted: 02/22/2014] [Indexed: 11/10/2022] Open
Abstract
Visual neglect results from dysfunction within the spatial attention network. The structural connectivity in undamaged brain tissue in neglect has barely been investigated until now. In the present study, we explored the microstructural white matter characteristics of the contralesional hemisphere in relation to neglect severity and recovery in acute stroke patients. We compared age-matched healthy subjects and three groups of acute stroke patients (9 ± 0.5 days after stroke): (i) patients with nonrecovered neglect (n = 12); (ii) patients with rapid recovery from initial neglect (within the first week post-stroke, n = 7), (iii) stroke patients without neglect (n = 17). We analyzed the differences between groups in grey and white matter density and fractional anisotropy (FA) and used fiber tracking to identify the affected fibers. Patients with nonrecovered neglect differed from those with rapid recovery by FA-reduction in the left inferior parietal lobe. Fibers passing through this region connect the left-hemispheric analogues of the ventral attention system. Compared with healthy subjects, neglect patients with persisting neglect had FA-reduction in the left superior parietal lobe, optic radiation, and left corpus callosum/cingulum. Fibers passing through these regions connect centers of the left dorsal attention system. FA-reduction in the identified regions correlated with neglect severity. The study shows for the first time white matter changes within the spatial attention system remote from the lesion and correlating with the extent and persistence of neglect. The data support the concept of neglect as disintegration within the whole attention system and illustrate the dynamics of structural-functional correlates in acute stroke.
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Affiliation(s)
- Roza M Umarova
- Department of Neurology, University Medical Centre Freiburg, Freiburg, Germany; Freiburg Brain Imaging, University Medical Centre Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of, Freiburg, Germany
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Ticini LF. On the debated role of temporo-parietal dysfunction in patients with basal ganglia neglect. Front Behav Neurosci 2013; 7:168. [PMID: 24302901 PMCID: PMC3831090 DOI: 10.3389/fnbeh.2013.00168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/01/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Luca F Ticini
- The Italian Society for Neuroaesthetics 'Semir Zeki' Trieste, Italy
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Longitudinal effects of lesions on functional networks after stroke. J Cereb Blood Flow Metab 2013; 33:1279-85. [PMID: 23715061 PMCID: PMC3734780 DOI: 10.1038/jcbfm.2013.80] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/19/2013] [Accepted: 04/26/2013] [Indexed: 11/08/2022]
Abstract
While ischemic stroke reflects focal damage determined by the affected vascular territory, clinical symptoms are often more complex and may be better explained by additional indirect effects of the focal lesion. Assumed to be structurally underpinned by anatomical connections, supporting evidence has been found using alterations in the functional connectivity of resting-state functional magnetic resonance imaging (fMRI) data in both sensorimotor and attention networks. To assess the generalizability of this phenomenon in a stroke population with heterogeneous lesions, we investigated the distal effects of lesions on a global level. Longitudinal resting-state fMRI scans were acquired at three consecutive time points, beginning during the acute phase (days 1, 7, and 90 post-stroke) in 12 patients after ischemic stroke. We found a preferential functional change in affected networks (i.e., networks containing lesions changed more during recovery when compared with unaffected networks). This change in connectivity was significantly correlated with clinical changes assessed with the National Institute of Health Stroke Scale. Our results provide evidence that the functional architecture of large-scale networks is critical to understanding the clinical effect and trajectory of post-stroke recovery.
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Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke 2013; 8:38-45. [PMID: 23280268 DOI: 10.1111/j.1747-4949.2012.00972.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive impairment after stroke is common and can cause disability with major impacts on quality of life and independence. There are also indirect effects of cognitive impairment on functional recovery after stroke through reduced participation in rehabilitation and poor adherence to treatment guidelines. In this article, we attempt to establish the following: ● whether there is a distinct profile of cognitive impairment after stroke; ● whether the type of cognitive deficit can be associated with the features of stroke-related damage; and ● whether interventions can improve poststroke cognitive performance. There is not a consistent profile of cognitive deficits in stroke, though slowed information processing and executive dysfunction tend to predominate. Our understanding of structure-function relationships has been advanced using imaging techniques such as lesion mapping and will be further enhanced through better characterization of damage to functional networks and identification of subtle white matter abnormalities. Effective cognitive rehabilitation approaches have been reported for focal cortical deficits such as neglect and aphasia, but treatments for more diffusely represented cognitive impairment remain elusive. In the future, the hope is that different techniques that have been shown to promote neural plasticity (e.g., exercise, brain stimulation, and pharmacological agents) can be applied to improve the cognitive function of stroke survivors.
