Trupe Lydia A, Mulheren Rachel W, Tippett Donna, Hillis Argye E, González-Fernández Marlís
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Dysphagia. 2018 Oct;33(5):610-615. doi: 10.1007/s00455-018-9879-6. Epub 2018 Feb 24.
Speech and swallowing utilize overlapping anatomy and are thus inherently related processes. We sought to identify common neural mechanisms between risk of swallowing dysfunction and apraxia of speech (AOS). This was a retrospective analysis using data from a prospectively collected cohort. Left hemisphere stroke patients (68 subjects) tested with the Apraxia Battery for Adults II, a swallow screen, and MRI were included in the study. Main outcome measure was the presence of AOS or aspiration risk after stroke. We identified a significant association between AOS measures and increased aspiration risk (defined by failed swallow screen; p = 0.04; OR 5.2). Lesions in pars opercularis of Broca's area (BA 44) were associated with both AOS (p = 0.044; OR 9.7) and increased aspiration risk (p = 0.04; OR 5) but deficits rarely co-occurred in the same cases. Lesions in left premotor cortex (BA 6) were not significantly associated with increased aspiration risk (p = 0.06; OR 3.3) but were significantly associated with AOS (p = 0.008; OR 7). Impaired swallowing function was also associated with lesions in Wernicke's area (BA 22; p = 0.05; OR 3.5) and pars triangularis (BA 45; p = 0.02; OR 6.8). AOS and risk of aspiration are associated in patients with acute left hemisphere stroke. Acute infarct in the pars opercularis of Broca's area is associated with both deficits, though they rarely co-occur in the same individual. The co-occurrence of AOS and risk of aspiration likely reflects dependence on closely related neural structures.
言语和吞咽功能利用重叠的解剖结构，因此本质上是相关的过程。我们试图确定吞咽功能障碍风险与言语失用症（AOS）之间的共同神经机制。这是一项回顾性分析，使用了前瞻性收集的队列数据。研究纳入了使用成人失用症第二电池测试、吞咽筛查和MRI检查的左半球中风患者（68名受试者）。主要结局指标是中风后是否存在AOS或误吸风险。我们发现AOS测量指标与误吸风险增加之间存在显著关联（通过吞咽筛查失败定义；p = 0.04；OR 5.2）。布洛卡区（BA 44）岛盖部的病变与AOS（p = 0.044；OR 9.7）和误吸风险增加（p = 0.04；OR 5）均相关，但在同一病例中这两种缺陷很少同时出现。左前运动皮层（BA 6）的病变与误吸风险增加无显著关联（p = 0.06；OR 3.3），但与AOS显著相关（p = 0.008；OR 7）。吞咽功能受损也与韦尼克区（BA 22；p = 0.05；OR 3.5）和三角部（BA 45；p = 0.02；OR 6.8）的病变相关。急性左半球中风患者中AOS与误吸风险相关。布洛卡区岛盖部的急性梗死与这两种缺陷均相关，尽管它们很少在同一个体中同时出现。AOS与误吸风险的同时出现可能反映了对密切相关神经结构的依赖。
