Leavitt Victoria M, Simani Leila, Haghighi Afshin Borhani, Koch Marcus, König Alexandra, Rusz Jan
Cognitive Neuroscience Division, Department of Neurology, Columbia University Irving Medical Center, 630 West 168th Street, P&S Box 16, New York, NY, 10032, USA.
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Neural Transm (Vienna). 2025 Sep 6. doi: 10.1007/s00702-025-03015-w.
Cognitive decline is a common feature of neurologic conditions, with language functions often affected. Word finding difficulties are commonly reported to neurologists in clinic. Receptive language dysfunction (i.e., comprehension) tends to be more difficult to recognize for both the patient and the clinician. Subtle yet pervasive decrements in language may be a key feature (and potential driver) of pathological cognitive decline inherent to neurologic diseases involving a primary or secondary neurodegenerative process. While severe language impairment such as aphasia presenting in the context of stroke or dementia has been studied in detail, mild or insidious presentations remain relatively understudied. In this review, we evaluate neural substrates and clinical manifestations of language deficits noted in four neurologic populations: Alzheimer's disease (AD), stroke, multiple sclerosis (MS), and Parkinson's disease (PD). Despite differences in etiology and pathophysiology, these four neurologic populations each present with prominent language dysfunction. For each, we describe neuroanatomical substrates and networks underlying language dysfunction. We then describe current observations of language dysfunction in each population. We incorporate a discussion of emerging speech measurement tools employing machine learning (ML) and artificial intelligence (AI). Overall, we provide evidence to support a nascent hypothesis of language dysfunction as a potential driver of cognitive decline across neurologic populations with the aim of motivating novel research insights and informing clinical care.
认知衰退是神经系统疾病的常见特征，语言功能常受影响。在临床中，词汇查找困难是向神经科医生报告的常见症状。对于患者和临床医生而言，接受性语言功能障碍（即理解能力）往往更难识别。语言方面细微但普遍存在的减退可能是涉及原发性或继发性神经退行性过程的神经系统疾病所固有的病理性认知衰退的关键特征（以及潜在驱动因素）。虽然诸如中风或痴呆背景下出现的失语等严重语言障碍已得到详细研究，但轻度或隐匿性表现仍相对研究不足。在本综述中，我们评估了在四种神经系统疾病人群中观察到的语言缺陷的神经基础和临床表现：阿尔茨海默病（AD）、中风、多发性硬化症（MS）和帕金森病（PD）。尽管病因和病理生理学存在差异，但这四种神经系统疾病人群均存在明显的语言功能障碍。对于每种疾病，我们描述了语言功能障碍背后的神经解剖学基础和神经网络。然后我们描述了目前在每种人群中观察到的语言功能障碍情况。我们纳入了对采用机器学习（ML）和人工智能（AI）的新兴语音测量工具的讨论。总体而言，我们提供证据支持语言功能障碍作为神经系统疾病人群认知衰退潜在驱动因素的新假说，旨在激发新的研究见解并为临床护理提供信息。