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Affiliation(s)
- Toby B Cumming
- Stroke Division, Florey Neuroscience Institutes, Melbourne, Vic., Australia.
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González-Fernández M, Christian AB, Davis C, Hillis AE. Role of aphasia in discharge location after stroke. Arch Phys Med Rehabil 2012; 94:851-5. [PMID: 23237764 DOI: 10.1016/j.apmr.2012.11.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate language deficits after acute stroke and their association with post-acute care at a setting other than home. We hypothesized that deficits in language comprehension would be associated with discharge to a setting other than home after adjustment for physical/occupational therapy (PT/OT) needs. DESIGN Secondary analysis of prospectively collected data. Discharge location, demographic characteristics (age, sex, race), and the presence of PT/OT recommendations were abstracted from the medical record. SETTING Acute stroke unit at a tertiary medical center. PARTICIPANTS Left hemispheric stroke patients (N=152) within 24 hours of event. INTERVENTIONS The following tasks were administered: (a-b) oral and written naming of pictured objects, (c) oral naming with tactile input (tactile naming), (d-f) oral reading, oral spelling, and repetition of words and pseudowords, (g) written spelling to dictation, (h) spoken word-picture verification (ie, auditory comprehension), and (i) written word-picture verification (ie, written word comprehension). MAIN OUTCOME MEASURE Discharge to a setting other than home. RESULTS Of 152 cases, 88 were discharged home and 64 to another setting. Among stroke subjects discharged to a setting other than home, 63.6% had auditory comprehension deficits compared with 42.9% of those discharged home (P=.03). Deficits in auditory and reading comprehension and oral spelling to dictation were significantly associated with increased odds of discharge to a setting other than home after adjustment for age and PT/OT recommendations. CONCLUSIONS Cases with deficits in auditory comprehension, reading comprehension, and oral spelling to dictation had increased odds of being discharged to settings other than home. Early evaluation of these language deficits and prompt treatment may allow patients who would otherwise be discharged to an institution to go home. Further research is needed to design and evaluate individualized treatment protocols and their effect on discharge recommendations.
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Affiliation(s)
- Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Thiebaut de Schotten M, Tomaiuolo F, Aiello M, Merola S, Silvetti M, Lecce F, Bartolomeo P, Doricchi F. Damage to white matter pathways in subacute and chronic spatial neglect: a group study and 2 single-case studies with complete virtual "in vivo" tractography dissection. Cereb Cortex 2012; 24:691-706. [PMID: 23162045 DOI: 10.1093/cercor/bhs351] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The exact anatomical localization of right hemisphere lesions that lead to left spatial neglect is still debated. The effect of confounding factors such as acute diaschisis and hypoperfusion, visual field defects, and lesion size may account for conflicting results that have been reported in the literature. Here, we present a comprehensive anatomical investigation of the gray- and white matter lesion correlates of left spatial neglect, which was run in a sample 58 patients with subacute or chronic vascular strokes in the territory of the right middle cerebral artery. Standard voxel-based correlates confirmed the role played by lesions in the posterior parietal cortex (supramarginal gyrus, angular gyrus, and temporal-parietal junction), in the frontal cortex (frontal eye field, middle and inferior frontal gyrus), and in the underlying parietal-frontal white matter. Using a new diffusion tensor imaging-based atlas of the human brain, we were able to run, for the first time, a detailed analysis of the lesion involvement of subcortical white matter pathways. The results of this analysis revealed that, among the different pathways linking parietal with frontal areas, damage to the second branch of the superior longitudinal fasciculus (SLF II) was the best predictor of left spatial neglect. The group study also revealed a subsample of patients with neglect due to focal lesion in the lateral-dorsal portion of the thalamus, which connects the premotor cortex with the inferior parietal lobule. The relevance of fronto-parietal disconnection was further supported by complete in vivo tractography dissection of white matter pathways in 2 patients, one with and the other without signs of neglect. These 2 patients were studied both in the acute phase and 1 year after stroke and were perfectly matched for age, handedness, stroke onset, lesion size, and for cortical lesion involvement. Taken together, the results of the present study support the hypothesis that anatomical disconnections leading to a functional breakdown of parietal-frontal networks are an important pathophysiological factor leading to chronic left spatial neglect. Here, we propose that different loci of SLF disconnection on the rostro-caudal axis can also be associated with disconnection of short-range white matter pathways within the frontal or parietal areas. Such different local disconnection patterns can play a role in the important clinical variability of the neglect syndrome.
