Anatomical evidence of an indirect pathway for word repetition

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Title: Anatomical evidence of an indirect pathway for word repetition
Authors: Forkel, SJ
Rogalski, E
Drossinos Sancho, N
D'Anna, L
Luque Laguna, P
Sridhar, J
Dell'Acqua, F
Weintraub, S
Thompson, C
Mesulam, M-M
Catani, M
Item Type: Journal Article
Abstract: Objective To combine MRI-based cortical morphometry and diffusion white matter tractography to describe the anatomical correlates of repetition deficits in patients with primary progressive aphasia (PPA). Methods The traditional anatomical model of language identifies a network for word repetition that includes Wernicke and Broca regions directly connected via the arcuate fasciculus. Recent tractography findings of an indirect pathway between Wernicke and Broca regions suggest a critical role of the inferior parietal lobe for repetition. To test whether repetition deficits are associated with damage to the direct or indirect pathway between both regions, tractography analysis was performed in 30 patients with PPA (64.27 ± 8.51 years) and 22 healthy controls. Cortical volume measurements were also extracted from 8 perisylvian language areas connected by the direct and indirect pathways. Results Compared to healthy controls, patients with PPA presented with reduced performance in repetition tasks and increased damage to most of the perisylvian cortical regions and their connections through the indirect pathway. Repetition deficits were prominent in patients with cortical atrophy of the temporo-parietal region with volumetric reductions of the indirect pathway. Conclusions The results suggest that in PPA, deficits in repetition are due to damage to the temporo-parietal cortex and its connections to Wernicke and Broca regions. We therefore propose a revised language model that also includes an indirect pathway for repetition, which has important clinical implications for the functional mapping and treatment of neurologic patients.
Issue Date: 11-Feb-2020
Date of Acceptance: 11-Aug-2019
DOI: 10.1212/wnl.0000000000008746
ISSN: 0028-3878
Publisher: Ovid Technologies (Wolters Kluwer Health)
Start Page: e594
End Page: e606
Journal / Book Title: Neurology
Volume: 94
Issue: 6
Copyright Statement: © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: 1103 Clinical Sciences
1109 Neurosciences
1702 Cognitive Sciences
Neurology & Neurosurgery
Publication Status: Published
Online Publication Date: 2020-01-29
Appears in Collections:Department of Brain Sciences

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