When finding words becomes difficult: is there activation of the subdominant hemisphere?

Language-related activation has been observed in the right cerebral hemisphere by functional imaging in dysphasic patients who had partially recovered from a left hemispheric ischemic stroke with aphasia. It has been cautioned that, because dysphasic patients have difficulties in retrieving words, a right-hemisphere activation could be the result of an unspecific increase in global brain activation because of an increased effort. To test this hypothesis, we increased the difficulty of finding words in a word completion task in healthy subjects (n = 14) and measured hemispheric activation by functional transcranial Doppler sonography (fTCD). The sensitivity of fTCD for this approach was validated with an established motor paradigm by detecting a steady increase in bilateral cerebral perfusion in parallel to increasing the speed of finger tapping. Conversely, in the linguistic task, increasing the difficulty of word completion did not change task related perfusion of the dominant or subdominant hemisphere (repeated measurement ANOVA: P = 0.8). These results demonstrate that difficult to perform word searches do not lead to an additional involvement of the subdominant hemisphere. This suggests that after stroke, language-related activation of the subdominant hemisphere is not simply an effort-related effect.