1
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Yu Q, Sun Y, Ju X, Ye T, Liu K. Prediction models of the aphasia severity after stroke by lesion load of cortical language areas and white matter tracts: An atlas-based study. Brain Res Bull 2024; 217:111074. [PMID: 39245352 DOI: 10.1016/j.brainresbull.2024.111074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/28/2024] [Accepted: 09/06/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE To construct relatively objective, atlas-based multivariate models for predicting early aphasia severity after stroke, using structural magnetic resonance imaging. METHODS We analyzed the clinical and imaging data of 46 patients with post-stroke aphasia. The aphasia severity was identified with a Western Aphasia Battery Aphasia Quotient. The assessments of stroke lesions were indicated by the lesion load of both the cortical language areas (Areas-LL) and four white matter tracts (i.e., the superior longitudinal fasciculus, SLF-LL; the inferior frontal occipital fasciculi, IFOF-LL; the inferior longitudinal, ILF-LL; and the uncinate fasciculi, UF-LL) extracted from human brain atlas. Correlation analyses and multiple linear regression analyses were conducted to evaluate the correlations between demographic, stroke- and lesion-related variables and aphasia severity. The predictive models were then established according to the identified significant variables. Finally, the receiver operating characteristic (ROC) curve was utilized to assess the accuracy of the predictive models. RESULTS The variables including Areas-LL, the SLF-LL, and the IFOF-LL were significantly negatively associated with aphasia severity (p < 0.05). In multiple linear regression analyses, these variables accounted for 59.4 % of the variance (p < 0.05). The ROC curve analyses yielded the validated area under the curve (AUC) 0.84 both for Areas-LL and SLF-LL and 0.76 for IFOF-LL, indicating good predictive performance (p < 0.01). Adding the combination of SLF-LL and IFOF-LL to this model increased the explained variance to 62.6 % and the AUC to 0.92. CONCLUSIONS The application of atlas-based multimodal lesion assessment may help predict the aphasia severity after stroke, which needs to be further validated and generalized for the prediction of more outcome measures in populations with various brain injuries.
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Affiliation(s)
- Qiwei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China.
| | - Yan Sun
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Xiaowen Ju
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Tianfen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Kefu Liu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China.
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2
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Ding J, Thye M, Edmondson-Stait AJ, Szaflarski JP, Mirman D. Metric comparison of connectome-based lesion-symptom mapping in post-stroke aphasia. Brain Commun 2024; 6:fcae313. [PMID: 39318782 PMCID: PMC11420983 DOI: 10.1093/braincomms/fcae313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/26/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024] Open
Abstract
Connectome-based lesion-symptom mapping relates behavioural impairments to disruption of structural brain connectivity. Connectome-based lesion-symptom mapping can be based on different approaches (diffusion MRI versus lesion mask), network scales (whole brain versus regions of interest) and measure types (tract-based, parcel-based, or network-based metrics). We evaluated the similarity of different connectome-based lesion-symptom mapping processing choices and identified factors that influence the results using multiverse analysis-the strategy of conducting and displaying the results of all reasonable processing choices. Metrics derived from lesion masks and diffusion-weighted images were tested for association with Boston Naming Test and Token Test performance in a sample of 50 participants with aphasia following left hemispheric stroke. 'Direct' measures were derived from diffusion-weighted images. 'Indirect' measures were derived by overlaying lesion masks on a white matter atlas. Parcel-based connectomes were constructed for the whole brain and regions of interest (14 language-relevant parcels). Numerous tract-based and network-based metrics were calculated. There was a high discrepancy across processing approaches (diffusion-weighted images versus lesion masks), network scales (whole brain versus regions of interest) and metric types. Results indicate weak correlations and different connectome-based lesion-symptom mapping results across the processing choices. Substantial methodological work is needed to validate the various decision points that arise when conducting connectome-based lesion-symptom mapping analyses. Multiverse analysis is a useful strategy for evaluating the similarity across different processing choices in connectome-based lesion-symptom mapping.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Melissa Thye
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | | | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Daniel Mirman
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
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3
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Liu N, Ye TF, Yu QW. The role of the right hemispheric homologous language pathways in recovery from post-stroke aphasia: A systematic review. Psychiatry Res Neuroimaging 2024; 343:111866. [PMID: 39098261 DOI: 10.1016/j.pscychresns.2024.111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/06/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
The involvement of the right hemisphere, mainly the activation of the right cerebral regions, in recovery from post-stroke aphasia has been widely recognized. In contrast, the role of the right white matter pathways in the recovery from post-stroke aphasia is rarely understood. In this study, we aimed to provide a primary overview of the correlation between the structural integrity of the right hemispheric neural tracts based on the dual-stream model of language organization and recovery from post-stroke aphasia by systematically reviewing prior longitudinal interventional studies. By searching electronic databases for relevant studies according to a standard protocol, a total of 10 records (seven group studies and three case studies) including 79 participants were finally included. After comprehensively analyzing these studies and reviewing the literature, although no definite correlation was found between the right hemispheric neural tracts and recovery from post-stroke aphasia, our review provideds a new perspective for investigating the linguistic role of the right hemispheric neural tracts. This suggests that the involvement of the right hemispheric neural tracts in recovery from post-stroke aphasia may be mediated by multiple factors; thus, this topic should be comprehensively investigated in the future.
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Affiliation(s)
- Na Liu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Tian-Fen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Qi-Wei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China.
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4
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Roth RW, Schwen Blackett D, Gleichgerrcht E, Wilmskoetter J, Rorden C, Newman-Norlund R, Sen S, Fridriksson J, Busby N, Bonilha L. Long-range white matter fibres and post-stroke verbal and non-verbal cognition. Brain Commun 2024; 6:fcae262. [PMID: 39185028 PMCID: PMC11342249 DOI: 10.1093/braincomms/fcae262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/04/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
Among stroke survivors, linguistic and non-linguistic impairments exhibit substantial inter-individual variability. Stroke lesion volume and location do not sufficiently explain outcomes, and the neural mechanisms underlying the severity of aphasia or non-verbal cognitive deficits remain inadequately understood. Converging evidence supports the idea that white matter is particularly susceptible to ischaemic injury, and long-range fibres are commonly associated with verbal and non-verbal function. Here, we investigated the relationship among post-stroke aphasia severity, cognition, and white matter integrity. Eighty-seven individuals in the chronic stage of stroke underwent diffusion MRI and behavioural testing, including language and cognitive measures. We used whole-brain structural connectomes from each participant to calculate the ratio of long-range fibres to short-range fibres. We found that a higher proportion of long-range fibres was associated with lower aphasia severity, more accurate picture naming, and increased performance on non-verbal semantic memory/processing and non-verbal reasoning while controlling for lesion volume, key damage areas, age, and years post stroke. Our findings corroborate the hypothesis that, after accounting for age and lesion anatomy, inter-individual differences in post-stroke aphasia severity, verbal, and non-verbal cognitive outcomes are related to the preservation of long-range white matter fibres beyond the lesion.
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Affiliation(s)
- Rebecca W Roth
- Department of Neurology, Emory University, Atlanta, GA 30329, USA
| | - Deena Schwen Blackett
- Department of Otolaryngology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | | | - Souvik Sen
- Department of Neurology, University of South Carolina, Columbia, SC 29209, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Department of Neurology, University of South Carolina, Columbia, SC 29209, USA
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5
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Reißner B, Grohmann W, Peiseler N, Pinho J, Hußmann K, Werner CJ, Heim S. Quantifier processing and semantic flexibility in patients with aphasia. Front Psychol 2024; 15:1328853. [PMID: 39100551 PMCID: PMC11294751 DOI: 10.3389/fpsyg.2024.1328853] [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: 10/27/2023] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Processing of quantifiers such as "many" and "few" relies on number knowledge, linguistic abilities, and working memory. Negative quantifiers (e.g., "few," "less than half") induce higher processing costs than their positive counterparts. Furthermore, the meaning of some quantifiers is flexible and thus adaptable. Importantly, in neurotypical individuals, changing the meaning of one quantifier also leads to a generalized change in meaning for its polar opposite (e.g., the change of the meaning of "many" leads to the change of that of "few"). Here, we extended this research to patients with fluent and non-fluent aphasia after stroke. In two experiments, participants heard sentences of the type "Many/few of the circles are yellow/blue," each followed by a picture with different quantities of blue and yellow circles. The participants judged whether the sentence adequately described the picture. Each experiment consisted of three blocks: a baseline block to assess the participants' criteria for both quantifiers, a training block to shift the criteria for "many," and a test block, identical to the baseline to capture any changes in quantifier semantics. In Experiment 1, the change of the meaning of "many" was induced by using adaptation to small numbers (20-50%) of circles of the named color. In Experiment 2, explicit feedback was given in the training block after each response to rate proportions of 40% (or higher) as "many," whereas 40% is normally rather rated as "few." The objective was to determine whether people with fluent or non-fluent aphasia were able to process quantifiers appropriately and whether generalized semantic flexibility was present after brain damage. Sixteen out of 21 patients were able to perform the task. People with fluent aphasia showed the expected polarity effect in the reaction times and shifted their criteria for "many" with generalization to the untrained quantifier "few." This effect, however, was only obtained after explicit feedback (Experiment 2) but not by mere adaptation (Experiment 1). In contrast, people with non-fluent aphasia did not change the quantifier semantics in either experiment. This study contributes to gaining new insights into quantifier processing and semantic flexibility in people with aphasia and general underlying processing mechanisms.
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Affiliation(s)
- Birte Reißner
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Wiebke Grohmann
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Natalja Peiseler
- Department of Linguistics, Heinrich Heine University, Düsseldorf, Germany
| | - João Pinho
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Katja Hußmann
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Cornelius J. Werner
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Johanniter Hospital Stendal, Stendal, Germany
| | - Stefan Heim
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich GmbH, Jülich, Germany
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6
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Low TA, Chilvers MJ, Zhu H, Carlson HL, Harris AD, Goodyear BG, Dukelow SP. Structural network topology associated with naming improvements following intensive aphasia therapy in post-stroke aphasia. J Neurol Sci 2024; 462:123065. [PMID: 38820737 DOI: 10.1016/j.jns.2024.123065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
A stroke can disrupt the finely tuned language network resulting in aphasia, a language impairment. Though many stroke survivors with aphasia recover within the first 6 months, a significant proportion have lasting deficits. The factors contributing to optimal treatment response remain unclear. Some evidence suggests that increased modularity or fragmentation of brain networks may underlie post-stroke aphasia severity and the extent of recovery. We examined associations between network organization and aphasia recovery in sixteen chronic stroke survivors with non-fluent aphasia following 35 h of Multi-Modality Aphasia Therapy over 10 days and 20 healthy controls who underwent imaging at a single timepoint. Using diffusion-weighted scans obtained before and after treatment, we constructed whole-brain structural connectomes representing the number of probabilistic streamlines between brain regions. Graph theory metrics were quantified for each connectome using the Brain Connectivity Toolbox. Correlations were examined between graph metrics and speech performance measured using the Boston Naming Test (BNT) at pre-, post- and 3-months post-intervention. Compared to controls, participants with stroke demonstrated higher whole-brain modularity at pre-treatment. Modularity did not differ between pre- and post-treatment. In individuals who responded to therapy, higher pre-treatment modularity was associated with worse performance on the BNT. Moreover, higher pre-treatment participation coefficients (i.e., how well a region is connected outside its own module) for the left IFG, planum temporale, and posterior temporal gyri were associated with greater improvements at post-treatment. These results suggest that pre-treatment network topology may impact therapeutic gains, highlighting the influence of network organization on post-stroke aphasia recovery.
