Post-stroke Aphasic Patients Research Articles

Establishing and evaluating the gradient of item naming difficulty in post-stroke aphasia and semantic dementia

Anomia is a common consequence following brain damage and a central symptom in semantic dementia (SD) and post-stroke aphasia (PSA), for instance. Picture naming tests are often used in clinical assessments and experience suggests that items vary systematically in their difficulty. Despite clinical intuitions and theoretical accounts, however, the existence and determinants of such a naming difficulty gradient remain to be empirically established and evaluated. Seizing the unique opportunity of two large-scale datasets of semantic dementia and post-stroke aphasia patients assessed with the same picture naming test, we applied an Item Response Theory (IRT) approach and we (a) established that an item naming difficulty gradient exists, which (b) partly differs between patient groups, and is (c) related in part to a limited number of psycholinguistic properties - frequency and familiarity for SD, frequency and word length for PSA. Our findings offer exciting future avenues for new, adaptive, time-efficient, and patient-tailored approaches to naming assessment and therapy.

The effect of mobile application-based technology on post-stroke aphasia: a systematic review.

Enhancing speech-language therapy remains the most effective strategy for improving post-stroke aphasia, However, conventional face-to-face interventions often lack the necessary therapeutic intensity. In recent years, mobile application-based speech-language therapy has emerged progressively, offering new opportunities for independent rehabilitation among aphasic patients. This review aims to evaluate the impact of mobile application-based interventions on post-stroke aphasic. By conducting a systematic search across five databases (PubMed, Web of Science, EMBASE, CINAHL, and Scopus), we identified and included studies that investigated the utilization of mobile application-based technologies (such as computers, iPads, etc.) for treating post-stroke aphasia. This study included 15 research investigations, including 10 randomized controlled trials (RCTs), four self-controlled studies and one cross-over experimental design study. Among these, eight studies demonstrated the efficacy of mobile application-based therapy in enhancing overall language functionality for post-stroke aphasia patients, three studies highlighted its potential for improving communication skills, three studies observed its positive impact on spontaneous speech expression. Moreover, four studies indicated its effectiveness in enhancing naming abilities, two studies underscored the positive influence of mobile application-based interventions on the quality of life for individuals with aphasia. Six studies noted that speech improvement effects were maintained during the follow-up period. The results of this review demonstrate the potential of mobile application-based interventions for improving speech-language function in individuals with aphasia. However, further high-quality research is needed to establish their effects across different domains and to delve into the comparative advantages of various treatment approaches. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=405248.

Efficacy of different rehabilitation therapies on post-stroke aphasia patients: A network meta-analysis.

Although several rehabilitation interventions are effective in post-stroke aphasia (PSA), the efficacy of different rehabilitation interventions compared to each other remains controversial. Here, we aimed to compare the effectiveness of varying rehabilitation interventions in PSA. Randomized controlled trials on 8 kinds of rehabilitation interventions to improve speech function in patients with PSA were searched by computer from 10 databases, including PubMed, Web of Science, Cochrane, OVID, CINAHL, Embase, CNKI, WanFang, CBM, and VIP. The search scope was from the establishment of the database to August 2023. The literature screening, extraction of basic information, and quality assessment of the literature were conducted independently by 2 researchers. Network meta-analysis (NMA) was performed using Stata 17.0 software. Fifty-four studies involving 2688 patients with PSA were included. The results of NMA showed that: ① in terms of improving the severity of aphasia, the therapeutic effects of repetitive transcranial magnetic stimulation were the most significant; ② motor imagery therapy was the most effective in improving spontaneous speech, repetition, and naming ability; ③ in terms of improving listening comprehension ability, the therapeutic effects of mirror neuron therapy was the most significant. The 8 rehabilitation interventions have different focuses in improving the speech function of PSA patients, and the clinical therapists can select the optimal rehabilitation interventions in a targeted manner according to the results of this NMA and the patients' conditions and other relevant factors.

Prolonged intermittent theta burst stimulation for post-stroke aphasia: protocol of a randomized, double-blinded, sham-controlled trial.

