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PubMed1981

Age and type of aphasia in patients with stroke.

The age and gender of a series of patients with different types of aphasia were analysed. Regardless of gender, patients with Broca and conduction aphasias were significantly younger than those with Wernicke and global aphasias. Considering the established cerebral localisation of each of those aphasia types, it appears that, with age, stroke in the territory of the middle cerebral artery will tend to either shift posteriorly (producing Wernicke aphasia) or occupy most of the middle cerebral artery territory (producing global aphasia). But in the absence of concurrent verification of the locus of lesion in each of the cases in our sample, a possible alternative hypothesis must be entertained: that there might be age-related changes in the neurophysiological mechanism subserving language, such that some types of aphasia would tend to be more prevalent with age, regardless of lesion location.

Adult↗

PubMed1997

Impairment of short-term memory in left hemispheric traumatic brain injuries.

We report on two patients with traumatic lesions in the temporal and parietal lobes who demonstrated disturbances of short-term memory (STM) following improvement on the aphasia. Patient 1 was a 66-year-old right-handed man who presented to our hospital with a cerebral contusion. One admission we observed a Wernicke's aphasia with paraphasic jargon in this patient that resolved within 8 weeks. Patient 2 was a 35-year-old right-handed woman, with an acute subdural haematoma and a cerebral contusion, who underwent craniotomy and evacuation of the haematoma. In this patient we noted a transient Wernicke's aphasia following the operation that improved within 3 months. Linguistically, the aphasia observed in each of these two patients was not a typical conduction aphasia because of the absence of paraphasia, and impairment of comprehension was unclear despite a decrease in performance on repetition tasks. Both verbal and non-verbal tasks suggested an impairment in STM. These findings suggest that involvement of the left hemisphere may cause disturbances in both verbal and non-verbal STM.

Adult↗

PubMed1997

[Language and aphasias].

INTRODUCTION AND OBJECTIVE: Approximately 400,000 years ago men started to use language. Initially it was probably poor with few phonemes. With social evolution it became more complex, with the appearance of new phonemes and a more complete grammatical structure. The current concept of the processing of language dates, with little change, from the nineteenth century. DEVELOPMENT: With the birth of phrenology language began to be studied. This lead to the hypothesis of Wernicke, with two main areas joined by the fasciculo arcuato, which is still held to be valid with modifications by Gerchwind and Damasio, amongst others. Important advances in the study of language are due to Chomsky and his transformational grammar. This supports the universal structure of language, since one learns it following genetically determined laws. Language has three main aspects: creativity which makes both the transmitter and the receiver active participants in communication, the form from which words are constructed and the content of the message. Aphasia is an alteration in the comprehension and understanding of language, which may be the clinical expression of many different aetiologies. They help us to localize the lesion topographically. They are divided depending on the clinical signs, into motor or Broca's aphasia, in which understanding is conserved but the patient uses a language with poor grammatical structure, although the semantic content is acceptable: sensitive or Wernicke's aphasia, with inability to understand and language which is fluid but unintelligible; conduction aphasia due to limitation in the transmission of impulses from Wernicke's area to that of Broca, with acceptable understanding and fluid language and the trans-cortical aphasias where the main characteristic is indemnity of the capacity of repetition. CONCLUSIONS: The aphasias, as the expression of an alteration of language are an important support in the topographical localization of lesions, even before these can be shown on computerized tomography.

Agraphia↗

PubMed1984

A two-route model of speech production. Evidence from aphasia.

Quantitative investigations of speech production deficits are reported in three aphasic patients. Two had impaired paraphasic performance in repetition tasks but relatively well preserved spontaneous speech (conduction aphasia). The other patient had impaired paraphasic spontaneous speech but intact repetition (transcortical motor aphasia). In repetition tasks which required active semantic processing the conduction aphasics were facilitated and the transcortical motor aphasic impaired; in tasks which required passive repetition the opposite pattern of dissociation was observed. These findings are accounted for within a two-route model of the speech production process.

