Improving language assessment in bilinguals with epilepsy using advanced neuroimaging and culturally-sensitive neuropsychological measures

使用先进的神经影像学和文化敏感的神经心理学措施改善双语癫痫患者的语言评估

• 批准号: 10284796
• 负责人: Alena Stasenko
• 金额: $ 6.6万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10284796
• 关键词: Address; Age; Anterior; Anterior Temporal Lobectomy; Benchmarking; Bilateral; Brain; California; Classification; Clinical; Clinical Research; Cognitive; Country; Data; Data Set; Diffusion Magnetic Resonance Imaging; Ensure; Epilepsy; Evaluation; Excision; Functional Magnetic Resonance Imaging; Goals; Handedness; Image; Impairment; Individual; K-Series Research Career Programs; Laboratories; Language; Language Disorders; Lead; Left; Light; Linguistics; Link; Literature; Maps; Measures; Minority; Multilingualism; Multimodal Imaging; Names; National Institute of Neurological Disorders and Stroke; Neuropsychology; Occupational; Operative Surgical Procedures; Outcome; Pathology; Patient Self-Report; Patients; Pattern; Phenotype; Population; Postoperative Period; Process; Public Health; Quality of life; Research; Retrieval; Risk; Seizures; Side; Special Population; Structure; Temporal Lobe; Temporal Lobe Epilepsy; Testing; Theoretical model; Time; Training; Universities; Work; base; bilingualism; career; cognitive recovery; design; early experience; experience; functional outcomes; health care disparity; health goals; improved; language impairment; language outcome; neural correlate; neuroimaging; neurosurgery; novel; novel strategies; personalized approach; precision medicine; prospective; recruit; relating to nervous system; white matter

PROJECT SUMMARY/ABSTRACT Language impairment is common in temporal lobe epilepsy (TLE) and often correlated with the amount of pathology in the anterior temporal lobe. Language deficits can also be exacerbated by surgical removal of critical language structures on the language-dominant side. The majority of epilepsy research is with monolingual, native English speakers, which is a problem given the rapidly growing number of bilingual individuals and considerable data showing that language is processed differently in the bilingual vs monolingual brain. Bilinguals are known to 1) perform worse than monolinguals on language measures—in particular on those designed for monolinguals—which suffer from cultural and linguistic biases and 2) show more bilateral language representation. This suggests that current clinical interpretation of a bilingual's presurgical language data may lead to false positives (i.e., classifying a patient as impaired and falsely assuming temporal lobe pathology when language structures are intact) or inaccurate prediction of post-operative language decline. We hypothesize that the clinical utility of pre-surgical language assessment would improve with the use of culturally and linguistically sensitive measures tailored to bilinguals. Studies to date tested bilinguals in only one language and/or used self- reported language proficiency ratings which are known to be less reliable. Further, there is a lack of studies combining neuropsychological data with neuroimaging to evaluate the functional and structural integrity of the temporal lobes in bilinguals. In Aim 1, we evaluate whether a novel, tailored approach that objectively measures language proficiency and naming in both languages is superior to a conventional approach that assesses proficiency only by self-report and tests naming with monolingual-normed measures. The tailored approach would ensure that impairment is defined based on a bilingual's dominant language. In Aim 2, we examine whether language phenotypes will differ as a result of approach using functional MRI and diffusion tensor imaging, and whether bilingual language factors (e.g., proficiency, age of acquisition) influence laterality. Aim 3 determines whether the tailored approach predicts post-operative language decline and if bilingual language factors are related to post-operative outcomes. We leverage a multisite, retrospective and prospective dataset obtained from three large University of California epilepsy centers. Fulfillment of these aims will improve precision medicine and shed light on the combined effects of bilingualism and TLE on language network re-organization, while providing the applicant with training in multimodal imaging and clinical research with a neurosurgical population. This will lead to a K-award and career as a research neuropsychologist trained in imaging, with a special focus on bilingualism, which is often correlated with minority status in the USA.

项目摘要/摘要 语言障碍在临时叶癫痫（TLE）中很常见，并且通常与 前临时叶中的病理学。语言定义也可能通过手术删除关键来加剧 语言以语言为主导的一面。大多数癫痫研究是用单语的，本地的 说英语的人，这是一个问题，鉴于双语人数迅速增长和相当多的人 数据显示，在双语与单语言大脑中，语言的处理方式不同。双语是已知的 到1）在语言测量方面的表现比单语言差，尤其是针对设计的 单语言 - 遭受文化和语言偏见的困扰，2）显示更多双边语言 表示。这表明当前对双语的预性语言数据的临床解释可能 导致假阳性（即，将患者分类为受损并虚假假定暂时性叶病理学 语言结构是完整的）或不准确的术后语言下降预测。我们假设这一点 外科语言评估的临床实用性将随着文化和语言的使用而改善 针对双语的敏感措施。迄今为止的研究仅以一种语言和/或使用自我 报告的语言水平评级较不可靠。此外，缺乏研究 将神经心理学数据与神经成像结合起来，以评估 暂时的爱在双语者中。在AIM 1中，我们评估了一种小说，量身定制的方法是否客观地衡量 语言水平和两种语言的命名优于评估的传统方法 仅通过自我报告和通过单语音措施进行命名。量身定制的方法 将确保根据双语的主导语言来定义障碍。在AIM 2中，我们检查 语言表型是否会因使用功能MRI和差异张量而导致的语言表型会有所不同 成像，以及双语语言因素（例如熟练程度，获取年龄）是否影响侧向。目标3 确定量身定制的方法是否可以预测术后语言的下降和双语语言 因素与术后结局有关。我们利用多站点，回顾性和潜在的数据集 从三个大型加利福尼亚大学癫痫中心获得。实现这些目标将提高精度 医学和阐明双语和TLE对语言网络重组的综合影响， 在为申请人提供多模式成像和临床研究的培训时， 人口。这将导致K-Award和职业作为一名接受成像训练的研究神经心理学家的职业， 特别关注双语，这通常与美国的少数群体地位相关。