Post-stroke aphasia (PSA) is one of the most devastating symptoms after stroke, yet limited treatment options are available. Prolonged intermittent theta burst stimulation (piTBS) is a promising therapy for PSA. However, its efficacy remains unclear. Therefore, we aim to investigate the efficacy of piTBS over the left supplementary motor area (SMA) in improving language function for PSA patients and further explore the mechanism of language recovery. This is a randomized, double-blinded, sham-controlled trial. A total of 30 PSA patients will be randomly allocated to receive either piTBS stimulation or sham stimulation for 15 sessions over a period of 3 weeks. The primary outcome is the Western Aphasia Battery Revised (WAB-R) changes after treatment. The secondary outcomes include The Stroke and Aphasia Quality of Life Scale (SAQOL-39 g), resting-state electroencephalogram (resting-state EEG), Event-related potentials (ERP), brain derived neurotrophic factor (BDNF). These outcome measures are assessed before treatment, after treatment, and at 4-weeks follow up. This study was registered in Chinese Clinical Trial Registry (No. ChiCTR23000203238). This study protocol is promising for improving language in PSA patients. Resting-state EEG, ERP, and blood examination can be used to explore the neural mechanisms of PSA treatment with piTBS. https://www.chictr.org.cn/index.html, ChiCTR2300074533.

Abstract TP78: Characteristics of Verbal and Non-Verbal Cognitive Function in Post-Stroke Aphasia Based on Language-Cognition Neuropsychological Processing Model

Introduction: Post-stroke aphasia (PSA) patients have different levels of phonetic, lexical, semantic, syntactic, and other linguistic domain impairment, and accompanied by non-verbal cognitive impairment. However, the association between verbal and non-verbal cognitive functions is not fully understood.In this study, we used the Chinese Aphasia Language Battery (CALB) and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to fully evaluate the characteristics of verbal and non-verbal cognitive function impairment in PSA patients. Methods: A total of 105 stroke patients were recruited in this study. Language and non-linguistic cognitive impairments were evaluated by CALB and LOTCA, respectively. Patients in the PSA group were subdivided into the fluent aphasia group (FAG) and the non-FAG group. Potential confounders were adjusted in the analysis of covariance. Partial correlation analysis between the subscores of CALB and LOTCA was also performed. Results: This study showed that PSA patients had worse speech analysis ability, vocabulary processing ability, semantic processing ability, syntactic structure conversion ability, and non-verbal cognitive performance(P<0.001). Moreover, the scores of phonetic decoding, phonetic vocabulary production, noun category classification, total LOTCA, orientation, visual perception, motor use, and thinking operation were lower in the non-FAG compared with the FAG (p<0.05). The total score of LOTCA was positively correlated with the aphasia quotient (r=0.637, P<0.001) and scores of speech analysis ability, vocabulary processing ability, semantic processing ability, and syntactic structure conversion ability (r>0; P<0.0005). Conclusions: Based on the language-cognition neuropsychological processing model, this study adopted a comprehensive verbal and non-verbal cognitive assessment set of tests, and found that PSA patients have extensive phonological, lexical, semantic, syntactic, and grammatical processing disorders. Moreover, PSA patients often have more extensive and serious non-verbal cognitive impairments, and the severity of aphasia is significantly positively correlated with the degree of nonverbal cognitive impairment.

The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis.

Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.

