Aguilar Mejia, Oscar Mauricio; (2017) Understanding the neurobiological basis of reading disorders in aphasia and predicting patients' responses to reading therapy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis investigated cognitive abilities and brain regions associated with reading impairments in chronic aphasic patients with central alexia (CA). Moreover, analyses on cognitive abilities and brain lesion-site were conducted to determine whether these may predict patients’ outcomes in response to a computerised reading therapy called iReadMore. First, a review of the literature was undertaken. This included reading models and reading impairments in aphasia, neuroanatomical basis of reading, executive function in aphasia, computerised-based aphasia treatments, transcranial direct current stimulation in language therapies, and individual factors that influence aphasia recovery and patients’ response to therapy. Second, iReadMore was described and its therapeutic effect on a group of patients (n=23) was reported. Then, behavioural and neuroimaging methods implemented in this thesis were described. The first experimental chapter explored the cognitive profile of CA patients. Moreover, it included principal component analysis and voxel-based-morphometry conducted to study which brain regions are associated with reading patterns underlying patients’ remaining abilities. Here results showed that preserved white matter deep to the lingual gyrus was related to semantic abilities in reading. This region has not been related before. The second experimental chapter aimed to identify what patients’ demographic information, cognitive abilities and brain lesions explain their response to iReadMore. In this study, it is demonstrated for the first time, that lesion-site is determinant in patients’ response to therapy and also that therapy response in new patients is predictable. The final chapter investigated structural brain changes in response to iReadMore. Here a quantitative MRI protocol was implemented to study biomarkers associated with reading improvement. Results showed that iron content increases in two regions infrequently associated with reading, the left superior frontal gyrus and the supplementary motor area bilateral, when patients respond positively to the therapy. Finally, a general discussion and suggestions of new studies were provided.

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