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Ng S, Moritz-Gasser S, Lemaitre AL, Duffau H, Herbet G. Multivariate mapping of low-resilient neurocognitive systems within and around low-grade gliomas. Brain 2024; 147:2718-2731. [PMID: 38657204 DOI: 10.1093/brain/awae130] [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: 12/31/2023] [Revised: 03/18/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Accumulating evidence suggests that the brain exhibits a remarkable capacity for functional compensation in response to neurological damage, a resilience potential that is deeply rooted in the malleable features of its underlying anatomofunctional architecture. This propensity is particularly exemplified by diffuse low-grade glioma, a subtype of primary brain tumour. However, functional plasticity is not boundless, and surgical resections directed at structures with limited neuroplasticity can lead to incapacitating impairments. Yet, maximizing diffuse low-grade glioma resections offers substantial oncological benefits, especially when the resection extends beyond the tumour margins (i.e. supra-tumour or supratotal resection). In this context, the primary objective of this study was to identify which cerebral structures were associated with less favourable cognitive outcomes after surgery, while accounting for intra-tumour and supra-tumour features of the surgical resections. To achieve this objective, we leveraged a unique cohort of 400 patients with diffuse low-grade glioma who underwent surgery with awake cognitive mapping. Patients benefitted from a neuropsychological assessment consisting of 18 subtests administered before and 3 months after surgery. We analysed changes in performance and applied topography-focused and disconnection-focused multivariate lesion-symptom mapping using support vector regressions, in an attempt to capture resected cortico-subcortical structures less amenable to full cognitive compensation. The observed changes in performance were of a limited magnitude, suggesting an overall recovery (13 of 18 tasks recovered fully despite a mean resection extent of 92.4%). Nevertheless, lesion-symptom mapping analyses revealed that a lack of recovery in picture naming was linked to damage in the left inferior temporal gyrus and inferior longitudinal fasciculus. Likewise, for semantic fluency abilities, an association was established with damage to the left precuneus/posterior cingulate. For phonological fluency abilities, the left dorsomedial frontal cortex and the frontal aslant tract were implicated. Moreover, difficulties in spatial exploration were associated with injury to the right dorsomedial prefrontal cortex and its underlying connectivity. An exploratory analysis suggested that supra-tumour resections were associated with a less pronounced recovery following specific resection patterns, such as supra-tumour resections of the left uncinate fasciculus (picture naming), the left corticostriatal tract and the anterior corpus callosum (phonological fluency), the hippocampus and parahippocampus (episodic memory) and the right frontal-mesial areas (visuospatial exploration). Collectively, these patterns of results shed new light on both low-resilient neural systems and the prediction of cognitive recovery following glioma surgery. Furthermore, they indicate that supra-tumour resections were only occasionally less well tolerated from a cognitive viewpoint. In doing so, they have deep implications for surgical planning and rehabilitation strategies.
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Affiliation(s)
- Sam Ng
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Sylvie Moritz-Gasser
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Anne-Laure Lemaitre
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Laboratoire Praxiling, UMR 5267, CNRS, Université Paul Valéry-Montpellier 3, Bâtiment de recherche Marc Bloch, 34090 Montpellier, France
| | - Hugues Duffau
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, 34094 Montpellier, France
| | - Guillaume Herbet
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 34090 Montpellier, France
- Laboratoire Praxiling, UMR 5267, CNRS, Université Paul Valéry-Montpellier 3, Bâtiment de recherche Marc Bloch, 34090 Montpellier, France
- Faculté de médecine, campus ADV, Université de Montpellier, 34090 Montpellier, France
- Institut Universitaire de France, 75231 Paris CEDEX 05, France
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Garuma D, Lamba D, Abessa TG, Bonnechère B. Advancing public health: enabling culture-fair and education-independent automated cognitive assessment in low- and middle-income countries. Front Public Health 2024; 12:1377482. [PMID: 39005983 PMCID: PMC11239414 DOI: 10.3389/fpubh.2024.1377482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Desalegm Garuma
- Department of Psychology, College of Education and Behavorial Sciences, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dheeraj Lamba
- Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teklu Gemechu Abessa
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
- Centre of Expertise in Care Innovation, Department of PXL–Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Hong Y, Ryun S, Chung CK. Evoking artificial speech perception through invasive brain stimulation for brain-computer interfaces: current challenges and future perspectives. Front Neurosci 2024; 18:1428256. [PMID: 38988764 PMCID: PMC11234843 DOI: 10.3389/fnins.2024.1428256] [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: 05/06/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Encoding artificial perceptions through brain stimulation, especially that of higher cognitive functions such as speech perception, is one of the most formidable challenges in brain-computer interfaces (BCI). Brain stimulation has been used for functional mapping in clinical practices for the last 70 years to treat various disorders affecting the nervous system, including epilepsy, Parkinson's disease, essential tremors, and dystonia. Recently, direct electrical stimulation has been used to evoke various forms of perception in humans, ranging from sensorimotor, auditory, and visual to speech cognition. Successfully evoking and fine-tuning artificial perceptions could revolutionize communication for individuals with speech disorders and significantly enhance the capabilities of brain-computer interface technologies. However, despite the extensive literature on encoding various perceptions and the rising popularity of speech BCIs, inducing artificial speech perception is still largely unexplored, and its potential has yet to be determined. In this paper, we examine the various stimulation techniques used to evoke complex percepts and the target brain areas for the input of speech-like information. Finally, we discuss strategies to address the challenges of speech encoding and discuss the prospects of these approaches.
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Affiliation(s)
- Yirye Hong
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seokyun Ryun
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chun Kee Chung
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Thumbeck SM, Schmid P, Chesneau S, Domahs F. Efficacy of reading strategies on text-level reading comprehension in people with post-stroke chronic aphasia: A repeated measures study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1066-1089. [PMID: 37962246 DOI: 10.1111/1460-6984.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND People with aphasia (PWA) frequently experience difficulties in understanding longer written content such as paragraphs or books. Reading strategies are a promising approach to treat text-level reading comprehension deficits in PWA. Nevertheless, empirical evidence for their efficacy remains rare. AIMS The primary objective of this study was to analyse the efficacy of a strategy-based intervention on text-level reading comprehension in PWA. Secondary objectives were to compare the effects of two strategy-based intervention components and to explore potential moderator effects. METHODS & PROCEDURES A protocol was published prior to data acquisition. In a repeated measures trial, 26 German participants with chronic, post-stroke aphasia participated in a waiting period without aphasia treatment (control condition) followed by a strategy-based intervention called 'Strategiebasierte Textverständnis-Therapie bei Aphasie' (StraTexT, 14 face-to-face-sessions, twice per week, 60 min each). Two strategy combinations, Intervention Micro targeting microstructure and Intervention Macro targeting macrostructure, were applied to newspaper and magazine articles. Participants were randomly allocated to two parallel groups that received these strategy combinations in interchanged sequences. Assessments were implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure was text-level reading comprehension measured with the total score of a German version of the Test de Compréhension de Textes (TCT-D). Secondary outcome measures addressed the self-reported perception of reading abilities, reading activities and feelings about reading (German version of the Comprehensive Assessment of Reading in Aphasia CARA reading questionnaire) as well as selected cognitive functions. OUTCOMES & RESULTS The per-protocol-analysis included data from 22 participants. We found significant small improvements up to 6 months post-intervention compared to pre-intervention in the TCT-D Total (d = 0.35-0.46) as well as medium to large improvements in the CARA questionnaire (d = 0.68-0.96). Up to 3 months after the intervention, treatment-induced improvements in the TCT-D Total were significantly larger than change without treatment during the control condition. There was no evidence of moderator effects. Furthermore, we found improvements in several cognitive functions. CONCLUSIONS & IMPLICATIONS Reading strategies can lead to long-term improvements in text-level reading comprehension and in self-reported reading abilities, feelings about reading and reading activities in aphasia. In regular clinical settings, it seems reasonable to implement both Intervention Micro and Intervention Macro. It remains important to investigate participant characteristics that contribute to treatment success. WHAT THIS PAPER ADDS What is already known on the subject Systematic reviews and multiple case studies suggest that reading strategies are a promising approach to treat text-level reading comprehension in aphasia. The efficacy of reading strategies has been demonstrated for different populations. However, to date no group study has evaluated the efficacy of reading strategies on text-level reading comprehension in people with aphasia. What this study adds This study provides the first group-level evidence about the efficacy of a systematic strategy-based intervention in 22 people with post-stroke chronic aphasia. During 14 treatment sessions, participants applied four reading strategies to newspaper and magazine articles within two intervention components called Intervention Micro and Intervention Macro (two strategies per intervention component). We found improvements in text-level reading comprehension for at least 3 months post-intervention, as well as effects on selected cognitive functions and self-reported reading abilities, thoughts and feelings about reading and the ability to engage in reading activities. What are the clinical implications of this work? The strategies and materials evaluated in this study could be used in clinical practice with people with aphasia. In order to replicate treatment effects in clinical practice, we suggest applying the strategy combination with the same protocol features (e.g., frequency, duration, homework, product orientation) as in this study, implementing Intervention Micro and Intervention Macro sequentially in either order. As treatment response was not equal in all individuals, it seems important to investigate individual features that contribute to treatment success.
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Affiliation(s)
| | - Philipp Schmid
- Centre for Language Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Sophie Chesneau
- Département d'Orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Frank Domahs
- Department of Linguistics, University of Erfurt, Erfurt, Germany
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modelling disentangles language versus executive control disruption in stroke. Brain Commun 2024; 6:fcae129. [PMID: 38707712 PMCID: PMC11069117 DOI: 10.1093/braincomms/fcae129] [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: 10/17/2023] [Revised: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage can disrupt cognition, often with persisting deficits in language and executive capacities. Yet, despite their clinical relevance, the commonalities and differences between language versus executive control impairments remain under-specified. To fill this gap, we tailored a Bayesian hierarchical modelling solution in a largest-of-its-kind cohort (1080 patients with stroke) to deconvolve language and executive control with respect to the stroke topology. Cognitive function was assessed with a rich neuropsychological test battery including global cognitive function (tested with the Mini-Mental State Exam), language (assessed with a picture naming task), executive speech function (tested with verbal fluency tasks), executive control functions (Trail Making Test and Digit Symbol Coding Task), visuospatial functioning (Rey Complex Figure), as well as verbal learning and memory function (Soul Verbal Learning). Bayesian modelling predicted interindividual differences in eight cognitive outcome scores three months after stroke based on specific tissue lesion topologies. A multivariate factor analysis extracted four distinct cognitive factors that distinguish left- and right-hemispheric contributions to ischaemic tissue lesions. These factors were labelled according to the neuropsychological tests that had the strongest factor loadings: One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized mental flexibility, task switching and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two distinct factors that were labelled as executive speech functions and verbal memory. Impairments on both factors were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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Affiliation(s)
- Gesa Hartwigsen
- Wilhelm Wundt Institute for Psychology, Leipzig University, 04109 Leipzig, Germany
- Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Jakub Kopal
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
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6
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Kiss A, Csépe V. The role of cognitive control and naming in aphasia. Biol Futur 2024; 75:129-143. [PMID: 38421595 DOI: 10.1007/s42977-024-00212-8] [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: 06/06/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The classical aphasia literature has placed considerable emphasis on the language-centered understanding of aphasia and failed to consider the role of executive functions (EFs) regarding different aspects of patients' performance. Many current studies suggest deficits in EFs in individuals with aphasia, however, the available data is still limited. Here, our aim was to investigate the impairment of EFs and its potential negative effects on naming (slower performance, increased reaction time and/or decreased accuracy). We sought to determine whether the poor performance observed in word fluency task correlated with similar outcomes in naming. Our study involved five Hungarian post stroke aphasic patients (2 males and 3 females) between the ages of 60 and 70, as well as a control group matched for age and gender. The participants were diagnosed with different types of aphasia (global, Wernicke's, anomic and conduction). This study employed various neuropsychological and linguistic batteries. By comparing the patients' performance to that of the control group, we aimed to investigate the impacts of stroke. Within the aphasia group, we observed difficulties in following complex commands and a connection between general slowness and reduced accuracy in naming. We concluded that impairment of executive functions may have a negative impact on naming, comprehension, and fluency. Therefore, it is important to consider functional variations in neural networks, and to base our interpretations on the available psychophysiological data in literature. Our findings provide an alternative perspective to the traditional assessment of aphasia and highlight the importance of considering the role of executive functions.