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Affiliation(s)
- Trevor A Low
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Chilvers
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harold Zhu
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.
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7
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Han Y, Jing Y, Shi Y, Mo H, Wan Y, Zhou H, Deng F. The role of language-related functional brain regions and white matter tracts in network plasticity of post-stroke aphasia. J Neurol 2024; 271:3095-3115. [PMID: 38607432 DOI: 10.1007/s00415-024-12358-5] [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] [Received: 01/05/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
The neural mechanisms underlying language recovery after a stroke remain controversial. This review aimed to summarize the plasticity and reorganization mechanisms of the language network through neuroimaging studies. Initially, we discussed the involvement of right language homologues, perilesional tissue, and domain-general networks. Subsequently, we summarized the white matter functional mapping and remodeling mechanisms associated with language subskills. Finally, we explored how non-invasive brain stimulation (NIBS) promoted language recovery by inducing neural network plasticity. It was observed that the recruitment of right hemisphere language area homologues played a pivotal role in the early stages of frontal post-stroke aphasia (PSA), particularly in patients with larger lesions. Perilesional plasticity correlated with improved speech performance and prognosis. The domain-general networks could respond to increased "effort" in a task-dependent manner from the top-down when the downstream language network was impaired. Fluency, repetition, comprehension, naming, and reading skills exhibited overlapping and unique dual-pathway functional mapping models. In the acute phase, the structural remodeling of white matter tracts became challenging, with recovery predominantly dependent on cortical activation. Similar to the pattern of cortical activation, during the subacute and chronic phases, improvements in language functions depended, respectively, on the remodeling of right white matter tracts and the restoration of left-lateralized language structural network patterns. Moreover, the midline superior frontal gyrus/dorsal anterior cingulate cortex emerged as a promising target for NIBS. These findings offered theoretical insights for the early personalized treatment of aphasia after stroke.
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Affiliation(s)
- Yue Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yuanyuan Jing
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanmin Shi
- Health Management (Physical Examination) Center, The Second Norman Bethune Hospital of Jilin University, Changchun, China
| | - Hongbin Mo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yafei Wan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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8
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Peng Y, Huang S, Yang X, Ma J. Efficacy and safety of mirror therapy for post-stroke aphasia: A systematic review and meta-analysis protocol. PLoS One 2024; 19:e0301468. [PMID: 38718090 PMCID: PMC11078370 DOI: 10.1371/journal.pone.0301468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/13/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Aphasia is one of the most common complications of stroke. Mirror therapy (MT) is promising rehabilitation measure for the treatment of post-stroke aphasia. Although some studies suggested that MT is effective and safe for aphasia, the effects and safety remain uncertain due to lacking strong evidence, such as the relevant systematic review and meta- analysis. METHODS This study will search PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network (CNKI), WANFANG, China Biomedical Literature Database (CBM), from inception to 1th May 2023 to identify any eligible study. No language or date of publication shall be limited. We will only include randomised controlled trials of MT in the Treatment of poststroke aphasia. Two investigators will work separately on the study selection, data extraction, and study quality assessment. The western aphasia battery (WAB) and aphasia quotient (AQ) will be included as the main outcomes. Boston diagnostic aphasia examination method (BDAE), Chinese standard aphasia examination (CRRCAE) will be included as the secondary outcomes. The statistical analysis will be conducted by RevMan V.5.4 software. The risk of bias of included studies will be assessed by the Cochrane 'Risk of bias' tool. The quality of proof of the results will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS The finding will be presented in a journal or related conferences. CONCLUSION This study will provide a basis for whether mirror therapy (MT) is effective and safe in the treatment of post-stroke aphasia. TRIAL REGISTRATION Systematic review registration INPLASY registration number: INPLASY 202340054.
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Affiliation(s)
- Yufeng Peng
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shouqiang Huang
- Department of Emergency Medicine, Taihe Hospital, Hubei, China
| | - Xiaotong Yang
- Department of Emergency Medicine, Taihe Hospital, Hubei, China
| | - Jiao Ma
- Department of Emergency Medicine, Taihe Hospital, Hubei, China
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9
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Sun C, Zhang J, Bu L, Lu J, Yao Y, Wu J. A speech fluency brain network derived from gliomas. Brain Commun 2024; 6:fcae153. [PMID: 38756538 PMCID: PMC11098038 DOI: 10.1093/braincomms/fcae153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/21/2024] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
The brain network of speech fluency has not yet been investigated via a study with a large and homogenous sample. This study analysed multimodal imaging data from 115 patients with low-grade glioma to explore the brain network of speech fluency. We applied voxel-based lesion-symptom mapping to identify domain-specific regions and white matter pathways associated with speech fluency. Direct cortical stimulation validated the domain-specific regions intra-operatively. We then performed connectivity-behaviour analysis with the aim of identifying connections that significantly correlated with speech fluency. Voxel-based lesion-symptom mapping analysis showed that damage to domain-specific regions (the middle frontal gyrus, the precentral gyrus, the orbital part of inferior frontal gyrus and the insula) and white matter pathways (corticospinal fasciculus, internal capsule, arcuate fasciculus, uncinate fasciculus, frontal aslant tract) are associated with reduced speech fluency. Furthermore, we identified connections emanating from these domain-specific regions that exhibited significant correlations with speech fluency. These findings illuminate the interaction between domain-specific regions and 17 domain-general regions-encompassing the superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus and rolandic operculum, superior temporal gyrus, temporal pole, inferior temporal pole, middle cingulate gyrus, supramarginal gyrus, fusiform gyrus, inferior parietal lobe, as well as subcortical structures such as thalamus-implicating their collective role in supporting fluent speech. Our detailed mapping of the speech fluency network offers a strategic foundation for clinicians to safeguard language function during the surgical intervention for brain tumours.
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Affiliation(s)
- Cechen Sun
- Department of Biostatistics, School of Public Health & National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 201107, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Linghao Bu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 201107, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 201107, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health & National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 201107, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200040, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
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10
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Ding J, Middleton EL, Mirman D. Impaired discourse content in aphasia is associated with frontal white matter damage. Brain Commun 2023; 5:fcad310. [PMID: 38025278 PMCID: PMC10664411 DOI: 10.1093/braincomms/fcad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Aphasia is a common consequence of stroke with severe impacts on employability, social interactions and quality of life. Producing discourse-relevant information in a real-world setting is the most important aspect of recovery because it is critical to successful communication. This study sought to identify the lesion correlates of impaired production of relevant information in spoken discourse in a large, unselected sample of participants with post-stroke aphasia. Spoken discourse (n = 80) and structural brain scans (n = 66) from participants with aphasia following left hemisphere stroke were analysed. Each participant provided 10 samples of spoken discourse elicited in three different genres, and 'correct information unit' analysis was used to quantify the informativeness of speech samples. The lesion correlates were identified using multivariate lesion-symptom mapping, voxel-wise disconnection and tract-wise analyses. Amount and speed of relevant information were highly correlated across different genres and with total lesion size. The analyses of lesion correlates converged on the same pattern: impaired production of relevant information was associated with damage to anterior dorsal white matter pathways, specifically the arcuate fasciculus, frontal aslant tract and superior longitudinal fasciculus. Damage to these pathways may be a useful biomarker for impaired informative spoken discourse and informs development of neurorehabilitation strategies.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | | | - Daniel Mirman
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
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11
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Neophytou K, Wiley R, Litovsky C, Tsapkini K, Rapp B. The right hemisphere's capacity for language: evidence from primary progressive aphasia. Cereb Cortex 2023; 33:9971-9985. [PMID: 37522277 PMCID: PMC10502784 DOI: 10.1093/cercor/bhad258] [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] [Received: 01/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.
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Affiliation(s)
- Kyriaki Neophytou
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Robert Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Celia Litovsky
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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12
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López-Barroso D, Paredes-Pacheco J, Torres-Prioris MJ, Dávila G, Berthier ML. Brain structural and functional correlates of the heterogenous progression of mixed transcortical aphasia. Brain Struct Funct 2023:10.1007/s00429-023-02655-6. [PMID: 37256346 DOI: 10.1007/s00429-023-02655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
Mixed transcortical aphasia (MTCA) is characterized by non-fluent speech and comprehension deficits coexisting with preserved repetition. MTCA may evolve to less severe variants of aphasias or even to full language recovery. Mechanistically, MCTA has traditionally been attributed to a disconnection between the spared left perisylvian language network (PSLN) responsible for preserved verbal repetition, and damaged left extrasylvian networks, which are responsible for language production and comprehension impairments. However, despite significant advances in in vivo neuroimaging, the structural and functional status of the PSLN network in MTCA and its evolution has not been investigated. Thus, the aim of the present study is to examine the status of the PSLN, both in terms of its functional activity and structural integrity, in four cases who developed acute post-stroke MTCA and progressed to different types of aphasia. For it, we conducted a neuroimaging-behavioral study performed in the chronic stage of four patients. The behavioral profile of MTCA persisted in one patient, whereas the other three patients progressed to less severe types of aphasias. Neuroimaging findings suggest that preserved verbal repetition in MTCA does not always depend on the optimal status of the PSLN and its dorsal connections. Instead, the right hemisphere or the left ventral pathway may also play a role in supporting verbal repetition. The variability in the clinical evolution of MTCA may be explained by the varying degree of PSLN alteration and individual premorbid neuroanatomical language substrates. This study offers a fresh perspective of MTCA through the lens of modern neuroscience and unveils novel insights into the neural underpinnings of repetition.
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Affiliation(s)
- Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - José Paredes-Pacheco
- Radiology and Psychiatry Department, Faculty of Medicine, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), General Foundation of the University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain.
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain.
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13
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Kernbach JM, Hartwigsen G, Lim JS, Bae HJ, Yu KH, Schlaug G, Bonkhoff A, Rost NS, Bzdok D. Bayesian stroke modeling details sex biases in the white matter substrates of aphasia. Commun Biol 2023; 6:354. [PMID: 37002267 PMCID: PMC10066402 DOI: 10.1038/s42003-023-04733-1] [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] [Received: 07/26/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Ischemic cerebrovascular events often lead to aphasia. Previous work provided hints that such strokes may affect women and men in distinct ways. Women tend to suffer strokes with more disabling language impairment, even if the lesion size is comparable to men. In 1401 patients, we isolate data-led representations of anatomical lesion patterns and hand-tailor a Bayesian analytical solution to carefully model the degree of sex divergence in predicting language outcomes ~3 months after stroke. We locate lesion-outcome effects in the left-dominant language network that highlight the ventral pathway as a core lesion focus across different tests of language performance. We provide detailed evidence for sex-specific brain-behavior associations in the domain-general networks associated with cortico-subcortical pathways, with unique contributions of the fornix in women and cingular fiber bundles in men. Our collective findings suggest diverging white matter substrates in how stroke causes language deficits in women and men. Clinically acknowledging such sex disparities has the potential to improve personalized treatment for stroke patients worldwide.
