Aphasia Neuroplasticity Review

van Oers et al. (2018)

Reference

Authorsvan Oers CAMM, van der Worp HB, Kappelle LJ, Raemaekers MAH, Otte WM, Dijkhuizen RM
TitleEtiology of language network changes during recovery of aphasia after stroke
ReferenceSci Rep 2018; 8: 856
PMID29339771
DOI10.1038/s41598-018-19302-4

Participants

LanguageDutch
Inclusion criteriaMRS <= 3; ability to perform tasks
Number of individuals with aphasia12
Number of control participants8
Were any of the participants included in any previous studies?No
Is age reported for patients and controls, and matched?Yes (mean 67.9 ± 11.4 years, range 46-86 years)
Is sex reported for patients and controls, and matched?Yes (males: 10; females: 2)
Is handedness reported for patients and controls, and matched?Yes (right: 12; left: 0)
Is time post stroke onset reported and appropriate to the study design?No* (moderate limitation) (T1: within 2 weeks; T2: ~3 months; T3: ~6 months; T4: ~12 months; specific timing of first time point not stated)
To what extent is the nature of aphasia characterized?Comprehensive battery
Language evaluationAAT, BNT
Aphasia severityT1: 8 moderate, 2 severe, 2 not stated; T2: 4 moderate, 3 recovered, 2 not stated, 1 mild, 1 severe
Aphasia typeT1: 6 Broca's, 3 anomic, 2 Wernicke's, 1 global; T2: 4 anomic, 3 recovered, 2 Broca's, 1 unclassified, 1 Wernicke's
First stroke only?Yes
Stroke typeIschemic only
To what extent is the lesion distribution characterized?Lesion overlay
Lesion extentRange 9-208 cc
Lesion locationL MCA
Participants notes

Imaging

ModalityfMRI
Is the study cross-sectional or longitudinal?Longitudinal—recovery
If longitudinal, at what time point(s) were imaging data acquired?T1: within 2 weeks; T2: ~3 months; T3: ~6 months; T4: ~12 months; specific timing of first time point not stated
If longitudinal, was there any intervention between the time points?Not stated
Is the scanner described?Yes (Philips Achieva 3 Tesla)
Is the timing of stimulus presentation and image acquisition clearly described and appropriate?No* (moderate limitation) (stimulus presentation was self-paced, but the ITI is not reported, nor are the number of trials presented per condition; it is likely that the language and control blocks contained different numbers of trials)
Design typeBlock
Total images acquired1656
Are the imaging acquisition parameters, including coverage, adequately described and appropriate?Yes (whole brain)
Is preprocessing and intrasubject coregistration adequately described and appropriate?Yes
Is first level model fitting adequately described and appropriate?Yes
Is intersubject normalization adequately described and appropriate?Yes
Imaging notesnot all participants scanned at each time point; the number scanned at each time point is not stated

Conditions

Are the conditions clearly described?Yes
ConditionResponse typeRepetitionsAll groups could do?All individuals could do?
written word-picture matchingButton press6UnknownUnknown
semantic decisionButton press6UnknownUnknown
visual decisionButton press12UnknownUnknown
restNone12N/AN/A
Conditions notes

Contrasts

Are the contrasts clearly described?Yes

Contrast 1: written word-picture matching vs visual decision

Language conditionWritten word-picture matching
Control conditionVisual decision
Are the conditions matched for visual demands?No
Are the conditions matched for auditory demands?Yes
Are the conditions matched for motor demands?Yes
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?Unknown, not reported
Is reaction time matched between the language and control tasks for all relevant groups?Unknown, not reported
Behavioral data notes
Are control data reported in this paper or another that is referenced?Somewhat
Does the contrast selectively activate plausible relevant language regions in the control group?No
Are activations lateralized in the control data?Somewhat
Control activation notesPrimarily bilateral visual activations; frontal activation is L-lateralized
Contrast notes

