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1.
Cortex ; 153: 224-234, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35714388

RESUMO

Theodore H. Weisenburg (1876-1934) and a series of colleagues embarked on a research program in 1927 to develop standardized tests to investigate the nature of language and intellectual impairments in aphasic and non-aphasic individuals. This project culminated in two significant contributions to neuropsychological testing (Weisenburg & McBride, 1935; Weisenburg, Roe and McBride, 1936). After an initial study demonstrated the problematic aspects of Henry Head's aphasia tests (1926), Weisenburg developed a new battery of tests which were given to individuals with aphasia. The significant innovation of this work was the original concept of a matched control group. This included those with other neurological impairments, and a range of non-neurologically impaired individuals with the aim of providing a characterization of what was 'normal'. They identified many crucial participant variables regarding age, education, and socioeconomic status and used population statistics to ensure their control sample was representative. A detailed critical assessment of each of their successive elaborations is examined, focusing on the methodological innovations they represent. The contribution of this work to contemporaries and successive generations of neuropsychologists is examined regarding ongoing issues in clinical testing and research design.


Assuntos
Afasia , Afasia/diagnóstico , Humanos , Inteligência , Idioma , Testes Neuropsicológicos
2.
Wiad Lek ; 75(5 pt 2): 1229-1233, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35758436

RESUMO

OBJECTIVE: The aim: Assess the impact of neurological SLA on improvement of language functions in post-stroke patients. PATIENTS AND METHODS: Materials and methods: The study covered a total of 82 patients aged 40-80, of both sexes, with stroke-induced cognitive deficits. They were in-patients of the Clinic Of Rehabilitation And Physical Medicine of the "WAM" Teaching Hospital in Lódz. The study comprised two groups. The study group consisted of post-stroke patients with aphasia, who were referred to four-week comprehensive program of neurological SLA therapy earlier (about a month) after experiencing stroke. The group comprised 44 patients. Six months after the stroke, the patients underwent another four weeks of neurological SLA. The control group consisted of post-stroke patients with aphasia. The group comprised 38 patients. The four-week neurological SLA therapy was applied more than six months after stroke ("late therapy"). The patients were ascribed to the groups randomly. Language abilities were evaluated with the Aphasia Dynamics Assessment Scale (Polish: Skala Oceny Dynamiki Afazji, abbrev. SODA). RESULTS: Results: The study showed that neurological SLA helped patients in both the study and control group to significantly regain their language functions. However, greater improvement was found in the study group, which underwent neurological SLA twice, which proves that duration of the therapeutic process is an important factor. CONCLUSION: Conclusions: neurological SLA was beneficial for both groups, regardless of the time that elapsed between stroke and start of the therapy. neurological SLA therapy allowed patients to restore part of their language functions, both in the study and control group. The sooner neurological SLA is implemented and the longer its duration, the more beneficial it is to patients.


Assuntos
Afasia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Afasia/etiologia , Afasia/psicologia , Afasia/terapia , Feminino , Humanos , Terapia da Linguagem , Masculino , Fala , Fonoterapia , Acidente Vascular Cerebral/complicações
3.
PLoS One ; 17(6): e0270135, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749406

RESUMO

A number of pharmaceuticals have been identified as potential adjuvants to speech language therapy following stroke, but it is also important to consider which pharmaceuticals may result in a less robust recovery. Here we examine whether post-stroke language recovery was meaningfully impeded by cholinergic, GABAergic, or dopaminergic medications patients received. Eighty participants with left hemisphere stroke were examined retrospectively to see whether the use of one of these three classes of medication prior to admission for acute stroke, during their inpatient stay, or at discharge was associated with differences in recovery on three common measures of language. While prescription of any of the candidate drugs was relatively uncommon, groups were very well matched for many common factors that impact performance. When age, education, and acute lesion volume were controlled, there were no significant differences in performance among those taking cholinergic, GABAergic, or dopaminergic medications and those who were not. Those who experienced a "good recovery" of language (≥10% improvement on any one language measure over time) had similar exposure to these drugs to those with a poor recovery. This work represents a first look at these drug classes with regard to their effects on the recovery of language after stroke and should not be interpreted as resolving all potential for concern, but these results do offer modest reassurance that these common classes of pharmacotherapy, when given for short periods in this population, do not appear to have marked deleterious effects on post-stroke recovery of language.