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Affiliation(s)
- Julius M Kernbach
- Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), RWTH Aachen University Hospital, Aachen, Germany
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Gottfried Schlaug
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Anna Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
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14
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Shekari E, Nozari N. A narrative review of the anatomy and function of the white matter tracts in language production and comprehension. Front Hum Neurosci 2023; 17:1139292. [PMID: 37051488 PMCID: PMC10083342 DOI: 10.3389/fnhum.2023.1139292] [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: 01/06/2023] [Accepted: 02/24/2023] [Indexed: 03/28/2023] Open
Abstract
Much is known about the role of cortical areas in language processing. The shift towards network approaches in recent years has highlighted the importance of uncovering the role of white matter in connecting these areas. However, despite a large body of research, many of these tracts' functions are not well-understood. We present a comprehensive review of the empirical evidence on the role of eight major tracts that are hypothesized to be involved in language processing (inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, extreme capsule, middle longitudinal fasciculus, superior longitudinal fasciculus, arcuate fasciculus, and frontal aslant tract). For each tract, we hypothesize its role based on the function of the cortical regions it connects. We then evaluate these hypotheses with data from three sources: studies in neurotypical individuals, neuropsychological data, and intraoperative stimulation studies. Finally, we summarize the conclusions supported by the data and highlight the areas needing further investigation.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Nazbanou Nozari
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition (CNBC), Pittsburgh, PA, United States
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15
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Constrained spherical deconvolution -based tractography of major language tracts reveals post-stroke bilateral white matter changes correlated to aphasia. Magn Reson Imaging 2023; 95:19-26. [PMID: 36252694 DOI: 10.1016/j.mri.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Using constrained spherical deconvolution (CSD)-based tractography, we aimed to obtain conjoint analysis of diffusion measures of major language white matter (WM) tracts in post-stroke aphasic patients bilaterally, and to correlate the measures of each tract to the different language deficits. MATERIAL AND METHODS 17 aphasic patients with left hemispheric stroke, at the subacute stage, and ten age- matched controls underwent diffusion MRI examination. CSD-based tractography was performed. Diffusion measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were extracted after dissection of major language tracts bilaterally. Aphasia was assessed using language subset of hemispheric stroke scale. Comparisons of diffusion measures, for all tracts, between the two groups were performed. Partial correlations between the diffusion measures and different language components were obtained. RESULTS In the left hemisphere, significant lower FA and or higher MD with higher RD of patients' WM tracts compared to the control group. Significant differences of diffusion measures were also evident in the right hemisphere yet, less prominent. All changes reflected damage of the tracts' integrity. Significant correlations were found between comprehension and FA of the left arcuate fasciculus (AF) and left inferior longitudinal fasciculus. Additionally, a significant correlation was found between MD of the right AF and repetition. CONCLUSION Conjoint analysis of diffusion measures, based on CSD tractography, can provide important markers for the underlying WM changes bilaterally. Moreover, our findings emphasize that language processing can be mediated by both ventral and dorsal streams and further highlight the contribution of the right AF in repetition.
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16
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Ding J, Schnur TT. Anterior connectivity critical for recovery of connected speech after stroke. Brain Commun 2022; 4:fcac266. [PMID: 36382224 PMCID: PMC9651028 DOI: 10.1093/braincomms/fcac266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/20/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023] Open
Abstract
Connected speech recovers to different degrees across people after left hemisphere stroke, but white matter predictors of differential recovery from the acute stage of stroke are unknown. We assessed changes in lexical-syntactic aspects of connected speech in a longitudinal analysis of 40 individuals (18 females) from the acute stage of left hemisphere stroke (within an average of 4 days post-stroke) to subacute (within 2 months) and chronic stages (early: 6 months, late: 1 year) while measuring the extent of acute lesions on white matter tracts to identify tracts predictive of recovery. We found that acute damage to the frontal aslant tract led to a decreased recovery of the fluency and structural complexity of connected speech during the year following left hemisphere stroke. The results were independent of baseline performance, overall lesion volume and the proportion of damage to tract-adjacent grey matter. This longitudinal analysis from acute to chronic stroke provides the first evidence that recovery of fluent and structurally complex spontaneous connected speech requires intact left frontal connectivity via the frontal aslant tract. That the frontal aslant tract was critical for recovery at early as well as later stages of stroke demonstrates that anterior connectivity plays a lasting and important role for the reorganization of function related to the successful production of connected speech.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tatiana T Schnur
- Correspondence to: Tatiana T. Schnur Department of Neurosurgery Baylor College of Medicine 1 Baylor Plaza, Houston, TX 77030, USA E-mail:
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17
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Egorova-Brumley N, Liang C, Khlif MS, Brodtmann A. White matter microstructure and verbal fluency. Brain Struct Funct 2022; 227:3017-3025. [PMID: 36251043 PMCID: PMC9653311 DOI: 10.1007/s00429-022-02579-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022]
Abstract
Poor performance on verbal fluency tasks is associated with an increased risk of post-stroke cognitive impairment. Grey matter regions supporting verbal fluency have been identified via lesion–symptom mapping, but the links between verbal fluency and white matter structure remain less well described. We examined white matter correlates of semantic (Category Fluency Animals) and phonemic or lexical fluency (COWAT FAS) after stroke, accounting for stroke severity measured with the National Institutes of health Stroke Scale (NIHSS), age, sex, and level of education. White matter fibre density and cross-section measures were automatically extracted from 72 tracts, using MRtrix and TractSeg software in 72 ischaemic stroke survivors assessed 3 months after their event. We conducted regression analyses separately for phonemic and semantic fluency for each tract. Worse semantic fluency was associated with lower fibre density in several tracts, including the arcuate fasciculus, superior longitudinal fasciculus, inferior occipito-frontal fasciculus, inferior longitudinal fasciculus, optic radiation, striato-occipital, thalamo-occipital tracts, and inferior cerebellar peduncle. Our stroke sample was heterogenous with largely non-overlapping and predominantly right-lateralised lesions (lesion distribution: left N = 27, right N = 43, bilateral N = 2), dissimilar to previous studies of verbal fluency. Yet, the tracts we identified as correlates of semantic fluency were all left-lateralised. No associations between phonemic fluency performance and fibre density metrics in any of the white matter tracts we extracted survived correction for multiple comparisons, possibly due to the limitations in the selection of tracts and sample characteristics. We conclude that when accounting for the effects of stroke severity, sex, age, and education, semantic fluency is associated with white matter microstructure in the left arcuate fasciculus, superior longitudinal fasciculus, and several occipital tracts, possibly reflecting the disconnection in the sagittal stratum. Our results obtained with fixel-based analysis, complement previous findings obtained with lesions–symptom mapping and neurodegenerative approaches.
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Affiliation(s)
- Natalia Egorova-Brumley
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia. .,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.
| | - Chen Liang
- Department of Speech Pathology, University of Melbourne, Melbourne, Australia
| | - Mohamed Salah Khlif
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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18
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Yu Q, Qian W. Poor Spontaneous Recovery of Aphemia Accompanied by Damage to the Anterior Segment of the Left Arcuate Fasciculus: A Case Report. Brain Sci 2022; 12:brainsci12091253. [PMID: 36138990 PMCID: PMC9496680 DOI: 10.3390/brainsci12091253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Aphemia is a rare and special type of speech disorder, and the mechanisms underlying the occurrence and recovery remain unclear. Here, we present a clinical case of poor spontaneous recovery of aphemia, with the anterior segment of the left arcuate fasciculus server damaged and the posterior segment intact, as detected by diffusion tensor imaging. Aphemia could be caused by the disruption of the cortical and subcortical language circuits. In particular, our data support the view that damage to the anterior segment of the left arcuate fasciculus may result in poor spontaneous recovery from speech production deficits and that an intact posterior segment seems to be crucial for supporting residual language comprehension ability in patients with post-stroke aphasia. Collectively, these data imply the importance of the left arcuate fasciculus during recovery from the language disorder in the subacute stage of stroke.
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19
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Bae CR, Na Y, Cho M, Hwang YM, Tae WS, Pyun SB. Structural Changes in the Arcuate Fasciculus and Recovery of Post-stroke Aphasia: A 6-Month Follow-up Study using Diffusion Tensor Imaging. Neurorehabil Neural Repair 2022; 36:633-644. [PMID: 36036555 DOI: 10.1177/15459683221121752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Temporal changes in the structural connectivity of major language tracts after stroke and their contribution to aphasia recovery are unclear. OBJECTIVE To investigate longitudinal arcuate fasciculus (AF) integrity changes and their relationship with post-stroke aphasia recovery using diffusion tensor imaging (DTI). METHODS Thirty-five patients with aphasia due to first-ever left hemispheric stroke underwent the Korean version of the Western Aphasia Battery and DTI at 1- and 6-month post stroke onset. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of both AF tracts were analyzed to evaluate the temporal changes in tract integrity and determine the correlation between changes (Δ; follow-up - initial) in DTI parameters and language scores. RESULTS At 6 months post-stroke, the mean FA decreased, and mean MD and RD increased in both hemispheres; however, compared with mean AD observed after 1 month, the mean observed at 6 months increased only in the left hemisphere (P < .05). ΔFA of the left AF and proportional change in the aphasia quotient showed a significant positive correlation (r = 0.365, P = .031). No correlation was found between changes in the right AF parameters and language score. The group with increased FA in the left AF showed more significant language improvement than the group with decreased FA. CONCLUSIONS During the subacute stage, the integrity of AF decreased in both hemispheres in patients with aphasia, and the change in structural connectivity of the left AF was associated with language improvement.
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Affiliation(s)
- Cho Rong Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoonhye Na
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minjae Cho
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.,BK21 Graduate Program, Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Mi Hwang
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
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20
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Integrity of the Left Arcuate Fasciculus Segments Significantly Affects Language Performance in Individuals with Acute/Subacute Post-Stroke Aphasia: A Cross-Sectional Diffusion Tensor Imaging Study. Brain Sci 2022; 12:brainsci12070907. [PMID: 35884714 PMCID: PMC9313217 DOI: 10.3390/brainsci12070907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objective: To investigate the correlation between the left arcuate fasciculus (AF) segments and acute/subacute post-stroke aphasia (PSA). Methods: Twenty-six patients underwent language assessment and MRI scanning. The integrity of the AF based on a three-segment model was evaluated using diffusion tensor imaging. All patients were classified into three groups according to the reconstruction of the left AF: completely reconstructed (group A, 8 cases), non-reconstructed (group B, 6 cases), and partially reconstructed (group C, 12 cases). The correlations and intergroup differences in language performance and diffusion indices were comprehensively estimated. Results: A correlation analyses showed that the lesion load of the language areas and diffusion indices on the left AF posterior and long segments was significantly related to some language subsets, respectively. When controlled lesion load was variable, significant correlations between diffusion indices on the posterior and long segments and comprehension, repetition, naming, and aphasia quotient were retained. Multiple comparison tests revealed intergroup differences in diffusion indices on the left AF posterior and long segments, as well as these language subsets. No significant correlation was found between the anterior segment and language performance. Conclusions: The integrity of the left AF segments, particularly the posterior segment, is crucial for the residual comprehension and repetition abilities in individuals with acute/subacute PSA, and lesion load in cortical language areas is an important factor that should be taken into account when illustrating the contributions of damage to special fiber tracts to language impairments.
