Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method

This study examined activation levels in the left (L) supplementary motor area (SMA) and the right (R) SMA (separately), and activation in nine R perisylvian language homologues during overt, propositional speech in chronic nonfluent aphasia patients. Previous functional imaging studies with a variety of chronic aphasia patients have reported activation in these regions during different language tasks, however, overt propositional speech has not been examined. In the present research, four nonfluent aphasia patients were studied during overt elicited propositional speech at 4-9 years post-single L hemisphere stroke, which spared the SMA. The dynamic susceptibility contrast (DSC) method of functional MRI was used to calculate relative cerebral blood volume (relCBV) for cortical regions of interest (ROIs) during the first-pass bolus of gadolinium during two conditions: (1) pattern (silent viewing of checkerboard patterns) and (2) story (overt, elicited propositional speech describing sequential pictures, which formed a story). During the story condition, controls had significantly higher relCBV in L SMA than in R SMA; aphasics, however, had significantly higher relCBV in R SMA than in L SMA. During the pattern condition, no significant differences were observed between the L SMA and the R SMA for either controls or aphasics. In addition, aphasics had significantly higher relCBV in the R sensorimotor mouth during story than pattern. This R sensorimotor mouth relCBV was also significantly higher in aphasics than controls during story, and the two groups did not differ during pattern. The overall mean relCBV for the nine R perisylvian ROIs was significantly higher for aphasics than controls during both story and pattern. These results suggest that poor modulation, including possible over-activation of R sensorimotor mouth and other R perisylvian language homologues may underlie in part, the hesitant, poorly articulated, agrammatic speech associated with nonfluent aphasia.     

失语症患者图形命名中语音错误的产生机制

目的:探讨失语症患者图形命名中语音错误的产生机制。方法:利用图形命名、复述以及同音判断任务,分析患者在不同任务中的错误模式。结果:该患者在图形命名中犯大量的语音错误,这些语音错误几乎全部为非词反应,且主要为语音高相似错误81%(92/113)。显著影响其命名成绩的是图形所对应的目标词长,而目标词的频率不影响命名。同音判断正常,而非词复述严重受损27%(45/165)。结论:SJ在图形命名中的语音错误不是源于语音输出词典受损,而是因为词典后加工环节损伤所导致。     

Contribution of the left and right inferior frontal gyrus in recovery from aphasia. A functional MRI study in stroke patients with preserved hemodynamic responsiveness

The relative contribution of dominant and non-dominant language networks to recovery from aphasia is a matter of debate. We assessed with functional magnetic resonance imaging (fMRI) to what extent the left and right hemispheres are associated with recovery from aphasia after stroke. fMRI with three language tasks was performed in 13 aphasic stroke patients and in 13 healthy subjects. Severity of aphasia was examined within 2 months after stroke and after at least 1 year. Recovery of naming ability and scores on the Token Test were correlated with data from fMRI in the chronic phase. A breath-hold paradigm was used to investigate hemodynamic responsiveness.Overall language performance in the chronic phase correlated with higher relative activation of left compared to right perisylvian areas. Recovery of naming ability was positively correlated with activation in the left inferior frontal gyrus (IFG) for semantic decision and verb generation. Recovery on the Token Test was positively correlated with activation in both left and right IFG during semantic decision and verb generation. Hemodynamic response to the breath-hold task was similar in patients and controls.Our study suggests that in the chronic stage after stroke left IFG activity is associated with improvement of picture naming and sentence comprehension, whereas activity in the right IFG may reflect up-regulation of non-linguistic cognitive processing. Altered hemodynamic responsiveness seems an unlikely confounder in the interpretations of fMRI results.     

静息态功能MRI观察脑梗死后失语症患者功能连接变化

目的 采用静息态功能MRI（rs-fMRI）观察脑梗死后失语患者各脑区功能连接（FC）变化。方法 对10例脑梗死后失语症患者（观察组）及10名健康志愿者（对照组）采集rs-fMRI,以左侧额下回（LIFG）布罗卡（Broca）区为种子点,分析组内和组间ROI与其他脑区FC相关性的差异。结果 对照组双侧枕叶、顶叶、额叶、颞叶、小脑半球、小脑扁桃体及脑干与ROI FC呈正相关（P均<0.05）;观察组双侧额下回,左侧中央后回、中央前回、额中回、扣带回、豆状核、海马、楔叶、枕叶,右侧顶下小叶、缘上回与ROI的FC呈正相关（P均<0.05）;观察组双侧缘上回、颞下回、梭状回、顶下小叶、枕中回,右侧额中回、扣带回、小脑半球,左侧颞中回、颞上回等与ROI的FC的相关性高于对照组（P均<0.05）。结论 静息态下健康人脑内存在语言功能网络;左侧脑梗死后失语症患者多个脑区与LIFG Broca区的FC呈正相关,以左侧大脑半球额叶为主,可能与脑梗死后失语症的发生及恢复机制有关。     