Factors predicting stroke specific quality of life in post stroke aphasia

Background: Understanding the factors that predict stroke-specific QoL in post-stroke aphasia patients in Pakistan is crucial for developing targeted interventions and improving the rehabilitation process. Objective: To determine the factors predicting the stroke-specific quality of life in post-stroke aphasia. Methodology: This cross-sectional analytical study was conducted over 18 months from June 2021 to December 2022 at RHS Rehabilitation Centre Islamabad Pakistan. A total of n=134 independent participants with fluent and non-fluent aphasia at least six months post-stroke, and able to follow one-step commands were included in the study through a non-probability convenient sampling technique. The stroke-specific quality of life (SS-QoL) scale was used to assess the quality of life in the participants, while the list of predictors was developed from the literature. SPSS version 21 was used for statistical analysis. Result: A multiple regression was run to predict the quality of life from marital status, gender, family status, patient's socioeconomic status, types of strokes, types of aphasia, and comorbidities. These variables statistically significantly predicted quality of life {F(13,120)=10.366, p&lt;0.001}. All variables cause 47.8% (Adj. R2=0.478) variance in stroke-specific quality of life in aphasia patients. Conclusion: The male gender, married marital status, middle and upper socioeconomic status, ischemic stroke compared to hemorrhagic stroke, fluent aphasia, and cardiac disease compared to other comorbidities positively affect the quality of life in post-stroke aphasia patients. However, age and the family system did not show any impact on the quality of life. Keywords: aphasia; diabetes; quality of life; stroke

Long-term effects of transcranial direct current stimulation (tDCS) combined with speech language therapy (SLT) on post-stroke aphasia patients: A systematic review and network meta-analysis of randomized controlled trials.

Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation tool for improving language performance in patients with aphasia after stroke. However, it remains unclear whether it has long-term effects. After consulting a large number of relevant studies, it was found that there are no definitive conclusions about the long-term effects of tDCS on post-stroke aphasia patients. To determine whether tDCS has long-term effects on post-stroke aphasia patients (PAPs) and which type of tDCS has the most beneficial treatment effects on language performance (especially naming ability). A network meta-analysis was conducted by searching for randomized controlled trials (RCTs) published until April 2023 in the following databases: Web of Science, Embase, Medline (from OVID and PubMed), PsycInfo and PsycARTICLES (from OVID). We only included RCTs published in English. PAPs treated by tDCS combined with speech-language therapy were selected. Sham tDCS was the control group. Naming ability or other language performance must be assessed at follow-up states. Two reviewers independently used checklists to assess the primary outcome (the long-term effects on naming ability) and the secondary outcome (other language performance, such as communication). Cochrane Collaboration guidelines were used to assess the risk of bias. Seven studies with 249 patients were included for data synthesis. For primary outcomes (naming nous), there was no obvious evidence to show a difference between interventions (C-tDCS vs. S-tDCS SMD = 0.06, 95% CI = -1.01, 1.12; A-tDCS vs. S-tDCS SMD = 0.00, 95% CI = -0.66, 0.65; D-tDCS vs. S-tDCS SMD = 0.77, 95% CI = -0.71, 2.24; A-tDCS vs. C-tDCS SMD = -0.06, 95% CI = -1.31,1.19; D-tDCS vs. C-tDCS SMD = 0.71, 95% CI = -1.11,2.53; D-tDCS vs. A-tDCS SMD = 0.77, 95% CI = -0.84, 2.39). In addition, no evidence showed differences in communication ability (C-tDCS vs. S-tDCS SMD = 0.08 95% CI = -1.77, 1.92; A-tDCS vs. S-tDCS SMD = 1.23 95% CI = -1.89, 4.34; D-tDCS vs. S-tDCS SMD = 0.70; 95% CI = -1.93, 3.34; A-tDCS vs. C-tDCS SMD = 1.15 95% CI = -2.48, 4.77; D-tDCS vs. C-tDCS SMD = 0.62 95% CI = -2.59, 3.84; D-tDCS vs. A-tDCS SMD = -0.52 95% CI = -4.60, 3.56). It seems that tDCS has no long-term effects on post-stroke aphasia patients in naming nouns and communication in terms of the results of our network meta-analysis. However, the results should be interpreted with caution. In the future, more RCTs with long follow-up times should be included in the research to conduct subgroup or meta-regression analyses to obtain a sufficient effect size.