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21
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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22
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LaCroix AN, James E, Rogalsky C. Neural Resources Supporting Language Production vs. Comprehension in Chronic Post-stroke Aphasia: A Meta-Analysis Using Activation Likelihood Estimates. Front Hum Neurosci 2021; 15:680933. [PMID: 34759804 PMCID: PMC8572938 DOI: 10.3389/fnhum.2021.680933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/22/2021] [Indexed: 02/04/2023] Open
Abstract
In post-stroke aphasia, language tasks recruit a combination of residual regions within the canonical language network, as well as regions outside of it in the left and right hemispheres. However, there is a lack of consensus as to how the neural resources engaged by language production and comprehension following a left hemisphere stroke differ from one another and from controls. The present meta-analysis used activation likelihood estimates to aggregate across 44 published fMRI and PET studies to characterize the functional reorganization patterns for expressive and receptive language processes in persons with chronic post-stroke aphasia (PWA). Our results in part replicate previous meta-analyses: we find that PWA activate residual regions within the left lateralized language network, regardless of task. Our results extend this work to show differential recruitment of the left and right hemispheres during language production and comprehension in PWA. First, we find that PWA engage left perilesional regions during language comprehension, and that the extent of this activation is likely driven by stimulus type and domain-general cognitive resources needed for task completion. In contrast to comprehension, language production was associated with activation of the right frontal and temporal cortices. Further analyses linked right hemisphere regions involved in motor speech planning for language production with successful naming in PWA, while unsuccessful naming was associated with the engagement of the right inferior frontal gyrus, a region often implicated in domain-general cognitive processes. While the within-group findings indicate that the engagement of the right hemisphere during language tasks in post-stroke aphasia differs for expressive vs. receptive tasks, the overall lack of major between-group differences between PWA and controls implies that PWA rely on similar cognitive-linguistic resources for language as controls. However, more studies are needed that report coordinates for PWA and controls completing the same tasks in order for future meta-analyses to characterize how aphasia affects the neural resources engaged during language, particularly for specific tasks and as a function of behavioral performance.
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Affiliation(s)
- Arianna N LaCroix
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Eltonnelle James
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Corianne Rogalsky
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
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Alyahya RSW, Halai AD, Conroy P, Lambon Ralph MA. Content Word Production during Discourse in Aphasia: Deficits in Word Quantity, Not Lexical-Semantic Complexity. J Cogn Neurosci 2021; 33:2494-2511. [PMID: 34407196 DOI: 10.1162/jocn_a_01772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although limited and reduced connected speech production is one, if not the most, prominent feature of aphasia, few studies have examined the properties of content words produced during discourse in aphasia, in comparison to the many investigations of single-word production. In this study, we used a distributional analysis approach to investigate the properties of content word production during discourse by 46 participants spanning a wide range of chronic poststroke aphasia and 20 neurotypical adults, using different stimuli that elicited three discourse genres (descriptive, narrative, and procedural). Initially, we inspected the discourse data with respect to the quantity of production, lexical-semantic diversity, and psycholinguistic features (frequency and imageability) of content words. Subsequently, we created a "lexical-semantic landscape," which is sensitive to subtle changes and allowed us to evaluate the pattern of changes in discourse production across groups. Relative to neurotypical adults, all persons with aphasia (both fluent and nonfluent) showed significant reduction in the quantity and diversity of production, but the lexical-semantic complexity of word production directly mirrored neurotypical performance. Specifically, persons with aphasia produced the same rate of nouns/verbs, and their discourse samples covered the full range of word frequency and imageability, albeit with reduced word quantity. These findings provide novel evidence that, unlike in other disorders (e.g., semantic dementia), discourse production in poststroke aphasia has relatively preserved lexical-semantic complexity but demonstrates significantly compromised quantity of content word production. Voxel-wise lesion-symptom mapping using both univariate and multivariate approaches revealed left frontal regions particularly the pars opercularis, insular cortex, and central and frontal opercular cortices supporting word retrieval during connected speech, irrespective of their word class or lexical-semantic complexity.
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Affiliation(s)
- Reem S W Alyahya
- University of Cambridge.,King Fahad Medical City, Riyadh, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
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24
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Sangtian S, Wang Y, Fridriksson J, Behroozmand R. Impairment of speech auditory feedback error detection and motor correction in post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106163. [PMID: 34768093 PMCID: PMC8627481 DOI: 10.1016/j.jcomdis.2021.106163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The present study investigated how damage to left-hemisphere brain networks affects the ability for speech auditory feedback error detection and motor correction in post-stroke aphasia. METHODS 34 individuals with left-hemisphere stroke and 25 neurologically intact age-matched control participants performed two randomized experimental tasks in which their online speech auditory feedback was altered using externally induced pitch-shift stimuli: 1) vocalization of a steady speech vowel sound /a/, and 2) listening to the playback of the same self-produced vowel vocalizations. Randomized control condition trials were interleaved in between vocalization and listening tasks where no pitch-shift stimuli were delivered. Following each trial, participants pressed a button to indicate whether they detected a pitch-shift error in their speech auditory feedback during vocalization and listening tasks. RESULTS Our data analysis revealed that speech auditory feedback error detection accuracy rate was significantly lower in the stroke compared with control participants, irrespective of the experimental task (i.e. vocalization vs. listening) and trial condition (i.e. pitch-shifted vs. no-pitch-shift). We found that this effect was associated with the reduced magnitude of speech compensation in the early phase of responses at 150-200 ms following the onset of pitch-shift stimuli in stroke participants. In addition, motor speech compensation deficit in the stroke group was correlated with lower scores on speech repetition tasks as an index of language impairment resulting from aphasia. CONCLUSIONS These findings provide evidence that left-hemisphere stroke is associated with impaired speech auditory feedback error processing, and such deficits account for specific aspects of language impairment in aphasia.
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Affiliation(s)
- Stacey Sangtian
- Speech Neuroscience Lab, Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America
| | - Yuan Wang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America
| | - Julius Fridriksson
- Aphasia Lab, Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, United States of America; Center for the Study of Aphasia Recovery (C-STAR), Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 915 Greene St., Columbia, SC 29208, United States of America
| | - Roozbeh Behroozmand
- Speech Neuroscience Lab, Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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25
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Effects of tDCS on Language Recovery in Post-Stroke Aphasia: A Pilot Study Investigating Clinical Parameters and White Matter Change with Diffusion Imaging. Brain Sci 2021; 11:brainsci11101277. [PMID: 34679342 PMCID: PMC8534035 DOI: 10.3390/brainsci11101277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: In this pilot study we investigated the effects of transcranial direct current stimulation (tDCS) on language recovery in the subacute stage of post-stroke aphasia using clinical parameters and diffusion imaging with constrained spherical deconvolution-based tractography. Methods: The study included 21 patients with subacute post-stroke aphasia. Patients were randomly classified into two groups with a ratio of 2:1 to receive real tDCS or sham tDCS as placebo control. Patients received 10 sessions (5/week) bi-hemispheric tDCS treatments over the left affected Broca's area (anodal electrode) and over the right unaffected Broca's area (cathodal stimulation). Aphasia score was assessed clinically using the language section of the Hemispheric Stroke Scale (HSS) before and after treatment sessions. Diffusion imaging and tractography were performed for seven patients of the real group, both before and after the 10th session. Dissection of language-related white matter tracts was achieved, and diffusion measures were extracted. A paired Student's t-test was used to compare the clinical recovery and diffusion measures of the dissected tracts both pre- and post- treatment. The partial correlation between changes in diffusion measures and the language improvements was calculated. Results: At baseline assessment, there were no significant differences between groups in demographic and clinical HSS language score. No significant clinical recovery in HSS was evident in the sham group. However, significant improvements in the different components of HSS were only observed in patients receiving real tDCS. Associated significant increase in the fractional anisotropy of the right uncinate fasciculus and a significant reduction in the mean diffusivity of the right frontal aslant tract were reported. A significant positive correlation was found between the changes in the right uncinate fasciculus and fluency improvement. Conclusions: Aphasia recovery after bi-hemispheric transcranial direct current stimulation was associated with contralesional right-sided white matter changes at the subacute stage. These changes probably reflect neuroplasticity that could contribute to the recovery. Both the right uncinate fasciculus and right frontal aslant tract seem to be involved in aphasia recovery.
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26
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Gajardo-Vidal A, Lorca-Puls DL, Team P, Warner H, Pshdary B, Crinion JT, Leff AP, Hope TMH, Geva S, Seghier ML, Green DW, Bowman H, Price CJ. Damage to Broca's area does not contribute to long-term speech production outcome after stroke. Brain 2021; 144:817-832. [PMID: 33517378 PMCID: PMC8041045 DOI: 10.1093/brain/awaa460] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023] Open
Abstract
Broca's area in the posterior half of the left inferior frontal gyrus has long been thought to be critical for speech production. The current view is that long-term speech production outcome in patients with Broca's area damage is best explained by the combination of damage to Broca's area and neighbouring regions including the underlying white matter, which was also damaged in Paul Broca's two historic cases. Here, we dissociate the effect of damage to Broca's area from the effect of damage to surrounding areas by studying long-term speech production outcome in 134 stroke survivors with relatively circumscribed left frontal lobe lesions that spared posterior speech production areas in lateral inferior parietal and superior temporal association cortices. Collectively, these patients had varying degrees of damage to one or more of nine atlas-based grey or white matter regions: Brodmann areas 44 and 45 (together known as Broca's area), ventral premotor cortex, primary motor cortex, insula, putamen, the anterior segment of the arcuate fasciculus, uncinate fasciculus and frontal aslant tract. Spoken picture description scores from the Comprehensive Aphasia Test were used as the outcome measure. Multiple regression analyses allowed us to tease apart the contribution of other variables influencing speech production abilities such as total lesion volume and time post-stroke. We found that, in our sample of patients with left frontal damage, long-term speech production impairments (lasting beyond 3 months post-stroke) were solely predicted by the degree of damage to white matter, directly above the insula, in the vicinity of the anterior part of the arcuate fasciculus, with no contribution from the degree of damage to Broca's area (as confirmed with Bayesian statistics). The effect of white matter damage cannot be explained by a disconnection of Broca's area, because speech production scores were worse after damage to the anterior arcuate fasciculus with relative sparing of Broca's area than after damage to Broca's area with relative sparing of the anterior arcuate fasciculus. Our findings provide evidence for three novel conclusions: (i) Broca's area damage does not contribute to long-term speech production outcome after left frontal lobe strokes; (ii) persistent speech production impairments after damage to the anterior arcuate fasciculus cannot be explained by a disconnection of Broca's area; and (iii) the prior association between persistent speech production impairments and Broca's area damage can be explained by co-occurring white matter damage, above the insula, in the vicinity of the anterior part of the arcuate fasciculus.