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Affiliation(s)
- Annamária Kiss
- Multilingualism Doctoral School, University of Pannonia, Veszprém, Hungary
| | - Valéria Csépe
- Multilingualism Doctoral School, University of Pannonia, Veszprém, Hungary.
- RCNS Brain Imaging Center, Magyar Tudósok Krt. 2, Budapest, 1117, Hungary.
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7
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Hope TMH, Halai A, Crinion J, Castelli P, Price CJ, Bowman H. Principal component analysis-based latent-space dimensionality under-estimation, with uncorrelated latent variables. Brain 2024; 147:e14-e16. [PMID: 37831657 PMCID: PMC10834232 DOI: 10.1093/brain/awad355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, Institute of Neurology, University College London, London, WC1N 3AR, UK
- Department of Psychological and Social Sciences, John Cabot University, 00165 Rome, Italy
| | - Ajay Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Jenny Crinion
- Institute of Cognitive Science, Department of Experimental Psychology, University College London, London, WC1N 3AR, UK
| | - Paola Castelli
- Department of Psychological and Social Sciences, John Cabot University, 00165 Rome, Italy
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, Institute of Neurology, University College London, London, WC1N 3AR, UK
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
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8
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Dai Z, Song L, Luo C, Liu D, Li M, Han Z. Hemispheric lateralization of language processing: insights from network-based symptom mapping and patient subgroups. Cereb Cortex 2024; 34:bhad437. [PMID: 38031356 DOI: 10.1093/cercor/bhad437] [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: 02/26/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
The hemispheric laterality of language processing has become a hot topic in modern neuroscience. Although most previous studies have reported left-lateralized language processing, other studies found it to be bilateral. A previous neurocomputational model has proposed a unified framework to explain that the above discrepancy might be from healthy and patient individuals. This model posits an initial symmetry but imbalanced capacity in language processing for healthy individuals, with this imbalance contributing to language recovery disparities following different hemispheric injuries. The present study investigated this model by analyzing the lateralization patterns of language subnetworks across multiple attributes with a group of 99 patients (compared to nonlanguage processing) and examining the lateralization patterns of language subnetworks in subgroups with damage to different hemispheres. Subnetworks were identified using a whole-brain network-based lesion-symptom mapping method, and the lateralization index was quantitatively measured. We found that all the subnetworks in language processing were left-lateralized, while subnetworks in nonlanguage processing had different lateralization patterns. Moreover, diverse hemisphere-injury subgroups exhibited distinct language recovery effects. These findings provide robust support for the proposed neurocomputational model of language processing.
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Affiliation(s)
- Zhiyun Dai
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Luping Song
- Shenzhen Sixth People's Hospital (Nanshan Hospital), Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Chongjing Luo
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Di Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Mingyang Li
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou 310027, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
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Cao Y, Fan C, Li G, Huang J, Zhang J. A computer-aid speech rehabilitation system with mirrored video generating. Technol Health Care 2024; 32:543-553. [PMID: 38759075 PMCID: PMC11191434 DOI: 10.3233/thc-248047] [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] [Indexed: 05/19/2024]
Abstract
BACKGROUND Aphasia is a communication disorder that affects the ability to process and produce language, which severely impacting their lives. Computer-aid exercise rehabilitation has shown to be highly effective for these patients. OBJECTIVE In our study, we proposed a speech rehabilitation system with mirrored therapy. The study goal is to construct a effective rehabilitation software for aphasia patients. METHODS This system collects patients' facial photos for mirrored video generation and speech synthesis. The visual feedback provided by the mirror creates an engaging and motivating experience for patients. And the evaluation platform employs machine learning technologies for assessing speech similarity. RESULTS The sophisticated task-oriented rehabilitation training with mirror therapy is also presented for experiments performing. The performance of three tasks reaches the average scores of 83.9% for vowel exercises, 74.3% for word exercies and 77.8% for sentence training in real time. CONCLUSIONS The user-friendly application system allows patients to carry out daily training tasks instructed by the therapists or the prompt information of menu. Our work demonstrated a promising intelligent mirror software system for reading-based aphasia rehabilitation.
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Affiliation(s)
- Yang Cao
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Chunjiang Fan
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Gang Li
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jian Huang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jinli Zhang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
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10
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Pini L, Bisogno AL, Salvalaggio A, Shulman GL, Corbetta M. The correlation of behavioural deficits post-stroke: a trivial issue? Brain 2023; 146:e83-e85. [PMID: 37226212 DOI: 10.1093/brain/awad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Lorenzo Pini
- Padova Neuroscience Center, University of Padova, 35131 Padova, Italy
- Veneto Institute of Molecular Medicine, VIMM, 35129 Padova, Italy
| | | | - Alessandro Salvalaggio
- Padova Neuroscience Center, University of Padova, 35131 Padova, Italy
- Department of Neuroscience, University of Padova, 35131 Padova, Italy
| | - Gordon L Shulman
- Department of Neurology, Washington University in Saint Louis, St Louis, MO 63110, USA
- Department of Radiology, Washington University in Saint Louis, St Louis, MO 63110, USA
| | - Maurizio Corbetta
- Padova Neuroscience Center, University of Padova, 35131 Padova, Italy
- Veneto Institute of Molecular Medicine, VIMM, 35129 Padova, Italy
- Department of Neuroscience, University of Padova, 35131 Padova, Italy
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11
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Zhou W, Wang S, Yan M. Fixation-related fMRI analysis reveals the neural basis of natural reading of unspaced and spaced Chinese sentences. Cereb Cortex 2023; 33:10401-10410. [PMID: 37566912 DOI: 10.1093/cercor/bhad290] [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: 05/23/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023] Open
Abstract
Although there are many eye-movement studies focusing on natural sentence reading and functional magnetic resonance imaging research on reading with serial visual presentation paradigms, there is a scarcity of investigations into the neural mechanism of natural sentence reading. The present study recruited 33 adults to read unspaced and spaced Chinese sentences with the eye tracking and functional magnetic resonance imaging data recorded simultaneously. By using fixation-related functional magnetic resonance imaging analysis, this study showed that natural reading of Chinese sentences produced activations in ventral visual, dorsal attention, and semantic brain regions, which were modulated by the properties of words such as word length and word frequency. The multivoxel pattern analysis showed that the activity pattern in the left middle temporal gyrus could significantly predict the visual layout categories (i.e. unspaced vs. spaced conditions). Dynamic causal modeling analysis showed that there were bidirectional brain connections between the left middle temporal gyrus and the left inferior occipital cortex in the unspaced Chinese sentence reading but not in the spaced reading. These results provide a neural mechanism for the natural reading of Chinese sentences from the perspective of word segmentation.
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Affiliation(s)
- Wei Zhou
- Beijing Key Lab of Learning and Cognition, School of Psychology, Capital Normal University, Beijing 100048, China
- Chinese Institute for Brain Research, Beijing 102206, China
| | - Sile Wang
- Beijing Key Lab of Learning and Cognition, School of Psychology, Capital Normal University, Beijing 100048, China
- School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Ming Yan
- Department of Psychology and Center for Cognitive and Brain Sciences, University of Macau, Taipa, Macau
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12
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modeling disentangles language versus executive control disruption in stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.06.552147. [PMID: 37609325 PMCID: PMC10441359 DOI: 10.1101/2023.08.06.552147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage disrupts cognition, often with persisting deficits in language and executive capacities. Despite their clinical relevance, the commonalities, and differences of language versus executive control impairments remain under-specified. We tailored a Bayesian hierarchical modeling solution in a largest-of-its-kind cohort (1080 stroke patients) to deconvolve language and executive control in the brain substrates of stroke insults. Four cognitive factors distinguished left- and right-hemispheric contributions to ischemic tissue lesion. One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized control and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two factors: executive speech functions and verbal memory. Impairments on both were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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Onishi H, Yokosawa K. Differential working memory function between phonological and visuospatial strategies: a magnetoencephalography study using a same visual task. Front Hum Neurosci 2023; 17:1218437. [PMID: 37680265 PMCID: PMC10480614 DOI: 10.3389/fnhum.2023.1218437] [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: 05/07/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023] Open
Abstract
Previous studies have reported that, in working memory, the processing of visuospatial information and phonological information have different neural bases. However, in these studies, memory items were presented via different modalities. Therefore, the modality in which the memory items were presented and the strategy for memorizing them were not rigorously distinguished. In the present study, we explored the neural basis of two working memory strategies. Nineteen right-handed young adults memorized seven sequential directions presented visually in a task in which the memory strategy was either visuospatial or phonological (visuospatial/phonological condition). Source amplitudes of theta-band (5-7 Hz) rhythm were estimated from magnetoencephalography during the maintenance period and further analyzed using cluster-based permutation tests. Behavioral results revealed that the accuracy rates showed no significant differences between conditions, while the reaction time in the phonological condition was significantly longer than that in the visuospatial condition. Theta activity in the phonological condition was significantly greater than that in the visuospatial condition, and the cluster in spatio-temporal matrix with p < 5% difference extended to right prefrontal regions in the early maintenance period and right occipito-parietal regions in the late maintenance period. The theta activity results did not indicate strategy-specific neural bases but did reveal the dynamics of executive function required for phonological processing. The functions seemed to move from attention control and inhibition control in the prefrontal region to inhibition of irrelevant information in the occipito-parietal region.
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Affiliation(s)
- Hayate Onishi
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Koichi Yokosawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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14
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Zhou L, Jin Y, Wu D, Cun Y, Zhang C, Peng Y, Chen N, Yang X, Zhang S, Ning R, Kuang P, Wang Z, Zhang P. Current evidence, clinical applications, and future directions of transcranial magnetic stimulation as a treatment for ischemic stroke. Front Neurosci 2023; 17:1177283. [PMID: 37534033 PMCID: PMC10390744 DOI: 10.3389/fnins.2023.1177283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain neurostimulation technique that can be used as one of the adjunctive treatment techniques for neurological recovery after stroke. Animal studies have shown that TMS treatment of rats with middle cerebral artery occlusion (MCAO) model reduced cerebral infarct volume and improved neurological dysfunction in model rats. In addition, clinical case reports have also shown that TMS treatment has positive neuroprotective effects in stroke patients, improving a variety of post-stroke neurological deficits such as motor function, swallowing, cognitive function, speech function, central post-stroke pain, spasticity, and other post-stroke sequelae. However, even though numerous studies have shown a neuroprotective effect of TMS in stroke patients, its possible neuroprotective mechanism is not clear. Therefore, in this review, we describe the potential mechanisms of TMS to improve neurological function in terms of neurogenesis, angiogenesis, anti-inflammation, antioxidant, and anti-apoptosis, and provide insight into the current clinical application of TMS in multiple neurological dysfunctions in stroke. Finally, some of the current challenges faced by TMS are summarized and some suggestions for its future research directions are made.