Aphasia↗

PubMed1990

Dissociations of language functions in aphasics with speech automatisms (recurring utterances).

The linguistic performance of 27 aphasics with frequent production of non-lexical speech automatisms (recurrent utterances; e.g. do-do-do...) in spontaneous speech was investigated. Of the 26 patients examined with the Aachen aphasia test (AAT), 24 cases suffered from global aphasia, one from Broca's aphasia, and one was not classifiable but most resembled the fluent types as Wernicke's or conduction aphasia. While most patients were severely impaired in language comprehension, a subgroup showed impairments on a moderate level. In four cases clear dissociations between oral and written output performance were found. Only one patient, and very rarely so, interspersed his written output with his speech automatism. Analysis of written output within the theoretical framework of the logogen model provided evidence for the possibility of a partially intact phonological system in patients with speech automatisms. Results are interpreted as supporting a sub-phonemic hypothesis of the generation of non-lexical speech automatisms.

Adult↗

PubMed2002

Vascular aphasias: main characteristics of patients hospitalized in acute stroke units.

BACKGROUND AND PURPOSE: Aphasia is frequent in stroke patients and is associated with poor prognosis. However, characteristics and determinants of vascular aphasias remain controversial. The aim of this study was to evaluate aphasia characteristics at the acute stage in patients admitted to a stroke unit. METHODS: The study was performed in 308 patients consecutively assessed with a standardized aphasia battery. RESULTS: Aphasia was observed in 207 patients; global and nonclassified aphasias accounted for 50% of aphasic syndromes at the acute stage, whereas classic aphasias (Wernicke's, Broca's, transcortical, and subcortical aphasias) were less frequent. Age differed across aphasic syndromes in ischemic stroke patients only; patients with conduction aphasia were younger, and patients with subcortical aphasia were older. Sex did not significantly differ across aphasic syndromes. The presence of a previous stroke was more frequent in nonclassified aphasia. CONCLUSIONS: This study shows (1) that vascular aphasias are frequently severe or nonclassic at the acute stage, a finding explained in part by the presence of a previous stroke; (2) that the age effect is due mainly to its influence on infarct location; and (3) that the main determinant of aphasia characteristics is lesion location.

Adolescent↗

PubMed1986

Focal brain lesions and intelligence: a study with a new version of Raven's Colored Matrices.

Contrasting results have been obtained in previous investigations, which have used the standard version of Raven's Colored Progressive Matrices for studying the effects of localized brain lesion on visual-spatial intelligence. Some of these discrepancies might be due to the fact that specific factors, such as unilateral spatial neglect, could contribute to decreased performance obtained on Raven's test by patients with focal brain lesions. A new set of Colored Matrices, devised to minimize the influence of unilateral spatial neglect without changing the essential features of the original task, was therefore constructed. The test was administered to 76 normal controls, 74 right brain-damaged patients, 87 aphasics, and 61 nonaphasic left brain-damaged patients, in order to study the effect of laterality of lesions and of language impairment on Raven's scores. The results show that, if the influence of unilateral spatial neglect is minimized and Raven's scores are corrected in reference to age, educational level, and lesion size, then: no significant differences are observed between right and left brain-damaged patients; aphasics score worse than nonaphasic left brain-damaged patients; impairment is greater in patients with Wernicke's and Global aphasia (i.e., in patients with severe language comprehension disorders) than in patients classified as Broca's, Anomic, or Conduction aphasia; impairment is greater in patients with semantic-lexical discrimination errors than in patients free from semantic-lexical comprehension disorders.

Aphasia↗

PubMed1987

Action-naming performance in four syndromes of aphasia.