听觉功能MRI研究的实验设计

目的探讨听觉fMRI研究的有效数据采集方式。方法对13例健康年轻受试者分别采用纯音及调幅音两种听觉刺激条件，刺激分别采用组块和事件相关设计进行听觉呈现，以比较连续及稀疏两种采集方式下听觉皮层的fMRI响应，运用SPM2软件进行数据分析和脑功能区定位，并分析两种不同实验数据采集方式下听觉皮层激活的差异。结果调幅声较纯音更易激发听觉皮层的激活；两种刺激条件下，稀疏采集时听觉皮层的fMRI响应明显多于连续采集，比较听觉皮层各区，以初级听觉皮层fMRI响应为著。结论调幅音是听觉fMRI研究中的合适刺激；稀疏采集方式有助于克服环境噪声的负面影响，结合物理衰减方法，可实现听觉功能的fMRI研究。     

运动性及感觉性失语患者语言功能区血流量变化:磁共振灌注成像分析

目的:通过功能磁共振揭示运动性、感觉性失语患者的语言功能区血流量变化,探讨失语症可能的发病机制。方法:对2004-02/2005-02在北京天坛医院神经内科住院的经CT或MRI证实为脑梗死患者,且第1次发病、有明确的失语征候群、神志清晰、无其他认知功能障碍的患者58例,采用西部失语成套测验评定标准判断失语症类型。评定结果为运动性或感觉性失语的患者,对病变可能波及的Broca区、Wernicke区进行磁共振灌注成像分析,主要测量Broca区或Wernicke区的局部脑血流量、局部脑血容量、对比剂平均通过时间、达峰时间,并与对侧镜像区进行对比。结果:58例患者均完成磁共振灌注成像检测,全部进入结果分析。①在纳入的58例脑梗死患者中,经西部失语成套测验评定为Broca失语(运动性失语)12例,Wernicke失语(感觉性失语)21例,其他失语症类型25例。②Broca失语患者左侧Broca区的对比剂平均通过时间较对侧镜像区延长,差异有显著性(P<0.05);Broca区的局部脑血流量、局部脑血容量与对侧镜像区相比差异无显著性(P>0.05);Broca区的达峰时间与对侧镜像区的相比差异无显著性(P=0.05)。③Wernicke失语患者左侧Wernicke区的局部脑血流量、局部脑血容量较对侧镜像区的减少,差异有显著性(P<0.01);对比剂平均通过时间、达峰时间较对侧镜像区延长,差异有显著性(P<0.01);提示Wernicke失语患者左侧Wernicke区与对侧镜像区相比存在低灌注的现象。结论:Broca失语(运动性失语)、Wernicke失语(感觉性失语)患者的磁共振灌注成像结果提示失语症患者受累语言功能区的处于低灌注的状态。这可能为失语症的发病机制之一。     

语义导航策略改善失语症患者命名能力的研究

目的:探讨语义导航策略(SNS)对失语症患者命名能力的改善作用。方法:14例失语症患者随机分为SNS组(n=7)和语义无关训练(US)组(n=7)。采用中文联想词汇中的122个词汇,SNS组按照网络分析技术自动生成的词汇顺序,US组则以随机词汇顺序呈现给患者。在西方成套失语症检查(WAB)和简易精神状态检查(MMSE)基线测试后,进行为期10d,每天1次言语训练,治疗前后应用75张训练图片评估患者的命名能力。结果:SNS组治疗后正确反应数显著高于治疗前以及治疗后US组,治疗后无反应数也显著低于治疗前以及治疗后US组。SNS组治疗后的正确反应数与WAB命名得分呈显著正相关。结论:SNS可以有效改善失语症患者的命名能力。     

Brain cortical activation during guitar-induced hand dystonia studied by functional MRI