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Affiliation(s)
- Li Zhou
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yaju Jin
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Danli Wu
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yongdan Cun
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Chengcai Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yicheng Peng
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Na Chen
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Xichen Yang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Simei Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Rong Ning
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Peng Kuang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Zuhong Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Pengyue Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
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15
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Smits AR, van Zandvoort MJE, Ramsey NF, de Haan EHF, Raemaekers M. Reliability and validity of DTI-based indirect disconnection measures. Neuroimage Clin 2023; 39:103470. [PMID: 37459698 PMCID: PMC10368919 DOI: 10.1016/j.nicl.2023.103470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
White matter connections enable the interaction within and between brain networks. Brain lesions can cause structural disconnections that disrupt networks and thereby cognitive functions supported by them. In recent years, novel methods have been developed to quantify the extent of structural disconnection after focal lesions, using tractography data from healthy controls. These methods, however, are indirect and their reliability and validity have yet to be fully established. In this study, we present our implementation of this approach, in a tool supplemented by uncertainty metrics for the predictions overall and at voxel-level. These metrics give an indication of the reliability and are used to compare predictions with direct measures from patients' diffusion tensor imaging (DTI) data in a sample of 95 first-ever stroke patients. Results show that, except for small lesions, the tool can predict fiber loss with high reliability and compares well to direct patient DTI estimates. Clinical utility of the method was demonstrated using lesion data from a subset of patients suffering from hemianopia. Both tract-based measures outperformed lesion localization in mapping visual field defects and showed a network consistent with the known anatomy of the visual system. This study offers an important contribution to the validation of structural disconnection mapping. We show that indirect measures of structural disconnection can be a reliable and valid substitute for direct estimations of fiber loss after focal lesions. Moreover, based on these results, we argue that indirect structural disconnection measures may even be preferable to lower-quality single subject diffusion MRI when based on high-quality healthy control datasets.
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Affiliation(s)
- A R Smits
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands; Department of Psychology, University of Amsterdam, the Netherlands.
| | - M J E van Zandvoort
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands
| | - N F Ramsey
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - E H F de Haan
- Department of Psychology, University of Amsterdam, the Netherlands; St. Hugh's College, Oxford University, United Kingdom
| | - M Raemaekers
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
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16
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Akkad H, Hope TMH, Howland C, Ondobaka S, Pappa K, Nardo D, Duncan J, Leff AP, Crinion J. Mapping spoken language and cognitive deficits in post-stroke aphasia. Neuroimage Clin 2023; 39:103452. [PMID: 37321143 PMCID: PMC10275719 DOI: 10.1016/j.nicl.2023.103452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
Aphasia is an acquired disorder caused by damage, most commonly due to stroke, to brain regions involved in speech and language. While language impairment is the defining symptom of aphasia, the co-occurrence of non-language cognitive deficits and their importance in predicting rehabilitation and recovery outcomes is well documented. However, people with aphasia (PWA) are rarely tested on higher-order cognitive functions, making it difficult for studies to associate these functions with a consistent lesion correlate. Broca's area is a particular brain region of interest that has long been implicated in speech and language production. Contrary to classic models of speech and language, cumulative evidence shows that Broca's area and surrounding regions in the left inferior frontal cortex (LIFC) are involved in, but not specific to, speech production. In this study we aimed to explore the brain-behaviour relationships between tests of cognitive skill and language abilities in thirty-six adults with long-term speech production deficits caused by post-stroke aphasia. Our findings suggest that non-linguistic cognitive functions, namely executive functions and verbal working memory, explain more of the behavioural variance in PWA than classical language models imply. Additionally, lesions to the LIFC, including Broca's area, were associated with non-linguistic executive (dys)function, suggesting that lesions to this area are associated with non-language-specific higher-order cognitive deficits in aphasia. Whether executive (dys)function - and its neural correlate in Broca's area - contributes directly to PWA's language production deficits or simply co-occurs with it, adding to communication difficulties, remains unclear. These findings support contemporary models of speech production that place language processing within the context of domain-general perception, action and conceptual knowledge. An understanding of the covariance between language and non-language deficits and their underlying neural correlates will inform better targeted aphasia treatment and outcomes.
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Affiliation(s)
- Haya Akkad
- Institute of Cognitive Neuroscience, University College London, UK.
| | - Thomas M H Hope
- Institute of Cognitive Neuroscience, University College London, UK; Wellcome Centre for Human Neuroimaging, University College London, UK
| | | | - Sasha Ondobaka
- Institute of Cognitive Neuroscience, University College London, UK
| | | | - Davide Nardo
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Education, University of Roma Tre, Italy
| | - John Duncan
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK; Department of Experimental Psychology, University of Oxford, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, UK; Wellcome Centre for Human Neuroimaging, University College London, UK; Institute of Neurology, University College London, UK
| | - Jenny Crinion
- Institute of Cognitive Neuroscience, University College London, UK; Wellcome Centre for Human Neuroimaging, University College London, UK
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17
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Zhang Q, Wei JH, Fu X, Liu X, Li XY, Liu W, Liu ZL, Duan XQ, Zheng B. Can we trust computers to assess the cognition of stroke patients? A systematic review. Front Neurol 2023; 14:1180664. [PMID: 37305744 PMCID: PMC10248476 DOI: 10.3389/fneur.2023.1180664] [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: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To summarize the classification of computerized cognitive assessment (CCA) tools for assessing stroke patients, to clarify their benefits and limitations, and to reveal strategies for future studies on CCA tools. Methods A literature review was performed using PubMed, Embase, Scopus, JAMA Network, Cochrane Library and PsycINFO databases from January 1st, 2010, to August 1st, 2022. Two authors independently screened the literature following the same criteria, evaluated the study quality, and collected data from the articles. Results A total of 8,697 papers were acquired from the six databases. A total of 74 potentially eligible articles were selected for review. Of these, 29 articles were not relevant to this research, 3 were reviews, 2 were not written in English, and 1 was on an ongoing trial. By screening the references of the reviews, 3 additional articles were included in this study. Thus, a total of 42 articles met the criteria for the review. In terms of the CCA tools analyzed in these studies, they included five types: virtual reality (VR)-based, robot-based, telephone-based, smartphone-based, and computer-based cognitive assessments. Patients' stages of the disease ranged from the subacute phase and rehabilitation phase to the community phase. A total of 27 studies supported the effectiveness of CCA tools, while 22 out of 42 articles mentioned their benefits and 32 revealed areas for future improvement of CCA tools. Conclusions Although the use of CCA tools for assessing the cognition of post-stroke patients is becoming popular, there are still some limitations and challenges of using such tools in stroke survivors. More evidence is thus needed to verify the value and specific role of these tools in assessing the cognitive impairment of stroke patients.
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Affiliation(s)
- Qi Zhang
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | | | - Xue Fu
- Changchun University of Chinese Medicine, Changchun, China
| | - Xin Liu
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xin-Yi Li
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Wei Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Xiao-Qin Duan
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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18
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Naranjo NP, Del Río D, Nieva S, Alted CG. Descriptive discourse in fluent aphasia: The predictive role of attention, phonology, lexical retrieval and semantics. JOURNAL OF COMMUNICATION DISORDERS 2023; 104:106335. [PMID: 37216892 DOI: 10.1016/j.jcomdis.2023.106335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
AIMS To study the relationship between cognitive and linguistic skills (as measured through standardized tasks) over spontaneous speech elicited during a picture description task. METHODS & PROCEDURES 21 controls and 19 people with fluent aphasia matched by age and sex were evaluated using transcripts made from a picture description task coded using the CHAT format and analyzed using Computerized Language Analysis (CLAN). Indices obtained from the speech samples contained measures of lexical quantity and diversity, morphosyntactic complexity, informativeness, and speech fluency, along with different kinds of speech errors. We studied their correlations with attentional measures from Conners' Continuous Performance Test and with standardized measures of naming, pseudoword repetition and semantic non-verbal association. We further used stepwise linear regression to analyze the predictive value of standardized linguistic and cognitive skills over discursive indices. OUTCOMES & RESULTS Contrary to our initial hypothesis, there were no significant correlations between attentional scores and discourse variables in aphasic participants. Moreover, semantic association, along with naming, was the measure more related with discourse performance in people with fluent aphasia, but cognitive and linguistic standardized measures had overall little predictive power on most discourse indices. In the control group, there was a certain association of naming skills and attentional reaction time with discourse variables, but their predictive power was also low. CONCLUSIONS & IMPLICATIONS The current results do not support a strong relationship between basic attentional skills and performance in descriptive discourse in fluent aphasia. Although some of the standardized tasks seem to bear some relationship with spontaneous speech, there is a high amount of interindividual variability in discourse that is not captured by classical cognitive tasks routinely used in assessment. Further work on the determinants of discourse performance in aphasia and on the clinical application of discourse analysis is warranted.
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Affiliation(s)
- Narcisa Pérez Naranjo
- Department of Experimental Psychology, Cognitive Processes and Speech and Language Therapy. Complutense University. Madrid, Spain.
| | - David Del Río
- Department of Experimental Psychology, Cognitive Processes and Speech and Language Therapy. Complutense University. Madrid, Spain; Centre for Cognitive and Computational Neuroscience. Complutense University. Madrid, Spain
| | - Silvia Nieva
- Department of Experimental Psychology, Cognitive Processes and Speech and Language Therapy. Complutense University. Madrid, Spain
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19
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Zhao Y, Cox CR, Lambon Ralph MA, Halai AD. Using in vivo functional and structural connectivity to predict chronic stroke aphasia deficits. Brain 2023; 146:1950-1962. [PMID: 36346107 PMCID: PMC10151190 DOI: 10.1093/brain/awac388] [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: 12/21/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Focal brain damage caused by stroke can result in aphasia and advances in cognitive neuroscience suggest that impairment may be associated with network-level disorder rather than just circumscribed cortical damage. Several studies have shown meaningful relationships between brain-behaviour using lesions; however, only a handful of studies have incorporated in vivo structural and functional connectivity. Patients with chronic post-stroke aphasia were assessed with structural (n = 68) and functional (n = 39) MRI to assess whether predicting performance can be improved with multiple modalities and if additional variance can be explained compared to lesion models alone. These neural measurements were used to construct models to predict four key language-cognitive factors: (i) phonology; (ii) semantics; (iii) executive function; and (iv) fluency. Our results showed that each factor (except executive ability) could be significantly related to each neural measurement alone; however, structural and functional connectivity models did not explain additional variance above the lesion models. We did find evidence that the structural and functional predictors may be linked to the core lesion sites. First, the predictive functional connectivity features were found to be located within functional resting-state networks identified in healthy controls, suggesting that the result might reflect functionally specific reorganization (damage to a node within a network can result in disruption to the entire network). Second, predictive structural connectivity features were located within core lesion sites, suggesting that multimodal information may be redundant in prediction modelling. In addition, we observed that the optimum sparsity within the regularized regression models differed for each behavioural component and across different imaging features, suggesting that future studies should consider optimizing hyperparameters related to sparsity per target. Together, the results indicate that the observed network-level disruption was predicted by the lesion alone and does not significantly improve model performance in predicting the profile of language impairment.
