Cognitive control and its impact on recovery from aphasic stroke.
Cognitive control and its impact on recovery from aphasic stroke.
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DOI：
10.1093/brain/awt289
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Wise RJ
中科院分区：
文献类型：
--
作者：
Brownsett SL;Warren JE;Geranmayeh F;Woodhead Z;Leech R;Wise RJ
失语症的缺陷通常只解释在特定领域的语言过程。然而，有效的人际沟通和测试，探索这一复杂的认知技能也依赖于域一般的过程。在临床上，注意力和执行功能受损会干扰失语症的康复，这是一个务实的观察。一个在认知控制中很重要的系统是显著性网络，它包括背侧前扣带皮层和邻近的上级额回（中线额叶皮层）。这项功能性成像研究评估了16名慢性失语症患者在康复计划前后的标准口语测试中的表现与中线额叶皮层（远离梗死）的域一般活动。在扫描过程中，参与者听到简单的句子，每次听力试验之后立即进行一次试验，他们重复前一句话。在重复任务的背景下听句子，预计将激活涉及语言特定过程（言语感知和理解，言语工作记忆和发音前排练）和一些特定的任务过程（包括注意到话语和试图克服反应前冲突和决策不确定性受损的言语感知）的区域。为了在健康参与者中可视化相同的系统，将句子作为三通道噪声声码语音呈现给他们，从而损害语音感知并评估这是否唤起域一般认知系统。正如预期的那样，将更困难的感知和准备重复噪声语音编码语音的任务与清晰语音的相同任务进行对比，表明健康参与者的中线额叶皮层活动增加。失语症患者在听标准（未失真）句子时，同一区域也被激活。使用从健康参与者的数据中定义的感兴趣区域，从患者获得来自中线额叶皮层的数据。在整个小组和不同的扫描过程中，活动与患者的沟通能力显着相关。这种相关性不受病变大小或患者实际年龄的影响。这是第一个研究，直接相关的活动领域的一般系统，特别是显着性网络，与中风后失语症的剩余语言表现。它提供了直接的证据，支持临床直觉，领域一般认知控制是一个重要因素，有助于从失语症中风的恢复潜力。
Aphasic deficits are usually only interpreted in terms of domain-specific language processes. However, effective human communication and tests that probe this complex cognitive skill are also dependent on domain-general processes. In the clinical context, it is a pragmatic observation that impaired attention and executive functions interfere with the rehabilitation of aphasia. One system that is important in cognitive control is the salience network, which includes dorsal anterior cingulate cortex and adjacent cortex in the superior frontal gyrus (midline frontal cortex). This functional imaging study assessed domain-general activity in the midline frontal cortex, which was remote from the infarct, in relation to performance on a standard test of spoken language in 16 chronic aphasic patients both before and after a rehabilitation programme. During scanning, participants heard simple sentences, with each listening trial followed immediately by a trial in which they repeated back the previous sentence. Listening to sentences in the context of a listen–repeat task was expected to activate regions involved in both language-specific processes (speech perception and comprehension, verbal working memory and pre-articulatory rehearsal) and a number of task-specific processes (including attention to utterances and attempts to overcome pre-response conflict and decision uncertainty during impaired speech perception). To visualize the same system in healthy participants, sentences were presented to them as three-channel noise-vocoded speech, thereby impairing speech perception and assessing whether this evokes domain general cognitive systems. As expected, contrasting the more difficult task of perceiving and preparing to repeat noise-vocoded speech with the same task on clear speech demonstrated increased activity in the midline frontal cortex in the healthy participants. The same region was activated in the aphasic patients as they listened to standard (undistorted) sentences. Using a region of interest defined from the data on the healthy participants, data from the midline frontal cortex was obtained from the patients. Across the group and across different scanning sessions, activity correlated significantly with the patients’ communicative abilities. This correlation was not influenced by the sizes of the lesion or the patients’ chronological ages. This is the first study that has directly correlated activity in a domain general system, specifically the salience network, with residual language performance in post-stroke aphasia. It provides direct evidence in support of the clinical intuition that domain-general cognitive control is an essential factor contributing to the potential for recovery from aphasic stroke.
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