-
Medicine Jan 2024Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Humans; Aphasia; Brain; Speech; Stroke; Stroke Rehabilitation; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Network Meta-Analysis
PubMed: 38215135
DOI: 10.1097/MD.0000000000036880 -
Frontiers in Psychiatry 2023We aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild...
Repetitive transcranial magnetic stimulation for apathy in patients with neurodegenerative conditions, cognitive impairment, stroke, and traumatic brain injury: a systematic review.
BACKGROUND
We aimed to determine the effects and tolerability of repetitive transcranial magnetic stimulation (rTMS) on apathy in patients with neurodegenerative conditions, mild cognitive impairment (MCI), stroke, and traumatic brain injury (TBI) via systematic review.
METHODS
We conducted a systematic search in major electronic health databases, including PubMed, Scopus, and PsycINFO, covering the period from inception to June 2023. Comparative clinical trials and cohort studies, and studies with before-after designs were considered for inclusion. We used the Cochrane Risk of Bias and the National Institutes of Health (NIH) tools to assess methodological quality.
RESULTS
Out of 258 records identified, 14 studies met our eligibility criteria (11 randomized controlled trials (RCT) and 3 studies utilized before-and-after designs) with a total of 418 patients (overall female-to-male ratio 1:1.17) included in the review. The overall methodological quality of the included studies was assessed to be fair to good. The stimulation parameters used varied considerably across the studies. The summary findings of our review indicate the following observations on the effects of rTMS on apathy: (1) the results of all included studies in Alzheimer's disease investigating the effects of rTMS on apathy have consistently shown a positive impact on apathy; (2) the majority of studies conducted in Parkinson's disease have not found statistically significant results; (3) a single study (RCT) on patients with primary progressive aphasia demonstrated significant beneficial effects of rTMS on apathy; (4) the trials conducted on individuals with MCI yielded varying conclusions; (5) one study (RCT) in chronic stroke suggested that rTMS might have the potential to improve apathy; (6) one study conducted on individuals with mild TBI did not find a significant favorable association on apathy; and (7) the use of different rTMS protocols on the populations described is generally safe.
CONCLUSION
The feasibility of utilizing rTMS as a treatment for apathy has been suggested in this review. Overall, limited evidence suggests that rTMS intervention may have the potential to modify apathy among patients with AD, PPA, MCI and chronic stroke, but less so in PD and mild TBI. These findings require confirmation by larger, well-designed clinical trials.
PubMed: 38034914
DOI: 10.3389/fpsyt.2023.1259481 -
Frontiers in Human Neuroscience 2023The semantic variant of primary progressive aphasia (svPPA), known also as "semantic dementia (SD)," is a neurodegenerative disorder that pertains to the frontotemporal...
The semantic variant of primary progressive aphasia (svPPA), known also as "semantic dementia (SD)," is a neurodegenerative disorder that pertains to the frontotemporal lobar degeneration clinical syndromes. There is currently no approved pharmacological therapy for all frontotemporal dementia variants. Transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation technique capable of modulating cortical excitability through a sub-threshold shift in neuronal resting potential. This technique has previously been applied as adjunct treatment in Alzheimer's disease, while data for frontotemporal dementia are controversial. In this scoped review, we summarize and critically appraise the currently available evidence regarding the use of tDCS for improving performance in naming and/or matching tasks in patients with svPPA. Clinical trials addressing this topic were identified through MEDLINE (accessed by PubMed) and Web of Science, as of November 2022, week 3. Clinical trials have been unable to show a significant benefit of tDCS in enhancing semantic performance in svPPA patients. The heterogeneity of the studies available in the literature might be a possible explanation. Nevertheless, the results of these studies are promising and may offer valuable insights into methodological differences and overlaps, raising interest among researchers in identifying new non-pharmacological strategies for treating svPPA patients. Further studies are therefore warranted to investigate the potential therapeutic role of tDCS in svPPA.