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Affiliation(s)
- Ying Zhao
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Christopher R Cox
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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20
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Andreou M, Peristeri E, Varlokosta S. Editorial: Executive functions and language processing in persons with aphasia. Front Psychol 2023; 14:1183870. [PMID: 37057167 PMCID: PMC10088508 DOI: 10.3389/fpsyg.2023.1183870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Maria Andreou
- Department of Speech and Language Therapy, University of Peloponnese, Kalamata, Greece
- *Correspondence: Maria Andreou
| | - Eleni Peristeri
- Department of Theoretical & Applied Linguistics, School of English, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridoula Varlokosta
- Department of Linguistics, Faculty of Philology, National and Kapodistrian University of Athens, Athens, Greece
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21
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Rader L, Thelen N, Fimm B. Validation of a Nonverbal Version of the Questionnaire of Experienced Attention Deficits (FEDA). ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2023. [DOI: 10.1024/1016-264x/a000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Abstract: Although objective attention deficits have been well established in aphasia patients, there is little evidence of subjective attention deficits since these are mostly assessed with rating scales and questionnaires that are often confounded by the language deficits of aphasic patients. To overcome this limitation, we developed a nonverbal version of the Questionnaire of Experienced Attention Deficits (FEDA) and assessed its preliminary reliability and validity in 70 healthy controls and 18 aphasia patients. An exploratory factor analysis revealed a two-factorial structure with good model fit in confirmatory factor analysis as well as good internal consistency (ω = .89) and discriminant validity. We consider the NFEDA to be a valuable diagnostic tool to assess subjective attention deficits in patients with language impairments such as aphasia.
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Affiliation(s)
- Lena Rader
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH Aachen, Germany
- Clinic for Neurology, Department of Neuropsychology, University Hospital RWTH Aachen, Germany
| | - Nadine Thelen
- Clinic for Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Germany
| | - Bruno Fimm
- Clinic for Neurology, Department of Neuropsychology, University Hospital RWTH Aachen, Germany
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Liu Y, Luo J, Fang J, Yin M, Cao J, Zhang S, Huang L, Cheng Q, Ai Y, Zheng H, Hu X. Screening diagnosis of executive dysfunction after ischemic stroke and the effects of transcranial magnetic stimulation: A prospective functional near-infrared spectroscopy study. CNS Neurosci Ther 2023; 29:1561-1570. [PMID: 36786133 PMCID: PMC10173709 DOI: 10.1111/cns.14118] [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: 08/12/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Post-ischemic stroke executive impairment (PISEI) is a serious obstacle for patients to returning to their society and is currently difficult to screen early and clinically ineffective. AIM The aim of the study was to clarify whether functional near-infrared spectroscopy (fNIRS) can be used as a rapid screening tool for PISEI and to explore the efficacy of transcranial magnetic stimulation (TMS) in PISEI patients and the changes in brain function. METHODS A single-blind, randomized controlled study design was used to detect hemodynamic differences by fNIIRS in 16 PISEI patients and 16 healthy subjects during the resting state and Stroop task, respectively. After 3 days, all subjects received a single TMS intervention and underwent simultaneous fNIRS testing for the Stroop task before and 3 days after the TMS intervention. RESULTS PISEI patients had significantly higher HbO2 content in the left dorsolateral prefrontal cortex (DLPFC), the right pre-motor cortex (PMC) and the right primary sensorimotor cortex (SM1) during the Stroop task compared to the resting state (F = 141.966, p < 0.001), but significantly lower than healthy subjects (T = -3.413, p = 0.002). After TMS intervention, PISEI patients' time and error number scores on the Stroop test were significantly enhanced, and the functional activity of the above-mentioned brain regions was significantly more active than at baseline, while the strength of their functional connections with each other was markedly increased. CONCLUSIONS fNIRS helped screen and diagnose PISEI. A single TMS session benefited PISEI patients with effects lasting 3 days, which may be attributed to activation of the left DLPFC, right PMC and right SM1 brain regions.
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Affiliation(s)
- Yuanwen Liu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Fang
- Department of Rehabilitation Medicine, Xiamen Humanity Rehabilitation Hospital, Xiamen, China
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Cao
- Department of Education, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuxian Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qilin Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Schumacher R, Halai AD, Lambon Ralph MA. Attention to attention in aphasia - elucidating impairment patterns, modality differences and neural correlates. Neuropsychologia 2022; 177:108413. [PMID: 36336090 PMCID: PMC7614452 DOI: 10.1016/j.neuropsychologia.2022.108413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
It is increasingly acknowledged that patients with aphasia following a left-hemisphere stroke often have difficulties in other cognitive domains. One of these domains is attention, the very fundamental ability to detect, select, and react to the abundance of stimuli present in the environment. Basic and more complex attentional functions are usually distinguished, and a variety of tests has been developed to assess attentional performance at a behavioural level. Attentional performance in aphasia has been investigated previously, but often only one specific task, stimulus modality, or type of measure was considered and usually only group-level analyses or data based on experimental tasks were presented. Also, information on brain-behaviour relationships for this cognitive domain and patient group is scarce. We report detailed analyses on a comprehensive dataset including patients' performance on various subtests of two well-known, standardised neuropsychological test batteries assessing attention. These tasks allowed us to explore: 1) how many patients show impaired performance in comparison to normative data, in which tasks and on what measure; 2) how the different tasks and measures relate to each other and to patients' language abilities; 3) the neural correlates associated with attentional performance. Up to 32 patients with varying aphasia severity were assessed with subtests from the Test of Attentional Performance (TAP) as well as the Test of Everyday Attention (TEA). Performance was compared to normative data, relationships between attention measures and other background data were explored with principal component analyses and correlations, and brain-behaviour relationships were assessed by means of voxel-based correlational methodology. Depending on the task and measure, between 3 and 53 percent of the patients showed impaired performance compared to normative data. The highest proportion of impaired performance was noted for complex attention tasks involving auditory stimuli. Patients differed in their patterns of performance and only the performance in the divided attention tests was (weakly) associated with their overall language impairment. Principal components analyses yielded four underlying factors, each being associated with distinct neural correlates. We thus extend previous research in characterizing different aspects of attentional performance within one sample of patients with chronic post stroke aphasia. Performance on a broad range of attention tasks and measures was variable and largely independent of patients' language abilities, which underlines the importance of assessing this cognitive domain in aphasic patients. Notably, a considerable proportion of patients showed difficulties with attention allocation to auditory stimuli. The reasons for these potentially modality-specific difficulties are currently not well understood and warrant additional investigations.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.
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24
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Caria A, Grecucci A. Neuroanatomical predictors of real‐time
fMRI
‐based anterior insula regulation. A supervised machine learning study. Psychophysiology 2022; 60:e14237. [PMID: 36523140 DOI: 10.1111/psyp.14237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/18/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Increasing evidence showed that learned control of metabolic activity in selected brain regions can support emotion regulation. Notably, a number of studies demonstrated that neurofeedback-based regulation of fMRI activity in several emotion-related areas leads to modifications of emotional behavior along with changes of neural activity in local and distributed networks, in both healthy individuals and individuals with emotional disorders. However, the current understanding of the neural mechanisms underlying self-regulation of the emotional brain, as well as their relationship with other emotion regulation strategies, is still limited. In this study, we attempted to delineate neuroanatomical regions mediating real-time fMRI-based emotion regulation by exploring whole brain GM and WM features predictive of self-regulation of anterior insula (AI) activity, a neuromodulation procedure that can successfully support emotional brain regulation in healthy individuals and patients. To this aim, we employed a multivariate kernel ridge regression model to assess brain volumetric features, at regional and network level, predictive of real-time fMRI-based AI regulation. Our results showed that several GM regions including fronto-occipital and medial temporal areas and the basal ganglia as well as WM regions including the fronto-occipital fasciculus, tapetum and fornix significantly predicted learned AI regulation. Remarkably, we observed a substantial contribution of the cerebellum in relation to both the most effective regulation run and average neurofeedback performance. Overall, our findings highlighted specific neurostructural features contributing to individual differences of AI-guided emotion regulation. Notably, such neuroanatomical topography partially overlaps with the neurofunctional network associated with cognitive emotion regulation strategies, suggesting common neural mechanisms.
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Affiliation(s)
- Andrea Caria
- Department of Psychology and Cognitive Science University of Trento Rovereto Italy
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Science University of Trento Rovereto Italy
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25
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Thompson HE, Noonan KA, Halai AD, Hoffman P, Stampacchia S, Hallam G, Rice GE, De Dios Perez B, Lambon Ralph MA, Jefferies E. Damage to temporoparietal cortex is sufficient for impaired semantic control. Cortex 2022; 156:71-85. [PMID: 36183573 DOI: 10.1016/j.cortex.2022.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 01/26/2023]
Abstract
Semantic control allows us to focus semantic activation on currently relevant aspects of knowledge, even in the face of competition or when the required information is weakly encoded. Diverse cortical regions, including left prefrontal and posterior temporal cortex, are implicated in semantic control, however; the relative contribution of these regions is unclear. For the first time, we compared semantic aphasia (SA) patients with damage restricted to temporoparietal cortex (TPC; N = 8) to patients with infarcts encompassing prefrontal cortex (PF+; N = 22), to determine if prefrontal lesions are necessary for semantic control deficits. These SA groups were also compared with semantic dementia (SD; N = 10), characterised by degraded semantic representations. We asked whether TPC cases with semantic impairment show controlled retrieval deficits equivalent to PF+ cases or conceptual degradation similar to patients with SD. Independent of lesion location, the SA subgroups showed similarities, whereas SD patients showed a qualitatively distinct semantic impairment. Relative to SD, both TPC and PF+ SA subgroups: (1) showed few correlations in performance across tasks with differing control demands, but a strong relationship between tasks of similar difficulty; (2) exhibited attenuated effects of lexical frequency and concept familiarity, (3) showed evidence of poor semantic regulation in their verbal output - performance on picture naming was substantially improved when provided with a phonological cue, and (4) showed effects of control demands, such as retrieval difficulty, which were equivalent in severity across TPC and PF+ groups. These findings show that semantic impairment in SA is underpinned by damage to a distributed semantic control network, instantiated across anterior and posterior cortical areas.