Altered functional connectivity in language and non-language brain networks in patients diagnosed with acute post-stroke aphasia

ObjectiveA resting-state functional magnetic resonance imaging (rs-fMRI) approach was used to explore functional connectivity (FC) in language and non-language brain networks in acute post-stroke aphasia (PSA) patients, with a specific focus on the relationship between these fMRI results and patient clinical presentation. MethodsIn total, 20 acute PSA patients and 30 age-, sex-, and education level-matched healthy control (HC) participants were recruited and subjected to rs-fMRI imaging. In addition, western aphasia battery analyses（WAB） were used to compute aphasia quotient (AQ) values for PSA patients. Granger causality was employed to examine connections among cognition-associated resting-state brain networks, and the right middle frontal gyrus (RMFG),the mirror brain regions of Broca’s area and the Wernicke’s area, the right superior temporal gyrus were selected as regions of interest (ROIs). The REST plus software was then used to perform FC analyses of these regions to analyze changes in FC related to PSA pathogenesis. ResultsRelative to HC individuals, PSA patients exhibited significantly higher levels of intra-network FC between the right middle frontal gyrus (RMFG) and the left middle occipital gyrus (LMOG), with such FC being positively correlated with the AQ scores (P = 0.018). Moreover, reduced FC was detected between the Broca’s area homolog and the left middle frontal gyrus (LMFG), while FC was enhanced between the Wernicke’s area homolog and cerebellar vermis, and this FC was similarly positively correlated with patient AQ scores (P = 0.0297). ConclusionThese results suggest that FC between the bilateral hemispheres of the brain is significantly disrupted in acute PSA patients, interfering with the normal non-specific language network. Aphasia severity was further found to correlate with FC among many of the analyzed regions of the brain.

B - 84 Changes in Right Pars Triangularis Network Role and Naming Errors in Post-Stroke Aphasia.

The goal of the current study was to further clarify the role of right pars trianagularis (rPTr) in persons with aphasia (PWA) by investigating if the structural changes after stroke are associated with language deficits. We hypothesized that boundary controllability (bc), which measures the capacity of a region integrate/segregate brain regions, would be higher in rPTr for PWA than age-matched controls. We also sought to understand whether different types of naming errors corresponded to bc at rPTr. We hypothesized that bc would relate to phonological naming errors. We tested our hypothesis in 60 chronic post-stroke aphasia patients and 62 matched controls. All PWA completed the Western Aphasia Battery (WAB) and the Philadelphia Naming Test (PNT). With PNT data, we calculated the overall accuracy and proportion of error type (phonological, semantic, and mixed). Consistent with our first hypothesis, we found PWA had higher bc than age-matched controls at rPTr (t(120) = -2.52, p < 0.01). A regression model yielded a statistically significant negative relationship between bc and phonological errors that could not be accounted for by lesion volume (R2 = 0.11, F(1,48) = 6.21, p < 0.05). Our results demonstrate shift in the fundamental anatomical role of rPTr suggests the region becomes more critical for integrating and segregating communication across networks of the brain. Compared to findings in the left PTr in healthy subjects, our data suggest that homotopic recruitment may involve shifts in this anatomical property. and may relate to specific aspects of language processing.

A right convergence area of the prefrontal lobe is involved in the improvement of semantic fluency in patients with post-stroke aphasia

ABSTRACT Objectives This study aimed to longitudinally observe the improvement mechanism of semantic fluency in subacute post-stroke aphasia (PSA) patients using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Twelve PSA patients, about one month after onset, were enrolled in this study and received speech-language therapy (SLT) for one month. Auditory comprehension and semantic fluency were evaluated using the Western Aphasia Battery (WAB) and the Animal Fluency Test. Before and after treatment, rs-fMRI data were collected, and the dice similarity coefficient was used to measure the spatial similarity between each patient’s lesion and a reference lesion. The left posterior inferior temporal gyrus (pITG) was used as a seed to calculate the normalized functional connectivity in whole-brain voxel analysis using DPABI software for statistical analysis. Results The dice similarity coefficient between each patient’s lesion and the reference lesion showed moderate to high intensity (0.57 ± 0.14) in the Montreal Neurological Institute space. After treatment, we found a significant increase in functional connectivity between the left pITG and the right prefrontal lobe convergence area (peak t = 8.219, Gaussian random field multiple comparison correction, voxel p < 0.001, cluster p < 0.05). The increase in functional connectivity was negatively correlated with the improvement in auditory comprehension (r =–0.707, p = 0.033) and positively correlated with the improvement in semantic fluency (r = 0.79, p = 0.02). Conclusion The improvement of semantic fluency in subacute PSA patients may require the participation of the right convergence area of the prefrontal lobe.

