In the previous funding period this project focused on identifying areas of the brain essential for spatial attention in distinct reference frames and modalities, by identifying areas of tissue dysfunction associated with specific spatial attention deficits immediately after right or left hemisphere ischemic stroke in 661 patients. MRI scans, including diffusion weighted imaging and perfusion weighted imaging, were used to identify dysfunctional tissue, along with cognitive tests to identify specific types of hemispatial neglect within 24 hours of stroke onset. Repeat MRI and cognitive testing determined which deficits recovered in association with tissue recovery in specific regions by Day 3- 5. This work has shed some light on mechanisms of spatial attention and their neural correlates, as well as the cognitive impairments that underlie various types of hemispatial neglect. In the course of this work, the investigators noted the frequency and importance of other deficits that are frequently associated neglect -- such as loss of empathy and emotional expression -- particularly in individuals with right hemisphere stroke. These deficits have an enormous impact on the dignity of the individuals and on their relationships with spouses and other caregivers. Along with hemispatial neglect, they are among the most common and disabling consequences of right hemisphere stroke. In the next funding cycle, the project will use the same innovative methodology to identify and characterize the nature and neural correlates of two potentially related impairments that frequently co-occur with neglect: (1) loss of empathy and (2) affective aprosodia (impairment in one or more aspects of understanding and producing language with appropriate intonation, rate, pauses, and stress to convey emotion), and their association with hemispatial neglect, loss of sympathy, and other negative behavioral changes perceived by caregivers. The effects of age, brain volume, stroke volume, and metabolic factors, as well as location of dysfunctional tissue on the degree of impairment will be determined. Patients will be studied longitudinally through 6 months, to determine the factors, such as improved regional blood flow, that contribute to recovery.

Public Health Relevance

This research will contribute to the understanding of the neural and cognitive mechanisms underlying the ability to recognize and respond to emotions of others and to the ability to understand and express emotions through tone of voice, by studying stroke patients in whom these abilities are often impaired. A better understanding of these impairments and how they recover is essential, because of the impact of these deficits on the interpersonal relationships of stroke survivors. The results will also have clinical impact by aiding in functional prognosis in acute stroke, and in identifying appropriate candidates for intervention to restore blood flow in patients with such deficits due to acute stroke.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS047691-08
Application #
8287649
Study Section
Acute Neural Injury and Epilepsy Study Section (ANIE)
Program Officer
Babcock, Debra J
Project Start
2003-11-01
Project End
2014-06-30
Budget Start
2012-07-01
Budget End
2013-06-30
Support Year
8
Fiscal Year
2012
Total Cost
$431,598
Indirect Cost
$89,060
Name
Johns Hopkins University
Department
Neurology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Oishi, Kenichi; Faria, Andreia V; Hsu, John et al. (2015) Critical role of the right uncinate fasciculus in emotional empathy. Ann Neurol 77:68-74
Kortte, Kathleen B; McWhorter, Jessica Wolfman; Pawlak, Mikolaj A et al. (2015) Anosognosia for hemiplegia: The contributory role of right inferior frontal gyrus. Neuropsychology 29:421-32
Bonekamp, David; Barker, Peter B; Leigh, Richard et al. (2015) Susceptibility-based analysis of dynamic gadolinium bolus perfusion MRI. Magn Reson Med 73:544-54
Sebastian, Rajani; Schein, Mara G; Davis, Cameron et al. (2014) Aphasia or Neglect after Thalamic Stroke: The Various Ways They may be Related to Cortical Hypoperfusion. Front Neurol 5:231
Leigh, Richard; Krakauer, John W (2014) MRI-guided selection of patients for treatment of acute ischemic stroke. Curr Opin Neurol 27:425-33
Faria, Andreia V; Sebastian, Rajani; Newhart, Melissa et al. (2014) Longitudinal Imaging and Deterioration in Word Comprehension in Primary Progressive Aphasia: Potential Clinical Significance. Aphasiology 28:948-963
Leigh, Richard; Jen, Shyian S; Hillis, Argye E et al. (2014) Pretreatment blood-brain barrier damage and post-treatment intracranial hemorrhage in patients receiving intravenous tissue-type plasminogen activator. Stroke 45:2030-5
Beslow, Lauren A; Ichord, Rebecca N; Gindville, Melissa C et al. (2014) Frequency of hematoma expansion after spontaneous intracerebral hemorrhage in children. JAMA Neurol 71:165-71
Beslow, Lauren A; Ichord, Rebecca N; Gindville, Melissa C et al. (2014) Pediatric intracerebral hemorrhage score: a simple grading scale for intracerebral hemorrhage in children. Stroke 45:66-70
Hillis, Argye E (2014) Inability to empathize: brain lesions that disrupt sharing and understanding another's emotions. Brain 137:981-97

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