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Affiliation(s)
- Hannah E Thompson
- School of Psychology and Counselling, The Open University, Milton Keynes, UK.
| | - Krist A Noonan
- School of Social and Community Medicine, University of Bristol, UK
| | - Ajay D Halai
- MRC Cognition & Brain Sciences Unit, University of Cambridge, UK
| | - Paul Hoffman
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, UK
| | - Sara Stampacchia
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Psychology and York Neuroimaging Centre, University of York, UK
| | - Glyn Hallam
- School of Human and Health Sciences, University of Huddersfield, UK
| | - Grace E Rice
- MRC Cognition & Brain Sciences Unit, University of Cambridge, UK
| | - Blanca De Dios Perez
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK
| | | | - Elizabeth Jefferies
- Department of Psychology and York Neuroimaging Centre, University of York, UK
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26
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Yan Z, Xu S, Wei D, He X, Li C, Zhang Y, Chen M, Zhang J, Li X, Yang Q, Jia J. Comparison of three cognitive assessment methods in post-stroke aphasia patients. Front Psychol 2022; 13:896095. [PMID: 36337480 PMCID: PMC9631299 DOI: 10.3389/fpsyg.2022.896095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background The cognitive level of post-stroke aphasia (PSA) patients is generally lower than non-aphasia patients, and cognitive impairment (CI) affects the outcome of stroke. However, for different types of PSA, what kind of cognitive assessment methods to choose is not completely clear. We investigated the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Non-language-based Cognitive Assessment (NLCA) to observe the evaluation effect of CI in patients with fluent aphasia (FA) and non-fluent aphasia (NFA). Methods 92 stroke patients were included in this study. Demographic and clinical data of the stroke group were documented. The language and cognition were evaluated by Western Aphasia Battery (WAB), MoCA, MMSE, and NLCA. PSA were divided into FA and NFA according to the Chinese aphasia fluency characteristic scale. Pearson’s product–moment correlation coefficient test and multiple linear regression analysis were performed to explore the relationship between the sub-items of WAB and cognitive scores. The classification rate of CI was tested by Pearson’s Chi-square test or Fisher’s exact test. Results The scores of aphasia quotient (AQ), MoCA, MMSE, and NLCA in NFA were lower than FA. AQ was positively correlated with MoCA, MMSE, and NLCA scores. Stepwise multiple linear regression analysis suggested that naming explained 70.7% of variance of MoCA and 79.9% of variance of MMSE; comprehension explained 46.7% of variance of NLCA. In the same type of PSA, there was no significant difference in the classification rate. The classification rate of CI in NFA by MoCA and MMSE was higher than that in FA. There was no significant difference in the classification rate of CI between FA and NFA by NLCA. Conclusion MoCA, MMSE, and NLCA can be applied in FA. NLCA is recommended for NFA.
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Affiliation(s)
- Zhijie Yan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongshuai Wei
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinyuan He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongli Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengye Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingna Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaofang Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Qing Yang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Qing Yang,
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Jie Jia,
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27
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Hollinshead MG, Botchway A, Schmidt KE, Weybright GL, Zec RF, Ala TA, Kohlrus SR, Hoffman MR, Fifer AS, Hascup ER, Trivedi MA. Cognitive Component Structure of a Neuropsychological Battery Administered to Cognitively-Normal Adults in the SIU Longitudinal Cognitive Aging Study. Gerontol Geriatr Med 2022; 8:23337214221130157. [PMID: 36275411 PMCID: PMC9580077 DOI: 10.1177/23337214221130157] [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: 06/17/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
We used principal component analysis (PCA) to examine the component structure of a neuropsychological test battery administered to 943 cognitively-normal adults enrolled in the Southern Illinois University (SIU) Longitudinal Cognitive Aging Study (LCAS). Four components explaining the most variance (63.9%) in the dataset were identified: speed/cognitive flexibility, visuospatial skills, word-list learning/memory, and story memory. Regression analyses confirmed that increased age was associated with decreased component scores after controlling for gender and education. Our identified components differ slightly from previous studies using PCA on similar test batteries. Factors such as the demographic characteristics of the study sample, the inclusion of mixed patient and control samples, the inclusion of different test measures in previous studies, and the fact that many neuropsychological test measures assess multiple cognitive processes simultaneously, may help to explain these inconsistencies.
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Affiliation(s)
| | - Albert Botchway
- Southern Illinois University School of Medicine, Springfield, USA
| | | | | | - Ronald F. Zec
- Southern Illinois University School of Medicine, Springfield, USA
| | - Thomas A. Ala
- Southern Illinois University School of Medicine, Springfield, USA
| | | | | | - Amber S. Fifer
- Southern Illinois University School of Medicine, Springfield, USA
| | - Erin R. Hascup
- Southern Illinois University School of Medicine, Springfield, USA
| | - Mehul A. Trivedi
- Southern Illinois University School of Medicine, Springfield, USA,Mehul A. Trivedi, Department of Adult Psychiatry, Southern Illinois University School of Medicine, 319 East Madison Street, Springfield, IL 62702, USA.
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28
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Billot A, Thiebaut de Schotten M, Parrish TB, Thompson CK, Rapp B, Caplan D, Kiran S. Structural disconnections associated with language impairments in chronic post-stroke aphasia using disconnectome maps. Cortex 2022; 155:90-106. [PMID: 35985126 PMCID: PMC9623824 DOI: 10.1016/j.cortex.2022.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/14/2021] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
Inconsistent findings have been reported about the impact of structural disconnections on language function in post-stroke aphasia. This study investigated patterns of structural disconnections associated with chronic language impairments using disconnectome maps. Seventy-six individuals with post-stroke aphasia underwent a battery of language assessments and a structural MRI scan. Support-vector regression disconnectome-symptom mapping analyses were performed to examine the correlations between disconnectome maps, representing the probability of disconnection at each white matter voxel and different language scores. To further understand whether significant disconnections were primarily representing focal damage or a more extended network of seemingly preserved but disconnected areas beyond the lesion site, results were qualitatively compared to support-vector regression lesion-symptom mapping analyses. Part of the left white matter perisylvian network was similarly disconnected in 90% of the individuals with aphasia. Surrounding this common left perisylvian disconnectome, specific structural disconnections in the left fronto-temporo-parietal network were significantly associated with aphasia severity and with lower performance in auditory comprehension, syntactic comprehension, syntactic production, repetition and naming tasks. Auditory comprehension, repetition and syntactic processing deficits were related to disconnections in areas that overlapped with and extended beyond lesion sites significant in SVR-LSM analyses. In contrast, overall language abilities as measured by aphasia severity and naming seemed to be mostly explained by focal damage at the level of the insular and central opercular cortices, given the high overlap between SVR-DSM and SVR-LSM results for these scores. While focal damage seems to be sufficient to explain broad measures of language performance, the structural disconnections between language areas provide additional information on the neural basis of specific and persistent language impairments at the chronic stage beyond lesion volume. Leveraging routinely available clinical data, disconnectome mapping furthers our understanding of anatomical connectivity constraints that may limit the recovery of some language abilities in chronic post-stroke aphasia.
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Affiliation(s)
- Anne Billot
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA; School of Medicine, Boston University, Boston, MA, USA.
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - David Caplan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Swathi Kiran
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
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29
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Halai AD, De Dios Perez B, Stefaniak JD, Lambon Ralph MA. Efficient and effective assessment of deficits and their neural bases in stroke aphasia. Cortex 2022; 155:333-346. [PMID: 36087431 PMCID: PMC9548407 DOI: 10.1016/j.cortex.2022.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/17/2021] [Accepted: 07/20/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Ajay D Halai
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom.
| | - Blanca De Dios Perez
- Neuroscience and Aphasia Research Unit (NARU), School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - James D Stefaniak
- Neuroscience and Aphasia Research Unit (NARU), School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom.
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30
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Does Executive Function Training Impact on Communication? A Randomized Controlled tDCS Study on Post-Stroke Aphasia. Brain Sci 2022; 12:brainsci12091265. [PMID: 36139001 PMCID: PMC9497246 DOI: 10.3390/brainsci12091265] [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: 08/29/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia.
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31
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Jungblut M, Mais C, Binkofski FC, Schüppen A. The efficacy of a directed rhythmic-melodic voice training in the treatment of chronic non-fluent aphasia-Behavioral and imaging results. J Neurol 2022; 269:5070-5084. [PMID: 35604466 DOI: 10.1007/s00415-022-11163-2] [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: 11/28/2021] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
The main objective of this study was to investigate the efficacy of a directed rhythmic-melodic voice training (SIPARI) compared to language therapy with the focus on improvement in expressive linguistic performance. 20 patients suffering from chronic non-fluent aphasia, allocated by coin tossing to either of the groups, participated in 32 single therapy sessions over a period of 4 months. Before and after therapy, independent testers performed a standardized language test (Aachener Aphasie Test). Behavioral assessments revealed that improvements of patients of the experimental group were clinically significant compared to those of the control group. These improvements concerned the description level articulation and prosody for spontaneous speech and the subtests repetition, naming, and comprehension. Based on these improvements, a significant increase in profile level (effect size (ES) = 2.028, p < 0.001) was assessed, an overall and clinically relevant measure of the severity of aphasia. Additional fMRI examinations yielded activation in the left superior frontal gyrus for the post-minus pre- therapy assessments only for participants of the experimental group. Since this brain region is reported to be particularly involved in executive processing, we assume that the directed procedure of the SIPARI treatment with regard to musical, linguistic, and cognitive function potentially holds the key for successful language rehabilitation. While our imaging results hint at a possible explanation for its efficacy, our behavioral results corroborate the efficacy of this therapy in the treatment of chronic non-fluent aphasia patients. DRKS00026730, 19.10.21, retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026730.
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Affiliation(s)
- Monika Jungblut
- Interdisciplinary Institute for Music- and Speech-Therapy, Am Lipkamp 14, 47269, Duisburg, Germany.
| | - Christiane Mais
- Interdisciplinary Institute for Music- and Speech-Therapy, Am Lipkamp 14, 47269, Duisburg, Germany
- Aphasia Center North Rhine Westphalia, Essen, Germany
| | | | - André Schüppen
- Clinical Cognition Research, University Hospital Aachen, RWTH, Aachen, Germany
- Interdisciplinary Center for Clinical Research - Brain Imaging Facility, University Hospital, Aachen, Germany
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32
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Wei Y, Liang X, Guo X, Wang X, Qi Y, Ali R, Wu M, Qian R, Wang M, Qiu B, Li H, Fu X, Chen L. Brain hemispheres with right temporal lobe damage swap dominance in early auditory processing of lexical tones. Front Neurosci 2022; 16:909796. [PMID: 36090259 PMCID: PMC9459135 DOI: 10.3389/fnins.2022.909796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Labor division of the two brain hemispheres refers to the dominant processing of input information on one side of the brain. At an early stage, or a preattentive stage, the right brain hemisphere is shown to dominate the auditory processing of tones, including lexical tones. However, little is known about the influence of brain damage on the labor division of the brain hemispheres for the auditory processing of linguistic tones. Here, we demonstrate swapped dominance of brain hemispheres at the preattentive stage of auditory processing of Chinese lexical tones after a stroke in the right temporal lobe (RTL). In this study, we frequently presented lexical tones to a group of patients with a stroke in the RTL and infrequently varied the tones to create an auditory contrast. The contrast evoked a mismatch negativity response, which indexes auditory processing at the preattentive stage. In the participants with a stroke in the RTL, the mismatch negativity response was lateralized to the left side, in contrast to the right lateralization pattern in the control participants. The swapped dominance of brain hemispheres indicates that the RTL is a core area for early-stage auditory tonal processing. Our study indicates the necessity of rehabilitating tonal processing functions for tonal language speakers who suffer an RTL injury.
