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dissertation (2)


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2020 (2)

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Dissertation
Neuroconnectivity of the arcuate fasciculus for the prediction of language outome and change in aphasic stroke patients

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Abstract

Background: Every year millions of people worldwide suffer from a stroke, with aphasia being one of the most common consequences. After a couple of decades of research, the majority of studies agree on the impact of well-established anagraphic and lesion-related factors on the prediction of aphasia recovery. The advent of new research methods such as diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) revealed the contribution of white matter tracts to the prediction of aphasia recovery. Literature agrees on the idea that the arcuate fasciculus (AF) is a major neural tract in language processing. The relationship between the AF and language recovery after stroke is however ambiguous: on the one hand, 21st century research shows that integrity of the left AF is crucial in post stroke language recovery. On the other hand, till today, researchers do not equally agree on the role of bilateral AF and its different segments. Aim of the current study: In the present dissertation, we aimed to replicate the predictive value of two well-established predictors of language recovery: initial language impairment and initial stroke severity. Further we examined whether including (longitudinal) neuroconnectivity of the bilateral AF segments could improve the prediction of language recovery. Methods: Twenty patients were tested at two moments in time: one to three weeks post-stroke (acute phase) and three to four months post-stroke (subacute phase). In the acute phase, patients’ initial stoke severity was determined by the National Institutes of Health Stroke Scale (NIHSS) and patients underwent a diffusion MRI scan and two behavioral language tests: ScreeLing and Amsterdam-Nijmegen Everyday Language Test (ANELT). In the follow-up assessment, the two behavioral language tests and diffusion MRI scan were repeated. To study the effect of all potential predictor variables on language outcome and language change, multiple linear regression analysis was used. Results: Both Language outcome and language change could be predicted by the initial stroke severity and initial language severity. The prediction of language outcome improved when adding the FA values or volumes of the bilateral direct segments of the AF in the acute phase. The prediction also improved when adding the changes from acute to subacute phase in FA value of the bilateral direct AF segments. The prediction of language change from the acute to subacute phase improved by adding the volumes of the bilateral posterior segments of the AF. It also improved when adding the changes from acute to subacute phase in FA value or volume of the bilateral direct AF segments and the changes in FA value or volume of the bilateral posterior segments. Conclusion: Our dissertation confirms what earlier studies already found: initial stroke severity and initial language impairment are important predictors of language outcome in the subacute phase. Language change from acute to subacute phase can be predicted by these two factors as well. Further, our study shows that adding (longitudinal) neuroconnectivity of the bilateral direct AF segments improves the prediction of both language outcome and language change in the subacute phase. Last, our study suggests a role of the bilateral posterior AF segments in the prediction of language change from the acute to subacute phase.

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Dissertation
Neuroconnectivity of the arcuate fasciculus for the prediction of language outcome and change in aphasic stroke patients

Loading...
Export citation

Choose an application

Bookmark

Abstract

Background: Every year millions of people worldwide suffer from a stroke, with aphasia being one of the most common consequences. After a couple of decades of research, the majority of studies agree on the impact of well-established anagraphic and lesion-related factors on the prediction of aphasia recovery. The advent of new research methods such as diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) revealed the contribution of white matter tracts to the prediction of aphasia recovery. Literature agrees on the idea that the arcuate fasciculus (AF) is a major neural tract in language processing. The relationship between the AF and language recovery after stroke is however ambiguous: on the one hand, 21st century research shows that integrity of the left AF is crucial in post stroke language recovery. On the other hand, till today, researchers do not equally agree on the role of bilateral AF and its different segments. Aim of the current study: In the present dissertation, we aimed to replicate the predictive value of two well-established predictors of language recovery: initial language impairment and initial stroke severity. Further we examined whether including (longitudinal) neuroconnectivity of the bilateral AF segments could improve the prediction of language recovery. Methods: Twenty patients were tested at two moments in time: one to three weeks post-stroke (acute phase) and three to four months post-stroke (subacute phase). In the acute phase, patients’ initial stoke severity was determined by the National Institutes of Health Stroke Scale (NIHSS) and patients underwent a diffusion MRI scan and two behavioral language tests: ScreeLing and Amsterdam-Nijmegen Everyday Language Test (ANELT). In the follow-up assessment, the two behavioral language tests and diffusion MRI scan were repeated. To study the effect of all potential predictor variables on language outcome and language change, multiple linear regression analysis was used. Results: Both Language outcome and language change could be predicted by the initial stroke severity and initial language severity. The prediction of language outcome improved when adding the FA values or volumes of the bilateral direct segments of the AF in the acute phase. The prediction also improved when adding the changes from acute to subacute phase in FA value of the bilateral direct AF segments. The prediction of language change from the acute to subacute phase improved by adding the volumes of the bilateral posterior segments of the AF. It also improved when adding the changes from acute to subacute phase in FA value or volume of the bilateral direct AF segments and the changes in FA value or volume of the bilateral posterior segments. Conclusion: Our dissertation confirms what earlier studies already found: initial stroke severity and initial language impairment are important predictors of language outcome in the subacute phase. Language change from acute to subacute phase can be predicted by these two factors as well. Further, our study shows that adding (longitudinal) neuroconnectivity of the bilateral direct AF segments improves the prediction of both language outcome and language change in the subacute phase. Last, our study suggests a role of the bilateral posterior AF segments in the prediction of language change from the acute to subacute phase.

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