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Correlations between Dual-Pathway White Matter Alterations and Language Impairment in Patients with Aphasia: A Systematic Review and Meta-analysis

Abstract

While converging evidence suggests linguistic roles of white matter tracts, detailed associations between white matter alterations of dual pathways and language abilities remain unknown in aphasic patients. We aimed to verify language functions of dual-pathway tracts from specific domains and investigate the influence of moderators. PubMed, Web of Science, Embase, and CENTRAL were searched for studies published between January 1, 1985 and March 17, 2019. A meta-analysis of 46 studies including 1353 aphasic patients was performed by pooling correlation coefficients between linguistic domains and diffusion metrics of dual-pathway tracts. Among these tracts, the fractional anisotropy (FA) value of the left inferior fronto-occipital fasciculus predominated across most linguistic aspects, showing the strongest correlations with global severity, comprehension, naming and reading ability. The left uncinate fasciculus and inferior longitudinal fasciculus also showed significant FA − comprehension correlations. For syntactic processing, FA values of the left superior longitudinal fasciculus and arcuate fasciculus showed significant positive correlations. Meta-regression revealed no influence of etiology on FA − language correlations, while sex had a moderating effect on the FA − comprehension correlation of the arcuate fasciculus, and age influenced the FA − naming correlation in the superior longitudinal fasciculus. In conclusion, multifunctional characteristics of tracts were revealed in aphasic patients, including broad linguistic associations of the inferior fronto-occipital fasciculus, and repetition and syntactic involvement of the arcuate fasciculus. Language associations of the inferior longitudinal fasciculus and uncinate fasciculus were clarified regarding comprehension subdomains. The insignificant moderating effect of the etiology indicates damage of dual pathways is the common neural mechanism, while sex and age influence the correlation with comprehension and naming ability, respectively, in specific tracts.

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Funding

This study was supported by the grants from National Natural Science Foundation of P. R. China (No. 81902278), Zhejiang Provincial Natural Science Foundation (No. LGF20H170011), and the Science and Technology Planning Project of Zhejiang Province, P. R. China (2017C03011).

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Benyan Luo designed the study, and Jie Zhang and Shuchang Zhong were responsible for literature search. Yamei Yu and Min Wu extracted data and assessed the quality. Li Zhang, Yanmei Yu and Xufei Tan checked the data and solved disagreements. Jie Zhang, Yanfei Wu and Peng Sun contributed to statistical analysis. Jie Zhang drafted the manuscript; Ruidong Cheng plotted figures, and improved the interpretation of data; Liang Zhou and Wei Zhang contributed to the manuscript revision and responded to the reviewers’ comments with helpful ideas; and Juebao Li and Xiangming Ye supervised and revised it.

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Correspondence to Xiangming Ye.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Local Research Ethics Committee of Zhejiang Provincial People’s Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Since the data were based on previous published studies, informed consent was not required for this systematic review and meta-analysis.

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Zhang, J., Zhong, S., Zhou, L. et al. Correlations between Dual-Pathway White Matter Alterations and Language Impairment in Patients with Aphasia: A Systematic Review and Meta-analysis. Neuropsychol Rev 31, 402–418 (2021). https://doi.org/10.1007/s11065-021-09482-8

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Keywords

  • Aphasia
  • Diffusion tensor imaging
  • White matter
  • Dual pathway