Assuntos
Afasia , Medicamentos sob Prescrição , Acidente Vascular Cerebral , Afasia/complicações , Afasia/etiologia , Colinérgicos , Humanos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/patologia
4.
J Commun Disord ; 98: 106231, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35688011

RESUMO

Disparities in social determinants of health (SDOH) such as socioeconomic status and access to quality healthcare present serious barriers to enrollment in clinical rehabilitation programs for individuals who have experienced a stroke, especially for those who identify with a racial-ethnic minority group. Hispanic bilinguals with aphasia (HBWA) are one marginalized group who face even greater enrollment challenges since post-stroke language impairment and limited English proficiency make it difficult to advocate for one's needs and identify appropriate rehabilitation programs. Given the increasing representation of Hispanic individuals in the U.S. (projected to be 30% of the population in 2050), it is imperative that clinicians counter disparities in stroke care by facilitating access to clinical services for HBWA. However, the Hispanic population remains largely understudied in the stroke and aphasia literature, due in part to reduced opportunities to enroll in large-scale clinical research studies. In this paper we highlight how our team at Boston University has designed and implemented a variety of recruitment practices, assessment modifications, and treatment accommodations to circumvent the known barriers to participation in clinical research experienced by HBWA. Furthermore, we discuss the importance of cultural responsiveness and demonstrate how including principles of sensitivity and humility in clinical trial protocols improves participant enrollment and retention. Although clinical adjustments in this study were developed for use with HBWA, the effectiveness of the procedures suggests they may be useful blueprints for expanding access to research opportunities for various marginalized groups.


Assuntos
Afasia , Acidente Vascular Cerebral , Humanos , Grupos Minoritários , Determinantes Sociais da Saúde
5.
Trials ; 23(1): 501, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710437

RESUMO

BACKGROUND: Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. METHODS: VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. PRIMARY OUTCOME: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. RESULTS: Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. CONCLUSIONS: We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. TRIAL REGISTRATION: ACTRN 12613000776707.


Assuntos
Afasia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Afasia/diagnóstico , Afasia/reabilitação , Humanos , Fala , Fonoterapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Reabilitação do Acidente Vascular Cerebral/métodos
6.
Continuum (Minneap Minn) ; 28(3): 676-701, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35678398

RESUMO

PURPOSE OF REVIEW: This article discusses the clinical, neuroimaging, and biomarker profiles of sporadic atypical Alzheimer disease (AD) variants, including early-onset AD, posterior cortical atrophy, logopenic variant primary progressive aphasia, dysexecutive variant and behavioral variant AD, and corticobasal syndrome. RECENT FINDINGS: Significant advances are being made in the recognition and characterization of the syndromically diverse AD variants. These variants are identified by the predominant cognitive and clinical features: early-onset amnestic syndrome, aphasia, visuospatial impairments, dysexecutive and behavioral disturbance, or motor symptoms. Although understanding of regional susceptibility to disease remains in its infancy, visualizing amyloid and tau pathology in vivo and CSF examination of amyloid-ß and tau proteins are particularly useful in atypical AD, which can be otherwise prone to misdiagnosis. Large-scale research efforts, such as LEADS (the Longitudinal Early-Onset Alzheimer Disease Study), are currently ongoing and will continue to shed light on our understanding of these diverse presentations. SUMMARY: Understanding the clinical, neuroimaging, and biomarker profiles of the heterogeneous group of atypical AD syndromes improves diagnostic accuracy in patients who are at increased risk of misdiagnosis. Earlier accurate identification facilitates access to important interventions, social services and disability assistance, and crucial patient and family education.


