{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:34:47Z","timestamp":1792100087871,"version":"4.4.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Stroke"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Working memory (WM) impairment is common in patients after a stroke. WM training (WMT) has been suggested as a way to improve cognitive function. However, the neural effects following WMT in stroke patients remain largely unclear. This study aimed to explore the behavioral changes and neural effects of WMT on patients with chronic ischemic stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty first-ever ischemic stroke patients with WM deficits in the chronic stage were randomly assigned to either a 4-week WMT group or a control group. Verbal n-back, digital and spatial memory-span, Raven's standard progressive matrices, and the Stroop color-word test, as well as task-state and resting-state fMRI were assessed for all patients at baseline and after the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The WMT group showed improvements in WM, fluid intelligence, and attention after training. Additionally, the WMT group exhibited increased activation in the left middle frontal gyrus (MFG) and middle occipital gyrus after training. At baseline, all patients were impaired in their abilities to elevate activation in their WM network as a response to increasing WM load. However, in the WMT group, increased activation was observed in the left cerebellum anterior lobe, right cerebellum posterior lobe (CPL), and MFG in the 2-back vs. 1-back contrast after WMT. We also found increased functional connectivity between the left MFG and the left inferior parietal lobule (IPL), and between the bilateral IPL and the right CPL after training in the WMT group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study supported that WMT potentially improved WM capacity in ischemic stroke patients during the chronic stage, and that the training effects might transfer to fluid intelligence and attention ability. Our results also demonstrated that repeated WMT potentially increased brain activation and resting-state functional connectivity within the WM network in patients with ischemic stroke. These findings provided robust evidence to support WMT as an effective intervention to enhance cognitive rehabilitation and shed light on the functional neuroplasticity mechanism of WMT on cognitive recovery after ischemic stroke.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fstro.2023.1189573","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T05:06:01Z","timestamp":1695963961000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Increased brain activation and functional connectivity after working memory training in patients with ischemic stroke: an fMRI study"],"prefix":"10.3389","volume":"2","author":[{"given":"Zhengwei","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Yun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.3109\/02699052.2013.830195","article-title":"Can computerized working memory training improve impaired working memory, cognition and psychological health?","volume":"27","author":"Akerlund","year":"2013","journal-title":"Brain. Inj"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2222","DOI":"10.1016\/j.clinph.2019.09.009","article-title":"Poor working memory performance in healthy elderly adults with electroencephalographic risk of cognitive decline affects syntactic processing","volume":"130","author":"Alatorre-Cruz","year":"2019","journal-title":"Clin. Neurophysiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1038\/nrn1201","article-title":"Working memory: looking back and looking forward","volume":"4","author":"Baddeley","year":"2003","journal-title":"Nat. Rev. Neurosci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1146\/annurev-psych-120710-100422","article-title":"Working memory: theories, models, and controversies","volume":"63","author":"Baddeley","year":"2012","journal-title":"Annu. Rev. Psychol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1002\/ana.24272","article-title":"What part of the cerebellum contributes to a visuospatial working memory task?","volume":"76","author":"Baier","year":"2014","journal-title":"Ann. Neurology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1037\/0894-4105.20.5.529","article-title":"The role of inferior parietal and inferior frontal cortex in working memory","volume":"20","author":"Baldo","year":"2006","journal-title":"Neuropsychology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e146","DOI":"10.1161\/CIR.0000000000000485","article-title":"Heart disease and stroke statistics-2017 update: a report from the American Heart Association","volume":"135","author":"Benjamin","year":"2017","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.actpsy.2013.02.009","article-title":"Early and late stages of working-memory maintenance contribute differentially to long-term memory formation","volume":"143","author":"Bergmann","year":"2013","journal-title":"Acta. Psychol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"103","DOI":"10.3233\/JAD-2010-091054","article-title":"Altered brain activation during a verbal working memory task in subjects with amnestic mild cognitive impairment","volume":"21","author":"Bokde","year":"2010","journal-title":"J. AlzheimersDis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2012.00063","article-title":"Working-memory training in younger and older adults: training gains, transfer, and maintenance","author":"Brehmer","year":"2012","journal-title":"Front. Hum. Neurosci"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2018.00401","article-title":"Working memory from the psychological and neurosciences perspectives: a review","author":"Chai","year":"2018","journal-title":"Front. Psychol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1148\/radiol.12112154","article-title":"Working memory in patients with mild traumatic brain injury: functional MR imaging analysis","volume":"264","author":"Chen","year":"2012","journal-title":"Radiology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1136\/jnnp.71.2.161","article-title":"Functional magnetic resonance imaging of working memory impairment after traumatic brain injury","volume":"71","author":"Christodoulou","year":"2001","journal-title":"J. Neurol. Neurosurq. Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.tics.2003.10.005","article-title":"Working memory capacity and its relation to general intelligence","volume":"7","author":"Conway","year":"2003","journal-title":"Trends. Cogn. Sci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1126\/science.1155466","article-title":"Transfer of learning after updating training mediated by the striatum","volume":"320","author":"Dahlin","year":"2008","journal-title":"Science"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3405","DOI":"10.1523\/JNEUROSCI.3405-11.2012","article-title":"Reduced prefrontal-parietal effective connectivity and working memory deficits in schizophrenia","volume":"32","author":"Deserno","year":"2012","journal-title":"J. Neurosci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3233\/NRE-201583","article-title":"Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: a pilot study","volume":"48","author":"Eschweiler","year":"2021","journal-title":"NeuroRehabilitation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.cortex.2016.04.023","article-title":"Unity and diversity of executive functions: Individual differences as a window on cognitive structure","volume":"86","author":"Friedman","year":"2017","journal-title":"Cortex"},{"key":"B19","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1037\/a0021483","article-title":"The structure of working memory abilities across the adult life span","volume":"26","author":"Hale","year":"2011","journal-title":"Psychol. Aging"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1093\/jpepsy\/jsab030","article-title":"A randomized controlled trial of working memory training in pediatric sickle cell disease","volume":"46","author":"Hardy","year":"2021","journal-title":"J. Pediatr. Psychol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1053\/apmr.2001.25970","article-title":"Is there a relation between neuropsychologic variables and quality of life after stroke?","volume":"82","author":"Hochstenbach","year":"2001","journal-title":"Arch. Phys. Med. Rehabil"},{"key":"B22","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/j.1467-7687.2009.00848.x","article-title":"Adaptive training leads to sustained enhancement of poor working memory in children","volume":"12","author":"Holmes","year":"2009","journal-title":"Dev. Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"6829","DOI":"10.1073\/pnas.0801268105","article-title":"Improving fluid intelligence with training on working memory","volume":"105","author":"Jaeggi","year":"2008","journal-title":"Proc. Natl. Acad. Sci. U.S.A"},{"key":"B24","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.intell.2010.09.001","article-title":"The relationship between n-back performance and matrix reasoning \u2013 implications for training and transfer","volume":"38","author":"Jaeggi","year":"2010","journal-title":"Intelligence"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2473","DOI":"10.1161\/STROKEAHA.108.541144","article-title":"Hidden dysfunctioning in subacute stroke","volume":"40","author":"Jaillard","year":"2009","journal-title":"Stroke"},{"key":"B26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.neuropsychologia.2014.05.015","article-title":"Functional correlates of prospective memory in stroke","volume":"60","author":"Kant","year":"2014","journal-title":"Neuropsychologia"},{"key":"B27","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1016\/j.apmr.2006.08.333","article-title":"Patterns of normal human brain plasticity after practice and their implications for neurorehabilitation. Arch. Phys. Med","volume":"87","author":"Kelly","year":"2006","journal-title":"Rehabil"},{"key":"B28","doi-asserted-by":"publisher","first-page":"4492","DOI":"10.1523\/JNEUROSCI.4341-14.2016","article-title":"A Brain System for Auditory Working Memory","volume":"36","author":"Kumar","year":"2016","journal-title":"J. Neurosci"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09297049.2011.575772","article-title":"Working memory training improves reading processes in typically developing children","volume":"2011","author":"Loosli","year":"2011","journal-title":"Child. Neuropsychol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1007\/s11065-020-09462-4","article-title":"Post-stroke working memory dysfunction: a meta-analysis and systematic review","volume":"31","author":"Lugtmeijer","year":"2021","journal-title":"Neuropsychol. Rev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.3109\/02699052.2010.498007","article-title":"Computerized training of working memory in a group of patients suffering from acquired brain injury. Brain","volume":"24","author":"Lundqvist","year":"2010","journal-title":"Inj"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/texcom\/tgab005","article-title":"Working memory capacities neurally dissociate: evidence from acute stroke","volume":"2","author":"Martin","year":"2021","journal-title":"Cerebral Cortex Commun"},{"key":"B33","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1016\/j.cortex.2009.08.017","article-title":"The contributions of cerebro-cerebellar circuitry to executive verbal working memory","volume":"46","author":"Marvel","year":"2010","journal-title":"Cortex"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1006\/nimg.2001.0899","article-title":"Differential working memory load effects after mild traumatic brain injury","volume":"14","author":"McAllister","year":"2001","journal-title":"Neuroimage"},{"key":"B35","doi-asserted-by":"publisher","first-page":"263","DOI":"10.2496\/hbfr.26.263","article-title":"A five-year model project for supporting persons with higher brain dysfunctions","volume":"26","author":"Nakajima","year":"2006","journal-title":"High. Brain. Funct. Res"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcomdis.2020.106077","article-title":"Working