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Affiliation(s)
- Andrea Gajardo-Vidal
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK.,Faculty of Health Sciences, Universidad del Desarrollo, Concepcion, Chile
| | - Diego L Lorca-Puls
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK.,Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Ploras Team
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Holly Warner
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Bawan Pshdary
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, London, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Sharon Geva
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Mohamed L Seghier
- Cognitive Neuroimaging Unit, Emirates College for Advanced Education, Abu Dhabi, UAE.,Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, UAE
| | - David W Green
- Department of Experimental Psychology, University College London, London, UK
| | - Howard Bowman
- Centre for Cognitive Neuroscience and Cognitive Systems and the School of Computing, University of Kent, Canterbury, UK.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
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27
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Durfee AZ, Sheppard SM, Blake ML, Hillis AE. Lesion loci of impaired affective prosody: A systematic review of evidence from stroke. Brain Cogn 2021; 152:105759. [PMID: 34118500 PMCID: PMC8324538 DOI: 10.1016/j.bandc.2021.105759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
Affective prosody, or the changes in rate, rhythm, pitch, and loudness that convey emotion, has long been implicated as a function of the right hemisphere (RH), yet there is a dearth of literature identifying the specific neural regions associated with its processing. The current systematic review aimed to evaluate the evidence on affective prosody localization in the RH. One hundred and ninety articles from 1970 to February 2020 investigating affective prosody comprehension and production in patients with focal brain damage were identified via database searches. Eleven articles met inclusion criteria, passed quality reviews, and were analyzed for affective prosody localization. Acute, subacute, and chronic lesions demonstrated similar profile characteristics. Localized right antero-superior (i.e., dorsal stream) regions contributed to affective prosody production impairments, whereas damage to more postero-lateral (i.e., ventral stream) regions resulted in affective prosody comprehension deficits. This review provides support that distinct RH regions are vital for affective prosody comprehension and production, aligning with literature reporting RH activation for affective prosody processing in healthy adults as well. The impact of study design on resulting interpretations is discussed.
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Affiliation(s)
- Alexandra Zezinka Durfee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
| | - Shannon M Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Communication Sciences and Disorders, Chapman University Crean College of Health and Behavioral Sciences, Irvine, CA 92618, United States
| | - Margaret L Blake
- Department of Communication Sciences and Disorders, University of Houston College of Liberal Arts and Social Sciences, Houston, TX 77204, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, United States
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28
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Silva LL, Tuncer MS, Vajkoczy P, Picht T, Rosenstock T. Distinct approaches to language pathway tractography: comparison of anatomy-based, repetitive navigated transcranial magnetic stimulation (rTMS)-based, and rTMS-enhanced diffusion tensor imaging-fiber tracking. J Neurosurg 2021; 136:589-600. [PMID: 34330091 DOI: 10.3171/2020.12.jns204028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Visualization of subcortical language pathways by means of diffusion tensor imaging-fiber tracking (DTI-FT) is evolving as an important tool for surgical planning and decision making in patients with language-suspect brain tumors. Repetitive navigated transcranial magnetic stimulation (rTMS) cortical language mapping noninvasively provides additional functional information. Efforts to incorporate rTMS data into DTI-FT are promising, but the lack of established protocols makes it hard to assess clinical utility. The authors performed DTI-FT of important language pathways by using five distinct approaches in an effort to evaluate the respective clinical usefulness of each approach. METHODS Thirty patients with left-hemispheric perisylvian lesions underwent preoperative rTMS language mapping and DTI. FT of the principal language tracts was conducted according to different strategies: Ia, anatomical landmark based; Ib, lesion-focused landmark based; IIa, rTMS based; IIb, rTMS based with postprocessing; and III, rTMS enhanced (based on a combination of structural and functional data). The authors analyzed the respective success of each method in revealing streamlines and conducted a multinational survey with expert clinicians to evaluate aspects of clinical utility. RESULTS The authors observed high usefulness and accuracy ratings for anatomy-based approaches (Ia and Ib). Postprocessing of rTMS-based tractograms (IIb) led to more balanced perceived information content but did not improve the usefulness for surgical planning and risk assessment. Landmark-based tractography (Ia and Ib) was most successful in delineating major language tracts (98% success), whereas rTMS-based tractography (IIa and IIb) frequently failed to reveal streamlines and provided less complete tractograms than the landmark-based approach (p < 0.001). The lesion-focused landmark-based (Ib) and the rTMS-enhanced (III) approaches were the most preferred methods. CONCLUSIONS The lesion-focused landmark-based approach (Ib) achieved the best ratings and enabled visualization of the principal language tracts in almost all cases. The rTMS-enhanced approach (III) was positively evaluated by the experts because it can reveal cortico-subcortical connections, but the functional relevance of these connections is still unclear. The use of regions of interest derived solely from cortical rTMS mapping (IIa and IIb) leads to cluttered images that are of limited use in clinical practice.
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Affiliation(s)
- Luca L Silva
- Departments of1Neurosurgery and.,2Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | | | - Thomas Picht
- Departments of1Neurosurgery and.,3Cluster of Excellence: "Matters of Activity. Image Space Material"-Humboldt University, Berlin; and
| | - Tizian Rosenstock
- Departments of1Neurosurgery and.,4Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Germany
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29
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Sihvonen AJ, Ripollés P, Leo V, Saunavaara J, Parkkola R, Rodríguez-Fornells A, Soinila S, Särkämö T. Vocal music listening enhances post-stroke language network reorganization. eNeuro 2021; 8:ENEURO.0158-21.2021. [PMID: 34140351 PMCID: PMC8266215 DOI: 10.1523/eneuro.0158-21.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
Abstract
Listening to vocal music has been recently shown to improve language recovery in stroke survivors. The neuroplasticity mechanisms supporting this effect are, however, still unknown. Using data from a three-arm single-blind randomized controlled trial including acute stroke patients (N=38) and a 3-month follow-up, we set out to compare the neuroplasticity effects of daily listening to self-selected vocal music, instrumental music, and audiobooks on both brain activity and structural connectivity of the language network. Using deterministic tractography we show that the 3-month intervention induced an enhancement of the microstructural properties of the left frontal aslant tract (FAT) for the vocal music group as compared to the audiobook group. Importantly, this increase in the strength of the structural connectivity of the left FAT correlated with improved language skills. Analyses of stimulus-specific activation changes showed that the vocal music group exhibited increased activations in the frontal termination points of the left FAT during vocal music listening as compared to the audiobook group from acute to 3-month post-stroke stage. The increased activity correlated with the structural neuroplasticity changes in the left FAT. These results suggest that the beneficial effects of vocal music listening on post-stroke language recovery are underpinned by structural neuroplasticity changes within the language network and extend our understanding of music-based interventions in stroke rehabilitation.Significance statementPost-stroke language deficits have a devastating effect on patients and their families. Current treatments yield highly variable outcomes and the evidence for their long-term effects is limited. Patients often receive insufficient treatment that are predominantly given outside the optimal time window for brain plasticity. Post-stroke vocal music listening improves language outcome which is underpinned by neuroplasticity changes within the language network. Vocal music listening provides a complementary rehabilitation strategy which could be safely implemented in the early stages of stroke rehabilitation and seems to specifically target language symptoms and recovering language network.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
- Centre for Clinical Research, The University of Queensland, Australia
| | - Pablo Ripollés
- Department of Psychology, New York University, USA
- Music and Audio Research Laboratory, New York University, USA
- Center for Language Music and emotion, New York UniversityUSA
| | - Vera Leo
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital and University of Turku, Finland
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Education Psychology, University of Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Finland
| | - Seppo Soinila
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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30
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Burkhardt E, Kinoshita M, Herbet G. Functional anatomy of the frontal aslant tract and surgical perspectives. J Neurosurg Sci 2021; 65:566-580. [PMID: 33870673 DOI: 10.23736/s0390-5616.21.05344-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The frontal aslant tract (FAT) is an intralobar white matter fasciculus providing dense connections between the medial part of the superior frontal gyrus, in particular the pre-supplementary motor area (SMA) and the SMA proper, and the lateral part of the frontal lobe, especially the inferior frontal gyrus. Although this tract has been characterized belatedly, it has received important attention in recent years due notably to its increasingly evidenced role in the speech and language networks. As cerebral tumors frequently affect the frontal lobe, an improved knowledge of the functional anatomy of the FAT is mandatory to refine the way neurosurgeries are performed and to give the patients the best opportunities to recover after surgery. In this work, we first describe the spatial arrangement of the FAT and detail its cortical projections. We then provide a comprehensive review of the functions supposedly mediated by this transverse frontal connectivity. It is structured following a tripartite organization where the linguistic (i.e. speech and language), supralinguistic (i.e. functions that interact with speech and language: executive functions, working memory, and social communication) and extralinguistic implications (i.e. functions outside the linguistic domain: visuospatial processing, praxis and motor skills) are successively addressed. We lastly discussed this knowledge in the context of wide-awake neurosurgeries for brain tumors. We emphasize the need to evaluate thoroughly the functions conveyed by FAT by means of longitudinally-designed studies to first estimate its plasticity potential and then to determine which tasks should be selected to avoid lasting impairments due to its disconnective breakdown.
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Affiliation(s)
- Eléonor Burkhardt
- Praxiling, CNRS UMR 5267, Paul Valéry Montpellier 3 University, Montpellier, France
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Guillaume Herbet
- University of Montpellier, CNRS UMR5203, INSERM U1191, Institute of Functional Genomics, Montpellier, France - .,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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31
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Hybbinette H, Schalling E, Plantin J, Nygren-Deboussard C, Schütz M, Östberg P, Lindberg PG. Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke. Front Neurol 2021; 12:634065. [PMID: 33868144 PMCID: PMC8044583 DOI: 10.3389/fneur.2021.634065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.