This study examined the influence of two situational contexts on the action-naming performances of 44 aphasic patients: single-word confrontation naming and naming within the context of connected speech. Subjects were evenly distributed among the syndromes of Broca's. Wernicke's, anomic, and conduction aphasia. The two naming tasks employed each comprised the same 18 target verbs. Naming performance was not systematically influenced by the particular naming task in any of the aphasia groups studied. However, for some individuals, particularly in the group of anomic aphasia, there were substantial performance discrepancies between scores obtained on the two different tasks. Correlations between scores on the confrontation-naming and picture-description tasks were highest for the Wernicke's aphasics, followed by the conduction, Broca's, and anomic aphasics. The extent to which action-naming error types could discriminate between the four groups of aphasics was examined. Results obtained in the present study were compared to results obtained in an earlier study on object-naming (S. Williams & G. Canter, 1982), Brain and Language, 17, 92-106). Discussion focuses on implications for the psycholinguistic processes involved in action versus object-naming.

Adult↗

PubMed1986

A comparison of speech sound durations in three syndromes of aphasia.

This study compared the durations of selected vowels and consonants produced by three groups of aphasics and a normal control group in confrontation naming and single-word repetition tasks. There were seven aphasic subjects in each of the syndromes of Broca's, Wernicke's, amnesic, and conduction aphasia, in addition to a group of seven normal subjects. Wide-band spectrograms were used to measure speech sound durations. Analysis of group data revealed no significant differences in the durations of vowels or consonants across the four subject groups. In addition, there were no differences in speech sound durations for the confrontation naming versus repetition tasks. When two speech-language pathologists listened to tape recordings of all subjects performing the two tasks, they judged the speech of two Broca's aphasics as being labored, while the speech of the remaining subjects was not judged as labored. Clinical judgments of labored speech appeared to correspond to acoustical measurements of speech sound duration, as the two Broca's aphasics judged to be labored displayed longer durations than those subjects who were not judged as labored. The increase in duration was particularly marked for vowels and for sounds in polysyllabic words. The results are discussed in relation to current descriptions of the articulatory characteristics of Broca's aphasics. Clinical implications are also addressed.

Adult↗

PubMed1989

Hemianesthesia and aphasia. An anatomical and behavioral study.

A 61-year-old right-handed man with a history of lacunar cerebrovascular disease and hypertension had the sudden onset of right-sided numbness and difficulty speaking. Neurologic evaluation revealed a dense right hemianesthesia that included the face, trunk, arm, and leg. Neuropsychological examination documented a conduction aphasia, which resolved nearly completely several months later. Computed tomographic and magnetic resonance imaging studies showed a lesion in the left hemisphere that involved the posterior insula and disrupted thalamocortical connections but entirely spared the thalamus proper. We suggest that the combination of hemianesthesia and aphasia indicates a white matter lesion subjacent to inferior parietal and posterior temporal cortices.

Aphasia↗

PubMed1987

Comparative classification of aphasic disorders.

This study compares aphasia classification of 20 aphasics who were evaluated with the Western Aphasia Battery (WAB) and the Lisbon Aphasia Examination Battery (LAEB). High correlations were found between tests evaluating the same functions in both batteries. Aphasia types derived from these two batteries showed only a partial overlap. This was due to the use of different numerical diagnostic criteria. When these criteria were used to specify aphasia types of 179 acute and 113 chronic aphasics grouped by cluster analysis, similar discrepancies were noted. Two major differences were found: some LAEB global aphasics turned out to be WAB Broca's and some LAEB anomics were classified as WAB conduction aphasics. These disagreements reflect difficulties in delimiting Broca's and conduction aphasia. The importance of the numerical approach to aphasia classification is stressed, as it is a reliable method to classify aphasic patients in order to allow comparison of data from different centers.

Adult↗

PubMed1979

The resolving stroke and aphasia. A case study with computerized tomography.

A 39-year-old man suffered an intracerebral hemorrhage in the region of the left internal capsule deep to Wernicke's area. The location of the lesion was confirmed by computerized tomography (CT) performed two days postictally. Two weeks after admission, the Boston Diagnostic Aphasia Examination (BDAE) diclosed Wernicke's aphasia. We hypothesize that the hematoma exerted pressure on Wernicke's cortical area, thus causing the resulting Wernicke's aphasia at that time. A CT scan three months later showed absorption of the hematoma, with a residual low-density lesion deep to Wernicke's area, in the region of the arcuate fasciculus. At that time, BDAE testing disclosed a mild conduction aphasia. Serial CT scanning combined with discriminating clinical evaluation of aphasia provides a valuable opportunity for study of the processes underlying stroke resolution and aphasia.