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Affiliation(s)
- Michel Thiebaut de Schotten
- Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
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Chechlacz M, Rotshtein P, Roberts KL, Bickerton WL, Lau JKL, Humphreys GW. The prognosis of allocentric and egocentric neglect: evidence from clinical scans. PLoS One 2012; 7:e47821. [PMID: 23133604 PMCID: PMC3486857 DOI: 10.1371/journal.pone.0047821] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/17/2012] [Indexed: 11/19/2022] Open
Abstract
We contrasted the neuroanatomical substrates of sub-acute and chronic visuospatial deficits associated with different aspects of unilateral neglect using computed tomography scans acquired as part of routine clinical diagnosis. Voxel-wise statistical analyses were conducted on a group of 160 stroke patients scanned at a sub-acute stage. Lesion-deficit relationships were assessed across the whole brain, separately for grey and white matter. We assessed lesions that were associated with behavioural performance (i) at a sub-acute stage (within 3 months of the stroke) and (ii) at a chronic stage (after 9 months post stroke). Allocentric and egocentric neglect symptoms at the sub-acute stage were associated with lesions to dissociated regions within the frontal lobe, amongst other regions. However the frontal lesions were not associated with neglect at the chronic stage. On the other hand, lesions in the angular gyrus were associated with persistent allocentric neglect. In contrast, lesions within the superior temporal gyrus extending into the supramarginal gyrus, as well as lesions within the basal ganglia and insula, were associated with persistent egocentric neglect. Damage within the temporo-parietal junction was associated with both types of neglect at the sub-acute stage and 9 months later. Furthermore, white matter disconnections resulting from damage along the superior longitudinal fasciculus were associated with both types of neglect and critically related to both sub-acute and chronic deficits. Finally, there was a significant difference in the lesion volume between patients who recovered from neglect and patients with chronic deficits. The findings presented provide evidence that (i) the lesion location and lesion size can be used to successfully predict the outcome of neglect based on clinical CT scans, (ii) lesion location alone can serve as a critical predictor for persistent neglect symptoms, (iii) wide spread lesions are associated with neglect symptoms at the sub-acute stage but only some of these are critical for predicting whether neglect will become a chronic disorder and (iv) the severity of behavioural symptoms can be a useful predictor of recovery in the absence of neuroimaging findings on clinical scans. We discuss the implications for understanding the symptoms of the neglect syndrome, the recovery of function and the use of clinical scans to predict outcome.
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Affiliation(s)
- Magdalena Chechlacz
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
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Cauquil-Michon C, Flamand-Roze C, Denier C. Borderzone strokes and transcortical aphasia. Curr Neurol Neurosci Rep 2012; 11:570-7. [PMID: 21904919 DOI: 10.1007/s11910-011-0221-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Borderzone infarcts (BZIs) are anatomically defined as ischemic lesions occurring at the junction between two arterial territories, accounting for 2% to 10% of strokes. Three types of hemispheric BZIs are described according to topography (ie, superficial anterior, posterior, and deep). Although published series on related aphasia are rare in the setting of BZI, aphasia is of transcortical (TCA) type, characterized by the preservation of repetition. TCA can be of motor, sensory, or mixed type depending on whether expression, understanding, or both are impaired. Recent studies have reported specific aphasic patterns. BZI patients initially presented with mixed TCA. Aphasia specifically evolved according to the stroke location, toward motor or sensory TCA in patients with respectively anterior or posterior BZI. TCA was associated with good long-term prognosis. This specific aphasic pattern is interesting in clinical practice because it prompts the suspicion of a BZI before the MRI is done, and it helps in the planning of rehabilitation and in providing adapted information to the patient and family concerning the likelihood of language recovery.