PubMed: 38021245
DOI: 10.3389/fnhum.2023.1219737 -
Medicine Nov 2023The aim of this systematic review is to evaluate the effectiveness of combining acupuncture with speech rehabilitation training, compared to acupuncture alone or speech... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this systematic review is to evaluate the effectiveness of combining acupuncture with speech rehabilitation training, compared to acupuncture alone or speech rehabilitation training alone, in the treatment of post-stroke aphasia.
METHODS
To gather data for this study, we searched 6 databases: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP Database. We included clinical randomized controlled trials on acupuncture combined with rehabilitation training for post-stroke aphasia published between January 1, 2011 and October 8, 2023. Two researchers independently screened the literature, evaluated its quality, and extracted the data using Stata 15.1 SE and RevMan 5.4 software. We conducted a meta-analysis using the random effects model, and expressed dichotomous variables as odds ratios (OR) with 95% confidence intervals (CIs) and continuous variables as weighted mean differences (WMD) with 95% confidence intervals. Specifically, the odds of improvement were significantly higher in the combination group (OR = 3.89, 95% CI = [2.62, 5.78]). Improvements were also seen in several language functions, including expression (WMD = 5.14, 95% CI = [3.87, 6.41]), understanding (WMD = 9.16, 95% CI = [5.20, 13.12]), retelling (WMD = 11.35, 95% CI = [8.70, 14.00]), naming (WMD = 11.36, 95% CI = [8.12, 14.61] ), reading (WMD = 9.20, 95% CI = [4.87, 13.52]), writing (WMD = 5.65, 95% CI = [3.04, 8.26]), and reading aloud (WMD = 7.45, 95% CI = [3.12, 11.78]). Scores on the Chinese Aphasia Complete Test Scale, Western Aphasia Complete Test Scale, and China Rehabilitation Research Center Aphasia Check Scale were also significantly higher in the combination group, with improvements of 7.89, 9.89, and 9.27, respectively.
RESULTS
A total of 16 clinical randomized controlled trials, including 1258 patients, were included in this meta-analysis. The results showed that compared to simple rehabilitation training or acupuncture treatment alone, the combination of acupuncture and language rehabilitation training was more effective in improving clinical outcomes for patients with post-stroke aphasia.
CONCLUSIONS
The results of this meta-analysis indicate that acupuncture combined with language rehabilitation training can effectively improve the language function of post-stroke aphasia patients and increase clinical effectiveness. However, further research is needed to confirm these findings and provide a more reliable evidence-based basis for clinical practice. In particular, additional studies with large sample sizes, high quality, and more specific and standardized outcome measures are needed to strengthen the evidence. The limited quantity and quality of the current studies may affect the generalizability of the results.
Topics: Humans; Aphasia; Stroke; Acupuncture Therapy; Recovery of Function; Treatment Outcome; Stroke Rehabilitation
PubMed: 38013378
DOI: 10.1097/MD.0000000000036160 -
Brain and Language Nov 2023Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results.... (Meta-Analysis)
Meta-Analysis Review
Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results. We conducted a systematic review and a meta-analysis to examine within- and cross-language treatment effects and the variables that affect them. We searched PubMed, PsycINFO, CINAHL, and Google Scholar (February 2020; January 2023), identifying 40 studies reporting on 1573 effect sizes from 85 individuals. We synthesized effect sizes for treatment outcomes using a multi-level model to correct for multiple observations from the same individuals. The results showed significant treatment effects, with robust within-language treatment effects and weaker cross-language treatment effects. Age of language acquisition of the treatment language predicted within-language and cross-language effects. Our results suggest that treating multilingual people with aphasia in one language may generalize to their other languages, especially following treatment in an early-acquired language and a later-learned language that became the language of immersion.
Topics: Humans; Language; Aphasia; Multilingualism; Language Development; Treatment Outcome
PubMed: 37994828
DOI: 10.1016/j.bandl.2023.105326 -
Acta Neurobiologiae Experimentalis Sep 2023Language disorders can occur as a consequence of stroke or neurodegenerative disorders, among other causes. Post‑stroke aphasia (PSA) and primary progressive aphasia...
