Evaluation de la réorganisation cérébrale du langage chez les patients épileptiques. Apport de la psychologie cognitive

National audienceL'objectif de cet article est de rappeler les exigences spécifiques nécessaires à la mise en place d'un paradigme d'activation en IRMf dans le cadre de l'évaluation fonctionnelle du langage lors du bilan pré- et post-chirurgical de l'épilepsie

Dynamic causal modeling of spatiotemporal integration of phonological and semantic processes: an electroencephalographic study.: DCM of phonology and semantics

International audienceIntegration of phonological and lexicosemantic processes is essential for visual word recognition. Here we used dynamic causal modeling of event-related potentials, combined with group source reconstruction, to estimate how those processes translate into context-dependent modulation of effective connectivity within the temporal-frontal language network. Fifteen healthy human subjects performed a phoneme detection task in pseudo-words and a semantic categorization task in words. Cortical current densities revealed the sequential activation of temporal regions, from the occipital-temporal junction toward the anterior temporal lobe, before reaching the inferior frontal gyrus. A difference of activation between phonology and semantics was identified in the anterior temporal lobe within the 240-300 ms peristimulus time window. Dynamic causal modeling indicated this increase of activation of the anterior temporal lobe in the semantic condition as a consequence of an increase of forward connectivity from the posterior inferior temporal lobe to the anterior temporal lobe. In addition, fast activation of the inferior frontal region, which allowed a feedback control of frontal regions on the superior temporal and posterior inferior temporal cortices, was found to be likely. Our results precisely describe spatiotemporal network mechanisms occurring during integration of phonological and semantic processes. In particular, they support the hypothesis of multiple pathways within the temporal lobe for language processing, where frontal regions would exert a top-down control on temporal regions in the recruitment of the anterior temporal lobe for semantic processing

Strategies and cognitive reserve to preserve lexical production in aging.

In the absence of any neuropsychiatric condition, older adults may show declining performance in several cognitive processes and among them, in retrieving and producing words, reflected in slower responses and even reduced accuracy compared to younger adults. To overcome this difficulty, healthy older adults implement compensatory strategies, which are the focus of this paper. We provide a review of mainstream findings on deficient mechanisms and possible neurocognitive strategies used by older adults to overcome the deleterious effects of age on lexical production. Moreover, we present findings on genetic and lifestyle factors that might either be protective or risk factors of cognitive impairment in advanced age. We propose that "aging-modulating factors" (AMF) can be modified, offering prevention opportunities against aging effects. Based on our review and this proposition, we introduce an integrative neurocognitive model of mechanisms and compensatory strategies for lexical production in older adults (entitled Lexical Access and Retrieval in Aging, LARA). The main hypothesis defended in LARA is that cognitive aging evolves heterogeneously and involves complementary domain-general and domain-specific mechanisms, with substantial inter-individual variability, reflected at behavioral, cognitive, and brain levels. Furthermore, we argue that the ability to compensate for the effect of cognitive aging depends on the amount of reserve specific to each individual which is, in turn, modulated by the AMF. Our conclusion is that a variety of mechanisms and compensatory strategies coexist in the same individual to oppose the effect of age. The role of reserve is pivotal for a successful coping with age-related changes and future research should continue to explore the modulating role of AMF

Areas activated during naturalistic reading comprehension overlap topological visual, auditory, and somatotomotor maps

Cortical mapping techniques using fMRI have been instrumental in identifying the boundaries of topological (neighbor-preserving) maps in early sensory areas. The presence of topological maps beyond early sensory areas raises the possibility that they might play a significant role in other cognitive systems, and that topological mapping might help to delineate areas involved in higher cognitive processes. In this study, we combine surface-based visual, auditory, and somatomotor mapping methods with a naturalistic reading comprehension task in the same group of subjects to provide a qualitative and quantitative assessment of the cortical overlap between sensory-motor maps in all major sensory modalities, and reading processing regions. Our results suggest that cortical activation during naturalistic reading comprehension overlaps more extensively with topological sensory-motor maps than has been heretofore appreciated. Reading activation in regions adjacent to occipital lobe and inferior parietal lobe almost completely overlaps visual maps, whereas a significant portion of frontal activation for reading in dorsolateral and ventral prefrontal cortex overlaps both visual and auditory maps. Even classical language regions in superior temporal cortex are partially overlapped by topological visual and auditory maps. By contrast, the main overlap with somatomotor maps is restricted to a small region on the anterior bank of the central sulcus near the border between the face and hand representations of M-I

Neurolinguistics Research Advancing Development of a Direct-Speech Brain-Computer Interface

A direct-speech brain-computer interface (DS-BCI) acquires neural signals corresponding to imagined speech, then processes and decodes these signals to produce a linguistic output in the form of phonemes, words, or sentences. Recent research has shown the potential of neurolinguistics to enhance decoding approaches to imagined speech with the inclusion of semantics and phonology in experimental procedures. As neurolinguistics research findings are beginning to be incorporated within the scope of DS-BCI research, it is our view that a thorough understanding of imagined speech, and its relationship with overt speech, must be considered an integral feature of research in this field. With a focus on imagined speech, we provide a review of the most important neurolinguistics research informing the field of DS-BCI and suggest how this research may be utilized to improve current experimental protocols and decoding techniques. Our review of the literature supports a cross-disciplinary approach to DS-BCI research, in which neurolinguistics concepts and methods are utilized to aid development of a naturalistic mode of communication. : Cognitive Neuroscience; Computer Science; Hardware Interface Subject Areas: Cognitive Neuroscience, Computer Science, Hardware Interfac