Assuntos
Doença de Alzheimer , Afasia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/patologia , Atrofia , Biomarcadores , Humanos , Neuroimagem , Proteínas tau/metabolismo
7.
Epileptic Disord ; 24(3): 1-6, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35653085

RESUMO

Objective Among the clinical manifestations of stroke mimics, isolated aphasia is one of the most challenging due to its aetiopathogenic diagnosis. This short communication describes a specific perfusion and brain oscillatory pattern in a challenging case of prolonged isolated aphasia caused by status epilepticus, jointly investigated by computed tomography (CT) perfusion, single-photon emission computerized tomography (SPECT)/CT and EEG qualitative and quantitative analysis. Methods We discuss the different patterns of perfusion neuroimaging and EEG between SE and ischaemic stroke or postictal (Todd's)-related isolated aphasia, and propose these differences as a basis to support the differential diagnosis. Results The pattern associated with SE was characterized by focal hyperperfusion on CT perfusion maps (the left mean transit time was shorter with >10% asymmetry, and left cerebral blood volume and cerebral blood flow increased or slightly altered, relative to the contralateral side) and SPECT (focal left temporal hyperperfusion), without any early ischaemic signs on non-enhanced CT, while the EEG showed a predominant left hemispheric slow delta power. The aforementioned perfusion pattern contrasts with postictal epileptic Todd's phenomenon, which is characterized by hypoperfusion on CT perfusion (the mean transit time is prolonged and cerebral blood volume and cerebral blood flow are reduced, compared to the contralateral hemisphere) and SPECT (focal hypoperfusion), not restricted to the specific vascular territories. Significance CT perfusion patterns may add valuable information to support the differential diagnosis of status epilepticus, rather than acute ischaemic stroke or postictal Todd's phenomenon, in cases with challenging symptoms of prolonged isolated aphasia.


Assuntos
Afasia , Isquemia Encefálica , Acoplamento Neurovascular , Estado Epiléptico , Acidente Vascular Cerebral , Afasia/diagnóstico por imagem , Afasia/etiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Diagnóstico Diferencial , Eletroencefalografia , Humanos , Perfusão/efeitos adversos , Estado Epiléptico/complicações , Estado Epiléptico/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos
8.
Neuropsychologia ; 172: 108270, 2022 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-35597266

RESUMO

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.


Assuntos
Afasia , Acidente Vascular Cerebral , Função Executiva , Humanos , Idioma , Fala
9.
Neural Plast ; 2022: 5635596, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35494482

RESUMO

Background: Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study. Methods: Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics. Result: After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales. Conclusion: In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.


Assuntos
Terapia por Acupuntura , Afasia , Acidente Vascular Cerebral , Terapia por Acupuntura/métodos , Animais , Afasia/diagnóstico por imagem , Afasia/etiologia , Afasia/terapia , Área de Broca , Imagem de Tensor de Difusão , Humanos , Estudos Multicêntricos como Assunto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
10.
J Healthc Eng ; 2022: 3270534, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35494510

RESUMO

Aphasia after stroke is one of the common complications of cerebral infarction. Early diagnosis and treatment of aphasia after stroke is of great significance for the recovery of language function. At present, there are different views on the pathogenesis of aphasia after stroke. Functional magnetic resonance imaging (fMRI) can reflect the brain function, brain tissue metabolism, and the level of brain local blood flow. It has the advantages of noninvasive, high resolution and sensitivity, low price, and so on. It has been widely used in the study of sensory aphasia after stroke. This study focuses on the development of functional magnetic resonance imaging in patients with poststroke aphasia and summarizes the published studies on functional magnetic resonance imaging in patients with poststroke aphasia. Evidence acquisition: A literature search was conducted in PubMed, Hindawi, PLoS, IEEE, Wiley, ScienceDirect, Springer, EMBASE, and web of science, with the keywords of "stroke" and "Aphasia" and "functional magnetic resonance imaging", "RS fMRI", or "DTI", to review the research of functional magnetic resonance imaging in patients with aphasia after stroke. The results included clinical evaluation, diagnostic scale, and imaging analysis; the study design was a randomized controlled trial, case series and case report, and observational study. A total of 67 articles were identified in the first search and 43 after the second search. Based on the analysis of 43 selected articles, 19 articles were included, and 24 articles were excluded. The selected information is shown in Table 1. Eleven of them did not contain imaging-related data. Six articles are related review articles. Four studies were conducted on patients without poststroke aphasia. Three studies studied the effect of poststroke aphasia on patients' social participation.