Adult↗

PubMed1998

Crossed aphasia in a dextral: a test of the Alexander-Annett theory of anomalous organization of brain function.

A case of crossed aphasia is presented in a strongly right-handed 77-year-old white female without history of familial sinistrality or prior neurological illness. She developed a right middle cerebral artery infarction documented by CT and accompanied by obvious clinical signs of a conduction aphasia with some resolution but continuing obvious language defect after 9 weeks in rehabilitation. Comprehensive neuropsychological and aphasia testing suggested anomalous lateralization of phonologic-output aspects of language, emotional prosody, motor planning and body schema modules with usual lateralization of lexical-semantic aspects of language and visuo-spatial functions. Experimental validation of the uncrossed lexical-semantic aspects of language using tachistoscope methods found support for the Alexander-Annett theory that different aspects of language can be dissociated in their lateralization. The subject had difficulty identifying a semantic associate of a picture presented to the left visual field (7 errors out of 10) relative to right visual field presentation (2 errors out of 10). Bilateral free naming errors (6 and 5 errors in the left and right visual fields, respectively) occurred consistent with the aphasic presentation, suggesting phonologic-output dysfunction from the right cerebral vascular accident. Implications of the results for aphasia classification are discussed.

Aged↗

PubMed1980

Music and language: musical alexia and agraphia.

Two aphasic right-handed professional musicians with left hemispheric lesions had disturbed musical function, especially musical alexia and agraphia. In Case 1 aphasia was of transcortical sensory type, with severe agraphia and decreased comprehension of written words, although she could match them with pictures. Except for reading and writing, musical ability was normal; she could sing in five languages. Musical alexia and agraphia affected pitch symbols more than rhythm. Case 2 had conduction aphasia and severe expressive amusia, especially for rhythm. Although his language alexia and agraphia were milder than Case 1's, his musical alexia and agraphia were more severe, affecting rhythm as much as pitch. In neither patient were those aspects of musical notation either closest to verbal language or most dependent upon temporal (sequential) processing maximally impaired. These cases are consistent with the literature in suggesting that the presence or absence of aphasia or of right or left hemispheric damage fails to predict the presence, type, or severity of amusia, including musical alexia and agraphia. The popular notion that receptive amusia follows lesions of the language-dominant temporal lobe, whereas expressive amusia follows non-dominant frontal lobe damage, is an over-simplification, as is the view that increasing musical sophistication causes a shift of musical processing from the right hemisphere to the left.

Adult↗

PubMed1992

Sigmund Freud and the diagram-maker school of aphasiology.

Published 100 years ago, Freud's monograph on aphasia, Zur Auffassung der Aphasien, is an incisive analysis of the so-called diagram-makers, those aphasiologists who would reduce brain and language to simple schemes of circumscribed cortical centers linked by unidirectional subcortical pathways. Chief architects of the diagram-maker school were Wernicke and Lichtheim, and their formulations of conduction aphasia and the transcortical aphasias were particular targets of Freud's trenchant criticism. Freud argued against functional differentiation within left hemisphere perisylvian language regions, and he suggested that traditional aphasic syndromes were artifacts of lesions that included cortical language regions and deeper white matter pathways not directly involved with language. He provided an innovative classification of aphasia based on types of associations presumed to be affected. Freud, however, failed to adduce new clinical or pathological observations; he was perhaps unnecessarily harsh in challenging authorities in the field of aphasia; and his theory had to compete with a straightforward and already entrenched anatomical view of language representation. Despite Freud's lucid argumentation, his carefully crafted monograph was never widely noted.

Aphasia↗

PubMed2005

Treating attention in mild aphasia: evaluation of attention process training-II.

