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Diabetes, Brain Health, and Long-Term Language Related-Treatment Gains in Post-Stroke Aphasia

Poster B49 in Poster Session B and Reception, Thursday, October 6, 6:30 - 8:30 pm EDT, Millennium Hall

Rebecca Roth¹, Natalie Busby², Janina Wilmskoetter³, Deena Blackett³, Ezequiel Gleichgerrcht³, Chris Rorden², Roger Newman-Norlund², Argye Hillis⁴, Dirk den Ouden², Julius Fridriksson², Leonardo Bonilha¹; ¹Emory University, ²University of South Carolina, ³Medical University of South Carolina, ⁴Johns Hopkins University

Background: In chronic post-stroke aphasia, language improvements following speech therapy are variable and can only be partially explained by the stroke lesion. Brain tissue integrity beyond the stroke lesion (brain health) may influence language recovery and depends on cardiovascular risk factors, notably diabetes. Importantly, stroke survivors commonly present with cardiovascular risk factors (e.g., diabetes, hypertension), which increase risk for recurrent strokes and decrease the likelihood of recovery post-stroke. Diabetes is also independently associated with progressive declines in cognitive ability and poorer neurological outcomes among older adults post-stroke. In this study, we examined the impact of diabetes on brain health and language recovery in aphasia. Method: Seventy-five participants with chronic post-stroke aphasia underwent three weeks of semantic and three weeks of phonological language therapy. Participants had a variety of aphasia types (assessed by WAB-R), including Broca’s aphasia (48%), followed by Anomic aphasia (26%), Conduction aphasia (16%), Global aphasia (5%), Wernicke’s aphasia (4%), and Transcortical motor aphasia (1%). Participants were administered the Philadelphia Naming Test (PNT) at baseline, one month following treatment, and 6 months following treatment. To quantify brain health, we measured the integrity of long-range white matter fibers from each participant’s whole brain connectome created from baseline diffusion tensor imaging. We then examined the relationship among diabetes, pre-treatment integrity of long-range white matter fibers, and changes in naming accuracy from baseline to 1 month and 6 months post treatment. We applied statistical moderation analyses to determine the impact of diabetes (moderator) on the relationship between long-range white matter fibers outside of the stroke lesion (independent variable) and long-term treatment-related language gains (dependent variable). Results: Controlling for age, lesion volume, and baseline PNT performance, diabetes moderated the relationship between proportion of long-range fibers and naming improvement at 1 and 6 months. For those without diabetes (n=54), there was a positive relationship integrity of long-range fibers and naming improvement (1 month: t = 2.2017, p = .0311, 6 months: t = 3.1609, p = .0023). The same relationship was not observed among individuals with diabetes (n=21). Discussion: Our results indicate that higher proportion of long-range fibers is associated with long-term treatment related naming improvement in aphasia; however, only among individuals without diabetes. These results show the importance of post-stroke structural white matter architectural integrity in aphasia recovery related to diabetes status. Our results have clinical implications, stressing the importance of cardiovascular risk factors in patient counseling and treatment planning. Conclusion: Our results contribute to the broad brain health perspective of language recovery, showing the importance of healthy, residual brain tissue in post-stroke aphasia. Our results also pave the way for future research further probing the neurobiological changes associated with diabetes in individuals with aphasia.

Topic Areas: Disorders: Acquired, Computational Approaches