Acute Diffusivity Biomarkers for Prediction of Motor and Language Outcome in Mild-to-Severe Stroke Patients

Abstract

Background and Purpose— Early severity of stroke symptoms—especially in mild-to-severe stroke patients—are imperfect predictors of long-term motor and aphasia outcome. Motor function and language processing heavily rely on the preservation of important white matter fasciculi in the brain. Axial diffusivity (AD) from the diffusion tensor imaging model has repeatedly shown to accurately reflect acute axonal damage and is thus optimal to probe the integrity of important white matter bundles and their relationship with long-term outcome. Our aim was to investigate the independent prognostic value of the AD of white matter tracts in the motor and language network evaluated at 24 hours poststroke for motor and aphasia outcome at 3 months poststroke. Methods— Seventeen (motor cohort) and 28 (aphasia cohort) thrombolyzed patients with initial mild-to-severe stroke underwent a diffusion tensor imaging sequence at 24 hours poststroke. Motor and language outcome were evaluated at 3 months poststroke with a composite motor score and the aphasia handicap scale. We first used stepwise regression to determine which classic (age, initial motor or aphasia severity, and lesion volume) and imaging (ratio of affected/unaffected AD of motor and language fasciculi) factors were related to outcome. Second, to determine the specificity of our a priori choices of fasciculi, we performed voxel-based analyses to determine if the same, additional, or altogether new regions were associated with long-term outcome. Results— The ratio of AD in the corticospinal tract was the sole predictor of long-term motor outcome, and the ratio of AD in the arcuate fasciculus—along with age and initial aphasia severity—was an independent predictor of 3-month aphasia outcome. White matter regions overlapping with these fasciculi naturally emerged in the corresponding voxel-based analyses. Conclusions— AD of the corticospinal tract and arcuate fasciculus are effective biomarkers of long-term motor and aphasia outcome, respectively.

Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review

“…The findings show that children with better cognitive ability have a better prognosis for language development. The results support the concept insisting that issues in comprehension are correlated with the most severe language disorders (49,50) . From the list of continuous variables the hearing or visual impairments showed small significant effect, possibly due to different aiding methods used in therapy process.…”

The Role of the Right Hemisphere White Matter Tracts in Chronic Aphasic Patients After Damage of the Language Tracts in the Left Hemisphere

“…AD, on the other hand, is a measure of water diffusion parallel to the axonal course and has been related to axonal status (Alexander et al, 2007 ). Decreased AD has been related to acute axonal damage (Song et al, 2003 ) and has been shown to predict aphasia and motor outcome 3 months post-stroke (Moulton et al, 2019 ). Moreover, AD increases have also been related to axonal damage (Arfanakis et al, 2002 ), as has been shown in the study of Kraus et al ( 2007 ) who examined the white matter in chronic traumatic brain injury (TBI) patients.…”

Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study

“…Spontaneous speech ability, one of the language functions, is most closely related to UE motor status, which explained 51% of the variance in the motor deficit and 42% in motor function, respectively (see Figures 3(c) and 3(d) ). Previous studies have mentioned that the recovery of motor and language function is operated in parallel [ 20 – 23 ]. Due to the lack of data demonstrating UE motor status associated with language function, current stroke rehabilitation evaluations and therapies have treated these two symptoms separately [ 8 , 24 ].…”