Chenausky Karen, Paquette Sébastien, Norton Andrea, Schlaug Gottfried
Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston.
Neurol Clin Pract. 2020 Apr;10(2):162-169. doi: 10.1212/CPJ.0000000000000699.
To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency.
In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performing conversational, how-to and picture-description tasks, word and sentence repetition, and diadochokinetic tasks were used to diagnose AOS using the Apraxia of Speech Rating Scale (ASRS). Anomia was quantified by patients' scores on the 30 even-numbered items from the Boston Naming Test (BNT).
Together, ASRS and BNT scores accounted for 51.4% of the total variance in CIUs/min; the ASRS score accounted for the majority of that variance. The BNT score was associated with lesions in the left superior temporal gyrus, left inferior frontal gyrus, and large parts of the insula. The global ASRS score was associated with lesions in the left dorsal arcuate fasciculus (AF), pre- and post-central gyri, and both banks of the central sulcus of the insula. The ASRS score for the primary distinguishing features of AOS (no overlap with features of aphasia) was associated with less AF and more insular involvement. Only ∼27% of this apraxia-specific lesion overlapped with lesions associated with the BNT score. Lesions associated with AOS had minimal overlap with the frontal aslant tract (FAT) (<1%) or the extreme capsule fiber tract (1.4%). Finally, ASRS scores correlated significantly with damage to the insula but not to the AF, extreme capsule, or FAT.
Results are consistent with previous findings identifying lesions of the insula and AF in patients with AOS, damage to both of which may create dysfluency in patients with aphasia.
确定言语失用（AOS）和命名障碍对对话流畅性的影响。
在这项对52例慢性失语症患者（其中47例伴有AOS）的观察性研究中，通过命题言语任务中每分钟正确信息单元（CIUs/分钟）对流畅性进行量化。使用患者执行对话、操作说明和图片描述任务、单词和句子重复以及连发性运动任务的视频，通过言语失用评定量表（ASRS）诊断AOS。命名障碍通过患者在波士顿命名测试（BNT）中30个偶数项的得分进行量化。
ASRS和BNT得分共同占CIUs/分钟总方差的51.4%；ASRS得分占该方差的大部分。BNT得分与左侧颞上回、左侧额下回和大部分脑岛的病变有关。ASRS总体得分与左侧背侧弓状束（AF）、中央前回和中央后回以及脑岛中央沟两岸的病变有关。AOS主要鉴别特征（与失语症特征无重叠）的ASRS得分与较少的AF受累和较多的脑岛受累有关。这种特定于失用症的病变中只有约27%与BNT得分相关的病变重叠。与AOS相关的病变与额斜束（FAT）（<1%）或极端囊纤维束（1.4%）的重叠最小。最后，ASRS得分与脑岛损伤显著相关，但与AF、极端囊或FAT损伤无关。
结果与先前在AOS患者中发现脑岛和AF病变的研究结果一致，这两者的损伤都可能导致失语症患者出现言语不流畅。
