Mapping the intersection of language and reading: the neural bases of the primary systems hypothesis

Constraining current neuroanatomical models of reading: the view from Arabic

There is a growing interest in imaging understudied orthographies to unravel their neuronal correlates and their implications for existing computational and neuroanatomical models. Here, we review current brain mapping literature about Arabic words. We first offer a succinct description of some unique linguistic features of Arabic that challenge current cognitive models of reading. We then appraise the existing functional neuroimaging studies that investigated written Arabic word processing. Our review revealed that (1) Arabic is still understudied, (2) the most investigated features concerned the effects of vowelling and diglossia in Arabic reading, (3) findings were not always discussed in the light of existing reading models such as the dual route cascaded, the triangle, and the connectionist dual process models, and (4) current evidence is unreliable when it comes to the exact neuronal pathways that sustain Arabic word processing. Overall, despite the fact that Arabic has some unique linguistic features that challenge and ultimately enrich current reading models, the existing functional neuroimaging literature falls short of offering a reliable evidence about brain networks of Arabic reading. We conclude by highlighting the need for more systematic studies of the linguistic features of Arabic to build theoretical and neuroanatomical models that are concurrently specific and general.

Simultaneous simulations of pure, surface and phonological acquired dyslexia within a full computational model of the primary systems hypothesis

According to the primary systems hypothesis, reading requires interactions of visual-orthographic, phonological and semantic systems. Damage to each primary system generates very different types of acquired dyslexia. Variants of the connectionist 'triangle' models of reading have been developed to investigate individual acquired dyslexia. However, only a few studies have investigated multiple acquired alexia within one framework. Importantly, there are no studies that simultaneously simulate both central dyslexia (e.g. surface and phonological dyslexia) and peripheral dyslexia (e.g. pure alexia). That is largely due to the lack of a visual component in the traditional reading models. To verify the predictions made by the primary systems hypothesis, we developed a connectionist 'deep' multi-layer triangle model of reading including visual, orthographic, phonological and semantic processing layers. We investigated whether damage to the model could produce the general behavioural patterns of impaired performance observed in patients with the corresponding reading deficits. Crucially, damage to the visual-orthographic, phonological or semantic components of the model resulted in the expected reading impairments associated with pure alexia, phonological dyslexia and surface dyslexia, respectively. The simulation results demonstrated for the first time that neurologically-impaired reading including both central and peripheral dyslexia could be addressed within a single triangle model of reading. The findings are consistent with the predictions made by the primary systems hypothesis.

The relationship between semantics, phonology, and naming performance in aphasia: a structural equation modeling approach

The exploration of naming error patterns in aphasia provides insights into the cognitive processes underlying naming performance. We investigated how semantic and phonological abilities correlate and how they influence naming performance in aphasia. Data from 296 individuals with aphasia, drawn from the Moss Aphasia Psycholinguistics Project Database, were analyzed using a structural equation model. The model incorporated latent variables for semantics and phonology and manifest variables for naming accuracy and error patterns. There was a moderate positive correlation between semantics and phonology after controlling for overall aphasia severity. Both semantic and phonological abilities influenced naming accuracy. Semantic abilities negatively related to semantic, mixed, unrelated errors, and no responses. Interestingly, phonology positively affected semantic errors. Additionally, phonological abilities negatively related to each of phonological and neologism errors. These results highlight the role of semantic and phonological skills on naming performance in aphasia and reveal a relationship between these cognitive processes.

Using Monte-Carlo simulation to test predictions about the time-course of semantic and lexical access in reading

One of the main theoretical distinctions between reading models is how and when they predict semantic processing occurs. Some models assume semantic activation occurs after word-form is retrieved. Other models assume there is no-word form, and that what people think of as word-form is actually just semantics. These models thus predict semantic effects should occur early in reading. Results showing words with inconsistent spelling-sound correspondences are faster to read aloud if they are imageable/concrete compared to if they are abstract have been used as evidence supporting this prediction, although null-effects have also been reported. To investigate this, I used Monte-Carlo simulation to create a large set of simulated experiments from RTs taken from different databases. The results showed significant main effects of concreteness and spelling-sound consistency, as well as age-of-acquisition, a variable that can potentially confound the results. Alternatively, simulations showing a significant interaction between spelling-sound consistency and concreteness did not occur above chance, even without controlling for age-of-acquisition. These results support models that use lexical form. In addition, they suggest significant interactions from previous experiments may have occurred due to idiosyncratic items affecting the results and random noise causing the occasional statistical error.

Dissociating reading and auditory comprehension in persons with aphasia

Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.