Assuntos
Afasia , Acidente Vascular Cerebral , Afasia/complicações , Afasia/etiologia , Encéfalo/diagnóstico por imagem , Humanos , Idioma , Imageamento por Ressonância Magnética , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
11.
J Allied Health ; 51(2): 110-115, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35640289

RESUMO

BACKGROUND: Communication partner training (CPT) involves educating conversation partners to implement communication strategies that facilitate improved interactions with people with aphasia (PWA). This study aimed to investigate (1) whether a CPT program increased the knowledge and confidence of students with and without a communication disorders background and (2) the differential effects of this training on students from different allied health disciplines. METHODS: Quasi-experimental design study with 6 adult volunteers with aphasia and 36 students (18 speech-language pathology [SLP] students and 18 physical therapy/occupational therapy [PT/OT] students). The CPT program was provided twice (in 2015 and 2016) as a single seminar at an American university. RESULTS: All students reported increased confidence in communicating with PWA and were able to identify a greater number of appropriate communication strategies after the CPT than they could identify before the training. The SLP students demonstrated greater aphasia knowledge than the PT/OT students prior to training; only the PT/OT students reported increased knowledge about aphasia after training. DISCUSSION: Involvement of PWA in CPT programs may be particularly important in enabling students to develop confidence in communicating with PWA. Practice opportunities with PWA can be provided as early as the beginning of didactic coursework through an interdisciplinary CPT program.


Assuntos
Afasia , Patologia da Fala e Linguagem , Adulto , Afasia/terapia , Humanos , Comunicação Interdisciplinar , Patologia da Fala e Linguagem/educação , Estudantes , Universidades
12.
Neurocase ; 28(2): 206-217, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35580361

RESUMO

Chronic lexical anomia after left hemisphere (LH) stroke improves under personalized phonological treatment (PT). Cortical linking between language and hand motor areas (hand_M1) questioned whether PT-related improvement relies on the unlesioned hemisphere (UH) plasticity when LH is dysfunctional. Our 70-yo-woman case study showed that 10 sessions of excitatory stimulation of UH_hand-M1 combined with PT hastened oral picture naming improvement as compared to sham+PT and changes were maintained together with changes of untrained items andcorticomotor excitability increase. This supports a role of stimulation-induced plasticity of UH_hand M1 in language recovery, at least in the improvement of lexical anomia in chronic stroke.


Assuntos
Afasia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Anomia/etiologia , Anomia/terapia , Feminino , Humanos , Linguística , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
13.
Neuroimage Clin ; 34: 103020, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35526498

RESUMO

The frontal aslant tract (FAT) is a recently described intralobar tract that connects the superior and inferior frontal gyri. The FAT has been implicated in various speech and language processes and disorders, including motor speech impairments, stuttering disorders, opercular syndrome, and verbal fluency, but the specific function(s) of the FAT have yet to be elucidated. In the current study, we aimed to address this knowledge gap by investigating the underlying role that the FAT plays in motor aspects of speech and language abilities in post-stroke aphasia. Our goals were three-fold: 1) To identify which specific motor speech or language abilities are impacted by FAT damage by utilizing a powerful imaging analysis method, High Angular Resolution Diffusion Imaging (HARDI) tractography; 2) To determine whether damage to the FAT is associated with functional deficits on a range of motor speech and language tasks even when accounting for cortical damage to adjacent cortical regions; and 3) To explore whether subsections of the FAT (lateral and medial segments) play distinct roles in motor speech performance. We hypothesized that damage to the FAT would be most strongly associated with motor speech performance in comparison to language tasks. We analyzed HARDI data from thirty-three people with aphasia (PWA) with a history of chronic left hemisphere stroke. FAT metrics were related to scores on several speech and language tests: the Motor Speech Evaluation (MSE), the Western Aphasia Battery (WAB) aphasia quotient and subtests, and the Boston Naming Test (BNT). Our results indicated that the integrity of the FAT was strongly associated with the MSE as predicted, and weakly negatively associated with WAB subtest scores including Naming, Comprehension, and Repetition, likely reflecting the fact that performance on these WAB subtests is associated with damage to posterior areas of the brain that are unlikely to be damaged with a frontal lesion. We also performed hierarchical stepwise regressions to predict language function based on FAT properties and lesion load to surrounding cortical areas. After accounting for the contributions of the inferior frontal gyrus, the ventral precentral gyrus, and the superior precentral gyrus of the insula, the FAT still remained a significant predictor of MSE apraxia scores. Our results further showed that the medial and lateral subsections of the FAT did not appear to play distinct roles but rather may indicate normal anatomical variations of the FAT. Overall, current results indicate that the FAT plays a specific and unique role in motor speech. These results further our understanding of the role that white matter tracts play in speech and language.


