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Neural Correlates of Linguistic and Pragmatic Deficits in Right Hemisphere Stroke: A Systematic Review
Poster Session C, Friday, October 25, 4:30 - 6:00 pm, Great Hall 3 and 4
Shannon M. Sheppard1, Petrea Cornwell2, Alexandra Zezinka Durfee3, Melissa Johnson4, Perrine Ferré5, Laura Murray6, Margaret Lehman Blake7, Jamila Minga8, Ronelle Hewetson2; 1University of Washington, Seattle, WA, 2Griffith University, South East Queensland, Australia, 3Towson University, Towson, MD, 4Nazareth University, Rochester, NY, 5McGill University, 6Western University, London, ON, Canada, 7University of Houston, 8Duke University
Introduction: Right hemisphere damage (RHD) can cause a wide variety of deficits impacting language and pragmatics, yet we know little about concomitant neural correlates. A previous systematic review focused on prosodic deficits in RHD (Zezinka Durfee et al., 2021) found that damage to right hemisphere dorsal stream structures were implicated in expressive prosodic deficits, and damage to ventral stream structures were implicated in receptive deficits. The current study is a systematic review by the Academy of Neurologic Communication Disorders and Sciences (ANCDS) Right Hemisphere Disorder (RHD) Evidence-based Writing Group to investigate neural regions implicated in additional language and pragmatic deficits frequently seen following RHD. Method: A PRISMA-guided systematic review searched research published between 1970 and 2022 and identified over 10,000 unduplicated papers. The full review included 1118 articles, and 440 remained following full article review. Methodological quality was evaluated (Kmet et al., 2004), which excluded 72 additional articles using a 55% cutoff out of the total possible quality points. Authors independently completed data extraction for the remaining 316 articles. These 316 articles were evaluated for their ability to determine brain-behavior relationships through lesion localization, and 252 were excluded. The remaining 64 articles were evaluated to determine which areas of language and pragmatics were addressed in localization analyses. Areas (e.g., neglect dyslexia, discourse production, etc.) where at least three articles evaluated localization were included in the review, which resulted in 33 articles. Lesion trends within each identified area were explored. Descriptive data on the types of lesion analyses were also extracted to determine whether articles provided specific (e.g., “superior temporal gyrus,” voxel-level) or broad (e.g., anterior/posterior) lesion information, and whether lesion relationships were explored using statistical analyses or description of relationships without statistical support. Results: The 33 articles with relevant lesion localization data addressed several linguistic and pragmatic categories: Neglect dyslexia (5 articles), emotional facial expression recognition (4 articles), theory of mind (3 articles), discourse production (6 articles), discourse comprehension (5 articles), emotion processing (experiencing emotion) (3 articles), figurative language comprehension (6 articles), word-level language comprehension (6 articles), and word-level language production (5 articles). Note that some articles addressed more than one area. Specific lesion information was provided in 42% of articles, and 64% of articles explored lesion relationships using support from statistical analyses. Similar to previous findings in expression and comprehension of emotional prosody, RH dorsal stream lesions were associated with discourse production deficits, whereas RH ventral stream lesions were linked to discourse comprehension deficits. Conclusion: Localized right antero-superior (dorsal stream) regions contributed to discourse production impairments, whereas damage to more postero-lateral (ventral stream) regions resulted in discourse comprehension deficits. This review provides support that distinct RH regions are vital for discourse comprehension and production. Impact of study design on resulting interpretations is discussed. A better understanding of brain-behavior relationships can support the identification of profiles of impairment based on neurological deficits to improve clinical assessment recommendations.
Topic Areas: Disorders: Acquired, Meaning: Discourse and Pragmatics