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Lin MS, Chiu MJ, Wu YW, Huang CC, Chao CC, Chen YH, Lin HJ, Li HY, Chen YF, Lin LC, Liu YB, Chao CL, Tseng WYI, Chen MF, Kao HL. Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia. Stroke 2011; 42:2850-4. [DOI: 10.1161/strokeaha.111.613133] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mao-Shin Lin
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Ming-Jang Chiu
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Yen-Wen Wu
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Ching-Chang Huang
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Chi-Chao Chao
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Ying-Hsien Chen
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Hung-Ju Lin
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Hung-Yuan Li
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Ya-Fang Chen
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Lung-Chun Lin
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Yen-Bin Liu
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Chia-Lun Chao
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Wen-Yih Isaac Tseng
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Ming-Fong Chen
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
| | - Hsien-Li Kao
- From the Department of Internal Medicine (M.-S.L., Y.-W.W., C.-C.H., Y.-H.C., H.-J.L., H.-Y.L., L.-C.L., Y.-B.L., M.-F.C., H.-L.K.), National Taiwan University Hospital, Taipei; Graduate Institute of Clinical Medicine (M.-S.L.), Medical College, National Taiwan University, Taipei; Department of Neurology (M.-J.C., C.-C.C.), National Taiwan University Hospital, Taipei; Department of Psychology (M.-J.C.), National Taiwan University, Taipei; Department of Nuclear Medicine (Y.-W.W.), National Taiwan
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Flamand-Roze C, Cauquil-Michon C, Roze E, Souillard-Scemama R, Maintigneux L, Ducreux D, Adams D, Denier C. Aphasia in border-zone infarcts has a specific initial pattern and good long-term prognosis. Eur J Neurol 2011; 18:1397-401. [PMID: 21554494 DOI: 10.1111/j.1468-1331.2011.03422.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND While border-zone infarcts (BZI) account for about 10% of strokes, studies on related aphasia are infrequent. The aim of this work was to redefine specifically their early clinical pattern and evolution. METHODS We prospectively studied consecutive patients referred to our stroke unit within a 2-year period. Cases of aphasia in right-handed patients associated with a MRI confirmed left-sided hemispheric BZI were included. These patients had a standardized language examination in the first 48 h, at discharge from stroke unit and between 6 and 18 months later. RESULTS Eight patients were included. Three had anterior (MCA/ACA), two posterior (MCA/PCA), two both anterior and posterior, and one bilateral BZI. All our patients initially presented transcortical mixed aphasia, characterized by comprehension and naming difficulties associated with preserved repetition. In all patients, aphasia rapidly improved. It fully recovered within a few days in three patients. Initial improvement was marked, although incomplete in the five remaining patients: their aphasias specifically evolved according to the stroke location toward transcortical motor aphasia for the three patients with anterior BZI and transcortical sensory aphasia for the two patients with posterior BZI. All patients made a full language recovery within 18 months after stroke. CONCLUSIONS We report a specific aphasic pattern associated with hemispheric BZI, including an excellent long-term outcome. These findings appear relevant to (i) clinically suspect BZI and (ii) plan rehabilitation and inform the patient and his family of likelihood of full language recovery.
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Affiliation(s)
- C Flamand-Roze
- Service de neurologie, CHU Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
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Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 2010; 9:895-905. [PMID: 20723846 DOI: 10.1016/s1474-4422(10)70164-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke remains a primary cause of morbidity throughout the world mainly because of its effect on cognition. Individuals can recover from physical disability resulting from stroke, but might be unable to return to their previous occupations or independent life because of cognitive impairments. Cognitive dysfunction ranges from focal deficits, resulting directly from an area of infarction or from hypoperfusion in adjacent tissue, to more global cognitive dysfunction. Global dysfunction is likely to be related to other underlying subclinical cerebrovascular disease, such as white-matter disease or subclinical infarcts. Study of cognitive dysfunction after stroke is complicated by varying definitions and lack of measurement of cognition before stroke. Additionally, stroke can affect white-matter connectivity, so newer imaging techniques, such as diffusion-tensor imaging and magnetisation transfer imaging, that can be used to assess this subclinical injury are important tools in the assessment of cognitive dysfunction after stroke. As research is increasingly focused on the role of preventable risk factors in the development of dementia, the role of stroke in the development of cognitive impairment and dementia could be another target for prevention.