Assuntos
Afasia , Fala , Afasia/diagnóstico por imagem , Afasia/etiologia , Afasia/patologia , Mapeamento Encefálico/métodos , Imagem de Tensor de Difusão , Lobo Frontal , Humanos , Idioma
14.
Neuroimage Clin ; 34: 103036, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35561556

RESUMO

Post-stroke aphasia is a consequence of localized stroke-related damage as well as global disturbances in a highly interactive and bilaterally-distributed language network. Aphasia is increasingly accepted as a network disorder and it should be treated as such when examining the reorganization and recovery mechanisms after stroke. In the current study, we sought to investigate reorganized patterns of electrophysiological connectivity, derived from resting-state magnetoencephalography (rsMEG), in post-stroke chronic (>6 months after onset) aphasia. We implemented amplitude envelope correlations (AEC), a metric of connectivity commonly used to describe slower aspects of interregional communication in resting-state electrophysiological data. The main focus was on identifying the oscillatory frequency bands and frequency-specific spatial topology of connections associated with preserved language abilities after stroke. RsMEG was recorded for 5 min in 21 chronic stroke survivors with aphasia and in 20 matched healthy controls. Source-level MEG activity was reconstructed and summarized within 72 atlas-defined brain regions (or nodes). A 72 × 72 leakage-corrected connectivity (of AEC) matrix was obtained for frequencies from theta to low-gamma (4-50 Hz). Connectivity was compared between groups, and, the correlations between connectivity and subscale scores from the Western Aphasia Battery (WAB) were evaluated in the stroke group, using partial least squares analyses. Posthoc multiple regression analyses were also conducted on a graph theory measure of node strengths, derived from significant connectivity results, to control for node-wise properties (local spectral power and lesion sizes) and demographic and stroke-related variables. Connectivity among the left hemisphere regions, i.e. those ipsilateral to the stroke lesion, was greatly reduced in stroke survivors with aphasia compared to matched healthy controls in the alpha (8-13 Hz; p = 0.011) and beta (15-30 Hz; p = 0.001) bands. The spatial topology of hypoconnectivity in the alpha vs. beta bands was distinct, revealing a greater involvement of ventral frontal, temporal and parietal areas in alpha, and dorsal frontal and parietal areas in beta. The node strengths from alpha and beta group differences remained significant after controlling for nodal spectral power. AEC correlations with WAB subscales of object naming and fluency were significant. Greater alpha connectivity was associated with better naming performance (p = 0.045), and greater connectivity in both the alpha (p = 0.033) and beta (p = 0.007) bands was associated with better speech fluency performance. The spatial topology was distinct between these frequency bands. The node strengths remained significant after controlling for age, time post stroke onset, nodal spectral power and nodal lesion sizes. Our findings provide important insights into the electrophysiological connectivity profiles (frequency and spatial topology) potentially underpinning preserved language abilities in stroke survivors with aphasia.


Assuntos
Afasia , Acidente Vascular Cerebral , Afasia/complicações , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Humanos , Idioma , Imageamento por Ressonância Magnética , Magnetoencefalografia/métodos , Acidente Vascular Cerebral/complicações
15.
Dement Geriatr Cogn Disord ; 51(2): 193-202, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35526526

