卒中后失语语言和非语言认知功能相关的静息态功能磁共振成像研究

doi:10.3969/j.issn.1673-5765.2021.03.007

摘要/Abstract

摘要：

目的本研究拟借助静息态功能磁共振成像（resting-state functional magnetic resonance imaging，rsfMRI ），探讨卒中后失语（post-stroke aphasia，PSA）患者语言及非语言认知功能特征及其相关的脑功能变化情况。方法选择2019年3月-2020年1月连续就诊于首都医科大学附属北京天坛医院的PSA患者作为病例组，筛选年龄、性别、受教育程度相匹配的健康志愿者作为健康对照（healthy controls，HCs）组。应用西方失语成套测验（western aphasia battery，WAB）及洛文斯顿作业疗法认知评定（Loewenstein occupational therapy cognitive assessment，LOTCA）评估语言及非语言认知功能。应用rs-fMRI采集低频振幅（amplitude of low frequency fluctuation，ALFF）及功能连接密度（functional connectivity density， FCD）等参数。比较两组影像学参数，并将其与WAB及LOTCA评分进行Pearson相关分析。结果本研究纳入16例PSA患者及17例HCs。与HCs组比较，PSA组双侧海马、海马旁回、颞下回等区域ALFF值升高，左侧额下回岛盖部、岛叶等部位ALFF值降低；右侧海马、海马旁回的FCD值升高，左侧顶下回、枕上回、枕中回、楔前叶等脑区FCD值降低。ALFF值与WAB及LOTCA评分的相关性分析显示，左侧额下回岛盖部的ALFF值与WAB-失语商及流畅度得分呈正比（r =0.693，P =0.026；r =0.662， P =0.037）；左侧额下回岛盖部的ALFF值与LOTCA定向得分呈正比（r =0.642，P =0.045），左侧海马的 ALFF值与LOTCA注意力及专注力评分呈正比（r =0.706，P =0.022）。结论 PSA患者合并部分脑区局部自发活动的强度变化及脑区间的连通性改变，这些改变与PSA患者语言障碍和非语言认知功能障碍密切相关，这些影像学改变可以作为PSA重要影像学标记。

文章导读： 本研究利用rs-fMRI技术，发现PSA患者语言及非语言认知功能损害与部分脑区局部活动强度的变化及脑区间的连通性改变有关，这些变化为深入了解失语症的病理生理机制提供了客观的影像学依据。

关键词: 卒中后失语; 语言障碍; 非语言认知功能障碍; 静息态功能磁共振成像

Abstract:

Objective To explore the language and non-linguistic cognitive impairment characteristics and related brain functional changes in patients with poststroke aphasia (PSA) using resting-state functional magnetic resonance imaging (rs-fMRI). Methods Patients with PSA who were consecutively admitted to Beijing Tiantan Hospital, Capital Medical University from March 2019 to January 2020 were enrolled in this retrospective analysis. The healthy controls (HCs) matched for age, gender, and education were selected. Western aphasia battery (WAB) and Loewenstein occupational therapy cognitive assessment (LOTCA) were used to evaluate the language and non-linguistic cognitive function. The amplitude of low frequency fluctuation (ALFF) and functional connectivity density (FCD) were collected by rs-fMRI. The imaging parameters of the two groups were compared, and pearson correlation analysis was used to analyze the correlation of WAB/LOTCA scores with the imaging parameters. Results 16 PSA patients with and 17 controls were included. Compared to the HCs, the ALFF values of the bilateral hippocampus, parahippocampal gyrus, and inferior temporal gyrus significantly increased, the ALFF values of the left inferior frontal gyrus pars perculairs and insular lobe significantly decreased, the FCD values of the right hippocampus and parahippocampal gyrus significantly increased, and the FCD values of the left inferior parietal lobule, superior occipital gyrus, middle occipital gyrus, and precuneus significantly decreased in PSA patients. Correlation analysis found that the ALFF value of the left inferior frontal gyrus partes opercularis was positively correlated with WAB-aphasia quotient (AQ), fluency score (r =0.693, P =0.026; r =0.662, P =0.037). The ALFF value of the left inferior frontal gyrus pars perculairs was positively correlated with LOTCA orientation score (r =0.642, P =0.045), and the ALFF value of the left hippocampus was positively correlated with LOTCA attention score (r =0.706, P =0.022). Conclusions The intensity of local cerebral spontaneous activity in some brain regions and brain functional connectivity changed in PSA patients, which are closely related to the language and nonlinguistic cognitive impairment. These imaging changes may be used as the important imaging markers for PSA.

Key words: Poststroke aphasia; Language disorder; Non-linguistic cognitive impairment;Resting-state functional magnetic resonance imaging

姚婧璠，徐成，陈红燕，王铄，张玉梅. 卒中后失语语言和非语言认知功能相关的静息态功能磁共振成像研究[J]. 中国卒中杂志, 2021, 16(03): 251-258.

YAO Jing-Fan, XU Cheng, CHEN Hong-Yan, WANG Shuo, ZHANG Yu-Mei. The Language and Non-linguistic Cognitive Impairment in Poststroke Aphasia: A Resting-state Functional Magnetic Resonance Imaging Study[J]. Chinese Journal of Stroke, 2021, 16(03): 251-258.

