Don't let your incompetent? doctor use this as an excuse for failing to get you recovered! Screaming at them might be required, referencing their incompetence!
Predicting failure to recover is the sign of PURE INCOMPETENCE!
Brain Age Offers Clues to Aphasia Outcomes After Stroke
Following stroke, patterns of accelerated brain aging in the intact hemisphere may help explain differences in chronic aphasia severity and predict response to language rehabilitation.
Using an online tool that compares brain scans with age-based reference data, researchers found that brain-aging patterns in the intact right hemisphere explained an additional 7% of the variation in aphasia severity beyond age, lesion volume, and lesion location.
In a smaller group of patients who received speech therapy paired with noninvasive brain stimulation, brain-age measures taken before treatment were also associated with language improvement 6 months later.
“The most important takeaway for clinicians and people with aphasia, is that recent breakthroughs in neuroimaging will allow groundbreaking advances in understanding the mechanisms of recovery after stroke in the coming years, which will ultimately help people with aphasia and their families,” lead investigator Nicholas Riccardi, PhD, research assistant professor, Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina Floyd School of Medicine in Columbia, South Carolina, told Medscape Medical News.
- Right-hemisphere brain age explained +7% aphasia severity variance beyond lesion factors.
- Older age, larger lesions, temporal lesions → lower WAB-R AQ scores.
- Medial prefrontal + cerebellar/ventral brain age linked to worse language function.
- Brain age added +7% variance in naming; medial prefrontal pattern predicted naming.
- Pre-treatment brain age predicted 6-month naming gain after speech therapy + tDCS.
The study was published online on September 28 in The Journal of Neuroscience.
Assessing the Intact Brain
Stroke size and location do not fully explain why some patients have more severe or persistent aphasia.
Previous studies suggest that the health of brain tissue spared by the stroke may also affect language recovery. Brain-age estimates offer one way to assess this.
Using structural MRI, researchers can estimate how old a person’s brain tissue appears compared with their actual age. Riccardi and colleagues focused on age-related patterns in the intact right hemisphere to examine whether these patterns were linked to aphasia severity and treatment response.
They analyzed 188 adults (mean age, 61 years; 67 women, 121 men) with chronic left hemisphere stroke. Participants were at least 6 months poststroke, with an average time since stroke of approximately 50 months.
Aphasia severity was assessed using the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ), which ranges from 0 to 100, with higher scores indicating better language function. Naming ability was assessed with the Philadelphia Naming Test (PNT) in 165 participants.
Because the left hemisphere contained stroke damage, the researchers focused their brain-age analyses on the right, contralesional hemisphere. They digitally filled in damaged areas by mirroring corresponding tissue from the intact right hemisphere, allowing the scans to be processed by the brain-age tool.
They used the volBrain BrainStructureAges pipeline to estimate brain age from routine MRI scans, then grouped the regional estimates into four broader brain-aging patterns in the right hemisphere: medial prefrontal, frontotemporoparietal, cerebellar/ventral, and dorsal.
Why Brain Age Matters
Brain aging measures in the right hemisphere accounted for an additional 7% of the variance in language scores after adjusting for patients’ age, sex, and stroke size and location. When all of these factors were considered, they accounted for 46% of the variance in participants’ WAB-R AQ scores.
Older age, larger lesions, and a temporal lesion pattern were associated with lower WAB-R AQ scores. Higher brain-age estimates in the right hemisphere’s medial prefrontal and cerebellar/ventral areas were also tied to lower scores (beta = -.31; P < .001 and beta = -.18; P = .009, respectively).
In an analysis of 131 participants, brain aging measures accounted for an additional 7% of the variance in naming performance after adjustment for age and stroke characteristics. The medial prefrontal pattern was independently associated with naming ability (beta = -.30; P = .008).
The study could not determine whether the differences in brain age were related to the stroke or reflected preexisting differences in brain health.
The researchers also looked at whether regional brain-age estimates were associated with longer-term language improvement. The analysis included 34 participants who had received 3 weeks of speech therapy paired with anodal transcranial direct-current stimulation.
Mean PNT scores increased from 60.2 at baseline to 68.2 at 6 months. Age, lesion volume, and the medial prefrontal brain-age measure together explained 23% of the differences in naming-score change at 6 months. The medial prefrontal measure was associated with naming-score change (beta = -.47; P = .03).
Overall right-hemisphere gray-matter volume was not significantly associated with naming-score changes.
Brain Health and Recovery
Recovery after stroke may depend not only on the area that had been directly damaged but also on the health of brain tissue that remains intact, Riccardi said.
“More and more, we are learning that overall brain health is extremely important for resilience and recovery after brain injury.”
This includes factors such as high blood pressure, diabetes, and other cardiometabolic risks that can affect brain health, he added. The current study did not examine these factors, but determining whether they can be modified to support brain health is a next step.
The researchers also want to better understand what underlies the brain aging signature associated with treatment response.
“We found a brain signature of people who will respond to this therapy, so now we need to better understand what causes this brain signature,” Riccardi said. If the signature is influenced by modifiable health or lifestyle factors, it could eventually have implications for treatment planning.
The findings will need to be replicated in other groups of people with aphasia and tested with different rehabilitation approaches, as the treatment subgroup received a specific combination of speech therapy and brain stimulation. Because the approach relies on routine MRI and a freely available online tool, it could be practical to study in other settings.
“This type of ‘ease of use’ is very important for approaches that could eventually make it into the clinic,” Riccardi said.
Disclosure information for study authors is available in the original study publication.
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