RESUMO

INTRODUCTION: Progressive agrammatic aphasia (PAA) can be associated with abnormal behaviors; however, it is unknown whether behaviors occur and/or are different in patients with primary progressive apraxia of speech (PPAOS). We aimed to compare baseline and longitudinal behavioral symptomatology between PPAOS, patients with PAA, and patients with both apraxia of speech and PAA (AOS-PAA). METHODS: We recruited 89 patients for this study, 40 with PPAOS, 11 with PAA, and 38 with AOS-PAA. Behavioral disturbances were evaluated using the frontal behavior inventory (FBI) which was also split into negative behaviors and disinhibition, and the 20-item behavioral assessment scale (20-BAS). Data analysis was performed using linear regression and linear mixed models. RESULTS: Of the 89 patients in the study, 54% were women and the mean age at onset was 68 years. All patients, regardless of diagnosis, endorsed at least one symptom on the FBI at baseline, most frequently verbal apraxia (100%), logopenia (95.6%), irritability (55.9%), and apathy (42.6%). On the 20-BAS, 47.6% of the patients endorsed at least one symptom, most commonly "crying more easily" (19.5%) and personality change (18.3%). PPAOS was the least behaviorally affected group, with differences between PPAOS and AOS-PAA mainly driven by negative behaviors as opposed to disinhibition for PPAOS and PAA. The behavioral metrics showed average sensitivity and specificity to distinguish between groups. Behavioral disturbances worsened over time although rate of behavioral change across groups was similar. CONCLUSION: Behavioral disturbances are more common and severe in patients with agrammatic aphasia with or without AOS compared to patients with isolated apraxia of speech.


Assuntos
Afasia Primária Progressiva , Afasia , Apraxias , Afasia Primária Progressiva/diagnóstico , Apraxias/complicações , Apraxias/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Fala
16.
J Neurosci ; 42(24): 4913-4926, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35545436

RESUMO

Aphasia is a prevalent cognitive syndrome caused by stroke. The rarity of premorbid imaging and heterogeneity of lesion obscures the links between the local effects of the lesion, global anatomic network organization, and aphasia symptoms. We applied a simulated attack approach in humans to examine the effects of 39 stroke lesions (16 females) on anatomic network topology by simulating their effects in a control sample of 36 healthy (15 females) brain networks. We focused on measures of global network organization thought to support overall brain function and resilience in the whole brain and within the left hemisphere. After removing lesion volume from the network topology measures and behavioral scores [the Western Aphasia Battery Aphasia Quotient (WAB-AQ), four behavioral factor scores obtained from a neuropsychological battery, and a factor sum], we compared the behavioral variance accounted for by simulated poststroke connectomes to that observed in the randomly permuted data. Global measures of anatomic network topology in the whole brain and left hemisphere accounted for 10% variance or more of the WAB-AQ and the lexical factor score beyond lesion volume and null permutations. Streamline networks provided more reliable point estimates than FA networks. Edge weights and network efficiency were weighted most highly in predicting the WAB-AQ for FA networks. Overall, our results suggest that global network measures provide modest statistical value beyond lesion volume when predicting overall aphasia severity, but less value in predicting specific behaviors. Variability in estimates could be induced by premorbid ability, deafferentation and diaschisis, and neuroplasticity following stroke.SIGNIFICANCE STATEMENT Poststroke, the remaining neuroanatomy maintains cognition and supports recovery. However, studies often use small, cross-sectional samples that cannot fully model the interactions between lesions and other variables that affect networks in stroke. Alternate methods are required to account for these effects. "Simulated attack" models are computational approaches that apply virtual damage to the brain and measure their putative consequences. Using a simulated attack model, we estimated how simulated damage to anatomic networks could account for language performance. Overall, our results reveal that global network measures can provide modest statistical value predicting overall aphasia severity, but less value in predicting specific behaviors. These findings suggest that more theoretically precise network models could be necessary to robustly predict individual outcomes in aphasia.


Assuntos
Afasia , Conectoma , Acidente Vascular Cerebral , Afasia/diagnóstico por imagem , Afasia/etiologia , Encéfalo/patologia , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/patologia
17.
J Commun Disord ; 97: 106215, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35367876

RESUMO

INTRODUCTION: Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. METHODS: In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. RESULTS: Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. CONCLUSIONS: Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.


