Dosage and predictors of naming treatment response in aphasia

描述（由申请人提供）： 中风后的语言和沟通障碍（失语症）影响超过30%的中风幸存者，每年新发病例超过180，000例。失语症的后果是深远的，可以影响心理社会调整，家庭角色参与，职业机会和在社会中独立运作的能力。 最近的估计表明，VHA门诊诊所每年有2000例失语症新病例，这意味着大约有20，000名登记的VHA患者和100，000名美国退伍军人目前患有这种疾病。为了满足这一需求，VA匹兹堡医疗保健系统老年研究，教育和临床中心（GRECC）于2009年1月启动了密集住宅失语症治疗和教育（PIRATE）计划。 PIRATE是一个临床示范项目，在4周的时间内为社区居住的退伍军人提供大约100小时的认知语言导向的失语症治疗。 海盗目前每年为18名退伍军人提供服务，每两个月一次。与PIRATE和失语症治疗相关的资源限制通常要求以最具成本效益的剂量向最有可能从中受益的退伍军人提供治疗。 拟议的治疗有效性研究通过检查语义导向命名治疗的剂量-反应关系，并确定治疗成功的认知，心理语言学和神经解剖学预测因子来解决这些问题。研究受试者（n = 50，为期4年）将在全国范围内从参加PIRATE的退伍军人中招募。他们将在进入PIRATE之前、每周治疗期间和项目退出/随访时测量其命名表现。在治疗前还将收集一系列认知测量和大脑结构磁共振图像。将在不同时间间隔内比较受试者在训练和未训练词汇项上的表现以及命名表现的标准化测量，以指定实现最大治疗获益的治疗量。他们的治疗结果也将与特定的认知测试分数及其脑损伤的位置和程度相关，以确定预测阳性治疗反应的认知和神经学标志物。治疗反应也将在具有不同心理语言学特征的参与者之间进行比较，以确定哪些患者组从语义导向的命名治疗中获益最大。 这项拟议中的研究应该为两个相互关联的问题提供答案：失语症治疗对谁最有效，以及需要多少才能优化治疗结果。这些答案有可能为VHA内如何提供失语症治疗设定变革性的新标准。

DESCRIPTION (provided by applicant): Language and communicative impairments following stroke (aphasia) affect more than 30% of stroke survivors, with an incidence of over 180,000 new cases annually. The consequences of aphasia are far reaching and can affect psychosocial adjustment, family role participation, vocational opportunities, and the ability to function independently in society. Recent estimates suggest that VHA outpatient clinics see 2000 new cases of aphasia each year, meaning that approximately 20,000 enrolled VHA patients and 100,000 United States Veterans are currently living with the condition. In response to this need, the VA Pittsburgh Healthcare System Geriatric Research, Education, and Clinical Center (GRECC) initiated the Program for Intensive Residential Aphasia Treatment and Education (PIRATE) in January 2009. PIRATE is a clinical demonstration project that provides approximately 100 hours of cognitive- linguistically oriented aphasia treatment to community dwelling Veterans over a 4-week period. PIRATE currently serves 18 Veterans per year in bi-monthly sessions. Resource limitations associated with PIRATE and aphasia treatment in general require that treatments be offered in the most cost-effective doses to those Veterans most likely to benefit from them. The proposed treatment-effectiveness research addresses these issues by examining the dose-response relationship for semantically-oriented naming treatment, and identifying cognitive, psycholinguistic and neuroanatomical predictors of treatment success. Study participants (n=50, over a 4-year period) will be recruited nationwide from Veterans enrolled in PIRATE. They will have their naming performance measured prior to PIRATE entry, during each week of treatment, and at program exit/follow-up. A battery of cognitive measures and structural magnetic resonance images of their brains will also be collected prior to treatment. Participants' performance on trained and untrained lexical items and a standardized measure of naming performance will be compared across time intervals to specify the therapy amounts for which maximum treatment benefits are achieved. Their treatment outcomes will also be correlated with specific cognitive test scores and the location and extent of their brain lesions to identify cognitive and neurological markers predictive of positive treatment response. Treatment response will also be compared across participants with different psycholinguistic profiles, to determine which groups of patients show greatest benefit from semantically-oriented naming treatment. The proposed research should provide answers to two interlocking questions: for whom is aphasia therapy most effective, and how much of it is needed to optimize treatment outcomes. These answers have the potential to set transformative new standards for how aphasia treatment is delivered within VHA.