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比较急性和慢性中风失语症中的脑-行为关系。

Comparing the brain-behaviour relationship in acute and chronic stroke aphasia.

作者信息

Busby Natalie, Hillis Argye E, Bunker Lisa, Rorden Chis, Newman-Norlund Roger, Bonilha Leo, Meier Erin, Goldberg Emily, Hickok Gregory, Yourganov Grigori, Fridriksson Julius

机构信息

Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29209, USA.

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MA 21287, USA.

出版信息

Brain Commun. 2023 Mar 29;5(2):fcad014. doi: 10.1093/braincomms/fcad014. eCollection 2023.

Abstract

In stroke aphasia, lesion volume is typically associated with aphasia severity. Although this relationship is likely present throughout recovery, different factors may affect lesion volume and behaviour early into recovery (acute) and in the later stages of recovery (chronic). Therefore, studies typically separate patients into two groups (acute/chronic), and this is often accompanied with arguments for and against using data from acute stroke patients over chronic. However, no comprehensive studies have provided strong evidence of whether the lesion-behaviour relationship early in recovery is comparable to later in the recovery trajectory. To that end, we investigated two aims: (i) whether lesion data from acute and chronic patients yield similar results in region-based lesion-symptom mapping analyses and (ii) if models based on one timepoint accurately predict the other. Lesions and aphasia severity scores from acute ( = 63) and chronic ( = 109) stroke survivors with aphasia were entered into separate univariate region-based lesion-symptom mapping analyses. A support vector regression model was trained on lesion data from either the acute or chronic data set to give an estimate of aphasia severity. Four model-based analyses were conducted: trained on acute/chronic using leave-one-out, tested on left-out behaviour or trained on acute/chronic to predict the other timepoint. Region-based lesion-symptom mapping analyses identified similar but not identical regions in both timepoints. All four models revealed positive correlations between actual and predicted Western Aphasia Battery-Revised aphasia-quotient scores. Lesion-to-behaviour predictions were almost equivalent when comparing within versus across stroke stage, despite differing lesion size/locations and distributions of aphasia severity between stroke timepoints. This suggests that research investigating the brain-behaviour relationship including subsets of patients from only one timepoint may also be applicable at other timepoints, although it is important to note that these comparable findings may only be seen using broad measures such as aphasia severity, rather than those aimed at identifying more specific deficits. Subtle differences found between timepoints may also be useful in understanding the nature of lesion volume and aphasia severity over time. Stronger correlations found when predicting acute behaviour (e.g. predicting acute: = 0.6888, < 0.001, predicting chronic = 0.5014, < 0.001) suggest that the acute lesion/perfusion patterns more accurately capture the critical changes in underlying vascular territories. Differences in critical brain regions between timepoints may shed light on recovery patterns. Future studies could focus on a longitudinal design to compare acute and chronic patients in a more controlled manner.

摘要

在中风失语症中,病灶体积通常与失语症严重程度相关。尽管这种关系在整个恢复过程中可能都存在,但不同因素可能在恢复早期(急性期)和恢复后期(慢性期)影响病灶体积和行为。因此,研究通常将患者分为两组(急性/慢性),并且这常常伴随着关于使用急性中风患者数据而非慢性中风患者数据的支持和反对观点。然而,尚无全面研究提供有力证据表明恢复早期的病灶-行为关系是否与恢复轨迹后期的关系相当。为此,我们研究了两个目标:(i)急性和慢性患者的病灶数据在基于区域的病灶-症状映射分析中是否产生相似结果,以及(ii)基于一个时间点的模型是否能准确预测另一个时间点。将急性(n = 63)和慢性(n = 109)失语症中风幸存者的病灶和失语症严重程度评分分别纳入基于区域的单变量病灶-症状映射分析。使用急性或慢性数据集中的病灶数据训练支持向量回归模型以估计失语症严重程度。进行了四项基于模型的分析:使用留一法在急性/慢性数据上训练,对留出的行为进行测试,或在急性/慢性数据上训练以预测另一个时间点。基于区域的病灶-症状映射分析在两个时间点都识别出了相似但不完全相同的区域。所有四个模型都显示实际和预测的西方失语症成套测验修订版失语商数得分之间存在正相关。尽管中风时间点之间病灶大小/位置和失语症严重程度分布不同,但在中风阶段内与跨中风阶段比较时,病灶到行为的预测几乎等效。这表明,研究脑-行为关系且仅包括来自一个时间点的患者子集的研究,在其他时间点可能也适用,不过需要注意的是,这些可比的发现可能仅在使用失语症严重程度等宽泛指标时才能看到,而非旨在识别更具体缺陷的指标。在时间点之间发现的细微差异可能也有助于理解病灶体积和失语症严重程度随时间的变化性质。在预测急性行为时发现更强的相关性(例如,预测急性:r = 0.6888,p < 0.001,预测慢性:r = 0.5014)表明急性病灶/灌注模式更准确地捕捉了潜在血管区域的关键变化。时间点之间关键脑区的差异可能有助于揭示恢复模式。未来的研究可以侧重于纵向设计,以更可控的方式比较急性和慢性患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3885/10088484/8baa10968698/fcad014_ga1.jpg

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