Contrast 2: semantic decision vs visual decision

Language conditionSemantic decision
Control conditionVisual decision
Are the conditions matched for visual demands?No
Are the conditions matched for auditory demands?Yes
Are the conditions matched for motor demands?Yes
Are the conditions matched for cognitive/executive demands?No
Is accuracy matched between the language and control tasks for all relevant groups?Unknown, not reported
Is reaction time matched between the language and control tasks for all relevant groups?Unknown, not reported
Behavioral data notes
Are control data reported in this paper or another that is referenced?Somewhat
Does the contrast selectively activate plausible relevant language regions in the control group?Somewhat
Are activations lateralized in the control data?Yes
Control activation notesL frontal, L posterior ITG, L superior parietal
Contrast notes

Analyses

Are the analyses clearly described?No* (moderate limitation) (see specific limitation(s) below)

ROI analysis 1

First level contrastWritten word-picture matching vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) T1 (n = 10)
CovariateSubsequent outcome (T4) overall language measure (average of AAT measures)
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?12
What are the ROI(s)?(1) bilateral dorsal anterior cingulate; (2) L angular gyrus; (3) L IFG pars opercularis and triangularis; (4) L thalamus; (5) L MFG; (6) L posterior ITG; (7) R angular gyrus; (8) R IFG pars triangularis; (9) R thalamus; (10) R posterior ITG; (11) R IFG pars opercularis and triangularis; (12) R MFG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical details
Findings↑ L posterior inferior temporal gyrus/fusiform gyrus
Findings notesActivation predicted later outcome even when initial language performance was included in the model

ROI analysis 2

First level contrastWritten word-picture matching vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariateOverall language measure (average of AAT measures) all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?12
What are the ROI(s)?(1) bilateral dorsal anterior cingulate; (2) L angular gyrus; (3) L IFG pars opercularis and triangularis; (4) L thalamus; (5) L MFG; (6) L posterior ITG; (7) R angular gyrus; (8) R IFG pars triangularis; (9) R thalamus; (10) R posterior ITG; (11) R IFG pars opercularis and triangularis; (12) R MFG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
Findings↑ L posterior inferior temporal gyrus/fusiform gyrus
Findings notes

ROI analysis 3

First level contrastWritten word-picture matching vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariateAverage of AAT comprehension score and BNT, all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?12
What are the ROI(s)?(1) bilateral dorsal anterior cingulate; (2) L angular gyrus; (3) L IFG pars opercularis and triangularis; (4) L thalamus; (5) L MFG; (6) L posterior ITG; (7) R angular gyrus; (8) R IFG pars triangularis; (9) R thalamus; (10) R posterior ITG; (11) R IFG pars opercularis and triangularis; (12) R MFG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
Findings↓ R IFG pars opercularis
↓ R IFG pars triangularis
Findings notes

ROI analysis 4

First level contrastWritten word-picture matching vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariatePicture-word matching accuracy, all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Accuracy is covariate
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?12
What are the ROI(s)?(1) bilateral dorsal anterior cingulate; (2) L angular gyrus; (3) L IFG pars opercularis and triangularis; (4) L thalamus; (5) L MFG; (6) L posterior ITG; (7) R angular gyrus; (8) R IFG pars triangularis; (9) R thalamus; (10) R posterior ITG; (11) R IFG pars opercularis and triangularis; (12) R MFG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
Findings↑ R posterior inferior temporal gyrus/fusiform gyrus
Findings notes

ROI analysis 5

First level contrastWritten word-picture matching vs visual decision
Analysis classLongitudinal change in aphasia
Group(s)Aphasia: linear effect of time
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?12
What are the ROI(s)?(1) bilateral dorsal anterior cingulate; (2) L angular gyrus; (3) L IFG pars opercularis and triangularis; (4) L thalamus; (5) L MFG; (6) L posterior ITG; (7) R angular gyrus; (8) R IFG pars triangularis; (9) R thalamus; (10) R posterior ITG; (11) R IFG pars opercularis and triangularis; (12) R MFG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
Findings↑ L dorsolateral prefrontal cortex
↑ L angular gyrus
↑ L posterior inferior temporal gyrus/fusiform gyrus
↑ L anterior cingulate
↑ R dorsolateral prefrontal cortex
↑ R angular gyrus
↑ R anterior cingulate
↑ R thalamus
↓ L IFG pars opercularis
↓ L IFG pars triangularis
Findings notesSimilar numbers of findings are reported for controls