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Affiliation(s)
- Helena Hybbinette
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Plantin
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Nygren-Deboussard
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika Schütz
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Per Östberg
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Påvel G. Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Institut de Psychiatrie et Neurosciences Paris, Inserm U1266, Université de Paris, Paris, France
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32
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Griffis JC, Metcalf NV, Corbetta M, Shulman GL. Lesion Quantification Toolkit: A MATLAB software tool for estimating grey matter damage and white matter disconnections in patients with focal brain lesions. Neuroimage Clin 2021; 30:102639. [PMID: 33813262 PMCID: PMC8053805 DOI: 10.1016/j.nicl.2021.102639] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022]
Abstract
Lesion studies are an important tool for cognitive neuroscientists and neurologists. However, while brain lesion studies have traditionally aimed to localize neurological symptoms to specific anatomical loci, a growing body of evidence indicates that neurological diseases such as stroke are best conceptualized as brain network disorders. While researchers in the fields of neuroscience and neurology are therefore increasingly interested in quantifying the effects of focal brain lesions on the white matter connections that form the brain's structural connectome, few dedicated tools exist to facilitate this endeavor. Here, we present the Lesion Quantification Toolkit, a publicly available MATLAB software package for quantifying the structural impacts of focal brain lesions. The Lesion Quantification Toolkit uses atlas-based approaches to estimate parcel-level grey matter lesion loads and multiple measures of white matter disconnection severity that include tract-level disconnection measures, voxel-wise disconnection maps, and parcel-wise disconnection matrices. The toolkit also estimates lesion-induced increases in the lengths of the shortest structural paths between parcel pairs, which provide information about changes in higher-order structural network topology. We describe in detail each of the different measures produced by the toolkit, discuss their applications and considerations relevant to their use, and perform example analyses using real behavioral data collected from sub-acute stroke patients. We show that analyses performed using the different measures produced by the toolkit produce results that are highly consistent with results that have been reported in the prior literature, and we demonstrate the consistency of results obtained from analyses conducted using the different disconnection measures produced by the toolkit. We anticipate that the Lesion Quantification Toolkit will empower researchers to address research questions that would be difficult or impossible to address using traditional lesion analyses alone, and ultimately, lead to advances in our understanding of how white matter disconnections contribute to the cognitive, behavioral, and physiological consequences of focal brain lesions.
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Affiliation(s)
- Joseph C Griffis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nicholas V Metcalf
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Maurizio Corbetta
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Bioengineering, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neuroscience, University of Padua, Padua, Italy; Padua Neuroscience Center, Padua, Italy
| | - Gordon L Shulman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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33
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La Corte E, Eldahaby D, Greco E, Aquino D, Bertolini G, Levi V, Ottenhausen M, Demichelis G, Romito LM, Acerbi F, Broggi M, Schiariti MP, Ferroli P, Bruzzone MG, Serrao G. The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications. Front Neurol 2021; 12:641586. [PMID: 33732210 PMCID: PMC7959833 DOI: 10.3389/fneur.2021.641586] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.
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Affiliation(s)
- Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniela Eldahaby
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Greco
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Malte Ottenhausen
- Department of Neurological Surgery, University Medical Center Mainz, Mainz, Germany
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Michele Romito
- Parkinson's Disease and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Graziano Serrao
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Zhang B, Chang J, Park J, Tan Z, Tang L, Lyu T, Han Y, Fan R, Gao Y, Kong J. Uncinate fasciculus and its cortical terminals in aphasia after subcortical stroke: A multi-modal MRI study. NEUROIMAGE-CLINICAL 2021; 30:102597. [PMID: 33684729 PMCID: PMC7941046 DOI: 10.1016/j.nicl.2021.102597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/29/2020] [Accepted: 02/11/2021] [Indexed: 10/27/2022]
Abstract
Aphasia, one of the most common cognitive impairments after stroke, is commonly considered to be a cortical deficit. However, many studies have reported cases of post subcortical stroke aphasia (PSSA). The pathology and recovery mechanism of PSSA remain unclear. This study aimed to investigate PSSA mechanism through a multimodal magnetic resonance imaging (MRI) approach and a two-session study design (baseline and one month after treatment). Thirty-six PSSA patients and twenty-four matched healthy controls (HC) were included. All patients had subcortical infarctions involving left subcortical white matter for 1 to 6 months. The patients underwent MRI scan and Western Aphasia Battery (WAB) examination before and after one month's comprehensive treatment. Region-wise lesion-symptom mapping (RLSM), tractography, fractional anisotropy (FA), and amplitude of low-frequency fluctuations (ALFF) analysis were conducted. After MRI preprocessing and exclusion, FA analysis included 35 patients pre-treatment and 16 patients post-treatment. ALFF analysis included 30 patients pre-treatment and 14 patients post-treatment. We found: 1) the amount of damage in the left uncinate fasciculus (UF) was associated with WAB aphasia quotient (AQ); 2) the left UF FA and left temporal pole (TP) ALFF were decreased and positively correlated with WAB-AQ, spontaneous speech, and naming in PSSA patients; and 3) PSSA patients showed increased left TP ALFF when their language ability recovered after treatment. The left TP ALFF change was positively correlated with AQ change. Our results demonstrate the importance of left UF and left TP (one of the cortical terminals of the left UF) in PSSA pathology and recovery. These results may further provide support for the disconnection theory in the mechanism of PSSA.
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Affiliation(s)
- Binlong Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the Peoples Republic of China, Beijing, China
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhongjian Tan
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lu Tang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianli Lyu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Han
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruiwen Fan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the Peoples Republic of China, Beijing, China.
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ingram RU, Halai AD, Pobric G, Sajjadi S, Patterson K, Lambon Ralph MA. Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia. Brain 2021; 143:3121-3135. [PMID: 32940648 PMCID: PMC7586084 DOI: 10.1093/brain/awaa245] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Language impairments caused by stroke (post-stroke aphasia, PSA) and neurodegeneration (primary progressive aphasia, PPA) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, PPA and PSA have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g. semantic variants) or have focused on a specific cognitive/linguistic task (e.g. reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency-related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intra- and intergroup variations on all four extracted components. Classification analysis was used to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e. within group homogeneity and distinct between-group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (i) a multidimensional rather than categorical classification system may be a better conceptualization of aphasia from both causes; and (ii) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.
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Affiliation(s)
- Ruth U Ingram
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Gorana Pobric
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Seyed Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, USA
| | - Karalyn Patterson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Alyahya RSW, Halai AD, Conroy P, Lambon Ralph MA. A unified model of post-stroke language deficits including discourse production and their neural correlates. Brain 2020; 143:1541-1554. [PMID: 32330940 PMCID: PMC7241958 DOI: 10.1093/brain/awaa074] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/14/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022] Open
Abstract
The clinical profiles of individuals with post-stroke aphasia demonstrate considerable variation in the presentation of symptoms. Recent aphasiological studies have attempted to account for this individual variability using a multivariate data-driven approach (principal component analysis) on an extensive neuropsychological and aphasiological battery, to identify fundamental domains of post-stroke aphasia. These domains mainly reflect phonology, semantics and fluency; however, these studies did not account for variability in response to different forms of connected speech, i.e. discourse genres. In the current study, we initially examined differences in the quantity, diversity and informativeness between three different discourse genres, including a simple descriptive genre and two naturalistic forms of connected speech (storytelling narrative, and procedural discourse). Subsequently, we provided the first quantitative investigation on the multidimensionality of connected speech production at both behavioural and neural levels. Connected speech samples across descriptive, narrative, and procedural discourse genres were collected from 46 patients with chronic post-stroke aphasia and 20 neurotypical adults. Content analyses conducted on all connected speech samples indicated that performance differed across discourse genres and between groups. Specifically, storytelling narratives provided higher quantities of content words and lexical diversity compared to composite picture description and procedural discourse. The analyses further revealed that, relative to neurotypical adults, patients with aphasia, both fluent and non-fluent, showed reduction in the quantity of verbal production, lexical diversity, and informativeness across all discourses. Given the differences across the discourses, we submitted the connected speech metrics to principal component analysis alongside an extensive neuropsychological/aphasiological battery that assesses a wide range of language and cognitive skills. In contrast to previous research, three unique orthogonal connected speech components were extracted in a unified model, reflecting verbal quantity, verbal quality, and motor speech, alongside four core language and cognitive components: phonological production, semantic processing, phonological recognition, and executive functions. Voxel-wise lesion-symptom mapping using these components provided evidence on the involvement of widespread cortical regions and their white matter connections. Specifically, left frontal regions and their underlying white matter tracts corresponding to the frontal aslant tract and the anterior segment of the arcuate fasciculus were particularly engaged with the quantity and quality of fluent connected speech production while controlling for other co-factors. The neural correlates associated with the other language domains align with existing models on the ventral and dorsal pathways for language processing.
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Affiliation(s)
- Reem S W Alyahya
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Paul Conroy
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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37
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Ahtam B, Waisbren SE, Anastasoaie V, Berry GT, Brown M, Petrides S, Afacan O, Prabhu SP, Schomer D, Grant PE, Greenstein PE. Identification of neuronal structures and pathways corresponding to clinical functioning in galactosemia. J Inherit Metab Dis 2020; 43:1205-1218. [PMID: 32592186 DOI: 10.1002/jimd.12279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022]
Abstract
Classic galactosemia (OMIM# 230400) is an autosomal recessive disorder due to galactose-1-phosphate uridyltransferase deficiency. Newborn screening and prompt treatment with a galactose-free diet prevent the severe consequences of galactosemia, but clinical outcomes remain suboptimal. Five men and five women with classic galactosemia (mean age = 27.2 ± 5.47 years) received comprehensive neurological and neuropsychological evaluations, electroencephalogram (EEG) and magnetic resonance imaging (MRI). MRI data from nine healthy controls (mean age = 30.22 ± 3.52 years) were used for comparison measures. Galactosemia subjects experienced impaired memory, language processing, visual-motor skills, and increased anxiety. Neurological examinations revealed tremor and dysarthria in six subjects. In addition, there was ataxia in three subjects and six subjects had abnormal gait. Mean full scale IQ was 80.4 ± 17.3. EEG evaluations revealed right-sided abnormalities in five subjects and bilateral abnormalities in one subject. Compared to age- and gender-matched controls, subjects with galactosemia had reduced volume in left cerebellum white matter, bilateral putamen, and left superior temporal sulcus. Galactosemia patients also had lower fractional anisotropy and higher radial diffusivity values in the dorsal and ventral language networks compared to the controls. Furthermore, there were significant correlations between neuropsychological test results and the T1 volume and diffusivity scalars. Our findings help to identify anatomic correlates to motor control, learning and memory, and language in subjects with galactosemia. The results from this preliminary assessment may provide insights into the pathophysiology of this inborn error of metabolism.
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Affiliation(s)
- Banu Ahtam
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan E Waisbren
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vera Anastasoaie
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gerard T Berry
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Brown
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephanie Petrides
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald Schomer
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patricia E Greenstein
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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38
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Mapping articulatory and grammatical subcomponents of fluency deficits in post-stroke aphasia. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 19:1286-1298. [PMID: 31240565 PMCID: PMC6786948 DOI: 10.3758/s13415-019-00729-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fluent speech production is a critical aspect of language processing and is central to aphasia diagnosis and treatment. Multiple cognitive processes and neural subsystems must be coordinated to produce fluent narrative speech. To refine the understanding of these systems, measures that minimize the influence of other cognitive processes were defined for articulatory deficits and grammatical deficits. Articulatory deficits were measured by the proportion of phonetic errors (articulatory and prosodic) in a word repetition task in 115 participants with aphasia following left hemisphere stroke. Grammatical deficits were assessed in 46 participants based on two measures-proportion of closed class words and proportion of words in sentences-generated during semistructured narrative speech production (telling the Cinderella story). These measures were used to identify brain regions critical for articulatory and grammatical aspects of speech production using a multivariate lesion-symptom mapping approach based on support vector regression. Phonetic error proportion was associated with damage to the postcentral gyrus and the inferior parietal lobule (particularly the supramarginal gyrus). Proportion of closed class words in narrative speech did not have consistent lesion correlates. Proportion of words in sentences was strongly associated with frontal lobe damage, particularly the inferior and middle frontal gyri. Grammatical sentence structuring relies on frontal regions, particularly the inferior and middle frontal gyri, whereas phonetic-articulatory planning and execution relies on parietal regions, particularly the postcentral and supramarginal gyri. These results clarify and extend current understanding of the functional components of the frontoparietal speech production system.