UNLABELLED: This study examined whether attention processing training-II [Sohlberg, M. M., Johnson, L., Paule, L., Raskin, S. A., & Mateer, C. A. (2001). Attention Process Training-II: A program to address attentional deficits for persons with mild cognitive dysfunction (2nd ed.). Wake Forest, NC: Lash & Associates.; APT-II], when applied in the context of a multiple baseline ABA design, would improve the attention abilities of RW, a patient with mild conduction aphasia and concomitant attention and working memory deficits. We also explored whether APT-II training would enhance RW's auditory comprehension, other cognitive abilities such as memory, and his and his spouse's perceptions of his daily attention and communication difficulties. With treatment, RW improved on trained attention tasks and made modest gains on standardized tests and probes that evaluated cognitive skills related to treatment activities. Nominal change in auditory comprehension and untrained attention and memory functions was observed, and neither RW nor his spouse reported noticeable improvements in his daily attention or communication abilities. These and previous findings indicate that structured attention retraining may enhance specific attention skills, but that positive changes in broader attention and untrained functions are less likely. LEARNING OUTCOMES: As a result of reading this article, the participant will be able to: (1) summarize the previous literature regarding attention impairments and treatment approaches for patients with aphasia. (2) describe how Attention Processing Training-II affected the attention, auditory comprehension, and other cognitive abilities of the patient in this study.

Aphasia, Wernicke↗

PubMed2003

Speech and language in progressive nonfluent aphasia compared with early Alzheimer's disease.

BACKGROUND: Progressive nonfluent aphasia (PA) is a slow deterioration of language that remains relatively isolated from other cognitive or behavioral deficits for at least 2 years. The differentiation of PA from early Alzheimer's disease (AD) is important, given the presence of early language changes in AD. METHODS: A language assessment was administered to 15 patients who met established criteria for PA, 15 patients with clinically probable AD and mild dementia, and 15 normal control subjects. The language battery included verbal fluency, the Boston Naming Test with cuing and recognition, and an aphasia test battery with a motor speech exam. RESULTS: Pronounced literal paraphasic errors distinguished the PA patients from the AD patients. The PA group had anomia, decreased letter fluency, neologisms, difficulty on phrase repetition, decreased phrase length, and a decreased rate of verbal output. Interference from paraphasic anomia accounted for much of their decreased fluency. CONCLUSION: Many patients with PA have a primary defect in accessing sound-based representation of speech (phonemes), similar to conduction aphasia, possibly as a consequence of disturbed white matter tracts in the left superior temporal region.

Aged↗

PubMed1978

Delayed auditory feedback and aphasia.

The effect of Delayed Auditory Feedback (DAF) was evaluated in three groups of subjects: 10 normal controls, 10 non-fluent aphasics, and 10 fluent aphasics. Speec production tasks consisted of (1) repeating sound and words; (2) naming objects; (3) producing sentences from given stimulus words; (4) answering questions; (5) reciting nursery rhymes; and (6) reading. Two delays were used, 180 and 360 msec. Two independent judges rated patients' responses for changes in intensity, duration, and quality of speech. Inter-judge reliability was considered satisfactory. Contrary to some previous reports, all subjects, including all the fluent aphasics, showed some DAF effect. Fluent aphasics, however, showed a significantly smaller DAF effect than non-fluent aphasics. Patient with conduction aphasia appeared to be the least impaired. Overall DAF effect was greater with 180 msec. than with 360 msec. The largest DAF effect occurred during answering question, followed by repeating, reading, nursery rhymes, sentence production, and naming, in that order. Repetition of a complex word produced a greater DAF effect than repetition of a simple sound. Finally, we found a differential effect of DAF on the three measures used in the study. We hypothesize that DAF effects result from changes in two separate monitoring systems. One systems is related to changes in the intensity of speech and does not appear to be affected by aphasia. The other is responsible for duration and qualitative changes in speech and is differentially affected in relation to pathology producing aphasia.

Adult↗