ROI analysis 6

First level contrastSemantic decision vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (subset who returned for follow-up) T1 (n = 10)
CovariateSubsequent outcome (T4) overall language measure (average of AAT measures)
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Somewhat (not appropriate to correlate T1 imaging with T4 behavior without T1 behavior in model)
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?6
What are the ROI(s)?(1) L angular gyrus; (2) L IFG pars opercularis and triangularis; (3) L posterior ITG; (4) R angular gyrus; (5) R IFG pars opercularis and triangularis; (6) R posterior ITG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical details
FindingsNone
Findings notes

ROI analysis 7

First level contrastSemantic decision vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariateOverall language measure (average of AAT measures) all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?6
What are the ROI(s)?(1) L angular gyrus; (2) L IFG pars opercularis and triangularis; (3) L posterior ITG; (4) R angular gyrus; (5) R IFG pars opercularis and triangularis; (6) R posterior ITG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
FindingsNone
Findings notes

ROI analysis 8

First level contrastSemantic decision vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariateAverage of AAT comprehension score and BNT, all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?6
What are the ROI(s)?(1) L angular gyrus; (2) L IFG pars opercularis and triangularis; (3) L posterior ITG; (4) R angular gyrus; (5) R IFG pars opercularis and triangularis; (6) R posterior ITG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
FindingsNone
Findings notes

ROI analysis 9

First level contrastSemantic decision vs visual decision
Analysis classCross-sectional correlation with language or other measure
Group(s)Aphasia (all time points)
CovariateSemantic decision accuracy, all time points
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Accuracy is covariate
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?6
What are the ROI(s)?(1) L angular gyrus; (2) L IFG pars opercularis and triangularis; (3) L posterior ITG; (4) R angular gyrus; (5) R IFG pars opercularis and triangularis; (6) R posterior ITG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
FindingsNone
Findings notes

ROI analysis 10

First level contrastSemantic decision vs visual decision
Analysis classLongitudinal change in aphasia
Group(s)Aphasia: linear effect of time
Covariate
Is the second level contrast valid in terms of the group(s), time point(s), and measures involved?Yes
Is accuracy matched across the second level contrast?Unknown, not reported
Is reaction time matched across the second level contrast?Unknown, not reported
Behavioral data notes
Type of analysisRegions of interest (ROI)
ROI typeFunctional
How many ROIs are there?6
What are the ROI(s)?(1) L angular gyrus; (2) L IFG pars opercularis and triangularis; (3) L posterior ITG; (4) R angular gyrus; (5) R IFG pars opercularis and triangularis; (6) R posterior ITG
How are the ROI(s) defined?Control activations and their homotopic counterparts in the R hemisphere; activation measured as count of voxels activated at p < 0.001, uncorrected
Correction for multiple comparisonsFalse discovery rate (FDR)
Statistical detailsMixed model; minimal detail provided
Findings↑ L posterior inferior temporal gyrus/fusiform gyrus
↑ R angular gyrus
↓ L IFG pars opercularis
↓ L IFG pars triangularis
Findings notesSimilar numbers of findings are reported for controls

Notes

Excluded analyses(1) activation maps in patients at each time point (Fig. 2); (2) analyses assessing whether outcome can be better predicted by including fMRI data; (3) analyses examining relationships between activations related to breath holding and language tasks (there was little if any evidence that vascular reactivity was abnormal in patients); (4) correlations with ROI activity level instead of counts of activated voxels, which yielded similar but non-significant findings