Dynamic alterations of spontaneous neural activity in post-stroke aphasia: a resting-state functional magnetic resonance imaging study.

The dynamic alterations in spontaneous neural activity of the brain during the acute phase of post-stroke aphasia (PSA) remain unclear. Therefore, in this study, dynamic amplitude of low-frequency fluctuation (dALFF) was applied to explore abnormal temporal variability in local functional activity of the brain during acute PSA. Resting-state functional magnetic resonance imaging (rs-fMRI) data from 26 patients with PSA and 25 healthy controls (HCs) were acquired. The sliding window method was used to assess dALFF, with the k-means clustering method used to identify dALFF states. The two-sample t-test was applied to compare differences in dALFF variability and state metrics between the PSA and HC groups. (1) In the PSA group, greater variance of dALFF in the cerebellar network (CBN) and left fronto-temporo-parietal network (FTPN) was observed. (2) Three dALFF states were identified among all subjects. States 1 and 2 were identified in the PSA patients, and the two dALFF states shared a similar proportion. Moreover, the number of transitions between the two dALFF states was higher in the patients compared with that in HCs. The results of this study provide valuable insights into brain dysfunction that occurs during the acute phase (6.00 ± 3.52 days) of PSA. The observed increase in variability of local functional activities in CBN and left FTPN may be related to the spontaneous functional recovery of language during acute PSA, and it also suggests that cerebellum plays an important role in language.

Abnormalities of regional spontaneous brain activity in poststroke aphasia: a meta-analysis.

Poststroke aphasia is an acquired language disorder and has been proven to have adverse effects on patients' social skills and quality of life. However, there are some inconsistencies in the neuroimaging studies investigating poststroke aphasia from the perspective of regional alterations. A meta-analysis has been employed to examine the common pattern of abnormal regional spontaneous brain activity in poststroke aphasia in the current study. Specifically, the Anisotropic effect-size version of seed-based d mapping was utilized, and 237 poststroke aphasia patients and 242 healthy controls (HCs) from 12 resting-state functional magnetic resonance imaging studies using amplitude of low-frequency fluctuations (ALFF), fractional ALFF, or regional homogeneity were included. The results showed that compared with HCs, patients with poststroke aphasia demonstrated increased regional spontaneous brain activity in the right insula, right postcentral gyrus, left cerebellar lobule IX, left angular gyrus, right caudate nucleus, left parahippocampal gyrus, and right supplementary motor area, and decreased regional spontaneous brain activity in the left cerebellar lobule VI, left median cingulate and paracingulate gyri, right cerebellar crus I, and left supplementary motor area. The study could provide further evidence for pathophysiological mechanism of poststroke aphasia and help find targets for treatment.

Abnormal resting-state function within language network and its improvement among post-stroke aphasia

Several studies with resting-state magnetic resonance imaging (rs-fMRI) have examined functional impairments and plasticity within language network in patients with post-stroke aphasia (PSA). However, there is still ubiquitous inconsistency across these studies, partly due to restricted to very small sample size and the absence of validation with follow-up data. In the current study, we aimed at providing relatively strong evidence to support functional impairments and its reorganization in PSA. Here, the amplitude of low frequency fluctuations (ALFF) and functional connectivity were used to assess functional alterations of PSA with moderate sample size at baseline (thirty-five PSA patients and thirty-five healthy controls). Functional abnormalities at baseline were observed whether improved among sixteen follow-up patients. Compared with controls, PSA at baseline presented decreased ALFF in the left inferior frontal gyrus (IFG) and decreased functional connectivity of the left IFG with the bilateral supplementary motor area (SMA) and right superior temporal gyrus (STG). The decreased ALFF in IFG, decreased IFG-SMA and IFG-STG connectivity were enhanced among follow-up patients and was synchronized with language-performance improvement. Our results revealed reduced intrinsic neural activity and inter-connections within language network in PSA, which would be normalized synchronously as the improvement of language performance.

