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Behavioural Neurology 2019Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory,... (Review)
Review
Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain "understands," "speaks," and "writes," and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks ("streams"), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.
Topics: Aphasia; Brain; Brain Mapping; Comprehension; Humans; Language; Language Disorders; Nerve Net; Neurological Rehabilitation
PubMed: 31428210
DOI: 10.1155/2019/9894571 -
Archives of Clinical Neuropsychology :... May 2021Patients with aphasia can present a type of acalculia referred to as aphasic acalculia.
BACKGROUND
Patients with aphasia can present a type of acalculia referred to as aphasic acalculia.
AIMS
To investigate the correlation and to test regression models for one- and two-digit calculation skills using verbal and nonverbal predictors.
METHODS AND PROCEDURES
We selected an aphasia sample of 119 men and 81 women with a mean age of 57.37 years (SD = 15.56) and an average level of education of 13.52 years (SD = 4.08). Spanish versions of the Western Aphasia Battery and Boston Diagnostic Aphasia Examination, plus a Written Calculation test, were individually administered. The calculation section of the Western Aphasia Battery and the Written Calculation tests were used to pinpoint calculation difficulties.
OUTCOMES AND RESULTS
Calculation difficulties were more severe in Global and Mixed non-fluent aphasia; they were very similar in Broca, Conduction, and Amnesic Aphasia. All correlations between the two calculation subtests and the other subtests of the Western Aphasia Battery were statistically significant. Calculation subtests correlated negatively with age and positively with schooling. Sex and time post-onset did not show any correlation with the calculation scores. Education, Reading, Block Design, and Raven's Colored Progressive Matrices were significant predictors of Western Aphasia Battery Calculation. Writing was the only significant predictor of the Written Calculation scores.
CONCLUSIONS
Nonverbal abilities were predictors of calculation tests, whereas agraphia defects were predictors of the Written Calculation test. Therefore, calculation abilities can be regarded both as written language-dependent and verbal language-independent.
Topics: Aphasia; Dyscalculia; Educational Status; Female; Humans; Language; Male; Middle Aged; Neuropsychological Tests
PubMed: 32978628
DOI: 10.1093/arclin/acaa072 -
Current Neurology and Neuroscience... Nov 2021Subcortical structures have long been thought to play a role in language processing. Increasingly spirited debates on language studies, arising from as early as the... (Review)
Review
PURPOSE OF REVIEW
Subcortical structures have long been thought to play a role in language processing. Increasingly spirited debates on language studies, arising from as early as the nineteenth century, grew remarkably sophisticated as the years pass. In the context of non-thalamic aphasia, a few theoretical frameworks have been laid out. The disconnection hypothesis postulates that basal ganglia insults result in aphasia due to a rupture of connectivity between Broca and Wernicke's areas. A second viewpoint conjectures that the basal ganglia would more directly partake in language processing, and a third stream proclaims that aphasia would stem from cortical deafferentation. On the other hand, thalamic aphasia is more predominantly deemed as a resultant of diaschisis. This article reviews the above topics with recent findings on deep brain stimulation, neurophysiology, and aphasiology.
RECENT FINDINGS
The more recent approach conceptualizes non-thalamic aphasias as the offspring of unpredictable cortical hypoperfusion. Regarding the thalamus, there is mounting evidence now pointing to leading contributions of the pulvinar/lateral posterior nucleus and the anterior/ventral anterior thalamus to language disturbances. While the former appears to relate to lexical-semantic indiscrimination, the latter seems to bring about a severe breakdown in word selection and/or spontaneous top-down lexical-semantic operations. The characterization of subcortical aphasias and the role of the basal ganglia and thalamus in language processing continues to pose a challenge. Neuroimaging studies have pointed a path forward, and we believe that more recent methods such as tractography and connectivity studies will significantly expand our knowledge in this particular area of aphasiology.
Topics: Aphasia; Basal Ganglia; Diaschisis; Humans; Semantics; Thalamus
PubMed: 34817710
DOI: 10.1007/s11910-021-01156-5 -
JAMA Network Open Jan 2024Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.