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Affiliation(s)
- Yarui Wei
- Biomedical Engineering Center, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiuyuan Liang
- Department of Neurobiology and Biophysics, School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Xiaotao Guo
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Xiaoxiao Wang
- Biomedical Engineering Center, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Yunyi Qi
- Department of Neurobiology and Biophysics, School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Rizwan Ali
- Biomedical Engineering Center, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Ming Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Ruobing Qian
- Department of Neurosurgery, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Ming Wang
- Department of Neurobiology and Biophysics, School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Bensheng Qiu
- Biomedical Engineering Center, School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Huawei Li
- Clinical Hearing Center, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xianming Fu
- Department of Neurosurgery, The First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Lin Chen
- Department of Neurobiology and Biophysics, School of Life Sciences, University of Science and Technology of China, Hefei, China
- Clinical Hearing Center, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China
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33
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Litwińczuk MC, Trujillo-Barreto N, Muhlert N, Cloutman L, Woollams A. Combination of structural and functional connectivity explains unique variation in specific domains of cognitive function. Neuroimage 2022; 262:119531. [PMID: 35931312 DOI: 10.1016/j.neuroimage.2022.119531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
The relationship between structural and functional brain networks has been characterised as complex: the two networks mirror each other and show mutual influence but they also diverge in their organisation. This work explored whether a combination of structural and functional connectivity can improve the fit of regression models of cognitive performance. Principal Component Analysis (PCA) was first applied to cognitive data from the Human Connectome Project to identify latent cognitive components: Executive Function, Self-regulation, Language, Encoding and Sequence Processing. A Principal Component Regression approach with embedded Step-Wise Regression (SWR-PCR) was then used to fit regression models of each cognitive domain based on structural (SC), functional (FC) or combined structural-functional (CC) connectivity. Executive Function was best explained by the CC model. Self-regulation was equally well explained by SC and FC. Language was equally well explained by CC and FC models. Encoding and Sequence Processing were best explained by SC. Evaluation of out-of-sample models' skill via cross-validation showed that SC, FC and CC produced generalisable models of Language performance. SC models performed most effectively at predicting Language performance in unseen sample. Executive Function was most effectively predicted by SC models, followed only by CC models. Self-regulation was only effectively predicted by CC models and Sequence Processing was only effectively predicted by FC models. The present study demonstrates that integrating structural and functional connectivity can help explaining cognitive performance, but that the added explanatory value (in sample) may be domain-specific and can come at the expense of reduced generalisation performance (out-of-sample).
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Affiliation(s)
| | | | - Nils Muhlert
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Lauren Cloutman
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Anna Woollams
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
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Meier EL, Kelly CR, Hillis AE. Dissociable language and executive control deficits and recovery in post-stroke aphasia: An exploratory observational and case series study. Neuropsychologia 2022; 172:108270. [PMID: 35597266 PMCID: PMC9728463 DOI: 10.1016/j.neuropsychologia.2022.108270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/30/2022] [Accepted: 05/13/2022] [Indexed: 01/04/2023]
Abstract
A growing body of evidence indicates many, but not all, individuals with post-stroke aphasia experience executive dysfunction. Relationships between language and executive function skills are often reported in the literature, but the degree of interdependence between these abilities remains largely unanswered. Therefore, in this study, we investigated the extent to which language and executive control deficits dissociated in 1) acute stroke and 2) longitudinal aphasia recovery. Twenty-three individuals admitted to Johns Hopkins Hospital with a new left hemisphere stroke completed the Western Aphasia Battery-Revised (WAB-R), several additional language measures (of naming, semantics, spontaneous speech, and oral reading), and three non-linguistic cognitive tasks from the NIH Toolbox (i.e., Pattern Comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sort Test). Two participants with aphasia (PWA) with temporoparietal lesions, one of whom (PWA1) had greater temporal but less frontal and superior parietal damage than the other (PWA2), also completed testing at subacute (three months post-onset) and early chronic (six months post-onset) time points. In aim 1, principal component analysis on the acute test data (excluding the WAB-R) revealed language and non-linguistic executive control tasks largely loaded onto separate components. Both components were significant predictors of acute aphasia severity per the WAB-R Aphasia Quotient (AQ). Crucially, executive dysfunction explained an additional 17% of the variance in AQ beyond the explanatory power of language impairments alone. In aim 2, both case patients exhibited language and executive control deficits at the acute post-stroke stage. A dissociation was observed in longitudinal recovery of these patients. By the early chronic time point, PWA1 exhibited improved (but persistent) deficits in several language domains and recovered executive control. In contrast, PWA2 demonstrated mostly recovered language but persistent executive dysfunction. Greater damage to language and attention networks in these respective patients may explain the observed behavioral patterns. These results demonstrate that language and executive control can dissociate (at least to a degree), but both contribute to early post-stroke presentation of aphasia and likely influence longitudinal aphasia recovery.
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Affiliation(s)
| | | | - Argye E Hillis
- Department of Neurology, USA; Physical Medicine and Rehabilitation, USA; Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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35
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Mapping correlated neurological deficits after stroke to distributed brain networks. Brain Struct Funct 2022; 227:3173-3187. [PMID: 35881254 DOI: 10.1007/s00429-022-02525-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
Abstract
Understanding the relationships between brain organization and behavior is a central goal of neuroscience. Traditional teaching emphasizes that the human cerebrum includes many distinct areas for which damage or dysfunction would lead to a unique and specific behavioral syndrome. This teaching implies that brain areas correspond to encapsulated modules that are specialized for specific cognitive operations. However, empirically, local damage from stroke more often produces one of a small number of clusters of deficits and disrupts brain-wide connectivity in a small number of predictable ways (relative to the vast complexity of behavior and brain connectivity). Behaviors that involve shared operations show correlated deficits following a stroke, consistent with a low-dimensional behavioral space. Because of the networked organization of the brain, local damage from a stroke can result in widespread functional abnormalities, matching the low dimensionality of behavioral deficit. In alignment with this, neurological disease, psychiatric disease, and altered brain states produce behavioral changes that are highly correlated across a range of behaviors. We discuss how known structural and functional network priors in addition to graph theoretical concepts such as modularity and entropy have provided inroads to understanding this more complex relationship between brain and behavior. This model for brain disease has important implications for normal brain-behavior relationships and the treatment of neurological and psychiatric diseases.
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36
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Skipper JI. A voice without a mouth no more: The neurobiology of language and consciousness. Neurosci Biobehav Rev 2022; 140:104772. [PMID: 35835286 DOI: 10.1016/j.neubiorev.2022.104772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
Most research on the neurobiology of language ignores consciousness and vice versa. Here, language, with an emphasis on inner speech, is hypothesised to generate and sustain self-awareness, i.e., higher-order consciousness. Converging evidence supporting this hypothesis is reviewed. To account for these findings, a 'HOLISTIC' model of neurobiology of language, inner speech, and consciousness is proposed. It involves a 'core' set of inner speech production regions that initiate the experience of feeling and hearing words. These take on affective qualities, deriving from activation of associated sensory, motor, and emotional representations, involving a largely unconscious dynamic 'periphery', distributed throughout the whole brain. Responding to those words forms the basis for sustained network activity, involving 'default mode' activation and prefrontal and thalamic/brainstem selection of contextually relevant responses. Evidence for the model is reviewed, supporting neuroimaging meta-analyses conducted, and comparisons with other theories of consciousness made. The HOLISTIC model constitutes a more parsimonious and complete account of the 'neural correlates of consciousness' that has implications for a mechanistic account of mental health and wellbeing.
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McCall J, van der Stelt CM, DeMarco A, Dickens JV, Dvorak E, Lacey E, Snider S, Friedman R, Turkeltaub P. Distinguishing semantic control and phonological control and their role in aphasic deficits: A task switching investigation. Neuropsychologia 2022; 173:108302. [PMID: 35718138 DOI: 10.1016/j.neuropsychologia.2022.108302] [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: 09/23/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
People use cognitive control across many contexts in daily life, yet it remains unclear how cognitive control is used in contexts involving language. Distinguishing language-specific cognitive control components may be critical to understanding aphasia, which can co-occur with cognitive control deficits. For example, deficits in control of semantic representations (i.e., semantic control), are thought to contribute to semantic deficits in aphasia. Conversely, little is known about control of phonological representations (i.e., phonological control) in aphasia. We developed a switching task to investigate semantic and phonological control in 32 left hemisphere stroke survivors with aphasia and 37 matched controls. We found that phonological and semantic control were related, but dissociate in the presence of switching demands. People with aphasia exhibited group-wise impairment at phonological control, although individual impairments were subtle except in one case. Several individuals with aphasia exhibited frank semantic control impairments, and these individuals had relative deficits on other semantic tasks. The present findings distinguish semantic control from phonological control, and confirm that semantic control impairments contribute to semantic deficits in aphasia.
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Affiliation(s)
- Joshua McCall
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA
| | - Candace M van der Stelt
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA
| | - Andrew DeMarco
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA; Rehabilitation Medicine Department, Georgetown University Medical Center, Washington, DC, USA
| | - J Vivian Dickens
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Dvorak
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Lacey
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Sarah Snider
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC, USA
| | - Rhonda Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC, USA
| | - Peter Turkeltaub
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC, USA; Rehabilitation Medicine Department, Georgetown University Medical Center, Washington, DC, USA; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA; Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC, USA.
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Stefaniak JD, Geranmayeh F, Lambon Ralph MA. The multidimensional nature of aphasia recovery post-stroke. Brain 2022; 145:1354-1367. [PMID: 35265968 PMCID: PMC9128817 DOI: 10.1093/brain/awab377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/20/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022] Open
Abstract
Language is not a single function, but instead results from interactions between neural representations and computations that can be damaged independently of each other. Although there is now clear evidence that the language profile in post-stroke aphasia reflects graded variations along multiple underlying dimensions ('components'), it is still entirely unknown if these distinct language components have different recovery trajectories and rely on the same, or different, neural regions during aphasia recovery. Accordingly, this study examined whether language components in the subacute stage: (i) mirror those observed in the chronic stage; (ii) recover together in a homogeneous manner; and (iii) have recovery trajectories that relate to changing activation in distinct or overlapping underlying brain regions. We analysed longitudinal data from 26 individuals with mild-moderate aphasia following left hemispheric infarct who underwent functional MRI and behavioural testing at ∼2 weeks and ∼4 months post-stroke. The language profiles in early post-stroke aphasia reflected three orthogonal principal components consisting of fluency, semantic/executive function and phonology. These components did not recover in a singular, homogeneous manner; rather, their longitudinal trajectories were uncorrelated, suggesting that aphasia recovery is heterogeneous and multidimensional. Mean regional brain activation during overt speech production in unlesioned areas was compared with patient scores on the three principal components of language at both the early and late time points. In addition, the change in brain activation over time was compared with the change on each of the principal component scores, both before and after controlling for baseline scores. We found that different language components were associated with changing activation in multiple, non-overlapping bilateral brain regions during aphasia recovery. Specifically, fluency recovery was associated with increasing activation in bilateral middle frontal gyri and right temporo-occipital middle temporal gyrus; semantic/executive recovery was associated with reducing activation in bilateral anterior temporal lobes; while phonology recovery was associated with reducing activation in bilateral precentral gyri, dorso-medial frontal poles and the precuneus. Overlapping clusters in the ventromedial prefrontal cortex were positively associated with fluency recovery but negatively associated with semantic/executive and phonology recovery. This combination of detailed behavioural and functional MRI data provides novel insights into the neural basis of aphasia recovery. Because different aspects of language seem to rely on different neural regions for recovery, treatment strategies that target the same neural region in all stroke survivors with aphasia might be entirely ineffective or even impair recovery, depending on the specific language profile of each individual patient.