Functional neuroanatomy of reading in Czech: Evidence of a dual-route processing architecture in a shallow orthography

Introduction

According to the strong version of the orthographic depth hypothesis, in languages with transparent letter-sound mappings (shallow orthographies) the reading of both familiar words and unfamiliar nonwords may be accomplished by a sublexical pathway that relies on serial grapheme-to-phoneme conversion. However, in languages such as English characterized by inconsistent letter-sound relationships (deep orthographies), word reading is mediated by a lexical-semantic pathway that relies on mappings between word-specific orthographic, semantic, and phonological representations, whereas the sublexical pathway is used primarily to read nonwords.

Methods

In this study, we used functional magnetic resonance imaging to elucidate neural substrates of reading in Czech, a language characterized by a shallo worthography. Specifically, we contrasted patterns of brain activation and connectivity during word and nonword reading to determine whether similar or different neural mechanisms are involved. Neural correlates were measured as differences in simple whole-brain voxel-wise activation, and differences in visual word form area (VWFA) task-related connectivity were computed on the group level from data of 24 young subject. Trial-to-trial reading reaction times were used as a measure of task difficulty, and these effects were subtracted from the activation and connectivity effects in order to eliminate difference in cognitive effort which is naturally higher for nonwords and may mask the true lexicality effects.

Results

We observed pattern of activity well described in the literature mostly derived from data of English speakers - nonword reading (as compared to word reading) activated the sublexical pathway to a greater extent whereas word reading was associated with greater activation of semantic networks. VWFA connectivity analysis also revealed stronger connectivity to a component of the sublexical pathway - left inferior frontal gyrus (IFG), for nonword compared to word reading.

Discussion

These converging results suggest that the brain mechanism of skilled reading in shallow orthography languages are similar to those engaged when reading in languages with a deep orthography and are supported by a universal dual-pathway neural architecture.

Common predictors of spoken and written language performance in aphasia, alexia, and agraphia

Language performance requires support from central cognitive/linguistic abilities as well as the more peripheral sensorimotor skills to plan and implement spoken and written communication. Both output modalities are vulnerable to impairment following damage to the language-dominant hemisphere, but much of the research to date has focused exclusively on spoken language. In this study we aimed to examine an integrated model of language processing that includes the common cognitive processes that support spoken and written language, as well as modality-specific skills. To do so, we evaluated spoken and written language performance from 87 individuals with acquired language impairment resulting from damage to left perisylvian cortical regions that collectively constitute the dorsal language pathway. Comprehensive behavioral assessment served to characterize the status of central and peripheral components of language processing in relation to neurotypical controls (n = 38). Performance data entered into principal components analyses (with or without control scores) consistently yielded a strong five-factor solution. In line with a primary systems framework, three central cognitive factors emerged: semantics, phonology, and orthography that were distinguished from peripheral processes supporting speech production and allographic skill for handwriting. The central phonology construct reflected performance on phonological awareness and manipulation tasks and showed the greatest deficit of all the derived factors. Importantly, this phonological construct was orthogonal to the speech production factor that reflected repetition of words/non-words. When entered into regression analyses, semantics and phonological skill were common predictors of language performance across spoken and written modalities. The speech production factor was also a strong, distinct predictor of spoken naming and oral reading, in contrast to allographic skills which only predicted written output. As expected, visual orthographic processing contributed more to written than spoken language tasks and reading/spelling performance was strongly reliant on phonological and semantic abilities. Despite the heterogeneity of this cohort regarding aphasia type and severity, the marked impairment of phonological skill was a unifying feature. These findings prompt greater attention to clinical assessment and potential treatment of underlying phonological skill in individuals with left perisylvian damage.

Semantic network activation facilitates oral word reading in chronic aphasia

People with aphasia often show partial impairments on a given task. This trial-to-trial variability offers a potential window into understanding how damaged language networks function. We test the hypothesis that successful word reading in participants with phonological system damage reflects semantic system recruitment. Residual semantic and phonological networks were defined with fMRI in 21 stroke participants with phonological damage using semantic- and rhyme-matching tasks. Participants performed an oral word reading task, and activation was compared between correct and incorrect trials within the semantic and phonological networks. The results showed a significant interaction between hemisphere, network activation, and reading success. Activation in the left hemisphere semantic network was higher when participants successfully read words. Residual phonological regions showed no difference in activation between correct and incorrect trials on the word reading task. The results provide evidence that semantic processing supports successful phonological retrieval in participants with phonological impairment.

Efficient and effective assessment of deficits and their neural bases in stroke aphasia

OBJECTIVE

Multi-assessment batteries are necessary for diagnosing and quantifying the multifaceted deficits observed post-stroke. Extensive batteries are thorough but impractically long for clinical settings or large-scale research studies. Clinically-targeted "shallow" batteries superficially cover a wide range of language skills relatively quickly but can struggle to identify mild deficits or quantify the impairment level. Our aim was to compare these batteries across a large group of chronic stroke aphasia and to test a novel data-driven reduced version of an extensive battery that maintained sensitivity to mild impairment, ability to grade deficits and the underlying component structure.