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Dragoy O, Zyryanov A, Bronov O, Gordeyeva E, Gronskaya N, Kryuchkova O, Klyuev E, Kopachev D, Medyanik I, Mishnyakova L, Pedyash N, Pronin I, Reutov A, Sitnikov A, Stupina E, Yashin K, Zhirnova V, Zuev A. Functional linguistic specificity of the left frontal aslant tract for spontaneous speech fluency: Evidence from intraoperative language mapping. BRAIN AND LANGUAGE 2020; 208:104836. [PMID: 32673898 DOI: 10.1016/j.bandl.2020.104836] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/22/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
The left frontal aslant tract (FAT) has been proposed to be relevant for language, and specifically for spontaneous speech fluency. However, there is missing causal evidence that stimulation of the FAT affects spontaneous speech, and not language production in general. We present a series of 12 neurosurgical cases with awake language mapping of the cortex near the left FAT. Tasks for language mapping included the commonly used action picture naming, and sentence completion, tapping more specifically into spontaneous speech. A task dissociation was found in 10 participants: while being stimulated on specific sites, they were able to name a picture but could not complete a sentence. Overlaying of these sites on preoperative white-matter tract reconstructions revealed that in each individual case they were located on cortical terminations of the FAT. This corroborates the language functional specificity of the left FAT as a tract underlying fluent spontaneous speech.
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Affiliation(s)
- Olga Dragoy
- Center for Language and Brain, National Research University Higher School of Economics, Moscow, Russia.
| | - Andrey Zyryanov
- Center for Language and Brain, National Research University Higher School of Economics, Moscow, Russia
| | - Oleg Bronov
- Department of Radiology, National Medical and Surgical Center Named after N. I. Pirogov, Moscow, Russia
| | - Elizaveta Gordeyeva
- Center for Language and Brain, National Research University Higher School of Economics, Moscow, Russia
| | - Natalya Gronskaya
- Faculty of Humanities, National Research University Higher School of Economics, Nizhny Novgorod, Russia
| | - Oksana Kryuchkova
- Department of Radiology, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, Moscow, Russia
| | - Evgenij Klyuev
- Department of Radiology, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Dmitry Kopachev
- Department of Neurosurgery, National Medical Research Center for Neurosurgery Named after N. N. Burdenko, Moscow, Russia
| | - Igor Medyanik
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Lidiya Mishnyakova
- Department of Neurosurgery, Federal Centre of Treatment and Rehabilitation of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Nikita Pedyash
- Department of Neurosurgery, National Medical and Surgical Center Named after N. I. Pirogov, Moscow, Russia
| | - Igor Pronin
- Department of Neuroradiology, National Medical Research Center for Neurosurgery Named after N. N. Burdenko, Moscow, Russia
| | - Andrey Reutov
- Department of Neurosurgery, Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, Moscow, Russia
| | - Andrey Sitnikov
- Department of Neurosurgery, Federal Centre of Treatment and Rehabilitation of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Ekaterina Stupina
- Center for Language and Brain, National Research University Higher School of Economics, Moscow, Russia
| | - Konstantin Yashin
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Valeriya Zhirnova
- Center for Language and Brain, National Research University Higher School of Economics, Moscow, Russia
| | - Andrey Zuev
- Department of Neurosurgery, National Medical and Surgical Center Named after N. I. Pirogov, Moscow, Russia
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40
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Chang EF, Kurteff G, Andrews JP, Briggs RG, Conner AK, Battiste JD, Sughrue ME. Pure Apraxia of Speech After Resection Based in the Posterior Middle Frontal Gyrus. Neurosurgery 2020; 87:E383-E389. [PMID: 32097489 PMCID: PMC7690655 DOI: 10.1093/neuros/nyaa002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 12/01/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Apraxia of speech is a disorder of articulatory coordination and planning in speech sound production. Its diagnosis is based on deficits in articulation, prosody, and fluency. It is often described concurrent with aphasia or dysarthria, while pure apraxia of speech is a rare entity. CLINICAL PRESENTATION A right-handed man underwent focal surgical resection of a recurrent grade III astrocytoma in the left hemisphere dorsal premotor cortex located in the posterior middle frontal gyrus. After the procedure, he experienced significant long-term speech production difficulties. A battery of standard and custom language and articulatory assessments were administered, revealing intact comprehension and naming abilities, and preserved strength in orofacial articulators, but considerable deficits in articulatory coordination, fluency, and prosody-consistent with diagnosis of pure apraxia of speech. Tractography and resection volumes compared with publicly available imaging data from the Human Connectome Project suggest possible overlap with area 55b, an under-recognized language area in the dorsal premotor cortex and has white matter connectivity with the superior longitudinal fasciculus. CONCLUSION The case reported here details a rare clinical entity, pure apraxia of speech resulting from resection of posterior middle frontal gyrus. While not a classical language area, emerging literature supports the role of this area in the production of fluent speech, and has implications for surgical planning and the general neurobiology of language.
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Affiliation(s)
- Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Garret Kurteff
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John P Andrews
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K Conner
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - James D Battiste
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Torres-Prioris MJ, López-Barroso D, Càmara E, Fittipaldi S, Sedeño L, Ibáñez A, Berthier ML, García AM. Neurocognitive signatures of phonemic sequencing in expert backward speakers. Sci Rep 2020; 10:10621. [PMID: 32606382 PMCID: PMC7326922 DOI: 10.1038/s41598-020-67551-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/10/2020] [Indexed: 11/09/2022] Open
Abstract
Despite its prolific growth, neurolinguistic research on phonemic sequencing has largely neglected the study of individuals with highly developed skills in this domain. To bridge this gap, we report multidimensional signatures of two experts in backward speech, that is, the capacity to produce utterances by reversing the order of phonemes while retaining their identity. Our approach included behavioral assessments of backward and forward speech alongside neuroimaging measures of voxel-based morphometry, diffusion tensor imaging, and resting-state functional connectivity. Relative to controls, both backward speakers exhibited behavioral advantages for reversing words and sentences of varying complexity, irrespective of working memory skills. These patterns were accompanied by increased grey matter volume, higher mean diffusivity, and enhanced functional connectivity along dorsal and ventral stream regions mediating phonological and other linguistic operations, with complementary support of areas subserving associative-visual and domain-general processes. Still, the specific loci of these neural patterns differed between both subjects, suggesting individual variability in the correlates of expert backward speech. Taken together, our results offer new vistas on the domain of phonemic sequencing, while illuminating neuroplastic patterns underlying extraordinary language abilities.
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Affiliation(s)
- María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Malaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Malaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Estela Càmara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sol Fittipaldi
- Universidad de San Andrés, Vito Dumas 284, B1644BID Victoria, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Lucas Sedeño
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Universidad de San Andrés, Vito Dumas 284, B1644BID Victoria, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Global Brain Health Institute, University of California, San Francisco, United States
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, Malaga, Spain
| | - Adolfo M García
- Universidad de San Andrés, Vito Dumas 284, B1644BID Victoria, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina. .,Global Brain Health Institute, University of California, San Francisco, United States. .,Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina. .,Departamento de Lingüística Y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile.
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42
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Zhao Y, Halai AD, Lambon Ralph MA. Evaluating the granularity and statistical structure of lesions and behaviour in post-stroke aphasia. Brain Commun 2020; 2:fcaa062. [PMID: 32954319 PMCID: PMC7472896 DOI: 10.1093/braincomms/fcaa062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/06/2023] Open
Abstract
The pursuit of relating the location of neural damage to the pattern of acquired language and general cognitive deficits post-stroke stems back to the 19th century behavioural neurology. While spatial specificity has improved dramatically over time, from the large areas of damage specified by post-mortem investigation to the millimetre precision of modern MRI, there is an underlying issue that is rarely addressed, which relates to the fact that damage to a given area of the brain is not random but constrained by the brain’s vasculature. Accordingly, the aim of this study was to uncover the statistical structure underlying the lesion profile in chronic aphasia post-stroke. By applying varimax-rotated principal component analysis to the lesions of 70 patients with chronic post-stroke aphasia, we identified 17 interpretable clusters, largely reflecting the vascular supply of middle cerebral artery sub-branches and other sources of individual variation in vascular supply as shown in classical angiography studies. This vascular parcellation produced smaller displacement error in simulated lesion–symptom analysis compared with individual voxels and Brodmann regions. A second principal component analysis of the patients’ detailed neuropsychological data revealed a four-factor solution reflecting phonological, semantic, executive-demand and speech fluency abilities. As a preliminary exploration, stepwise regression was used to relate behavioural factor scores to the lesion principal components. Phonological ability was related to two components, which covered the posterior temporal region including the posterior segment of the arcuate fasciculus, and the inferior frontal gyrus. Three components were linked to semantic ability and were located in the white matter underlying the anterior temporal lobe, the supramarginal gyrus and angular gyrus. Executive-demand related to two components covering the dorsal edge of the middle cerebral artery territory, while speech fluency was linked to two components that were located in the middle frontal gyrus, precentral gyrus and subcortical regions (putamen and thalamus). Future studies can explore in formal terms the utility of these principal component analysis-derived lesion components for relating post-stroke lesions and symptoms.
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Affiliation(s)
- Ying Zhao
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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43
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Meier EL, Johnson JP, Pan Y, Kiran S. The utility of lesion classification in predicting language and treatment outcomes in chronic stroke-induced aphasia. Brain Imaging Behav 2020; 13:1510-1525. [PMID: 31093842 DOI: 10.1007/s11682-019-00118-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Stroke recovery models can improve prognostication of therapy response in patients with chronic aphasia, yet quantifying the effect of lesion on recovery is challenging. This study aimed to evaluate the utility of lesion classification via gray matter (GM)-only versus combined GM plus white matter (WM) metrics and to determine structural measures associated with aphasia severity, naming skills, and treatment outcomes. Thirty-four patients with chronic aphasia due to left hemisphere infarct completed T1-weighted and DTI scans and language assessments prior to receiving a 12-week naming treatment. GM metrics included the amount of spared tissue within five cortical masks. WM integrity was indexed by spared tissue and fractional anisotropy (FA) from four homologous left and right association tracts. Clustering of GM-only and GM + WM metrics via k-medoids yielded four patient clusters that captured two lesion characteristics, size and location. Linear regression models revealed that both GM-only and GM + WM clustering predicted baseline aphasia severity and naming skills, but only GM + WM clustering predicted treatment outcomes. Spearman correlations revealed that without controlling for lesion volume, the majority of left hemisphere metrics were related to language measures. However, adjusting for lesion volume, no relationships with aphasia severity remained significant. FA from two ventral left WM tracts was related to naming and treatment success, independent of lesion size. In sum, lesion volume and GM metrics are sufficient predictors of overall aphasia severity in patients with chronic stroke, whereas diffusion metrics reflecting WM tract integrity may add predictive power to language recovery outcomes after rehabilitation.
