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Grammatical and resource components of sentence processing in Parkinson’s disease

An fMRI study

From the Departments of Neurology (Drs. Grossman, Cooke, Detre, Stern, and Hurtig and C. DeVita, C. Lee and W. Chen) and Radiology (Drs. Alsop, Detre, and Gee), University of Pennsylvania Medical Center, Philadelphia.

Address correspondence and reprint requests to Dr. Murray Grossman, Department of Neurology, 3 Gates, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283.

Background: Sentence comprehension requires linguistic processing as well as cognitive resources such as working memory (WM) and information-processing speed (IPS). The authors hypothesize that sentence comprehension difficulty in patients with mild PD is due to degradation of the large-scale neural network that supports cognitive resources during sentence processing.

Objective: To understand the neural basis for sentence comprehension difficulty in PD.

Method: Regional brain activity with blood oxygenation level–dependent fMRI was monitored while seven PD patients and nine healthy seniors answered a simple probe about written sentences that vary in their grammatical and cognitive resource properties.

Results: Healthy seniors recruited posterolateral temporal and ventral inferior frontal regions of the left hemisphere, brain regions associated with grammatical processing that were also activated by PD patients. Healthy seniors also recruited left dorsal inferior frontal, right posterolateral temporal, and striatal regions that are associated with cognitive resources during sentence processing. Direct contrasts showed that striatal, anteromedial prefrontal, and right temporal regions are recruited to a significantly lesser degree in PD, but these patients have increased activation of right inferior frontal and left posterolateral temporal–parietal areas during sentence comprehension.

Conclusion: These findings associate impaired sentence comprehension in PD with interruption of a large-scale network important for cognitive resources during sentence processing. These results also imply compensatory up-regulation of cortical activity that allows patients with mild PD to maintain sentence comprehension accuracy.

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