METHODS

We tested 75 chronic left-sided stroke participants, spanning global to mild aphasia. The underlying structure of these three batteries was analysed using cross-validation and principal component analysis, in addition to univariate and multivariate lesion-symptom mapping.

RESULTS

This revealed a four-factor solution for the extensive and data-reduced batteries, identifying phonology, semantic skills, fluency and executive function in contrast to a two-factor solution using the shallow battery (language severity and cognitive severity). Lesion symptom mapping using participants' factor scores identified convergent neural structures for phonology (superior temporal gyrus), semantics (inferior temporal gyrus), speech fluency (precentral gyrus) and executive function (lateral occipitotemporal cortex). The two shallow battery components converged with the phonology and executive function clusters. In addition, we show that multivariate models could predict the component scores using neural data, however not for every component.

CONCLUSIONS

Overall, the data-driven battery appears to be an effective way to save time yet retain maintained sensitivity to mild impairment, ability to grade deficits and the underlying component structure observed in post-stroke aphasia.

Language systems from lesion-symptom mapping in aphasia: A meta-analysis of voxel-based lesion mapping studies

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Meta-analysis of 2,007 individuals with aphasia from 25 voxel-based lesion mapping studies.

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Distinctive patterns of lesions in aphasia are associated with different language functions.

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The patterns of lesion in aphasia support the dual pathway model of language processing.

Background

Aphasia is one of the most common causes of post-stroke disabilities. As the symptoms and impact of post-stroke aphasia are heterogeneous, it is important to understand how topographical lesion heterogeneity in patients with aphasia is associated with different domains of language impairments. Here, we aim to provide a comprehensive overview of neuroanatomical basis in post-stroke aphasia through coordinate based meta-analysis of voxel-based lesion-symptom mapping studies.

Methods

We performed a meta-analysis of lesion-symptom mapping studies in post-stroke aphasia. We obtained coordinate-based structural neuroimaging data for 2,007 individuals with aphasia from 25 studies that met predefined inclusion criteria.

Results

Overall, our results revealed that the distinctive patterns of lesions in aphasia are associated with different language functions and tasks. Damage to the insular-motor areas impaired speech with preserved comprehension and a similar pattern was observed when the lesion covered the insular-motor and inferior parietal lobule. Lesions in the frontal area severely impaired speaking with relatively good comprehension. The repetition-selective deficits only arise from lesions involving the posterior superior temporal gyrus. Damage in the anterior-to-posterior temporal cortex was associated with semantic deficits.

Conclusion

The association patterns of lesion topography and specific language deficits provide key insights into the specific underlying language pathways. Our meta-analysis results strongly support the dual pathway model of language processing, capturing the link between the different symptom complexes of aphasias and the different underlying location of damage.

Acquired dyslexias following temporal lesions

The acquisition of reading by children is supported by deep changes in the brain systems devoted to vision and language. The left temporal lobe contributes critically to both systems, and lesions affecting it may therefore cause both peripheral vision-related and central language-related reading impairments. The diversity of peripheral dyslexias reflects the anatomical and functional division of the visual cortex into early visual regions, whose lesions have a limited impact on reading; ventral regions, whose lesions are mostly associated to Pure Alexia; and dorsal regions, whose lesions may yield spatial, neglect-related, and attentional dyslexias. Similarly, central alexias reflect the broad distinction, within language processes, between phonological and lexico-semantic components. Phonological and surface dyslexias roughly result from impairment of the former and the latter processes, respectively, while deep dyslexia may be seen as the association of both. In this chapter, we review such types of acquired dyslexias, their clinical features, pathophysiology, and anatomical correlates.

White matter disconnectivity fingerprints causally linked to dissociated forms of alexia

For over 150 years, the study of patients with acquired alexia has fueled research aimed at disentangling the neural system critical for reading. An unreached goal, however, relates to the determination of the fiber pathways that root the different visual and linguistic processes needed for accurate word reading. In a unique series of neurosurgical patients with a tumor close to the visual word form area, we combine direct electrostimulation and population-based streamline tractography to map the disconnectivity fingerprints characterizing dissociated forms of alexia. Comprehensive analyses of disconnectivity matrices establish similarities and dissimilarities in the disconnection patterns associated with pure, phonological and lexical-semantic alexia. While disconnections of the inferior longitudinal and posterior arcuate fasciculi are common to all alexia subtypes, disconnections of the long arcuate and vertical occipital fasciculi are specific to phonological and pure alexia, respectively. These findings provide a strong anatomical background for cognitive and neurocomputational models of reading.