Language disorders can occur as a consequence of stroke or neurodegenerative disorders, among other causes. Post‑stroke aphasia (PSA) and primary progressive aphasia (PPA) are syndromes that, despite having common features, differ in the brain mechanisms that cause their symptoms. These differences in the underlying functional neuroanatomical changes may influence the way they are addressed by different non‑invasive brain stimulation techniques and, in particular, by repetitive transcranial magnetic stimulation (rTMS). The aim of this systematic review is to evaluate the efficacy of rTMS in the treatment of PSA and PPA, as well as the differences in the approach to these disorders using rTMS. To this end, a total of 36 articles were found in the Web of Science, Scopus, and PubMed. The results obtained suggest that whereas in PSA, the selection of the stimulation paradigm is based on bi‑hemispheric functional reorganisation models with a tendency towards the application of inhibitory rTMS in the contralateral right hemisphere, in PPA, the application of excitatory rTMS in functionally compromised areas seems to show promising changes. It is concluded that rTMS is a potential treatment in the therapy of both disorders, although differences in the underlying brain mechanisms differentiate the rTMS approach in each case.
Topics: Humans; Transcranial Magnetic Stimulation; Treatment Outcome; Stroke; Aphasia; Aphasia, Primary Progressive
PubMed: 37874189
DOI: 10.55782/ane-2023-2433 -
Frontiers in Psychology 2023Diffusion Tensor Imaging (DTI) indicators of different white matter (WM) fibers and brain region lesions for post-stroke aphasia (PSA) are inconsistent in existing...
INTRODUCTION
Diffusion Tensor Imaging (DTI) indicators of different white matter (WM) fibers and brain region lesions for post-stroke aphasia (PSA) are inconsistent in existing studies. Our study examines the consistency and differences between PSA tests performed with DTI. In addition, obtaining consistent and independent conclusions between studies was made possible by utilizing DTI in PSA assessment.
METHODS
In order to gather relevant studies using DTI for diagnosing PSA, we searched the Web of Science, PubMed, Embase, and CNKI databases. Based on the screening and evaluation of the included studies, the meta-analysis was used to conduct a quantitative analysis. Narrative descriptions were provided for studies that met the inclusion criteria but lacked data.
RESULTS
First, we reported on the left hemisphere. The meta-analysis showed that fractional anisotropy (FA) of the arcuate fasciculus (AF) and superior longitudinal fasciculus (SLF), inferior frontal-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), and uncinate fasciculus (UF) were decreased in the PSA group in comparison with the healthy controls ( < 0.00001). However, in the comparison of axial diffusivity (AD), there was no statistically significant difference in white matter fiber tracts in the dual-stream language model of the PSA group. Elevated radial diffusivity (RD) was seen only in the IFOF and ILF ( = 0.01; = 0.05). In the classic Broca's area, the FA of the PSA group was decreased ( < 0.00001) while the apparent diffusion coefficient was elevated ( = 0.03). Secondly, we evaluated the white matter fiber tracts in the dual-stream language model of the right hemisphere. The FA of the PSA group was decreased only in the IFOF ( = 0.001). AD was elevated in the AF and UF ( < 0.00001; PUF = 0.009). RD was elevated in the AF and UF ( = 0.01; = 0.003). The other fiber tracts did not undergo similar alterations.
CONCLUSION
In conclusion, DTI is vital for diagnosing PSA because it detects WM changes effectively, but it still has some limitations. Due to a lack of relevant language scales and clinical manifestations, diagnosing and differentiating PSA independently remain challenging.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=365897.
PubMed: 37790217
DOI: 10.3389/fpsyg.2023.1140588 -
Journal of Communication Disorders 2023Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger... (Review)
Review
INTRODUCTION
Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used.
METHODS
We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria.
RESULTS
We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used.