Focal hand dystonia in musicians is a strongly task-related movement disorder. Typically, symptoms become apparent only when players execute specific overpracticed skilled exercises on their instrument. We therefore examined five guitarists with functional MRI during dystonic symptom provocation by means of an adapted guitar inside the magnet. The activation patterns obtained in comparable nondystonic guitarists and in the study patients when performing normal-hand exercise served as references. A 1.5-T system equipped with echo-speed gradients and single-shot echoplanar imaging software was used. Data acquisition was centered on the cortical motor system encompassed in eight contiguous slices. Dystonic musicians compared with both control situations showed a significantly larger activation of the contralateral primary sensorimotor cortex that contrasted with a conspicuous bilateral underactivation of premotor areas. Our results coincide with studies of other dystonia types in that they show an abnormal recruitment of cortical areas involved in the control of voluntary movement. However, they do suggest that the primary sensorimotor cortex, rather than being underactive in idiopathic dystonic patients, may be overactive when tested during full expression of the task-induced movement disorder.     

The effects of aging upon the hemodynamic response measured by functional MRI

We comparedthe characteristics of the visually evoked hemodynamic response (HDR) in groups of young and elderly adults. Checkerboard stimuli were presented for 500 ms either singly or in pairs separated by a 2-s intrapair interval while gradient-echo echoplanar fMRI images were acquired concurrently every 1 s. Activated voxels, identified by correlation with an empirically derived reference waveform, were found for both groups in cortex along the calcarine sulcus and in the fusiform gyrus, with the mean HDR latency in calcarine cortex peaking approximately 300 ms earlier than the HDR evoked in the fusiform gyrus. On average, younger subjects had twice as many activated voxels as older subjects. The mean HDR had a similar onset time, rate of rise, and peak amplitude in both groups. However, the HDRs of older subjects reached their peak earlier and were more variable across subjects. Despite having average HDR amplitudes similar to those of younger subjects, older subjects had higher noise levels in activated voxels, resulting in lower signal-to-noise ratios. Distribution analyses of voxel statistics (t value, peak amplitude, peak latency) revealed that older subjects had proportionally fewer small-effect-size voxels, due to their increased voxelwise noise. This finding was consistent with the smaller spatial extent of activation in older subjects. To investigate age differences in the refractory period of the visual HDR, the HDR evoked by the second stimulus of each pair was isolated by subtracting the HDR evoked by a single stimulus from the composite HDR evoked by a pair. Recovery measures were similar across the age groups.     

Effects of two lexical retrieval cueing treatments on action naming in aphasia

The effects of two cueing treatments, Phonological Cueing Treatment (PCT) and Semantic Cueing Treatment (SCT), were examined with three chronic speakers with aphasia. The effects of treatment on action naming were measured with the use of single-subject experimental designs. The participants had received PCT and SCT to improve object naming in a previous investigation and had responded positively to both treatments. In the current study, Speaker 1 received SCT, Speaker 2 received PCT, and Speaker 3 received both SCT and PCT. Action naming improved for Speakers 1 and 3, but not for Speaker 2. These findings indicate that PCT and SCT may have utility in facilitating action naming for some speakers with aphasia but that the effects of these treatments may vary across grammatical form classes (e.g., nouns versus verbs).     

Non-intensive picture naming treatment is as efficacious as intensive treatment in chronic aphasia

This review provides a summary and appraisal commentary on the treatment review by Sage, K., Snell, C., & Lambon Ralph, M. A. (2011). How intensive does anomia therapy for people with aphasia need to be? Neuropsychological Rehabilitation, 21(1), 26–41.

Source of funding and disclosure of interest: Claerwen Snell was supported by a Medical Research Council PhD studentship, and the original authors of this research report no conflicts of interest.     