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Thompson CK, den Ouden DB, Bonakdarpour B, Garibaldi K, Parrish TB. Neural plasticity and treatment-induced recovery of sentence processing in agrammatism. Neuropsychologia 2010; 48:3211-27. [PMID: 20603138 PMCID: PMC3164559 DOI: 10.1016/j.neuropsychologia.2010.06.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 06/01/2010] [Accepted: 06/28/2010] [Indexed: 11/20/2022]
Abstract
This study examined patterns of neural activation associated with treatment-induced improvement of complex sentence production (and comprehension) in six individuals with stroke-induced agrammatic aphasia, taking into account possible alterations in blood flow often associated with stroke, including delayed time-to-peak of the hemodynamic response function (HRF) and hypoperfused tissue. Aphasic participants performed an auditory verification fMRI task, processing object cleft, subject cleft, and simple active sentences, prior to and following a course of Treatment of Underlying Forms (TUF; Thompson et al., 2003), a linguistically based approach for treating aphasic sentence deficits, which targeted object relative clause constructions. The patients also were scanned in a long-trials task to examine HRFs, to account for any local deviations resulting from stroke, and perfusion images were obtained to evaluate regions of hypoperfused tissue. Region-of-interest (ROI) analyses were conducted (bilaterally), modeling participant-specific local HRFs in left hemisphere areas activated by 12 healthy age-matched volunteers performing the same task, including the middle and inferior frontal gyri, precentral gyrus, middle and superior temporal gyri, and insula, and additional regions associated with complex syntactic processing, including the posterior perisylvian and superior parietal cortices. Results showed that, despite individual variation in activation differences from pre- to post-treatment scans in the aphasic participants, main-effects analyses revealed a general shift from left superior temporal activation to more posterior temporoparietal areas, bilaterally. Time-to-peak of these responses correlated negatively with blood flow, as measured with perfusion imaging.
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Affiliation(s)
- Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA.
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Krueger F, Landgraf S, van der Meer E, Deshpande G, Hu X. Effective connectivity of the multiplication network: a functional MRI and multivariate Granger Causality Mapping study. Hum Brain Mapp 2010; 32:1419-31. [PMID: 20715080 DOI: 10.1002/hbm.21119] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 06/02/2010] [Accepted: 06/04/2010] [Indexed: 11/11/2022] Open
Abstract
Developmental neuropsychology and functional neuroimaging evidence indicates that simple and complex mental calculation is subserved by a fronto-parietal network. However, the effective connectivity (connection direction and strength) among regions within the fronto-parietal network is still unexplored. Combining event-related fMRI and multivariate Granger Causality Mapping (GCM), we administered a multiplication verification task to healthy participants asking them to solve single and double-digit multiplications. The goals of our study were first, to identify the effective connectivity of the multiplication network, and second, to compare the effective connectivity patterns between a low and a high arithmetical competence (AC) group. The manipulation of multiplication difficulty revealed a fronto-parietal network encompassing bilateral intraparietal sulcus (IPS), left pre-supplementary motor area (PreSMA), left precentral gyrus (PreCG), and right dorsolateral prefrontal cortex (DLPFC). The network was driven by an intraparietal IPS-IPS circuit hosting a representation of numerical quantity intertwined with a fronto-parietal DLPFC-IPS circuit engaged in temporary storage and updating of arithmetic operations. Both circuits received additional inputs from the PreCG and PreSMA playing more of a supportive role in mental calculation. The high AC group compared to the low AC group displayed a greater activation in the right IPS and based its calculation more on a feedback driven intraparietal IPS-IPS circuit, whereas the low competence group more on a feedback driven fronto-parietal DLPFC-IPS circuit. This study provides first evidence that multivariate GCM is a sensitive approach to investigate effective connectivity of mental processes involved in mental calculation and to compare group level performances for different populations.
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Affiliation(s)
- Frank Krueger
- Department of Molecular Neuroscience, George Mason University, Fairfax, VA 22030, USA.
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