Functional MRI evidence for the decline of word retrieval and generation during normal aging

International audienceThis fMRI study aimed to explore the effect of normal aging on word retrieval and generation. The question addressed is whether lexical production decline is determined by a direct mechanism, which concerns the language operations or is rather indirectly induced by a decline of executive functions. Indeed, the main hypothesis was that normal aging does not induce loss of lexical knowledge, but there is only a general slowdown in retrieval mechanisms involved in lexical processing , due to possible decline of the executive functions. We used three tasks (verbal fluency, object naming , and semantic categorization). Two groups of participants were tested (Young, Y and Aged, A), without cognitive and psychiatric impairment and showing similar levels of vocabulary. Neuropsychological testing revealed that older participants had lower executive function scores, longer processing speeds, and tended to have lower verbal fluency scores. Additionally, older participants showed higher scores for verbal automa-tisms and overlearned information. In terms of behav-ioral data, older participants performed as accurate as younger adults, but they were significantly slower for the semantic categorization and were less fluent for verbal fluency task. Functional MRI analyses suggested that older adults did not simply activate fewer brain regions involved in word production, but they actually showed an atypical pattern of activation. Significant correlations between the BOLD (Blood Oxygen Level Dependent) signal of aging-related (A > Y) regions and cognitive scores suggested that this atypical pattern of the activation may reveal several compensatory mechanisms (a) to overcome the slowdown in retrieval, due to the decline of executive functions and processing speed and (b) to inhibit verbal automatic processes. The BOLD signal measured in some other aging-dependent regions did not correlate with the behavioral and neuro-psychological scores, and the overactivation of these uncorrelated regions would simply reveal dedifferentia-tion that occurs with aging. Altogether, our results suggest that normal aging is associated with a more difficult access to lexico-semantic operations and representations by a slowdown in executive functions, without any conceptual loss

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Hemispheric specialization and mapping of language in healthy subjects and epileptic patients : effect of inter-and intra-individual variable. Behavioral neuropsychological and neurophysiological (fMRI) assessment.

Le but de ce travail est d'identifier l'effet de certaines caractéristiques liée aux individus et aux paradigmes expérimentaux sur l'organisation inter-hémisphérique (spécialisation hémisphérique) et intra-hémisphérique (cartographie fonctionnelle) du langage, (a) en condition physiologique chez les sujets sains et (b) en condition pathologique chez des patients présentant une épilepsie focale et pharmaco-résistante. Pour aborder cette question, une approche méthodologique expérimentale pluridisciplinaire a été utilisée. Plus spécifiquement nous avons évalué l'effet des variables inter-individuelles (sexe, préférence manuelle, et caractéristiques pathologiques) et intra-individuelles (opération linguistique, tâche, type de stimuli) sur l'organisation cérébrale du langage. L'un des objectifs de ce travail est de corroborer les données issues de différentes méthodes pour mettre en place un modèle de représentation et de réorganisation langagière, en fonction des facteurs considérés. Un second objectif de ce travail est de proposer aux cliniciens des outils permettant de quantifier la spécialisation hémisphérique chez les patients épileptiques. Nos résultats chez les sujets sains mettent en évidence une interaction entre les variables inter- et intra-individuelles sur le degré de spécialisation hémisphérique et sur la cartographie fonctionnelle du langage. Chez les patients épileptiques, nos résultats préliminaires permettent de mettre en relation les patterns de réorganisation cérébrale et les variables évaluées. L'ensemble de nos résultats montre que la neuropsychologie cognitive et la neuroimagerie fonctionnelle apportent des informations complémentaires nous permettant une meilleure compréhension des mécanismes d'organisation et réorganisation cérébrale. Mots clés : langage, spécialisation, hémisphère, champ visuel divisé, IRMf, phonologie, sémantique, prosodie, sexe, sain, épileptique, plasticité, réorganisation.The purpose of this PhD research was to identify the effect of several individual and experimental variables on hemispheric specialization and cortical mapping of language in healthy subjects and epileptic patients. The question was addressed by means of a multidisciplinary approach including behavioral, neuropsychological and neurophysiological (fMRI) testing. The main goal of this work was to corroborate data provided from all these methods and to build a model of the representation and reorganization (plasticity) of language according to the considered factors. Moreover, we aimed to provide several practical tools to clinicians for presurgical evaluation of hemispheric specialization in patients with drug-resistant epilepsy. Overall, our results reflect the necessity to use a multidimensional approach composed of complementary techniques and methods, in order to assess cerebral representations in normal and pathological conditions. Key words: language, specialization, hemisphere, divided visual field, fMRI, phonology, semantics, prosody, gender, healthy, epilepsy, plasticity, reorganization