Assuntos
Anomia , Afasia , Anomia/terapia , Afasia/terapia , Humanos , Terapia da Linguagem , Semântica , Resultado do Tratamento
18.
Cortex ; 151: 15-29, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35378419

RESUMO

Apraxia of speech is a motor speech disorder that occurs after lesions to the left cerebral hemisphere, most often concomitant with aphasia. It requires specific approaches in the study of its physiological and neuroanatomical basis and special expertise in clinical care. Knowing its prevalence in patients with aphasia after stroke is therefore relevant for planning specific resources in clinical research and in health care provision. Systematic studies of the frequency of this condition are lacking. We examined the frequency of apraxia of speech in a representative sample of 156 patients with chronic post-stroke aphasia. Three experts classified the patients' speech by best-practice auditory-perceptual methods. Bayesian hierarchical models were fitted to obtain probability distributions for prevalence estimates. A prior distribution was calculated in two steps, including Bayesian models for published frequency data (step 1) and prevalence estimates from experienced clinicians (step 2). Separate models were fitted for different severity ranges. Overall, a prevalence rate of .44 [.30, .58] was obtained. When only moderate and severe cases were taken into account, the rate was .35 [.23, .49]. After a further restriction to only severe impairment, prevalence dropped to .22 [.12, .34]. Patients identified with apraxia of speech had suffered more severe strokes according to clinical criteria and had more severe aphasias. The presence of apraxia of speech was predicted by the articulation/prosody and syntax rating scales of the Aachen Aphasia Test. Lower prevalence estimates published earlier are probably biased by low sensitivity of assessment instruments for mild speech impairment.


Assuntos
Afasia , Apraxias , Acidente Vascular Cerebral , Afasia/complicações , Afasia/etiologia , Apraxias/epidemiologia , Teorema de Bayes , Humanos , Prevalência , Fala , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
20.
Neuroimage Clin ; 34: 102999, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35395498

RESUMO

Progressive apraxia of speech (AOS) is a motor speech disorder affecting the ability to produce phonetically or prosodically normal speech. Progressive AOS can present in isolation or co-occur with agrammatic aphasia and is associated with degeneration of the supplementary motor area. We aimed to assess breakdowns in structural connectivity from the supplementary motor area in patients with any combination of progressive AOS and/or agrammatic aphasia to determine which supplementary motor area tracts are specifically related to these clinical symptoms. Eighty-four patients with progressive AOS or progressive agrammatic aphasia were recruited by the Neurodegenerative Research Group and underwent neurological, speech/language, and neuropsychological testing, as well as 3 T diffusion magnetic resonance imaging. Of the 84 patients, 36 had apraxia of speech in isolation (primary progressive apraxia of speech, PPAOS), 40 had apraxia of speech and agrammatic aphasia (AOS-PAA), and eight had agrammatic aphasia in isolation (progressive agrammatic aphasia, PAA). Tractography was performed to identify 5 distinct tracts connecting to the supplementary motor area. Fractional anisotropy and mean diffusivity were assessed at 10 positions along the length of the tracts to construct tract profiles, and median profiles were calculated for each tract. In a case-control comparison, decreased fractional anisotropy and increased mean diffusivity were observed along the supplementary motor area commissural fibers in all three groups compared to controls. PPAOS also had abnormal diffusion in tracts from the supplementary motor area to the putamen, prefrontal cortex, Broca's area (frontal aslant tract) and motor cortex, with greatest abnormalities observed closest to the supplementary motor area. The AOS-PAA group showed abnormalities in the same set of tracts, but with greater involvement of the supplementary motor area to prefrontal tract compared to PPAOS. PAA showed abnormalities in the left prefrontal and frontal aslant tracts compared to both other groups, with PAA showing greatest abnormalities furthest from the supplementary motor area. Severity of AOS correlated with tract metrics in the supplementary motor area commissural and motor cortex tracts. Severity of aphasia correlated with the frontal aslant and prefrontal tracts. These findings provide insight into how AOS and agrammatism are differentially related to disrupted diffusivity, with progressive AOS associated with abnormalities close to the supplementary motor area, and the frontal aslant and prefrontal tracts being particularly associated with agrammatic aphasia.


Assuntos
Afasia Primária Progressiva , Afasia , Apraxias , Córtex Motor , Afasia/complicações , Afasia Primária Progressiva/complicações , Apraxias/diagnóstico por imagem , Humanos , Córtex Motor/diagnóstico por imagem , Córtex Motor/patologia , Testes Neuropsicológicos , Fala
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