Aphasia with anatomical isolation of the language area: A reanalysis on the light of modern neuroimaging techniques

Introduction : Goldstein (1948) and Geschwind (1968), based in data derived from anatomical post-mortem studies, postulated that the disconnection of the perisylvian language areas (PSLA) from other cortical areas was responsible for impairments in spontaneous speech and language comprehension with preservation of verbal repetition and echolalia (isolation of speech area). Nevertheless, other mechanisms (right hemisphere or bilateral hypotheses) underlying echolalic repetition have been proposed. Herein, we examined the structure and function of the PSLAs in two cases of aphasia with echolalic repetition and isolation of the left PSLA. Methods : Two patients with chronic post-stroke aphasia associated to isolation of the left PSLA were studied. Both patients underwent cognitive-language assessment and multimodal imaging. In patient 1 (p1), structural MRI, diffusion tensor imaging (DTI), functional MRI (fMRI) during repetition of words and non-words, resting state fMRI (rsfMRI) were acquired, whereas only structural MRI was performed in patient 2 (p2). The Tractotron software was used to examine the severity of disconnection in each language-related white matter tract in both patients. We quantified the severity of the disconnection by measuring the proportion of each tract that was affected. 18FDG-PET was also acquired in both patients. Results : P1 had a mixed transcortical aphasia and p2 had a transcortical sensory/anomic aphasia. In both, the MRI showed separate left anterior and posterior lesions with relative preservation of the PSLA. In both, 18FDG-PET revealed significant decrements of metabolic activity in areas of the left PSLA, although some parts showed normal metabolic activity. In p1 the left arcuate fasciculus (AF) and the inferior fronto-occipital fasciculi (IFOF) could not be reconstructed. fMRI showed perilesional activity in the left hemisphere and increased activity in the right during word repetition. rsfMRI showed compensatory activity in both hemispheres (right greater than left). Analysis with the Tractotron software revealed disconnection of both the AF and the IFOF in the left hemisphere of both patients. Discussion : Although some parts of the left PSLA had preserved metabolic activity in both patients, our neuroimaging data revealed that preserved repetition ability did not rely exclusively on the residual activity of the left PSLA. In support, the connectivity between different components of the left PSLA was severely affected. This coupled with the increased metabolic activity of the right PSLA supports the bilateral hypothesis of residual repetition in transcortical aphasias. References : Goldstein, K. (1948). Language and Language Disturbances. Geschwind, et al. (1968). Neuropsychologia 6, 327–340.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Beneficial effects of pharmacological treatment in post-stroke dynamic aphasia: a behavioural and neuroimaging study

Introduction : Dynamic Aphasia (DA) is a rare form of language disorder characterized by reduced spontaneous speech with preservation of other language functions. Two types of DA have been described: language-specific type (type I DA) and domain-general type (type II DA). In type I DA, deficits are selective for word and sentence generation, whereas in type II DA impairments affect discourse generation, narrative, fluency, and non-verbal generation tasks. There is little information on the treatment of DA. Although treatment with a cognitive enhancing drug (bromocriptine) improved outcome in previous studies, pharmacological interventions combining two drugs acting on other neurotransmitter systems in DA have not been reported so far. Methods : We report an open-label pharmacological single case study (n = 1) in a male patient with a chronic type I/II DA secondary to an ischemic infarction in the left fronto-opercular and insular regions. After baseline evaluation, the patient received donepezil 5 mg/day (2 months), donepezil 10 mg/day (2 months), donepezil 10 mg/day plus memantine 20 mg/day (4½ months) followed by a washout period (1½ months). No speech-language therapy was used. A comprehensive cognitive and language evaluation was carried out at baseline and at different endpoints. 18FDG-PET was performed at the four timepoints. Results : Donepezil (5 mg/day) significantly improved type I DA features (normalization of verbs generation, p = 0.01), whereas donepezil (10 mg/day) improved some type II features (normalizing spontaneous speech, verbal fluency and improving generation of novel thoughts, p = 0.004), along with improvement of executive-attentional functioning. Combined therapy further enhanced cognitive function, but did not additionally improved DA. 18 FDG-PET revealed significant reductions of perilesional hypometabolic activity mainly after donepezil (10 mg/day) and washout. Discussion : Treatment with donepezil improved language deficits in a patient with chronic post-stroke type I/II DA. Combined therapy (donepezil plus memantine) further enhanced executive-attentional functioning. Beneficial changes were associated with improvements in perilesional metabolic activity. References : Luria AR et al.Acta Neurologica et Psychiatrica (1967). Robinson G et al. Brain (1998). Keywords : Language; patients; single case study; adults; cerebrovascular; behavioural, functional imaging.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

“Need to know” and the right temporal lobe: Impaired access to semantic knowledge in acquired obsessive-compulsive disorder?