OBJECTIVE
To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.
INTERVENTIONS
Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle.
RESULTS
Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR1900026740.
Topics: United States; Adult; Male; Humans; Middle Aged; Aphasia, Broca; Quality of Life; Acupuncture Therapy; Communication; Stroke
PubMed: 38252438
DOI: 10.1001/jamanetworkopen.2023.52580 -
Frontiers in Aging Neuroscience 2022This study aims at reviewing, within the framework of motor neuron disease-frontotemporal degeneration (MND-FTD)- disorders, evidence on the co-occurrence between... (Review)
Review
BACKGROUND
This study aims at reviewing, within the framework of motor neuron disease-frontotemporal degeneration (MND-FTD)- disorders, evidence on the co-occurrence between primary progressive aphasia (PPA) and MND in order to profile such a complex at pathological, genetic and clinical levels.
METHODS
This review was pre-registered (osf.io/ds8m4) and performed in accordance with the 2020 PRISMA guidelines. Case reports/series and group studies were included if addressing (1) progressive non-fluent aphasia (PNFA) or semantic dementia (SD) with MND or (2) MND patients with co-morbid PNFA/SD.
RESULTS
Out of 546 initial records, 56 studies were included. As to case reports/series ( = 35), which included 61 PPA-MND patients, the following findings yielded: (1) PNFA is more frequent than SD in PPA-MND; (2) in PPA-MND, the most prevalent motor phenotypes are amyotrophic lateral sclerosis and predominant-upper MND, with bulbar involvement being ubiquitous; (3) extrapyramidal features are moderately frequent in PPA-MND; (4) PPA-MND patients usually display frontotemporal, left-greater-than-right involvement; (5) TDP-43-B is the typical pathological substrate of PPA-MND; (6) mutations represent the most frequent genetic risk factors for PPA-MND.As to group studies, including 121 patients, proportional meta-analytic procedures revealed that: (1) the lifetime prevalence of MND in PPA is 6%; (2) PPA occurs in 19% of patients with co-morbid MND and FTD; (3) MND is more frequent in PNFA (10%) than in SD patients (3%).
DISCUSSION
Insights herewith delivered into the clinical, neuropathological and genetic features of PPA-MND patients prompt further investigations aimed at improving clinical practice within the MND-FTD .
PubMed: 36158556
DOI: 10.3389/fnagi.2022.1003792 -
Clinical Linguistics & Phonetics Aug 2023In this study, we investigated the lexical tones and vowels produced by ten speakers diagnosed with aphasia and coexisting apraxia of speech (A-AOS) and ten healthy...
In this study, we investigated the lexical tones and vowels produced by ten speakers diagnosed with aphasia and coexisting apraxia of speech (A-AOS) and ten healthy participants, to compare their tone and vowel disruptions. We first judged the productions of both A-AOS and healthy participants and classified them into three categories, i.e. those by healthy speakers and rated as correct, those by A-AOS participants and rated as correct, and those by A-AOS participants and rated as incorrect. We then compared the perceptual results for the three groups based on their respective acoustic correlates to reveal the relations among different accuracy groups. Results showed that the numbers of tone and vowel disruptions by A-AOS speakers occurred on a comparable scale. In perception, approximately equal numbers of tones and vowels produced by A-AOS participants were identified as correct; however, acoustic parameters showed that, unlike vowels, the patients' tones categorised as correct by native Mandarin listeners differed considerably from those of the healthy speakers, suggesting that for Mandarin A-AOS patients, tones were in fact more disrupted than vowels in acoustic terms. Native Mandarin listeners seemed to be more tolerant of less well-targeted tones than less-well targeted vowels. The clinical implication is that tonal and segmental practice should be incorporated for Mandarin A-AOS patients to enhance their overall motor speech control.
Topics: Humans; Speech Perception; Speech; Phonetics; Apraxias; Aphasia; Speech Acoustics
PubMed: 35656744
DOI: 10.1080/02699206.2022.2081611