参考文献

[1] KIRAN S，THOMPSON C K. Neuroplasticity of

language networks in aphasia：advances，updates，

and future challenges[J/OL]. Front Neurol，2019，

10：295[2020-12-01]. https：//doi.org/10.3389/

fneur.2019.00295.

[2] EL HACHIOUI H，VISCH-BRINK E G，LINGSMA

H F，et al. Nonlinguistic cognitive impairment

in poststroke aphasia：a prospective study[J].

Neurorehabil Neural Repair，2014，28（3）：273-281.

[3] SANDBERG C W. Hypoconnectivity of restingstate

networks in persons with aphasia compared

with healthy age-matched adults[J/OL]. Front Hum

Neurosci，2017，11：91[2020-12-01]. https：//doi.

org/10.3389/fnhum.2017.00091.

[4] STOCKERT A，SAUR D. Aphasia：a neuronal

network disorder[J]. Nervenarzt，2017，88（8）：866-

873.

[5] MEDAGLIA J D，LYNALL M E，BASSETT D S.

Cognitive network neuroscience[J]. J Cogn Neurosci，

2015，27（8）：1471-1491.

[6] WANG X，WANG M H，WANG W Z，et al. Resting

state brain default network in patients with motor

aphasia resulting from cerebral infarction[J]. Chin

Sci Bull，2014，22（4）：435-446.

[7] 吴建满，李银官，范秋玲，等. 失语症患者静息态

fMRI成像研究[J]. 医学影像学杂志，2019，29（5）：

731-735，743.

[8] ZHU D，CHANG J J，FREEMAN S，et al. Changes

of functional connectivity in the left frontoparietal

network following aphasic stroke[J/OL]. Front Behav

Neurosci，2014，8：167[2020-12-01]. https：//doi.

org/10.3389/fnbeh.2014.00167.

[9] MARCOTTE K，PERLBARG V，MARRELEC G，

et al. Default mode network functional connectivity

in aphasia：therapy induced neuroplasticity[J]. Brain

Lang，2013，124（1）：45-55.

[10] BREUKELAAR I A，ANTEES C，GRIEVE S M，

et al. Cognitive control network anatomy correlates

with neurocognitive behavior：a longitudinal

study[J]. Hum Brain Mapp，2017，38（2）：631-643.

[11] SCHUMACHER R，HALAI A D，LAMBON

RALPH M A. Assessing and mapping language，

attention and executive multidimensional deficits in

stroke aphasia[J]. Brain，2019，142（10）：3202-3216.

[12] KERTESZ A. Western aphasia battery-revised[M].

San Antonio，TX：Pearson，2007.

[13] MAIER W，BULLER R，PHILIPP M，et al. The

Hamilton Anxiety Scale：reliability，validity and

sensitivity to change in anxiety and depressive

disorders[J]. J Affect Disord，1988，14（1）：61-68.

[14] WILLIAMS J B. A structured interview guide for

the Hamilton Depression Rating Scale[J]. Arch Gen

Psychiatry，1988，45（8）：742-747.

[15] MIKADZE Y V，ARDILA A，AKHUTINA T

V. A. R. Luria's approach to neuropsychological

assessment and rehabilitation[J]. Arch Clin

Neuropsychol，2019，34（6）：795-802.

[16] 燕铁斌，马超，郭友华，等. Loewenstein认知评定量

表（简体中文版）的效度及信度研究[J]. 中华物理医

学与康复杂志，2004，26（2）：81-84.

[17] YAN C G，ZANG Y F. DPARSF：a MATLAB

toolbox for "pipeline" data analysis of resting-state

fMRI[J/OL]. Frontiers in Systems Neuroscience，

2010，4：13[2020-12-01]. https：//doi.org/10.3389/

fnsys.2010.00013.

[18] YU H L，LIU W B，WANG T，et al. Difference in

resting-state fractional amplitude of low-frequency

fluctuation between bipolar depression and unipolar

depression patients[J]. Eur Rev Med Pharmacol Sci，

2017，21（7）：1541-1550.

[19] WANG Z Q，YAN C G，ZHAO C，et al. Spatial

patterns of intrinsic brain activity in mild cognitive

impairment and Alzheimer’s disease：a resting-state

functional MRI study[J]. Hum Brain Mapp，2011，32

（10）：1720-1740.

[20] 李淑青，王红. 静息态功能磁共振在失语症神经网

络的研究进展[J]. 广东医学，2017，38（13）：2078-

2081.

[21] BONAKDARPOUR B，ROGALSKI E J，WANG

A，et al. Functional connectivity is reduced in earlystage

primary progressive aphasia when atrophy is

not prominent[J]. Alzheimer Dis Assoc Disord，2017，

31（2）：101-106.

[22] 张敬，任华，张权，等. 正常人工作记忆任务和静息状

态下前额叶皮层内侧面的功能连接分析[J]. 临床放

射学杂志，2009，28（9）：1197-1201.

[23] 张启睿，舒华. 工作记忆与失语症关系的研究进展

[J]. 中国特殊教育，2011，18（6）：89-93.