Depression Risk in Post-Stroke Aphasia Patients: A Nationwide Population-Based Cohort Study.

Depression and aphasia impair the quality of life after a stroke. Studies linking depression risk to post-stroke aphasia (PSA) lacked confirmation using a large database. Using Taiwan's National Health Insurance claims data, we identified ≥18-year-old patients hospitalized for stroke from 2005 to 2009, and those diagnosed with aphasia during hospitalization or within 3 months after discharge were selected to form the aphasic group. We estimated depression incidence by December 31, 2018, and used the Cox proportional hazards model to estimate aphasia group to non-aphasia group hazard ratios (HRs). With a median follow-up period of 7.91 and 8.62 years for aphasia (n = 26,754) and non-aphasia groups (n = 139,102), respectively, the incidence of depression was higher in the aphasia group than in the non-aphasia group (9.02 vs. 8.13 per 1,000 person-years), with an adjusted HR (95% confidence intervals [CI]) of 1.21 (1.15-1.29) for depression. The adjusted HRs (95% CI) of depression were homogenous for females, 1.26 (1.15-1.37); for males, 1.18 (1.09-1.27); for hemorrhagic stroke, 1.22 (1.09-1.37); and for ischemic stroke, 1.21 (1.13-1.30). Results in analyzing 25,939 propensity score-matched pairs demonstrated an equivalent effect. Patients with PSA are at an increased risk of developing depression, regardless of sex or stroke type.

Comparison of three cognitive assessment methods in post-stroke aphasia patients.

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). 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. 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. MoCA, MMSE, and NLCA can be applied in FA. NLCA is recommended for NFA.

Constrained spherical deconvolution -based tractography of major language tracts reveals post-stroke bilateral white matter changes correlated to aphasia

PurposeUsing constrained spherical deconvolution (CSD)-based tractography, we aimed to obtain conjoint analysis of diffusion measures of major language white matter (WM) tracts in post-stroke aphasic patients bilaterally, and to correlate the measures of each tract to the different language deficits. Material and methods17 aphasic patients with left hemispheric stroke, at the subacute stage, and ten age- matched controls underwent diffusion MRI examination. CSD-based tractography was performed. Diffusion measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were extracted after dissection of major language tracts bilaterally. Aphasia was assessed using language subset of hemispheric stroke scale. Comparisons of diffusion measures, for all tracts, between the two groups were performed. Partial correlations between the diffusion measures and different language components were obtained. ResultsIn the left hemisphere, significant lower FA and or higher MD with higher RD of patients' WM tracts compared to the control group. Significant differences of diffusion measures were also evident in the right hemisphere yet, less prominent. All changes reflected damage of the tracts' integrity. Significant correlations were found between comprehension and FA of the left arcuate fasciculus (AF) and left inferior longitudinal fasciculus. Additionally, a significant correlation was found between MD of the right AF and repetition. ConclusionConjoint analysis of diffusion measures, based on CSD tractography, can provide important markers for the underlying WM changes bilaterally. Moreover, our findings emphasize that language processing can be mediated by both ventral and dorsal streams and further highlight the contribution of the right AF in repetition.

Effects of Acupuncture-Related Therapies in the Rehabilitation of Patients with Post-Stroke Aphasia-A Network Meta-Analysis of Randomized Controlled Trials.