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Affiliation(s)
- Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA. .,Neurology Department, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Phipps 546C, Baltimore, MD, 21287, USA.
| | - Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA.,Geriatric Research Education and Clinical Center, Audiology and Speech Pathology, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15260, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA.,Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 460 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA
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44
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Varriano F, Pascual-Diaz S, Prats-Galino A. Distinct Components in the Right Extended Frontal Aslant Tract Mediate Language and Working Memory Performance: A Tractography-Informed VBM Study. Front Neuroanat 2020; 14:21. [PMID: 32372922 PMCID: PMC7186483 DOI: 10.3389/fnana.2020.00021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/26/2020] [Indexed: 12/17/2022] Open
Abstract
The extended frontal aslant tract (exFAT) is a tractography-based extension of the frontal aslant tract (FAT) which has been shown to be related with language and working memory performance in healthy human adults, but whether those functional implications map to structurally separate regions along its trajectory is still an open question. We present a tractography-informed Voxel-Based Morphometry procedure capable of detecting local tract-specific structural differences in white matter regions and apply it in two maximum variation sampling studies by comparing local differences in diffusion-derived microstructural parameters and fiber density along the exFAT territory between top performers and bottom performers in language and working memory tasks. In the right hemisphere we were able to detect, without prior constraints, a vertical frontal aslant component approximating the original FAT trajectory whose fiber density was significantly correlated with language (but not working memory) performance and an anterior cluster component corresponding to a distinct anterior frontal aslant component whose fiber density was significantly correlated with working memory (but not language) performance. The reported sub-division of the exFAT territory describes a set of frontal connections that are compatible with previously reported results on the Broca’s territory and frontal cortex hierarchical organization along an anterior-posterior gradient, suggesting that the exFAT could be part of a common neuroanatomical scaffold where language and working memory functions are integrated in the healthy human brain.
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Affiliation(s)
- Federico Varriano
- Laboratory of Surgical Neuroanatomy, University of Barcelona, Barcelona, Spain
| | - Saül Pascual-Diaz
- Laboratory of Surgical Neuroanatomy, University of Barcelona, Barcelona, Spain
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45
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Halai AD, Woollams AM, Lambon Ralph MA. Investigating the effect of changing parameters when building prediction models for post-stroke aphasia. Nat Hum Behav 2020; 4:725-735. [PMID: 32313234 DOI: 10.1038/s41562-020-0854-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022]
Abstract
Neuroimaging has radically improved our understanding of how speech and language abilities map to the brain in normal and impaired participants, including the diverse, graded variations observed in post-stroke aphasia. A handful of studies have begun to explore the reverse inference: creating brain-to-behaviour prediction models. In this study, we explored the effect of three critical parameters on model performance: (1) brain partitions as predictive features, (2) combination of multimodal neuroimaging and (3) type of machine learning algorithms. We explored the influence of these factors while predicting four principal dimensions of language and cognition variation in post-stroke aphasia. Across all four behavioural dimensions, we consistently found that prediction models derived from diffusion-weighted data did not improve performance over models using structural measures extracted from T1 scans. Our results provide a set of principles to guide future work aiming to predict outcomes in neurological patients from brain imaging data.
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Affiliation(s)
- Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Anna M Woollams
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
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46
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Asymmetry of the frontal aslant tract is associated with lexical decision. Brain Struct Funct 2020; 225:1009-1017. [PMID: 32157449 DOI: 10.1007/s00429-020-02054-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
The frontal aslant tract (FAT) is a recently documented white matter tract that connects the inferior and superior frontal gyri with a tendency to be more pronounced in the left hemisphere. This tract has been found to play a role in language functions, particularly verbal fluency. However, it is not entirely clear to what extent FAT asymmetry is related to performance benefits in language-related tasks. In the present study, we aimed to fill this gap by examining the correlations between asymmetric micro- and macro-structural properties of the FAT and performance on verbal fluency and lexical decision tasks. The results showed no correlation between the FAT and verbal fluency; however, lexical decision was correlated with FAT laterality. Specifically, greater left lateralization in both micro- and macro-structural properties was related to faster lexical decision response times. The results were not due merely to motor or decision-making processes, as responses in a simple discrimination control task showed no correlation with laterality. These data are the first to suggest a role for the FAT in mediating processes underlying lexical decision.
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47
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Zyryanov A, Malyutina S, Dragoy O. Left frontal aslant tract and lexical selection: Evidence from frontal lobe lesions. Neuropsychologia 2020; 147:107385. [PMID: 32057935 DOI: 10.1016/j.neuropsychologia.2020.107385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/28/2019] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
The frontal aslant tract (FAT) is a white-matter tract connecting the inferior frontal gyrus (IFG) and the supplementary motor complex (SMC). Damage to either component of the network causes spontaneous speech dysfluency, indicating its critical role in language production. However, spontaneous speech dysfluency may stem from various lower-level linguistic deficits, precluding inferences about the nature of linguistic processing subserved by the IFG-SMC network. Since the IFG and the SMC are attributed a role in conceptual and lexical selection during language production, we hypothesized that these processes rely on the IFG-SMC connectivity via the FAT. We analysed the effects of FAT volume on conceptual and lexical selection measures following frontal lobe stroke. The measures were obtained from the sentence completion task, tapping into conceptual and lexical selection, and the picture-word interference task, providing a more specific measure of lexical selection. Lower FAT volume was not associated with lower conceptual or lexical selection abilities in our patient cohort. Current findings stand in marked discrepancy with previous lesion and neuroimaging evidence for the joint contribution of the IFG and the SMC to lexical and conceptual selection. A plausible explanation reconciling this discrepancy is that the IFG-SMC connectivity via the FAT does contribute to conceptual and/or lexical selection but its disrupted function undergoes reorganisation over the course of post-stroke recovery. Thus, our negative findings stress the importance of testing the causal role of the FAT in lexical and conceptual selection in patients with more acute frontal lobe lesions.
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Affiliation(s)
- Andrey Zyryanov
- Center for Language and Brain, National Research University Higher School of Economics, 21/4 Staraya Basmannaya St., Office 510, Moscow, 105066, Russia.
| | - Svetlana Malyutina
- Center for Language and Brain, National Research University Higher School of Economics, 21/4 Staraya Basmannaya St., Office 510, Moscow, 105066, Russia
| | - Olga Dragoy
- Center for Language and Brain, National Research University Higher School of Economics, 21/4 Staraya Basmannaya St., Office 510, Moscow, 105066, Russia; Department of Medical Rehabilitation, Federal Center for Cerebrovascular Pathology and Stroke, 1 Ostrovityanova St., 117997, Russia
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48
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Briggs RG, Conner AK, Rahimi M, Sali G, Baker CM, Burks JD, Glenn CA, Battiste JD, Sughrue ME. A Connectomic Atlas of the Human Cerebrum-Chapter 14: Tractographic Description of the Frontal Aslant Tract. Oper Neurosurg (Hagerstown) 2019; 15:S444-S449. [PMID: 30260440 DOI: 10.1093/ons/opy268] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/18/2018] [Indexed: 01/21/2023] Open
Abstract
In this supplement, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address the regions integrating to form the frontal aslant tract.
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Affiliation(s)
- Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Meherzad Rahimi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Goksel Sali
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Cordell M Baker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joshua D Burks
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - James D Battiste
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael E Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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49
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Altered structural brain connectivity involving the dorsal and ventral language pathways in 16p11.2 deletion syndrome. Brain Imaging Behav 2019; 13:430-445. [PMID: 29629500 DOI: 10.1007/s11682-018-9859-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Copy number variants at the chromosomal locus 16p11.2 contribute to neurodevelopmental disorders such as autism spectrum disorders, epilepsy, schizophrenia, and language and articulation disorders. Here, we provide detailed findings on the disrupted structural brain connectivity in 16p11.2 deletion syndrome (patients: N = 21, age range: 8-16 years; typically developing (TD) controls: 18, 9-16 years) using structural and diffusion MRI. We performed global short-, middle-, long-range, and interhemispheric connectivity analysis in the whole brain using gyral topology-based cortical parcellation. Using region of interest analysis, we studied bilateral dorsal (3 segments of arcuate fasciculus (AF)) and ventral (inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), uncinate fasciculus (UF)) language pathways. Our results showed significantly increased axial (AD) and radial (RD) diffusivities in bilateral anterior AF, decreased volume for left long AF, increased mean diffusivity (MD) and RD for right long AF, and increased AD for bilateral UF in the 16p11.2 deletion group in the absence of significant abnormalities in the whole-brain gyral and interhemispheric connectivity. The selective involvement of the language networks may aid in understanding effects of altered white matter connectivity on neurodevelopmental outcomes in 16p11.2 deletion.
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50
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Chenausky K, Paquette S, Norton A, Schlaug G. Apraxia of speech involves lesions of dorsal arcuate fasciculus and insula in patients with aphasia. Neurol Clin Pract 2019; 10:162-169. [PMID: 32309035 DOI: 10.1212/cpj.0000000000000699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/29/2019] [Indexed: 11/15/2022]
Abstract
Objective To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency. Methods In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performing conversational, how-to and picture-description tasks, word and sentence repetition, and diadochokinetic tasks were used to diagnose AOS using the Apraxia of Speech Rating Scale (ASRS). Anomia was quantified by patients' scores on the 30 even-numbered items from the Boston Naming Test (BNT). Results Together, ASRS and BNT scores accounted for 51.4% of the total variance in CIUs/min; the ASRS score accounted for the majority of that variance. The BNT score was associated with lesions in the left superior temporal gyrus, left inferior frontal gyrus, and large parts of the insula. The global ASRS score was associated with lesions in the left dorsal arcuate fasciculus (AF), pre- and post-central gyri, and both banks of the central sulcus of the insula. The ASRS score for the primary distinguishing features of AOS (no overlap with features of aphasia) was associated with less AF and more insular involvement. Only ∼27% of this apraxia-specific lesion overlapped with lesions associated with the BNT score. Lesions associated with AOS had minimal overlap with the frontal aslant tract (FAT) (<1%) or the extreme capsule fiber tract (1.4%). Finally, ASRS scores correlated significantly with damage to the insula but not to the AF, extreme capsule, or FAT. Conclusions Results are consistent with previous findings identifying lesions of the insula and AF in patients with AOS, damage to both of which may create dysfluency in patients with aphasia.
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Affiliation(s)
- Karen Chenausky
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Sébastien Paquette
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Andrea Norton
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Gottfried Schlaug
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
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