Language Disorders Due to Fiber Tract Disconnection in Aphasic Patients

失语症患者纤维束断开导致的语言障碍

• 批准号: 7931361
• 负责人: Nina F. Dronkers
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2014-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7931361
• 关键词: Affect; Anterior; Aphasia; Area; Arts; Behavioral; Brain; Brain Injuries; Brain Part; Brain imaging; Brain region; Caregivers; Caring; Characteristics; Chronic; Clinical; Collection; Communication; Complex; Coupled; Data; Development; Diagnosis; Diagnostic; Differential Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Evaluation; Fiber; Foundations; Generations; Glean; Goals; Human; Image; Image Analysis; Imagery; Imaging Device; Individual; Inferior; Injury; Internet; Investigation; Knowledge; Language; Language Disorders; Lead; Left; Lesion; Life; Location; Magnetic Resonance Imaging; Maps; Measurement; Measures; Medial; Medical; Methodology; Methods; Mission; Modeling; Motor; Names; Nerve Degeneration; Neurodegenerative Disorders; Normal tissue morphology; Output; Parietal; Pathway interactions; Patients; Performance; Play; Population; Production; Reading; Recovery; Recruitment Activity; Rehabilitation therapy; Relative (related person); Research; Resources; Role; Sampling; Severities; Speech; Speech Disorders; Stroke; Symptoms; Syndrome; System; Techniques; Test Result; Testing; Time; Traumatic Brain Injury; Variant; Veterans; abstracting; aphasic; auditory comprehension; base; behavior test; brain behavior; brain pathway; brain tract; capsule; coping; effective therapy; falls; in vivo; injured; interest; language processing; neuroimaging; neuromechanism; neuropsychological; remediation; semantic processing; skills; tool; transmission process; tumor; white matter; white matter change; white matter damage

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT The use of language in everyday life requires the participation of numerous regions of the brain as well as the intricate web of fiber pathways that connect them. The study of language and language disorders has largely focused on the contributions of these cortical regions in supporting speech and language functions, while the role of the underlying tracts, which could play a major role in language processing is largely unknown. While some "disconnection" syndromes have been described, the result of injury to some of the major fiber tracts in the brain has not been well studied. This has been due primarily to the difficulty in isolating these tracts with traditional neuroimaging tools, thus identifying those tracts that have been damaged over those that have been spared. In addition, recruiting the large sample of brain-injured patients required to obtain both the necessary imaging and behavioral data takes a great deal of time and resources. The goal of this project is to evaluate the contributions of major pathways of the brain that must play a role in language processing by examining the effects of damage to these pathways. This will be done through extensive evaluation of 60 chronic brain-injured patients with aphasia due to stroke, whose language and neuropsychological deficits will be thoroughly evaluated by our staff at the Center for Aphasia and Related Disorders. We will employ the latest techniques in imaging the fiber pathways of the brain, using diffusion tensor imaging (DTI) and diffusion spectrum imaging (DSI) with these patients to image the fiber pathways of the brain, obtain measurements of tract integrity, and perform tractography that visualizes the actual fiber pathways in each patient. The combined use of these behavioral data, the DTI and DSI results from the same patients, as well as voxel-based lesion-symptom mapping (VLSM) analyses will allow us the best possible evaluation of the role of these pathways in language functioning. Understanding the effects of brain injury to the language system is key to the accurate diagnosis and treatment of the language disorders that affect our veteran patients. Knowing how lesions to the cortex and to the underlying fiber tracts each affect the different components of language can help clinicians, patients and caregivers to understand the effect the injury has had on the patient's communication skills. Different disorders require different treatments, and thus more accurate diagnoses naturally lead to more effective remediation. We have already seen that damage to cortical areas, that cannot be replaced, responds differently to treatment than does damage to a fiber tract that can potentially be circumnavigated. With neuroimaging data now routinely available on patients in VA medical facilities, the information gleaned from this project can be applied directly to the veteran patients we serve, thus providing them with the optimum in diagnostic and rehabilitative care, not to mention hope for a better recovery. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Brain injury is very common in our veteran patients and one of its unfortunate consequences can be the disruption of speech and language skills (aphasia) that affect how people can communicate. While some research has been dedicated to understanding these problems and how they relate to injuries in different parts of the brain, very little has been done to understand how language skills can be affected by damage to the fiber pathways that connect these brain regions to one another. This research will use state-of-the- art brain imaging tools to understand how communication skills are affected after injury to fiber tract pathways and how this damage interacts with other parts of the brain. Such information provides the best information to clinicians whose mission is to give our veteran patients the most accurate diagnosis and most effective treatments. This knowledge also helps our patients and their caregivers to understand the injury and how they can best cope with the changes in their ability to communicate.

描述（由申请人提供）： 项目摘要/摘要在日常生活中使用语言需要大脑众多地区的参与以及连接它们的复杂的纤维途径。对语言和语言障碍的研究主要集中在这些皮质区域在支持语音和语言功能方面的贡献上，而基本领域的作用可能在语言处理中起主要作用，这在很大程度上是未知的。虽然已经描述了一些“断开”综合征，但尚未对大脑中某些主要纤维区域受伤的结果进行了很好的研究。这主要是由于难以用传统的神经影像学工具隔离这些区域的困难，因此确定了那些因幸免的区域而损坏的区域。此外，招募需要获得必要的成像和行为数据所需的大量脑损坏患者样本需要大量时间和资源。该项目的目的是评估大脑主要途径的贡献，必须通过检查损害对这些途径的影响来在语言处理中发挥作用。这将通过对60例慢性脑损伤患者失语症患者进行广泛评估来完成，他们的语言和神经心理学缺陷将由我们的失语症和相关疾病中心的员工进行彻底评估。我们将使用这些患者的扩散张量成像（DTI）和扩散光谱成像（DSI）来对大脑的纤维途径进行成像，与这些患者进行扩散光谱成像（DSI），从而对大脑的纤维途径进行成像，获得道路完整性的测量，并执行每位患者实际纤维途径的视频。这些行为数据的联合使用，DTI和DSI来自相同患者以及基于体素的病变 - 症状映射（VLSM）分析，将使我们能够最好地评估这些途径在语言功能中的作用。了解脑损伤对语言系统的影响是准确诊断和治疗影响我们退伍军人患者的语言障碍的关键。知道对皮层和基础纤维的病变如何影响语言的不同组成部分可以帮助临床医生，患者和看护人了解受伤对患者沟通技巧的影响。不同的疾病需要不同的治疗方法，因此更准确的诊断自然会导致更有效的补救。我们已经看到，无法替代的皮质区域的损害对治疗的反应与对纤维区的损害有所不同。借助VA医疗设施中的患者，现在可以将神经影像数据直接用于该项目中收集的信息，可以直接应用于我们服务的资深患者，从而为他们提供了最佳的诊断和康复护理，更不用说希望更好地康复了。 公共卫生相关性： 在我们的资深患者中，项目叙事脑损伤非常普遍，其不幸的后果之一可能是影响人们交流方式的言语和语言技能（失语症）的中断。尽管一些研究致力于理解这些问题及其与大脑不同部位的伤害有关的关系，但很少有了解语言技能如何受到将这些大脑区域相互联系的纤维途径的损害影响。这项研究将使用最先进的大脑成像工具来了解纤维道通路受伤后如何影响沟通技巧，以及这种损害如何与大脑其他部位相互作用。此类信息为临床医生提供了最佳信息，他们的任务是为我们的资深患者提供最准确的诊断和最有效的治疗方法。这些知识还可以帮助我们的患者及其护理人员了解伤害以及他们如何最好地应对他们交流能力的变化。