White Matter Hyperintensities as a Predictor of Aphasia Recovery.
Joseph S Kang, Lisa D Bunker, Melissa D Stockbridge and 1 others
PMID 38281579WHAT IT FOUND
In people with recent stroke and aphasia, periventricular white matter hyperintensities predicted less naming improvement only in those receiving active tDCS.
Deep white matter hyperintensities predicted less content production only in the sham group. Baseline white matter health may influence treatment response, but results are inconsistent.
Key findings
01Periventricular white matter hyperintensity severity was associated with less improvement in naming accuracy, but this relationship was found only in the group receiving active tDCS, not in the sham group.
02Deep white matter hyperintensity severity was associated with decreased change in content production (accurate content units) in the sham tDCS group, but not in the active tDCS group.
03Days post-onset was independently associated with improved naming accuracy in the whole sample and improved content production in the active tDCS group, indicating earlier treatment may yield better outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was small (43 participants), and the study was underpowered, particularly for discourse outcomes. There was limited variability in deep white matter hyperintensity scores, especially in the active tDCS group, which may have obscured true relationships. The study was a retrospective analysis of an RCT, not a pre-registered predictive analysis, increasing the risk of Type I errors. The Fazekas scale is subjective and does not account for the specific location of white matter tracts, which may be more relevant to language pathways than overall severity.
Declared interests
The authors declare no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not interpret the association between periventricular white matter hyperintensities and poor naming outcomes as a universal predictor of aphasia recovery. This effect was only significant in the active tDCS group and not in the sham group, and deep white matter hyperintensities showed the opposite pattern (significant only in sham). The findings are inconsistent and underpowered, so they do not yet support a clinical rule for patient selection.