CONCLUSIONS
Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
Topics: Humans; Aphasia; Linguistics; Language Tests; Language Development Disorders
PubMed: 37717472
DOI: 10.1016/j.jcomdis.2023.106368 -
Journal of Alzheimer's Disease : JAD 2023Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding which fluency task is more affected while developing AD. Most studies focus on SF assessment, given its connection with the temporoparietal amnesic system. PF is less reported, it is related to working memory, which is also impaired in probable and diagnosed AD. Differentiating between performance on these tasks might be informative in early AD diagnosis, providing an accurate linguistic profile.
OBJECTIVE
Compare SF and PF performance in healthy volunteers, volunteers with probable AD, and patients with AD diagnosis, considering the heterogeneity of age, gender, and educational level variables.
METHODS
A total of 8 studies were included for meta-analysis, reaching a sample size of 1,270 individuals (568 patients diagnosed with AD, 340 with probable AD diagnosis, and 362 healthy volunteers).
RESULTS
The three groups consistently performed better on SF than PF. When progressing to a diagnosis of AD, we observed a significant difference in SF and PF performance across our 3 groups of interest (p = 0.04). The age variable explained a proportion of this difference in task performance across the groups, and as age increases, both tasks equally worsen.
CONCLUSION
The performance of SF and PF might play a differential role in early AD diagnosis. These tasks rely on partially different neural bases of language processing. They are thus worth exploring independently in diagnosing normal aging and its transition to pathological stages, including probable and diagnosed AD.
Topics: Humans; Semantics; Alzheimer Disease; Verbal Behavior; Neuropsychological Tests; Linguistics
PubMed: 37482994
DOI: 10.3233/JAD-221272 -
Archives of Physical Medicine and... Mar 2024Although people with aphasia (PwA) represent 30% of stroke survivors, they are frequently excluded from stroke research, or their inclusion is unclear. Such practice...
BACKGROUND
Although people with aphasia (PwA) represent 30% of stroke survivors, they are frequently excluded from stroke research, or their inclusion is unclear. Such practice significantly limits the generalizability of stroke research, increases the need to duplicate research in aphasia-specific populations, and raises important ethical and human rights issues.
OBJECTIVE
To detail the extent and nature of inclusion of PwA in contemporary stroke randomized controlled trials (RCTs).
METHODS
We conducted a systematic search to identify completed stroke RCTs and RCT protocols published in 2019. Web of Science was searched using terms "stroke" and "randomized controlled trial". These articles were reviewed by extracting rates of PwA inclusion/exclusion, whether "aphasia" or related terms were referred to in the article or supplemental files, eligibility criteria, consent procedures, adaptations made to support the inclusion of PwA, and attrition rates of PwA. Data were summarized, and descriptive statistics applied when appropriate.
RESULTS
271 studies comprising 215 completed RCTs and 56 protocols were included. 36.2% of included studies referred to aphasia/dysphasia. Of completed RCTs, only 6.5% explicitly included PwA, 4.7% explicitly excluded PwA, and inclusion was unclear in the remaining 88.8%. Among RCT protocols, 28.6% of studies intended inclusion, 10.7% intended excluding PwA, and in 60.7%, inclusion was unclear. In 45.8% of included studies, sub-groups of PwA were excluded, either explicitly (ie, particular types/severities of aphasia, eg, global aphasia) or implicitly, by way of ambiguous eligibility criteria which could potentially relate to a sub-group of PwA. Little rationale for exclusion was provided. 71.2% of completed RCTs did not report any adaptations that could support the inclusion of PwA, and minimal information was provided about consent procedures. Where it could be determined, attrition of PwA averaged 10% (range 0%-20%).
CONCLUSION
This paper details the extent of inclusion of PwA in stroke research and highlights opportunities for improvement.
Topics: Humans; Aphasia; Stroke; Survivors; Patient Selection; Randomized Controlled Trials as Topic
PubMed: 37394026
DOI: 10.1016/j.apmr.2023.06.010