Objective: The purpose of this study was to evaluate the rehabilitation effects of four common interventions (BA: body acupuncture, SA: scalp acupuncture, TA: tongue acupuncture, SLT: speech and language training) used singly or in combination with language function in patients with post-stroke aphasia (PSA). Design: We systematically searched PubMed, EMBASE, Cochrane Library, Ovid, Web of Science, CNKI, VIP, and Wanfang from inception to 4 April 2022. Only randomized controlled trials that met the eligibility criteria were included. The risk of bias of studies included was assessed using the RoB-2 tool. The effects of different interventions for PSA patients were analyzed and ranked according to the surface under the cumulative ranking (SUCRA) analysis. Results: A total of 69 RCTs were included, including 5097 total participants. According to the results of the SUCRA curves, TA ranked highest in improving overall efficacy (SUCRA = 86%) and oral expression score (SUCRA = 86%). BA + TA ranked highest in increasing the comprehension score (SUCRA = 74.9%). BA + SA ranked highest in improving aphasia patients’ repetition (SUCRA = 89.2%) and denomination scores (SUCRA = 93%). Conclusions: Results of our network meta-analysis and SUCRA ranking showed that tongue acupuncture, body acupuncture + tongue acupuncture, and body acupuncture + scalp acupuncture seem to offer better advantages than other interventions for improving the language function in PSA patients. Moreover, it is noteworthy that our results are limited to the Chinese population, since all eligible studies are from China. Future well-designed studies with larger sample sizes and more ethnic groups are required to further verify these findings.

Cerebellar Continuous Theta Burst Stimulation for Aphasia Rehabilitation: Study Protocol for a Randomized Controlled Trial.

BackgroundLanguage recovery is limited in moderate to severe post-stroke aphasia patients. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in improving language dysfunctions caused by post-stroke aphasia, but the treatment outcome is as yet mixed. Considerable evidence has demonstrated the essential involvement of the cerebellum in a variety of language functions, suggesting that it may be a potential stimulation target of TMS for the treatment of post-stroke aphasia. Theta burst stimulation (TBS) is a specific pattern of rTMS with shorter stimulation times and better therapeutic effects. The effect of continuous TBS (cTBS) on the cerebellum in patients with aphasia with chronic stroke needs further exploration.MethodsIn this randomized, sham-controlled clinical trial, patients (n = 40) with chronic post-stroke aphasia received 10 sessions of real cTBS (n = 20) or sham cTBS (n = 20) over the right cerebellar Crus I+ a 30-min speech-language therapy. The Western Aphasia Battery (WAB) serves as the primary measure of the treatment outcome. The secondary outcome measures include the Boston Diagnostic Aphasia Examination, Boston Naming Test and speech acoustic parameters. Resting-state fMRI data were also obtained to examine treatment-induced changes in functional connectivity of the cerebro-cerebellar network. These outcome measures are assessed before, immediately after, and 12 weeks after cerebellar cTBS intervention.DiscussionThis protocol holds promise that cerebellar cTBS is a potential strategy to improve language functions in chronic post-stroke aphasia. The resting-state fMRI may explore the neural mechanism underlying the aphasia rehabilitation with cerebellar cTBS.

Linguistic characteristics of different types of aphasia: A computer-assisted qualitative analysis using T-LAB

Aphasic disorders are observed in patients with both vascular and neurodegenerative pathology. Although spontaneous speech in the various forms of aphasia has some features that are identifiable on a purely linguistic level, diagnosing the type of aphasia critically relies on the support of clinical and neuroimaging data. To identify some core characteristics of different types of fluent aphasias (i.e., disorders of speech production due to lesions in the posterior regions of the left perisylvian areas not associated with articulatory deficits or apraxia of speech) in spontaneous speech using T-LAB computer-assisted qualitative analyses. This is a mixed-method software that allows exploring narratives by highlighting their key features using linguistic, statistical and graphical tools. We collected samples of spontaneous speech (narratives) from 34 fluent aphasic Italian speakers (i.e.,11 post-stroke aphasic patients, 17 with the logopenic variant of Primary Progressive Aphasia and 6 with the semantic variant) during the description of the Cookie Theft Picture of the Boston Diagnostic Aphasia Examination. Thirty-four healthy control subjects were asked to complete the same task. Analyses of the entire corpus (all of the narratives), specific metadata introduction and tagging were performed by two raters and any conflicts were resolved by a third rater. T-LAB analysis revealed statistically significant differences between both aphasic patients and healthy controls and between vascular and degenerative patients. Although the main distinction emerged between post-stroke and neurodegenerative aphasias, important differences also emerged between the individuals with the logopenic variant and the semantic variant. These findings underline the potential usefulness of a computer-assisted analysis of speech production to identify the core linguistic characteristics of different aphasic disorders, independently of any clinical support.