Two types of phonological reading impairment in stroke aphasia

Alexia is common in the context of aphasia. It is widely agreed that damage to phonological and semantic systems not specific to reading causes co-morbid alexia and aphasia. Studies of alexia to date have only examined phonology and semantics as singular processes or axes of impairment, typically in the context of stereotyped alexia syndromes. However, phonology, in particular, is known to rely on subprocesses, including sensory-phonological processing, motor-phonological processing, and sensory-motor integration. Moreover, many people with stroke aphasia demonstrate mild or mixed patterns of reading impairment that do not fit neatly with one syndrome. This cross-sectional study tested whether the hallmark symptom of phonological reading impairment, the lexicality effect, emerges from damage to a specific subprocess of phonology in stroke patients not selected for alexia syndromes. Participants were 30 subjects with left-hemispheric stroke and 37 age- and education-matched controls. A logistic mixed-effects model tested whether post-stroke impairments in sensory phonology, motor phonology, or sensory-motor integration modulated the effect of item lexicality on patient accuracy in reading aloud. Support vector regression voxel-based lesion-symptom mapping localized brain regions necessary for reading and non-orthographic phonological processing. Additionally, a novel support vector regression structural connectome-symptom mapping method identified the contribution of both lesioned and spared but disconnected, brain regions to reading accuracy and non-orthographic phonological processing. Specifically, we derived whole-brain structural connectomes using constrained spherical deconvolution-based probabilistic tractography and identified lesioned connections based on comparisons between patients and controls. Logistic mixed-effects regression revealed that only greater motor-phonological impairment related to lower accuracy reading aloud pseudowords versus words. Impaired sensory-motor integration was related to lower overall accuracy in reading aloud. No relationship was identified between sensory-phonological impairment and reading accuracy. Voxel-based and structural connectome lesion-symptom mapping revealed that lesioned and disconnected left ventral precentral gyrus related to both greater motor-phonological impairment and lower sublexical reading accuracy. In contrast, lesioned and disconnected left temporoparietal cortex is related to both impaired sensory-motor integration and reduced overall reading accuracy. These results clarify that at least two dissociable phonological processes contribute to the pattern of reading impairment in aphasia. First, impaired sensory-motor integration, caused by lesions disrupting the left temporoparietal cortex and its structural connections, non-selectively reduces accuracy in reading aloud. Second, impaired motor-phonological processing, caused at least partially by lesions disrupting left ventral premotor cortex and structural connections, selectively reduces sublexical reading accuracy. These results motivate a revised cognitive model of reading aloud that incorporates a sensory-motor phonological circuit.

Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

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.

Investigating the effect of changing parameters when building prediction models for post-stroke aphasia

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.

A multi-path 2.5 dimensional convolutional neural network system for segmenting stroke lesions in brain MRI images

Automatic identification of brain lesions from magnetic resonance imaging (MRI) scans of stroke survivors would be a useful aid in patient diagnosis and treatment planning. It would also greatly facilitate the study of brain-behavior relationships by eliminating the laborious step of having a human expert manually segment the lesion on each brain scan. We propose a multi-modal multi-path convolutional neural network system for automating stroke lesion segmentation. Our system has nine end-to-end UNets that take as input 2-dimensional (2D) slices and examines all three planes with three different normalizations. Outputs from these nine total paths are concatenated into a 3D volume that is then passed to a 3D convolutional neural network to output a final lesion mask. We trained and tested our method on datasets from three sources: Medical College of Wisconsin (MCW), Kessler Foundation (KF), and the publicly available Anatomical Tracings of Lesions After Stroke (ATLAS) dataset. To promote wide applicability, lesions were included from both subacute (1 to 5 weeks) and chronic ( >  3 months) phases post stroke, and were of both hemorrhagic and ischemic etiology. Cross-study validation results (with independent training and validation datasets) were obtained to compare with previous methods based on naive Bayes, random forests, and three recently published convolutional neural networks. Model performance was quantified in terms of the Dice coefficient, a measure of spatial overlap between the model-identified lesion and the human expert-identified lesion, where 0 is no overlap and 1 is complete overlap. Training on the KF and MCW images and testing on the ATLAS images yielded a mean Dice coefficient of 0.54. This was reliably better than the next best previous model, UNet, at 0.47. Reversing the train and test datasets yields a mean Dice of 0.47 on KF and MCW images, whereas the next best UNet reaches 0.45. With all three datasets combined, the current system compared to previous methods also attained a reliably higher cross-validation accuracy. It also achieved high Dice values for many smaller lesions that existing methods have difficulty identifying. Overall, our system is a clear improvement over previous methods for automating stroke lesion segmentation, bringing us an important step closer to the inter-rater accuracy level of human experts.