Brain Connectivity Supporting Language Recovery in Aphasia

Aphasia, an impairment of language processing, is one of the most common consequences of
strokes affecting the dominant brain hemisphere4. Patients with aphasia are usually incapable
of working, and their interactions with family and friends are often severely affected. The
hallmark deficit of aphasia is the inability to name objects or people (anomia)12. The
severity of anomia is closely related to a poor quality of life.

While many patients with aphasia exhibit some language recovery in the first days to weeks
after the stroke, 30-40% persist with long lasting naming impairments4. Fortunately, speech
therapy can be very effective to improve naming for some patients with chronic aphasia5-8.
However, it is well recognized among clinicians that speech therapy can be ineffective for
other patients, making it difficult to predict how and why some patients benefit from naming
treatment, while others show little or no improvement.

Here, the investigators propose to evaluate whether naming impairment and naming recovery are
related to the extent of structural damage to the cortical language network. Importantly, the
investigators will evaluate damage as the combined effect of cortical necrosis and cortical
disconnection. The investigators hypothesize that assessing anomia as being either due to
gray matter necrosis or due to cortical disconnection constitutes a false dichotomy since
most chronic patients exhibit gray and white matter damage. Furthermore, the investigators
propose that disconnection of seemingly spared cortical areas has up till now been
underappreciated in patients with stroke due to limitations in brain connectivity assessment
tools. By examining only areas of cortical necrosis without considering disconnected areas,
one may underestimate the magnitude of language network damage. A better understanding of the
effects from both cortical damage and disconnection on anomia and its recovery could lead to
an improved clinical management of aphasia.

The investigators will employ the innovative concept of the brain connectome, i.e., the
individualized map of neural connections in the brain, to evaluate whether naming recovery is
supported by preserved gray matter and preserved connectivity involving key language areas in
the left hemisphere. The investigators propose that left frontal and left temporal
connectivity mapped based on the individual's connectome is an important explanatory variable
towards naming impairment and recovery.

The investigators believe that this research is significant for the three main reasons.
First, it can have a direct clinical impact by providing a better understanding of which
patients can benefit from therapy. Second, it can unveil the neurobiological mechanisms
supporting language recovery, improving our understanding of brain plasticity related to
language rehabilitation. Finally, if disconnection contributes to language impairment, our
methods can be developed to test specific theories of language organization in the brain. The
significance of these aspects is explained in detail below.

Criteria:No new patients will be recruited for the current project. We will rely solely on
data collection in the tDCS-Trial (U01 DC011739, period 7/1/2012-6/31/2017).

Following is the Eligibility for the TDCS-Trial:

Inclusion Criteria:

1. Patients must be willing and able to give informed consent.

2. Patients must be willing and able to comply with study requirements.

3. Patients must be between 25- and 80-years of age.

4. Patients must be native English speakers.

5. Patients must be pre-morbidly right-handed.

6. Patients must have sustained a one-time ischemic stroke in the left-hemisphere.

7. Patients must be greater than 6-months post-stroke.

8. Patients must have an aphasia diagnosis as confirmed by the Western Aphasia
Battery-Revised.

9. Patients must be MRI-compatible (e.g., no metal implants, not claustrophobic, etc.).

10. Patients must achieve at least 65% accuracy on naming task during screening -

Exclusion Criteria:

1. History of brain surgery

2. Seizures during the previous 12 months

3. Sensitive scalp (per patient report)

4. Able to overtly name more than an average of 140 out of 175 items during the
pre-treatment picture naming test (Philadelphia Naming Test) during Visits 2 or 3.

5. Unable to overtly name at least an average of 5 out of 80 items during the
pre-treatment fMRI sessions during Visits 2 or 3.