汉语失语症患者动词功能损伤的神经语言学分析

目的:分析汉语失语症患者动词功能的损伤和临床病灶部位。方法:于2000-02/04在江苏省徐州市第一、二、三、四医院、解放军第九十七医院等大型医院入住的神经内科患者中选择6位典型的汉语失语症患者作为测查对象。采用北京医科大学汉语失语症成套测验检查法,同时参考波士顿诊断性失语检查法、西方失语症成套测验,并结合头颅CT的检查结果判断失语类型。根据本实验的目的,设计听觉路径和视觉路径两种测试方法。听觉路径通过语音来测试患者的动词功能知识(配价知识);视觉路径则是通过画面来测试患者的动词功能知识。最后,根据被试对测试的正确结果进行统计分析。结果:患者6例均进入结果分析。6例失语症患者的单宾语动词(二价动词)听觉路径成绩为:①字词层级,患者1的正确率为10%,患者2为55%,患者3为75%,患者4为60%,患者5为80%,患者6为35%。②语句层级,患者1的正确率为5%,患者2为40%,患者3为60%,患者4为55%,患者5为65%,患者6为30%。③篇章层级,患者1的正确率为5%,患者2为30%,患者3为50%,患者4为50%,患者5为60%,患者6为25%。6例失语症患者的二价动词视觉路径成绩为:①字词层级,患者1的正确率为15%,患者2为55%,患者3为80%,患者4为65%,患者5为85%,患者6为75%。②语句层级,患者1的正确率为10%,患者2为45%,患者3为65%,患者4为60%,患者5为75%,患者6为65%。③篇章层级,患者1的正确率为5%,患者2为35%,患者3为55%,患者4为50%,患者5为65%,患者6为60%。结论:汉语失语症患者的动词功能中受损伤程度最小的是该动词的基本价位,大脑对任何动词的各种论元结构变换都有极强的适应能力;左额下回后部对动词配价加工起主要作用,还涉及左额下回后部的周围区域和其他较远的相关区域。     

词汇产生交互激活模型在脑卒中后失语症患者命名错误分析中的应用

摘要 目的：应用词汇产生交互激活模型(the interactive activation model of word production, IA模型)分析不同类型失语症命名错误反应的规律及产生机制,探讨针对性治疗方法。 方法：纳入脑卒中后失语症患者41例,对其进行语言能力评估、失语症亚型分类、视图命名能力评估,根据IA模型对命名错误反应进行分类并分析。 结果：①流利性失语症的命名正确率(42.0%)高于非流利性失语症(28.6%),前者命名错误类型出现率最高的为语义性错误(19.7%),后者为遗漏错误(21.05%);②遗漏错误和组词错误是最能够用以区分流利性和非流利性失语的命名错误反应类型;③每位失语症患者语义性错误占错误数的比率与命名正确率显著相关,命名正确率提高,语义性错误比率也升高。 结论：流利性和非流利性失语症命名错误类型存在显著性差异,可应用IA模型进行命名错误产生机制的分析并选择针对性治疗策略;应用IA模型得出了区分流利性和非流利性失语症的典型判别函数,可用于失语症亚型判别。     

双额叶在线经颅直流电刺激对失语症图命名的作用

摘要 目的：探查左侧Broca区阳极和Broca右侧对应区阴极经颅直流电刺激（tDCS）对脑卒中后失语症患者图命名是否有促进作用,两者的促进作用是否有差异。 方法：对29例额叶及基底核区脑卒中后（2—12个月）失语症患者进行图命名检查的同时,实施在线左侧Broca区阳极、Broca右侧对应区阴极tDCS,其检查结果与假刺激图命名检查结果对照。三种实验条件间隔时间≥24h。左右侧tDCS随机实施。 结果：尽管部分患者显示右侧对应区阴极tDCS可以提高图命名成绩,但是只有左侧Broca区阳极tDCS可以显著改善失语症患者的图命名能力（P＜0.05）。 结论：增强左Broca区皮质的兴奋性,可以促进失语症患者图命名能力的改善;左Broca区及其周围区在脑卒中后失语症患者的语言恢复中仍起着重要作用。     

原发性全面强直阵挛癫痫大脑-小脑功能连通性的静息态功能磁共振成像研究

目的探讨原发性全面强直阵挛癫痫(generalized tonic-clonic seizure,G T C S)发作间期静息态下大脑和小脑之间功能连通性的改变特点。材料与方法对19例原发性GTCS患者(GTCS组)及22名年龄、性别、受教育程度、利手等相匹配的健康对照组志愿者(HC组)采集静息态功能磁共振数据,计算并比较两组被试全脑低频振幅(amplitude of low-frequency fluctuations,ALFF)值,分别以大脑(小脑)ALFF差异区为种子区计算其与小脑(大脑)所有体素之间静息态功能连接(resting state functional connectivity,rs FC)并进行组间比较,提取组间显著差异脑区ALFF/rs FC值与患者国立医院癫痫严重程度量表(national hospital seizure severity scale,NHS3)评分做相关分析。结果相对于正常对照组,GTCS组右侧楔前叶、左侧额中回ALFF值显著升高,而右侧海马、右侧小脑脚2区、左侧小脑4/5区ALFF值显著降低;以各大脑(小脑)ALFF差异区为种子区域,GTCS患者组左侧小脑8区、右侧小脑4/5区rs FC值显著升高(左侧额下回、右侧颞中回rs FC值显著降低);GTCS患者组NHS3评分与左侧小脑8区rs FC值之间呈显著正相关(r=0.48,P=0.036),与右侧颞中回rs FC值之间呈显著负相关(r=-0.34,P=0.042)。结论 GTCS发作间期存在大脑和小脑之间静息态功能连通性异常,这些功能连通性的异常可能与GTCS患者的发病机理和临床表现有关。     

