Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia

Schumacher, Rahel; Halai, Ajay D; Ralph, Matthew A Lambon · 2019 · Crossref

DOI: 10.1093/brain/awz258

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Summary

This study investigates the prevalence, structure, and neural correlates of nonverbal cognitive deficits—specifically attention and executive functions—in individuals with chronic post-stroke aphasia. While it is recognized that aphasia often co-occurs with impairments in other cognitive domains, data regarding the specific nature of these nonverbal deficits and their relationship to brain lesions remain scarce. The authors aimed to address this gap by administering a comprehensive battery of standardized neuropsychological tests alongside detailed language assessments and structural magnetic resonance imaging (MRI) to 38 patients. The researchers employed a data-driven approach using Principal Component Analysis (PCA) to identify underlying behavioral components from the test data. Separate PCAs were conducted for nonverbal and language tests, followed by a combined analysis. For neuroimaging, the study utilized four distinct brain-behaviour mapping methods: voxel-based correlational methodology (VBCM), voxel-based lesion-symptom mapping (VLSM), support-vector regression lesion symptom mapping (SVR-LSM), and pattern recognition of neuroimaging toolbox (PRoNTo) models. This multi-method approach allowed for a robust comparison of univariate and multivariate techniques in linking behavioural scores to structural brain abnormalities. The results revealed that all participants exhibited impairments in at least one nonverbal test, with a mean impairment rate of 36.7% across nonverbal measures, compared to 65.0% for language measures. PCA extracted three orthogonal components for nonverbal cognition: "shift-update" (flexible processing and working memory), "inhibit-generate" (idea generation and response inhibition), and "speed" (reaction time). Language tests yielded components for phonology, semantics, and speech quanta. Structural mapping identified distinct neural correlates for each component. The shift-update component was associated with left temporo-occipital and bilateral medial parietal regions; inhibit-generate correlated with left frontal and bilateral medial frontal areas; and speed was linked to right-sided fronto-parieto-occipital clusters. Multivariate analyses confirmed these findings, showing converging results with univariate methods, particularly for the inhibit-generate, phonology, and semantics components. These findings confirm that stroke aphasia is multidimensional, involving significant deficits in attention and executive functions that are distinct from language impairments. The study demonstrates that specific nonverbal cognitive domains rely on identifiable brain networks, extending the understanding of aphasia beyond language processing. By validating the use of both univariate and multivariate mapping techniques, the research provides a methodological framework for future studies and emphasizes the clinical importance of assessing nonverbal cognition to better predict recovery and tailor rehabilitation strategies for patients with aphasia.

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• cognitive impairment