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Affiliation(s)
- James D Stefaniak
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9GB, UK
| | - Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
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Steiner L, Federspiel A, Slavova N, Wiest R, Grunt S, Steinlin M, Everts R. Cognitive outcome is related to functional thalamo-cortical connectivity after pediatric stroke. Brain Commun 2022; 4:fcac110. [PMID: 35611308 PMCID: PMC9122536 DOI: 10.1093/braincomms/fcac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
The thalamus has complex connections with the cortex and is involved in various cognitive processes. Despite increasing interest in the thalamus and the underlying thalamo-cortical interaction, little is known about thalamo-cortical connections after pediatric arterial ischemic stroke. Therefore, the aim of this study was to investigate thalamo-cortical connections and their association with cognitive performance after arterial ischemic stroke.
Twenty patients in the chronic phase after pediatric arterial ischemic stroke (≥ 2 years after diagnosis, diagnosed <16 years; aged 5–23 years, mean 15.1 years) and twenty healthy controls matched for age and sex were examined in a cross-sectional study design. Cognitive performance (selective attention, inhibition, working memory, and cognitive flexibility) was evaluated using standardized neuropsychological tests. Resting-state functional magnetic resonance imaging was used to examine functional thalamo-cortical connectivity. Lesion masks were integrated in the preprocessing pipeline to ensure that structurally damaged voxels did not influence functional connectivity analyses.
Cognitive performance (selective attention, inhibition and working memory) was significantly reduced in patients compared to controls. Network analyses revealed significantly lower thalamo-cortical connectivity for the motor, auditory, visual, default mode network, salience, left/right executive and dorsal attention network in patients compared to controls. Interestingly, analyses revealed as well higher thalamo-cortical connectivity in some subdivisions of the thalamus for the default mode network (medial nuclei), motor (lateral nuclei), dorsal attention (anterior nuclei), and the left executive network (posterior nuclei) in patients compared to controls. Increased and decreased thalamo-cortical connectivity strength within the same networks was, however, found in different thalamic sub-divisions. Thus, alterations in thalamo-cortical connectivity strength after pediatric stroke seem to point in both directions, with stronger as well as weaker thalamo-cortical connectivity in patients compared to controls. Multivariate linear regression, with lesion size and age as covariates, revealed significant correlations between cognitive performance (selective attention, inhibition, and working memory) and the strength of thalamo-cortical connectivity in the motor, auditory, visual, default mode network, posterior default mode network, salience, left/right executive, and dorsal attention network after childhood stroke.
Our data suggest that the interaction between different sub-nuclei of the thalamus and several cortical networks relates to post-stroke cognition. The variability in cognitive outcomes after pediatric stroke might partly be explained by functional thalamo-cortical connectivity strength.
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Affiliation(s)
- Leonie Steiner
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Psychiatric Neuroimaging Unit, Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Pediatric Radiology, University Children's Hospital Basel and University of Basel, Basel, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sebastian Grunt
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Regula Everts
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Schumacher R, Halai AD, Lambon Ralph MA. Assessing executive functions in post-stroke aphasia-utility of verbally based tests. Brain Commun 2022; 4:fcac107. [PMID: 35602650 PMCID: PMC9118101 DOI: 10.1093/braincomms/fcac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
It is increasingly acknowledged that, often, patients with post-stroke aphasia not only have language impairments but also deficits in other cognitive domains (e.g. executive functions) that influence recovery and response to therapy. Many assessments of executive functions are verbally based and therefore usually not administered in this patient group. However, the performance of patients with aphasia in such tests might provide valuable insights both from a theoretical and clinical perspective. We aimed to elucidate (i) if verbal executive tests measure anything beyond the language impairment in patients with chronic post-stroke aphasia, (ii) how performance in such tests relates to performance in language tests and nonverbal cognitive functions, and (iii) the neural correlates associated with performance in verbal executive tests. In this observational study, three commonly used verbal executive tests were administered to a sample of patients with varying aphasia severity. Their performance in these tests was explored by means of principal component analyses, and the relationships with a broad range of background tests regarding their language and nonverbal cognitive functions were elucidated with correlation analyses. Furthermore, lesion analyses were performed to explore brain-behaviour relationships. In a sample of 32 participants, we found that: (i) a substantial number of patients with aphasia were able to perform the verbal executive tests; (ii) variance in performance was not explained by the severity of an individual's overall language impairment alone but was related to two independent behavioural principal components per test; (iii) not all aspects of performance were related to the patient's language abilities; and (iv) all components were associated with separate neural correlates, some overlapping partly in frontal and parietal regions. Our findings extend our clinical and theoretical understanding of dysfunctions beyond language in patients with aphasia.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Ajay D. Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Matthew A. Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
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Bu X, Ng PH, Tong Y, Chen PQ, Fan R, Tang Q, Cheng Q, Li S, Cheng AS, Liu X. A Mobile-based Virtual Reality Speech Rehabilitation App for Patients With Aphasia After Stroke: Development and Pilot Usability Study. JMIR Serious Games 2022; 10:e30196. [PMID: 35389349 PMCID: PMC9031062 DOI: 10.2196/30196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023] Open
Abstract
Background Stroke has the highest disability-adjusted life-years lost in any disease, and approximately one-third of the patients get aphasia. Computers and tablets are innovative and aid in intensive treatments in speech rehabilitation for patients with aphasia. However, mechanical training limits the help to patients. Objective This study aims to provide a framework for an integrated virtual reality (VR) app to provide speech rehabilitation for patients with aphasia. Methods The content was generated through an in-depth literature review and discussion with experienced rehabilitation physicians and occupational therapists. We then conducted a 2-round Delphi study with 15 experts from hospitals and universities to rate the content using a 5-point Likert scale. The app was developed by an interdisciplinary team involving VR, medical science of rehabilitation, and therapeutic rehabilitation. Pilot usability testing of this novel app was conducted among 5 patients with aphasia, 5 healthy volunteers, 5 medical staff, and 2 VR experts. Results We designed 4 modules of speech rehabilitation: oral expression, auditory comprehension, cognition, and comprehensive application. Our VR-based interactive and intelligent app was developed to provide an alternative option for patients with aphasia. Pilot usability testing revealed user satisfaction with the app. Conclusions This study designed and tested a novel VR-based app for speech rehabilitation specifically adapted to patients with aphasia. This will guide other studies to develop a similar program or intelligent system in a clinical setting.
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Affiliation(s)
- Xiaofan Bu
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Peter Hf Ng
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying Tong
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Peter Q Chen
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rongrong Fan
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qingping Tang
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Qinqin Cheng
- Faculty of Medicine, Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
| | - Shuangshuang Li
- Department of Nursing, Second Xiangya Hospital of Central South University, Changsha, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiangyu Liu
- Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Meier EL, Kelly CR, Goldberg EB, Hillis AE. Executive control deficits and lesion correlates in acute left hemisphere stroke survivors with and without aphasia. Brain Imaging Behav 2022; 16:868-877. [PMID: 34647269 PMCID: PMC8514281 DOI: 10.1007/s11682-021-00580-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 01/18/2023]
Abstract
In contrast to the traditional definition of the disorder, many individuals with aphasia exhibit non-linguistic cognitive impairments, including executive control deficits. Classic lesion studies cite frontal lobe damage in executive dysfunction, but more recent lesion symptom-mapping studies in chronic aphasia present mixed results. In this study, we compared executive control abilities of acute stroke survivors with and without aphasia and investigated lesion correlates of linguistic and non-linguistic cognitive tasks. Twenty-nine participants with acute left hemisphere stroke resulting in aphasia (n = 14) or no aphasia (n = 15) completed clinical MRI and testing, including three NIH Toolbox Cognition Batteries (Pattern Comparison Processing Speed, Flanker Inhibitory Control and Attention, and Dimensional Change Card Sort Tests) and the Boston Naming Test. We compared performance between groups using Wilcoxon rank sum tests. We used Least Absolute Shrinkage and Selection Operator Regression to identify neural markers (percent regional damage, hypoperfusion within vascular territories, and total lesion volume) of executive control deficits and anomia. Group performance was comparable on the Pattern Comparison Processing Speed Test, but people with aphasia had poorer standard scores, lower accuracy, and slower response times on the Dimensional Change Card Sort Test than people without aphasia. Damage to extrasylvian regions (dorsolateral prefrontal cortex, intraparietal sulcus) was related to executive control deficits, whereas language network damage (to inferior frontal and superior and posterior middle temporal gyri) was linked to naming impairments. These results suggest people with aphasia can exhibit comorbid executive control impairments linked to damage outside classic language network areas.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, 228C FR, Boston, MA, 02215, USA.
| | - Catherine R Kelly
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily B Goldberg
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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A Case Study of Upper Limb Robotic-Assisted Therapy Using the Track-Hold Device. SENSORS 2022; 22:s22031009. [PMID: 35161755 PMCID: PMC8840074 DOI: 10.3390/s22031009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/07/2022]
Abstract
The Track-Hold System (THS) project, developed in a healthcare facility and therefore in a controlled and protected healthcare environment, contributes to the more general and broad context of Robotic-Assisted Therapy (RAT). RAT represents an advanced and innovative rehabilitation method, both motor and cognitive, and uses active, passive, and facilitating robotic devices. RAT devices can be equipped with sensors to detect and track voluntary and involuntary movements. They can work in synergy with multimedia protocols developed ad hoc to achieve the highest possible level of functional re-education. The THS is based on a passive robotic arm capable of recording and facilitating the movements of the upper limbs. An operational interface completes the device for its use in the clinical setting. In the form of a case study, the researchers conducted the experimentation in the former Tabarracci hospital (Viareggio, Italy). The case study develops a motor and cognitive rehabilitation protocol. The chosen subjects suffered from post-stroke outcomes affecting the right upper limb, including strength deficits, tremors, incoordination, and motor apraxia. During the first stage of the enrolment, the researchers worked with seven patients. The researchers completed the pilot with four patients because three of them got a stroke recurrence. The collaboration with four patients permitted the generation of an enlarged case report to collect preliminary data. The preliminary clinical results of the Track-Hold System Project demonstrated good compliance by patients with robotic-assisted rehabilitation; in particular, patients underwent a gradual path of functional recovery of the upper limb using the implemented interface.
