Two types of phonological reading impairment in stroke aphasia.
Two types of phonological reading impairment in stroke aphasia.
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DOI：
10.1093/braincomms/fcab194
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发表时间：
2021
影响因子：
4.8
通讯作者：
Turkeltaub PE
中科院分区：
文献类型：
--
作者：
Dickens JV;DeMarco AT;van der Stelt CM;Snider SF;Lacey EH;Medaglia JD;Friedman RB;Turkeltaub PE
失语症在失语症中很常见。人们普遍认为，非阅读特有的语音和语义系统的损害会导致失读症和失语症的共病。迄今为止，对失读症的研究仅将音韵学和语义学视为单一过程或损伤轴，通常是在刻板的失读症综合征的背景下进行的。然而，众所周知，音系学尤其依赖于子过程，包括感觉音系处理、运动音系处理和感觉运动整合。此外，许多患有中风失语症的人表现出轻度或混合模式的阅读障碍，与一种综合征并不完全相符。这项横断面研究测试了未选择患有失读症的中风患者中，语音阅读障碍的标志性症状（词汇效应）是否源于对语音特定子过程的损害。参与者包括 30 名患有左半球中风的受试者和 37 名年龄和教育程度匹配的对照者。逻辑混合效应模型测试了中风后感觉音韵学、运动音韵学或感觉运动整合的损伤是否调节了项目词汇对患者朗读准确性的影响。支持向量回归基于体素的病变症状映射阅读和非正字法语音处理所需的局部大脑区域。此外，一种新颖的支持向量回归结构连接组症状映射方法确定了受损和幸免但断开连接的大脑区域对阅读准确性和非拼写语音处理的贡献。具体来说，我们使用基于约束球形解卷积的概率纤维束成像技术导出了全脑结构连接体，并根据患者和对照组之间的比较识别了受损的连接。逻辑混合效应回归显示，与单词相比，只有更大的运动语音障碍与朗读伪词的准确度较低有关。感觉运动整合受损与朗读的整体准确性较低有关。感觉语音障碍和阅读准确性之间没有发现任何关系。基于体素和结构连接组病变症状映射显示，病变和断开的左腹中央前回与较大的运动语音损伤和较低的词汇下阅读准确性有关。相比之下，左颞顶皮层受损和断开与感觉运动整合受损和整体阅读准确性降低有关。这些结果阐明，至少有两种可分离的语音过程导致失语症的阅读障碍模式。首先，由于左颞顶叶皮层及其结构连接的损伤而引起的感觉运动整合受损，会非选择性地降低朗读的准确性。其次，运动语音处理受损，至少部分是由破坏左腹侧前运动皮层和结构连接的病变引起的，选择性地降低了词汇下阅读的准确性。这些结果激发了一种修订后的朗读认知模型，该模型结合了感觉运动语音回路。阅读模型不包含已知的语音处理的感觉运动子过程。狄更斯等人。报告了两种类型的获得性阅读障碍：额后部病变损害运动言语和新词阅读，而颞顶病变损害感觉运动整合以及已知和新词阅读。
Alexia is common in the context of aphasia. It is widely agreed that damage to phonological and semantic systems not specific to reading causes co-morbid alexia and aphasia. Studies of alexia to date have only examined phonology and semantics as singular processes or axes of impairment, typically in the context of stereotyped alexia syndromes. However, phonology, in particular, is known to rely on subprocesses, including sensory-phonological processing, motor-phonological processing, and sensory-motor integration. Moreover, many people with stroke aphasia demonstrate mild or mixed patterns of reading impairment that do not fit neatly with one syndrome. This cross-sectional study tested whether the hallmark symptom of phonological reading impairment, the lexicality effect, emerges from damage to a specific subprocess of phonology in stroke patients not selected for alexia syndromes. Participants were 30 subjects with left-hemispheric stroke and 37 age- and education-matched controls. A logistic mixed-effects model tested whether post-stroke impairments in sensory phonology, motor phonology, or sensory-motor integration modulated the effect of item lexicality on patient accuracy in reading aloud. Support vector regression voxel-based lesion-symptom mapping localized brain regions necessary for reading and non-orthographic phonological processing. Additionally, a novel support vector regression structural connectome-symptom mapping method identified the contribution of both lesioned and spared but disconnected, brain regions to reading accuracy and non-orthographic phonological processing. Specifically, we derived whole-brain structural connectomes using constrained spherical deconvolution-based probabilistic tractography and identified lesioned connections based on comparisons between patients and controls. Logistic mixed-effects regression revealed that only greater motor-phonological impairment related to lower accuracy reading aloud pseudowords versus words. Impaired sensory-motor integration was related to lower overall accuracy in reading aloud. No relationship was identified between sensory-phonological impairment and reading accuracy. Voxel-based and structural connectome lesion-symptom mapping revealed that lesioned and disconnected left ventral precentral gyrus related to both greater motor-phonological impairment and lower sublexical reading accuracy. In contrast, lesioned and disconnected left temporoparietal cortex is related to both impaired sensory-motor integration and reduced overall reading accuracy. These results clarify that at least two dissociable phonological processes contribute to the pattern of reading impairment in aphasia. First, impaired sensory-motor integration, caused by lesions disrupting the left temporoparietal cortex and its structural connections, non-selectively reduces accuracy in reading aloud. Second, impaired motor-phonological processing, caused at least partially by lesions disrupting left ventral premotor cortex and structural connections, selectively reduces sublexical reading accuracy. These results motivate a revised cognitive model of reading aloud that incorporates a sensory-motor phonological circuit. Reading models do not incorporate known sensory-motor subprocesses of speech processing. Dickens et al. report two types of acquired reading impairment: posterior frontal lesions impair motor speech and novel word reading, whereas temporoparietal lesions impair sensory-motor integration and known and novel word reading.
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