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Projection of damaged visual and language regions on low Trail Making Test Part- B performance in stroke patients

Provisionally accepted
The final version of the article will be published here soon pending final quality checks
  • 1Center for Exploratory Research, Research & Development Group, Hitachi (Japan), Japan
  • 2Department of Rehabilitation, Hibino Hospital, Japan
  • 3IoT Innovation Dept., New Business Produce Division, Maxell, Ltd., Japan
  • 4Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Hospital, Japan
  • 5Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
  • 6Graduate School of Advanced Science and Engineering, Hiroshima University, Japan

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. 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 of116 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 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 subjects in the moderate- score group mainly had damage in the language area. These results suggest the potential utility of TMT-B performance the lesion site.

Keywords: Data-driven classification, Trail Making Test Part-B, brain lesions, stroke patients, AAL atlas, unsupervised K-means clustering

Received: 13 Jan 2022; Accepted: 26 Apr 2022.

Copyright: © 2022 Nishimura, Sutoko, Kiguchi, Atsumori, Obata, Funane, Kandori, Mizuguchi, Shimonaga, Hama and Tsuji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Ayako Nishimura, Hitachi (Japan), Center for Exploratory Research, Research & Development Group, Tokyo, Japan