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Meersmans K, Storms G, De Deyne S, Bruffaerts R, Dupont P, Vandenberghe R. Orienting to Different Dimensions of Word Meaning Alters the Representation of Word Meaning in Early Processing Regions. Cereb Cortex 2021; 32:3302-3317. [PMID: 34963135 PMCID: PMC9340395 DOI: 10.1093/cercor/bhab416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Conscious processing of word meaning can be guided by attention. In this event-related functional magnetic resonance imaging study in 22 healthy young volunteers, we examined in which regions orienting attention to two fundamental and generic dimensions of word meaning, concreteness versus valence, alters the semantic representations coded in activity patterns. The stimuli consisted of 120 nouns in written or spoken modality which varied factorially along the concreteness and valence axis. Participants performed a forced-choice judgement of either concreteness or valence. Rostral and subgenual anterior cingulate were strongly activated during valence judgement, and precuneus and the dorsal attention network during concreteness judgement. Task and stimulus type interacted in right posterior fusiform gyrus, left lingual gyrus, precuneus, and insula. In the right posterior fusiform gyrus and the left lingual gyrus, the correlation between the pairwise similarity in activity patterns evoked by words and the pairwise distance in valence and concreteness was modulated by the direction of attention, word valence or concreteness. The data indicate that orienting attention to basic dimensions of word meaning exerts effects on the representation of word meaning in more peripheral nodes, such as the ventral occipital cortex, rather than the core perisylvian language regions.
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Affiliation(s)
- Karen Meersmans
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Gerrit Storms
- Laboratory of Experimental Psychology, 3000 Leuven, Belgium
| | - Simon De Deyne
- Computational Cognitive Science Lab, Melbourne School of Psychological Sciences, University of Melbourne, 3010 Melbourne, Australia
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, 3000 Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven Brain Institute, 3000 Leuven, Belgium.,Neurology Department, University Hospitals Leuven, 3000 Leuven, Belgium
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Kuptsova SV, Dragoy OV, Ivanova MV. Switching attention deficits in post-stroke individuals with different aphasia types. APHASIOLOGY 2021; 37:260-287. [PMID: 36699113 PMCID: PMC9873226 DOI: 10.1080/02687038.2021.2002804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/02/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Previous studies have shown that individuals with aphasia have impairments in switching attention compared to healthy controls. However, there is insufficient information about the characteristics of switching attention within one task and whether attention deficits vary depending on aphasia type and lesion location. We aimed to address these knowledge gaps by investigating characteristics of switching attention within one type of task in participants with different types of aphasia and distinct lesion sites. METHOD Forty individuals with post-stroke aphasia (20 with non-fluent aphasia and frontal lobe damage, and 20 with fluent aphasia and temporal lobe damage) and 20 neurologically healthy age-matched individuals performed an attention switching task. They listened to sequences of high-pitched and low-pitched tones that were presented to them one by one, tallied them separately, and, at the end of each sequence, had to say how many high- and low-pitched tones they had heard. RESULTS Participants with aphasia performed significantly worse on the task compared to healthy controls, and the performance of two aphasia groups also differed. Specifically, individuals with both aphasia types made more errors than healthy individuals, and the participants with non-fluent aphasia responded more slowly than controls, while reaction times of the participants with fluent aphasia did not differ significantly from those of controls. Also, the two groups of participants with aphasia differed significantly in accuracy, with individuals in the non-fluent group making more errors. CONCLUSIONS The data demonstrated that people with different types of aphasia have distinct impairments in switching attention. Since cognitive deficits impact language performance, this information is important for differentially addressing their language problems and selecting more specific and optimal rehabilitation programs that target different underlying mechanisms.
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Affiliation(s)
- Svetlana V. Kuptsova
- Center for Speech Pathology and Neurorehabilitation, Moscow, Russia
- HSE University, Moscow, Russia
| | - Olga V. Dragoy
- HSE University, Moscow, Russia
- Institute of Linguistics, Russian Academy of Sciences, Moscow, Russia
| | - Maria V. Ivanova
- Department of Psychology, University of California Berkeley, Berkeley, CA, USA
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Cai H, Zhao Z, Ni L, Han G, Hu X, Wu D, Ding X, Wang J. Structural and Functional Deficits in Patients with Poststroke Dementia: A Multimodal MRI Study. Neural Plast 2021; 2021:3536234. [PMID: 34777496 PMCID: PMC8580696 DOI: 10.1155/2021/3536234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/25/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
Although many neuroimaging studies have reported structural and functional abnormalities in the brains of patients with cognitive impairments following stroke, little is known about the pattern of such brain reorganization in poststroke dementia (PSD). The present study was aimed at investigating alterations in spontaneous brain activity and gray matter volume (GMV) in PSD patients. We collected T1-weighted and resting-state functional magnetic resonance imaging data from 20 PSD patients, 24 poststroke nondementia (PSND) patients, and 21 well-matched normal controls (NCs). We compared the differences among the groups in GMV and the fractional amplitude of low-frequency fluctuations (fALFF). Then, we evaluated the relationship between these brain measures and cognitive assessments and explored the possible distinguisher for PSD by receiver operating characteristic (ROC) curve analysis. PSD patients showed smaller GMV in the right superior temporal gyrus and lower fALFF values in the right inferior frontal gyrus than both PSND patients and NCs, but such differences were not observed between PSND patients and NCs. Moreover, GMV in the left medial prefrontal cortex showed a significant positive correlation with the Mini-Cog assessment in PSD patients, and GMV in the left CPL displayed the highest area under the ROC curve among all the features for classifying PSD versus PSND patients. Our findings suggest that PSD patients show dementia-specific structural and functional alteration patterns, which may help elucidate the pathophysiological mechanisms underlying PSD.
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Affiliation(s)
- Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Linhui Ni
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Guocan Han
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xingyue Hu
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Xianjun Ding
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jin Wang
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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Gleichgerrcht E, Roth R, Fridriksson J, den Ouden D, Delgaizo J, Stark B, Hickok G, Rorden C, Wilmskoetter J, Hillis A, Bonilha L. Neural bases of elements of syntax during speech production in patients with aphasia. BRAIN AND LANGUAGE 2021; 222:105025. [PMID: 34555689 PMCID: PMC8546356 DOI: 10.1016/j.bandl.2021.105025] [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: 07/18/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
The ability to string together words into a structured arrangement capable of conveying nuanced information is key to speech production. The assessment of the neural bases for structuring sentences has been challenged by the need of experts to delineate the aberrant morphosyntactic structures in aphasic speech. Most studies have relied on focused tasks with limited ecological validity. We characterized syntactic complexity during connected speech produced by patients with chronic post-stroke aphasia. We automated this process by employing Natural Language Processing (NLP). We conducted voxel-based and connectome-based lesion-symptom mapping to identify brain regions crucially associated with sentence production and syntactic complexity. Posterior-inferior aspects of left frontal and parietal lobes, as well as white matter tracts connecting these areas, were essential for syntactic complexity, particularly the posterior inferior frontal gyrus. These findings suggest that sentence structuring during word production depends on the integrity of Broca's area and the dorsal stream of language processing.
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Affiliation(s)
| | - Rebecca Roth
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - John Delgaizo
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Brielle Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Janina Wilmskoetter
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Argye Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
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Hodgson VJ, Lambon Ralph MA, Jackson RL. Multiple dimensions underlying the functional organization of the language network. Neuroimage 2021; 241:118444. [PMID: 34343627 PMCID: PMC8456749 DOI: 10.1016/j.neuroimage.2021.118444] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/24/2021] [Accepted: 07/31/2021] [Indexed: 02/08/2023] Open
Abstract
Understanding the different neural networks that support human language is an ongoing challenge for cognitive neuroscience. Which divisions are capable of distinguishing the functional significance of regions across the language network? A key separation between semantic cognition and phonological processing was highlighted in early meta-analyses, yet these seminal works did not formally test this proposition. Moreover, organization by domain is not the only possibility. Regions may be organized by the type of process performed, as in the separation between representation and control processes proposed within the Controlled Semantic Cognition framework. The importance of these factors was assessed in a series of activation likelihood estimation meta-analyses that investigated which regions of the language network are consistently recruited for semantic and phonological domains, and for representation and control processes. Whilst semantic and phonological processing consistently recruit many overlapping regions, they can be dissociated (by differential involvement of bilateral anterior temporal lobes, precentral gyrus and superior temporal gyri) only when using both formal analysis methods and sufficient data. Both semantic and phonological regions are further dissociable into control and representation regions, highlighting this as an additional, distinct dimension on which the language network is functionally organized. Furthermore, some of these control regions overlap with multiple-demand network regions critical for control beyond the language domain, suggesting the relative level of domain-specificity is also informative. Multiple, distinct dimensions are critical to understand the role of language regions. Here we present a proposal as to the core principles underpinning the functional organization of the language network.
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Ashaie S, Castro N. Exploring the Complexity of Aphasia With Network Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3928-3941. [PMID: 34534002 PMCID: PMC9132069 DOI: 10.1044/2021_jslhr-21-00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 06/12/2023]
Abstract
Purpose Aphasia is a complex, neurogenic language disorder, with different aphasia syndromes hallmarked by impairment in fluency, auditory comprehension, naming, and/or repetition. Broad, standardized assessments of language domains and specific language and cognitive assessments provide a holistic impairment profile of a person with aphasia. While many recognize the correlations between assessments, there remains a need to continue understanding the complexity of relationships between assessments for the purpose of better characterization of language impairment profiles of persons with aphasia. We explored the use of network analysis to identify the complex relationships between a variety of language assessments. Method We computed a regularized partial correlation network and a directed acyclic graph network to estimate the relations between different aphasia assessments in 128 persons with aphasia. Results Western Aphasia Battery-Revised Comprehension subtest was the most central assessment in the aphasia symptom network, whereas the Philadelphia Naming Test had the most putative causal influence on other assessments. Additionally, the language assessments segregated into three empirically derived communities denoting phonology, semantics, and syntax. Furthermore, several assessments, including the Philadelphia Naming Test, belonged to multiple communities, suggesting that certain assessments may capture multiple language impairments. Conclusion We discuss the implications of using a network analysis approach for clinical intervention and driving forward novel questions in the field of clinical aphasiology. Supplemental Material https://doi.org/10.23641/asha.16620229.
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Affiliation(s)
- Sameer Ashaie
- Shirley Ryan AbilityLab, Chicago, IL
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nichol Castro
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
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50
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Macoir J, Légaré A, Lavoie M. Contribution of the Cognitive Approach to Language Assessment to the Differential Diagnosis of Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11060815. [PMID: 34205444 PMCID: PMC8234372 DOI: 10.3390/brainsci11060815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Diagnosis of primary progressive aphasia (PPA) is essentially based on the identification of progressive impairment of language abilities while other cognitive functions are preserved. The three variants of PPA are characterized by core and supportive clinical features related to the presence or absence of language impairment in different linguistic domains. In this article, we review the cognitive neuropsychological approach to the assessment of PPA and its contribution to the differential diagnosis of the three variants. The main advantage of this assessment approach is that it goes beyond the mere description and classification of clinical syndromes and identifies impaired and preserved cognitive and linguistic components and processes. The article is structured according to the main language domains: spoken production, language comprehension, and written language. Each section includes a brief description of the cognitive processes involved in the assessment tasks, followed by a discussion of typical characteristics for each PPA variant and common pitfalls in the interpretation of the results. In addition, the clinical benefit of the cognitive neuropsychological approach for the behavioral management of PPA is briefly sketched out in the conclusion.
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Affiliation(s)
- Joël Macoir
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche CERVO (CERVO Brain Research Centre), Québec, QC G1J 2G3, Canada
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 412190)
| | - Annie Légaré
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille Lemaire, Québec, QC G1J 1Z4, Canada;
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