Projection of Damaged Visual and Language Regions on Low Trail Making Test Part-B Performance in Stroke Patients

Ayako Nishimura; Stephanie Sutoko; Masashi Kiguchi; Hirokazu Atsumori; Akiko Obata; Tsukasa Funane; Akihiko Kandori; Tomohiko Mizuguchi; Koji Shimonaga; Seiji Hama; Toshio Tsuji

doi:10.3389/fneur.2022.853942

Projection of Damaged Visual and Language Regions on Low Trail Making Test Part-B Performance in Stroke Patients

Front Neurol. 2022 Jun 2:13:853942. doi: 10.3389/fneur.2022.853942. eCollection 2022.

Authors

Ayako Nishimura^{1

2}, Stephanie Sutoko^{1

2}, Masashi Kiguchi^{1

2}, Hirokazu Atsumori^{1

2}, Akiko Obata^{1

2}, Tsukasa Funane^{1

2}, Akihiko Kandori^{1

2}, Tomohiko Mizuguchi³, Koji Shimonaga^{4

5}, Seiji Hama^{2

5}, Toshio Tsuji⁶

Affiliations

¹ Center for Exploratory Research, Research & Development Group, Hitachi. Ltd., Kokubunji, Japan.
² Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan.
³ IoT Innovation Department, New Business Produce Division, Maxell Ltd., Yokohama, Japan.
⁴ Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
⁵ Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁶ Graduate School of Advanced Science and Engineering, Hiroshima University, Higashihiroshima, Japan.

Abstract

Background: The Trail Making Test Part-B (TMT-B) is an attention functional test to investigate cognitive dysfunction. It requires the ability to recognize not only numbers but also letters. We analyzed the relationship between brain lesions in stroke patients and their TMT-B performance.

Methods: From the TMT-B, two parameters (score and completion time) were obtained. The subjects were classified into several relevant groups by their scores and completion times through a data-driven analysis (k-means clustering). The score-classified groups were characterized by low (≤10), moderate (10 < score < 25), and high (25) scores. In terms of the completion time, the subjects were classified into four groups. The lesion degree in the brain was calculated for each of the 116 regions classified by automated anatomical labeling (AAL). For each group, brain sites with a significant difference (corrected p < 0.1) between each of the 116 regions were determined by a Wilcoxon Rank-Sum significant difference test.

Results: Lesions at the cuneus and the superior occipital gyrus, which are mostly involved in visual processing, were significant (corrected p < 0.1) in the low-score group. Furthermore, the moderate-score group showed more-severe lesion degrees (corrected p < 0.05) in the regions responsible for the linguistic functions, such as the superior temporal gyrus and the supramarginal gyrus. As for the completion times, lesions in the calcarine, the cuneus, and related regions were significant (corrected p < 0.1) in the fastest group as compared to the slowest group. These regions are also involved in visual processing.

Conclusion: The TMT-B results revealed that the subjects in the low-score group or the slowest- group mainly had damage in the visual area, whereas the subjects in the moderate-score group mainly had damage in the language area. These results suggest the potential utility of TMT-B performance in the lesion site.

Keywords: AAL atlas; brain lesions; data-driven classification; stroke patients; trail making test part-B; unsupervised k-means clustering.