title: Imaging short- and long-term training success in chronic aphasia.
abstract: BACKGROUND
  To date, functional imaging studies of treatment-induced recovery from chronic aphasia only assessed short-term treatment effects after intensive language training. In the present study, we show with functional magnetic resonance imaging (fMRI), that different brain regions may be involved in immediate versus long-term success of intensive language training in chronic post-stroke aphasia patients.
  
  
  RESULTS
  Eight patients were trained daily for three hours over a period of two weeks in naming of concrete objects. Prior to, immediately after, and eight months after training, patients overtly named trained and untrained objects during event-related fMRI. On average the patients improved from zero (at baseline) to 64.4% correct naming responses immediately after training, and treatment success remained highly stable at follow-up. Regression analyses showed that the degree of short-term treatment success was predicted by increased activity (compared to the pretraining scan) bilaterally in the hippocampal formation, the right precuneus and cingulate gyrus, and bilaterally in the fusiform gyri. A different picture emerged for long-term training success, which was best predicted by activity increases in the right-sided Wernicke's homologue and to a lesser degree in perilesional temporal areas.
  
  
  CONCLUSIONS
  The results show for the first time that treatment-induced language recovery in the chronic stage after stroke is a dynamic process. Initially, brain regions involved in memory encoding, attention, and multimodal integration mediated treatment success. In contrast, long-term treatment success was predicted mainly by activity increases in the so-called 'classical' language regions. The results suggest that besides perilesional and homologue language-associated regions, functional integrity of domain-unspecific memory structures may be a prerequisite for successful (intensive) language interventions.
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Menke
authors.forename: Marcus
authors.initials: M
authors.lastname: Meinzer
authors.forename: Harald
authors.initials: H
authors.lastname: Kugel
authors.forename: Michael
authors.initials: M
authors.lastname: Deppe
authors.forename: Annette
authors.initials: A
authors.lastname: Baumgärtner
authors.forename: Hagen
authors.initials: H
authors.lastname: Schiffbauer
authors.forename: Marion
authors.initials: M
authors.lastname: Thomas
authors.forename: Kira
authors.initials: K
authors.lastname: Kramer
authors.forename: Hubertus
authors.initials: H
authors.lastname: Lohmann
authors.forename: Agnes
authors.initials: A
authors.lastname: Flöel
authors.forename: Stefan
authors.initials: S
authors.lastname: Knecht
authors.forename: Caterina
authors.initials: C
authors.lastname: Breitenstein
mesh_terms: D000328:Adult; D000368:Aged; D000849:Anomia / Q000503:physiopathology / Q000628:therapy; D001037:Aphasia / Q000503:physiopathology / Q000628:therapy*; D001931:Brain Mapping; D002908:Chronic Disease; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007808:Language Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011597:Psychomotor Performance / Q000502:physiology; D020127:Recovery of Function; D012044:Regression Analysis; D013702:Temporal Lobe / Q000503:physiopathology*; D016896:Treatment Outcome; D014825:Vocabulary