Brain Correlates of Multimodal Rehabilitation in Chronic Post-stroke Aphasia

Summary

Post-stroke aphasia (PSA), the partial or total loss of the ability to produce and/or understand language associated with stroke, is a highly prevalent and disabling disorder that negatively impacts the personal, social and working life of patients and families. Modern theory-based language therapies (LT) with proved efficacy in chronic PSA are brief (weeks), intensive, and oriented to specific domains (e.g., anomia). However, in order to maximize therapeutic benefits, it becomes essential to implement complementary strategies that boost gains in language, communication and behaviour and also to identify predictors of treatment response (demographics, anatomical) that enable to customize interventions adjusting them to each profile (linguistic deficits, brain structure and connectivity). Our group has repeatedly shown that LT combined with cognitive enhancing drugs (CED) (e.g., Donepezil and Memantine) are safe and promote better outcomes that when these interventions are administered separately. Moreover, non-invasive brain stimulation techniques (NIBS), such as transcranial direct current stimulation (tDCS), are also emerging as a promising treatment option for chronic PSA. However, is still unknown whether or not treatments that combine several biological strategies aid to improve outcomes further. Brain changes induced by these interventions and the premorbid characteristic of a "good responder" are also unknown. The aims of this clinical trial are: (1) Study the efficacy of combined treatments in a sample of patients with chronic PSA (n = 40); (2) Document with multimodal neuroimaging the functional and connectivity changes (neuroplasticity) promoted by these interventions; and (3) Identify linguistic, cognitive and behavioural variables that may predict outcomes for each intervention.

Timeline

Start

2019-01-08

Primary completion

2020-10-20

Completion

2020-10-20

Publications

• Background Berthier ML. Poststroke aphasia : epidemiology, pathophysiology and treatment. Drugs Aging. 2005;22(2):163-82. doi: 10.2165/00002512-200522020-00006.
• Background Berthier ML, Garcia-Casares N, Walsh SF, Nabrozidis A, Ruiz de Mier RJ, Green C, Davila G, Gutierrez A, Pulvermuller F. Recovery from post-stroke aphasia: lessons from brain imaging and implications for rehabilitation and biological treatments. Discov Med. 2011 Oct;12(65):275-89.
• Background Pulvermuller F, Berthier ML. Aphasia therapy on a neuroscience basis. Aphasiology. 2008 Jun;22(6):563-599. doi: 10.1080/02687030701612213. Epub 2008 May 21.
• Background Berthier ML, Pulvermuller F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol. 2011 Feb;7(2):86-97. doi: 10.1038/nrneurol.2010.201.
• Background Berthier ML, Pulvermuller F, Davila G, Casares NG, Gutierrez A. Drug therapy of post-stroke aphasia: a review of current evidence. Neuropsychol Rev. 2011 Sep;21(3):302-17. doi: 10.1007/s11065-011-9177-7. Epub 2011 Aug 16.
• Background Berthier ML, Green C, Higueras C, Fernandez I, Hinojosa J, Martin MC. A randomized, placebo-controlled study of donepezil in poststroke aphasia. Neurology. 2006 Nov 14;67(9):1687-9. doi: 10.1212/01.wnl.0000242626.69666.e2.
• Background Berthier ML, Green C, Lara JP, Higueras C, Barbancho MA, Davila G, Pulvermuller F. Memantine and constraint-induced aphasia therapy in chronic poststroke aphasia. Ann Neurol. 2009 May;65(5):577-85. doi: 10.1002/ana.21597.
• Background De-Torres I, Davila G, Berthier ML, Walsh SF, Moreno-Torres I, Ruiz-Cruces R. Repeating with the right hemisphere: reduced interactions between phonological and lexical-semantic systems in crossed aphasia? Front Hum Neurosci. 2013 Oct 18;7:675. doi: 10.3389/fnhum.2013.00675. eCollection 2013.
• Background Torres-Prioris MJ, Lopez-Barroso D, Paredes-Pacheco J, Roe-Vellve N, Dawid-Milner MS, Berthier ML. Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia. Front Psychol. 2019 May 8;10:678. doi: 10.3389/fpsyg.2019.00678. eCollection 2019.
• Background Mohr B, Stahl B, Berthier ML, Pulvermuller F. Intensive Communicative Therapy Reduces Symptoms of Depression in Chronic Nonfluent Aphasia. Neurorehabil Neural Repair. 2017 Dec;31(12):1053-1062. doi: 10.1177/1545968317744275. Epub 2017 Dec 1.
• Background Berthier ML, De-Torres I, Paredes-Pacheco J, Roe-Vellve N, Thurnhofer-Hemsi K, Torres-Prioris MJ, Alfaro F, Moreno-Torres I, Lopez-Barroso D, Davila G. Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts. Front Hum Neurosci. 2017 Jun 14;11:304. doi: 10.3389/fnhum.2017.00304. eCollection 2017.
• Background Barbancho MA, Berthier ML, Navas-Sanchez P, Davila G, Green-Heredia C, Garcia-Alberca JM, Ruiz-Cruces R, Lopez-Gonzalez MV, Dawid-Milner MS, Pulvermuller F, Lara JP. Bilateral brain reorganization with memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia: An ERP study. Brain Lang. 2015 Jun-Jul;145-146:1-10. doi: 10.1016/j.bandl.2015.04.003. Epub 2015 Apr 29.
• Edelkraut L, Lopez-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Davila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry. 2022 Mar 19;12(3):450-469. doi: 10.5498/wjp.v12.i3.450. eCollection 2022 Mar 19.

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Indications