memory training in post-stroke aphasia: near and far transfer effects","author":"Nikravesh","year":"2021","journal-title":"J. Commun. Disord"},{"key":"B37","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1038\/nn1165","article-title":"Increased prefrontal and parietal activity after training of working memory. Nature","volume":"7","author":"Olesen","year":"2004","journal-title":"Neuroscience"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.neuropsychologia.2013.10.017","article-title":"Selective transfer of visual working memory training on Chinese character learning","volume":"53","author":"Opitz","year":"2014","journal-title":"Neuropsychologia"},{"key":"B39","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1038\/362342a0","article-title":"The neural correlates of the verbal component of working memory","volume":"362","author":"Paulesu","year":"1993","journal-title":"Nature"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1080\/09602011.2018.1554534","article-title":"Dissociable effects of attention vs working memory training on cognitive performance and everyday functioning following fronto-parietal strokes","volume":"30","author":"Peers","year":"2020","journal-title":"Neuropsychol. Rehabil"},{"key":"B41","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.neuropsychologia.2018.03.012","article-title":"The role of the human cerebellum in linguistic prediction, word generation and verbal working memory: evidence from brain imaging, non-invasive cerebellar stimulation and lesion studies","volume":"115","author":"Pleger","year":"2018","journal-title":"Neuropsychologia"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.3758\/s13423-013-0453-9","article-title":"Complex span and n-back measures of working memory: a meta-analysis","volume":"20","author":"Redick","year":"2013","journal-title":"Psychonomic. Bullet Rev"},{"key":"B43","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1037\/a0023631","article-title":"Working memory training and transfer in older adults","volume":"26","author":"Richmond","year":"2011","journal-title":"Psychol. Aging"},{"key":"B44","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1037\/neu0000445","article-title":"Hildebrandt H. Improving everyday memory performance after acquired brain injury: an RCT on recollection and working memory training","volume":"32","author":"Richter","year":"2018","journal-title":"Neuropsychology"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0050431","article-title":"A potential spatial working memory training task to improve both episodic memory and fluid intelligence","author":"Rudebeck","year":"2012","journal-title":"PLoS ONE"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2555","DOI":"10.1093\/cercor\/bhr037","article-title":"Separating intra-modal and across-modal training effects in visual working memory: an fMRI investigation","volume":"21","author":"Schneiders","year":"2011","journal-title":"Cereb. Cortex"},{"key":"B47","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1037\/dev0000291","article-title":"Verbal and visual-spatial working memory: what develops over a life span?","volume":"53","author":"Swanson","year":"2017","journal-title":"Dev. Psychol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1016\/j.neuropsychologia.2005.10.005","article-title":"Brain areas involved in spatial working memory","volume":"44","author":"van Asselen","year":"2006","journal-title":"Neuropsychologia"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2018.3","article-title":"Vascular cognitive impairment","author":"Van Der Flier","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"B50","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1080\/09602011.2015.1048694","article-title":"Transfer and maintenance effects of online working-memory training in normal ageing and mild cognitive impairment","volume":"26","author":"Vermeij","year":"2015","journal-title":"Neuropsychol. Rehabil"},{"key":"B51","doi-asserted-by":"publisher","first-page":"2460","DOI":"10.1093\/cercor\/bhn010","article-title":"The functional architecture of the left posterior and lateral prefrontal cortex in humans","volume":"18","author":"Volle","year":"2008","journal-title":"Cerebral Cortex"},{"key":"B52","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1080\/02699050601148726","article-title":"Computerized working memory training after stroke\u2013a pilot study","volume":"21","author":"Westerberg","year":"2007","journal-title":"Brain Injury"},{"key":"B53","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.physbeh.2007.05.041","article-title":"Changes in cortical activity after training of working memory-a single-subject analysis","volume":"92","author":"Westerberg","year":"2007","journal-title":"Physiol. Behav"},{"key":"B54","doi-asserted-by":"publisher","first-page":"890483","DOI":"10.3389\/fnhum.2022.890483","article-title":"Phonological working memory representations in the left inferior parietal lobe in the face of distraction and neural stimulation","volume":"16","author":"Yue","year":"2022","journal-title":"Front. Human Neurosci"},{"key":"B55","doi-asserted-by":"publisher","first-page":"3204","DOI":"10.1002\/hbm.22136","article-title":"Intrinsic resting-state activity predicts working memory brain activation and behavioral performance","volume":"34","author":"Zou","year":"2013","journal-title":"Human Brain Mapp"}],"container-title":["Frontiers in Stroke"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2023.1189573\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T05:06:04Z","timestamp":1695963964000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2023.1189573\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":55,"alternative-id":["10.3389\/fstro.2023.1189573"],"URL":"https:\/\/doi.org\/10.3389\/fstro.2023.1189573","relation":{},"ISSN":["2813-3056"],"issn-type":[{"value":"2813-3056","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,28]]},"article-number":"1189573"}}