Delayed myelination in children with developmental delay detected by volumetric MRI

Delayed acquisition of developmental motor and cognitive milestones is a common clinical expression of many etiological processes. Imaging exams of developmentally delayed children often show no structural brain alterations despite suspicion of brain maturation delay. MRI studies increasingly suggest that white matter myelination finely reflects the progression in functional brain maturation. In this volumetric MRI study, we sought to evaluate whether developmental delay in children with normal conventional MRI exams is associated with reduced myelinated white matter. A total of 100 children (mean age, 4.4 years) with developmental delay and 50 normally developing age-matched control children underwent 3-D MRI to measure the volume of myelinated white matter. Patients showed a significant reduction in the relative content of myelinated white matter (accounting for 19.8% of brain volume in patients and 21.4% in control subjects, P = 0.005). The observed difference was equivalent to a 3.2-year myelination delay. Although the whole hemispheres were invariably symmetrical, the volume of myelinated white matter was asymmetrical in 30% of patients and 10% of control subjects (P = 0.006). We conclude that volumetric assessment of white matter may reveal a reduction in brain myelination beyond early childhood in developmentally delayed children showing normal brain appearance. This finding further emphasizes the view of white matter myelination as an indicator of functional brain maturation.     

脑梗死后运动性失语患者语言中枢的fMRI评价

目的评价脑梗死后运动性失语患者语言中枢的激活特点。方法采用1．5T磁共振扫描仪对15例脑梗死后运动性失语患者及15例正常中老年志愿者行组块设计的词语联想任务fMRI检查。采用SPM2软件进行预处理和统计分析,经组内和组间分析获得两组激活图及组问的差异图,观察有统计学意义的体素所在的脑区。结果最终10例患者符合实验要求并纳入研究,选取10if0年龄、性别相匹配正常男性作为对照组。对照组词语联想任务脑激活区主要包括Broca区及其镜像区、辅助运动区、左侧岛叶前部等脑区。患者组脑激活区主要包括左侧额中回、左顶下小叶、右侧额下回、辅助运动区等脑区。对照组激活高于患者组的脑区为左侧额下回后部;未见患者组激活高于对照组的脑区。结论脑梗死后运动性失语患者左侧额下回后部（Broca区）激活程度减低或消失,运动性语言中枢的损伤导致了失语症的发生。     

左外侧裂后部经颅直流电刺激对失语症动作图命名的作用

目的:前期研究结果提示左外侧裂后部周围区(PPR)阳极经颅直流电刺激(tDCS)可以提高失语症患者物体图命名能力.本研究的目的是明确左侧PPR区阳极tDCS对失语症患者动作图命名的作用.方法:采用自身对照A-B期设计.对接受2周常规语言治疗+tDCS假刺激(A期)后,动作图命名无明显变化的8例脑卒中后(＞3个月)失语症患者进行2周常规语言治疗+tDCS治疗(B期).结果:A期治疗前后动作图命名非治疗项和治疗项均无明显改善,提示患者语言功能处于“平台期”.B期治疗后较治疗前动作图命名的非治疗项和治疗项均明显改善(P＜0.05),提示动作图命名有泛化作用;动宾结构非治疗项未见明显变化,治疗项显著提高(P＜0.05).结论:对左PPR区实施阳极tDCS,可以促进失语症患者动作图命名的能力,并对动词命名有泛化作用.     

康复功能锻炼在脑梗死失语患者中的应用

目的探讨三维发音功能康复锻炼法在脑梗死失语患者中的临床疗效。方法 74例脑梗死失语患者随机分为2组。对照组给予常规治疗及护理干预,观察组在对照组基础上给予三维发音功能康复锻炼。比较2组患者治疗后失语改善程度及治疗后ABC评分各项差异。结果治疗后2组患者在ABC评分各亚项有显著差异(P<0.05),治疗后观察组失语改善程度显著优于对照组(P<0.05)。结论采用三维发音功能康复锻炼能够有效改善患者失语程度,提高患者语言能力恢复情况。