Introduction : Idiopathic obsessive-compulsive disorder (I-OCD) has been linked to abnormalities in corticostriatal circuits. Few studies have examined if the same structures are also responsible of acquired OCD (A-OCD) or if damage to anatomically-connected brain regions (e.g., temporal lobes) are also implicated in its pathogenesis. Additionally, there are some discrete obsessive-compulsive (OC) symptoms that by virtue of their presumed low occurrence and difficultly of categorization have received less attention. Amongst these, one intriguing and potentially severe type of obsessive thinking is the so-called “need to know” (NtK), a strong drive to know and obtain given information. In some patients this specific symptom, presumably resulting from impaired access to conceptual knowledge for specific verbal information (proper names, names of places), may be the principal or major feature of OCD symptomatology. We here report the cases of two male patients who developed “NtK” as the only OC symptomatology in association with malignant neoplasms involving the right temporal lobe and connected corticostriatal circuits. Methods : We used Tractotron and Disconnectome map softwares in order to identify the regions of white matter damage overlap across both patients and the proportion of damage (lesion load) of each tract of interest for each patient. We quantified the severity of the disconnection by measuring the proportion of each tract of interest to be affected by each patient´s lesion by using Tractotron software. Additionally, Positron Emission Tomography was used in order to study metabolic abnormalities. The tracts of interest were: the uncinate fasciculus, the anterior commissure, the anterior thalamic radiations, the inferior fronto-occipital fasciculus and the inferior longitudinal fasciculus. Results : There was a high overlap across brain lesions in patients 1 and 2. There was also a high overlap between areas that were affected (disconnected) due to the lesion. As expected, all the a priori selected pathways in the right hemisphere were affected since they cross the anterior part of the temporal lobe. Disconnection maps and metabolic changes in our patients suggest that the expression of OC symptoms underpinned by a semantic deficit due to right temporal damage is secondary to involvement of the uncinate fasciculus linking the temporal pole with the orbitofrontal cortex. Discussion : Data from the present study concur with previous research on A-OCD and current findings in I-OCD which suggest that the temporal lobes participate in the phenomenological expression of OCD. Also, patients with lesions in the anterior temporal lobe are prone to show a specific “Need to Know” symptoms phenomenologically similar to patients with semantic dementia in later stages. The expression of OC symptoms underpinned by a semantic deficit because of anterior right temporal lobe lesion, are due to a disconnection of the uncinate fasciculus and the orbitofrontal cortex. Further research about the neurological underpinnings of specific OCD subtypes, its evaluation and treatment, are essential. References : Berthier ML et al. Neurology. (1996) 47: 353–61. Huey E et al. J Neuropsych Clin Neurosci (2008). 20(4):390-408 Keywords : Emotions & Social Cognition; patients; single case study; adults; psychiatric; lesion mapping, behavioural.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Efficacy Of Intensive Tele-Rehabilitation Combined With Donepezil Compared To Face-to-face Administration

Se presentó el trabajo en la modalidad poster. Se trata de un artículo preliminar en desarrollo que se enmarca dentro del proyecto P20_00501 "Telerrehabilitación en afasia: evaluación de no inferioridad frente a terapia presencial e identificación de biomarcadores predictores de eficacia" (Junta de Andalucía (PAIDI 2020)).Objectives: (a) To evaluate the benefits promoted by two modalities of intensive language-action therapy, telerehabilitation (Tele-ILAT) and face-to-face (ILAT), applied alone and in combination with Donepezil to persons with chronic post-stroke aphasia (PSA) (phase 1). (b) To examine the best remote or hybrid strategy to maintain the gains in language and language-affiliated behaviours (communication, psychological adjustment, and quality of life) promoted by both modalities of ILAT, and to determine the efficacy of these interventions in reducing the therapist burden (phase 2). (c) To identify potential predictors of treatment response, including gene markers, and to detect changes in language, cognition, emotional functions and neural plasticity using multimodal MRI. Methodology: Estimated sample size: 48 participants with chronic PSA are required to obtain a power of 80% ( increment of 5 points ± 4) relative to baseline scores on the Western Aphasia Battery-Revised. Methods and design: a randomized control trial involving four groups comparing the effectiveness of ILAT applied online, and face-to-face administered alone and with Donepezil (phase 1); three quasi-randomised parallel groups (asynchronous, hybrid and control) (phase 2). Results and conclusions: Primary outcome measures: aphasia severity, communication, behaviour, and quality of life. Evaluations will determine potential predictive variables of response, as well as brain and language changes associated with the treatments at different timepoints. This trial will determine: (a) whether Tele-ILAT administered alone and combined with Donepezil reduces aphasia severity and language-affiliated deficits in the same manner as face-to-face ILAT and the contribution of adding Donepezil to these interventions; (b) the best long-term remote maintenance-therapy.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Teoría de la Mente como fuente de sugestionabilidad del testimonio infantil: un estudio experimental de sugestión del recuerdo episódico del tacto

"Teoría de la Mente como fuente de sugestionabilidad del testimonio infantil: un estudio experimental de sugestión del recuerdo episódico del tacto". Trabajo de Fin de Grado, Psicología. Alumna: Lisa-Marie Edelkraut. Tutora: Carmen Barajas.En este estudio se aspira a responder a dos objetivos. En primer lugar, se estudia la relación entre la aceptación de la sugestión en niños y su desarrollo de la Teoría de la Mente y memoria episódica. El segundo objetivo es analizar la relación entre la aceptación de la sugestión y la condición experimental del tacto físico. Se evaluaron a 20 niños de edades comprendidas entre cuatro y seis años (M= 4,9 años), con la finalidad de determinar sus capacidades mentalistas, la memoria episódica y la aceptación de la sugestión en función de la condición experimental del tacto a recordar. En el experimento, los niños bien fueron tocados en el codo y se sugestionó que fue en la cabeza (condición experimental de memoria modificada) o bien no recibieron contacto físico pero de nuevo se sugestionó que fueron tocados en la cabeza (condición experimental de memoria implantada). Los resultados indican que, independientemente de la edad, del desarrollo de la Teoría de la Mente y la memoria episódica, los niños de la condición experimental de memoria modificada se mostraron más propensos a ceder ante la sugestión que los niños de la condición de memoria implantada