[The problem of the centers and the mechanisms of articulated speech. Apropos of 1 case of Broca's aphasia with hemichorea].
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Aphasia↗
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Broca's area aphasias: aphasia after lesions including the frontal operculum.
We report 9 cases of aphasia following lesions in the region of the left frontal operculum. It is not possible to capture their variety of clinical manifestations with the simple labels of "Broca's area aphasia." or "Broca's area aphasia." Analysis of the breakdown of various components of speech and language in these cases suggests that the operculum, lower motor cortex, and subjacent subcortical and periventricular white matter contain critical parts of different language systems. These systems can be independently impaired. There are several common language syndromes that follow damage that includes the left frontal operculum. These syndromes reflect the effects of the direction and extent of the lesion in the various language systems.
Adult↗
[Recovery processes in 2 cases of bilingual aphasia].
Recovery processes of two English-Japanese bilingual aphasics were investigated with special emphasia on the effect of language therapy. Although the two patients had different types of aphasia (one Broca's aphasia and the other Wernicke's aphasia), the degree of the language impairment initially manifested in English and Japanese was almost equivalent in each case with the pattern of impairment corresponding to the respective types of aphasia. In either case, language therapy was conducted in English, and the course of recovery during the first six months was analyzed. The results indicated that auditory comprehension improved almost simultaneously in both treated (English) and untreated (Japanese) languages regardless of the type of the patients' aphasia. In contrast, oral language production in Broca's aphasia improved only for the treated language while that in Wernicke's aphasia improved simultaneously for both languages. Writing ability seemed to improve as a function of language therapy in both cases. The implications for the relationship between spontaneous recovery and the effects of treatment were discussed.
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[Spontaneous speech disturbances in so called transcortical motor aphasia--comparison of 3 cases with the different lesion sites].
So called transcortical motor aphasia (TCMA) is frequently subdivided, because the clinical features and the localization of the lesions are variable. The authors have been attempting to classify TCMA into three types according to the distribution of the lesions, such as Type F 1, Type F 2 and Type F 3. Case 1 N.S. belongs to Type F 1 showing the clinical features of TCMA with bleeding in the territory of the left anterior cerebral artery. Case 2 M.E. belongs to Type F 2 (published case). This case is similar to Luria's dynamic aphasia in its clinical features and results from the lesions including the posterior parts of left middle frontal gyrus. Case 3 N.T. belongs to Type F 3 who recovered from typical Broca aphasia after language training for four years. The case is similar to Goldstein's Type 1 of TCMA in its clinical features. These three cases are compared with regard to the fundamental bases of spontaneous speech disturbance. The items of comparison are as follows; the volume of speech production and the the time taken to start speech, word fluency test, cue effects necessary for the success of sentence constructions grammatical ability. The results are summerized in Table 2. Type F1 shows the most conspicuous defect of spontaneous speech, but no disturbance in grammatical ability. And when the top word of a sentence (a subject word) is given by the examiner, the patient can construct a structurally correct sentence. These findings imply that the spontaneous speech disturbance of Type F 1 is due to a defect of the starting mechanism of speech.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Syntactic component in language responsible cognitive structure: neurological evidence.
From the results of a broad ranging comprehension test, a hierarchy of difficulty emerged that is shared by the two groups of aphasics (Broca's and Wernicke's aphasics) and by the control group of normal subjects. The parallelism has been interpreted as a confirmation of the hypothesis that syntactic competence is not inaccessible either in Wernicke's or in Broca's aphasia. The Minimal Distance Principle, as a relevant recognition principle, has been studied, and although not confirmed by the scores has been brought to the fore both by the correlations between the variables under study and by the correlations with the concomitant variables of age and level of education.
Adult↗
"Prepairs" and repairs: different monitoring functions in aphasic language production.
Picture descriptions of aphasic patients and nonaphasic controls were analyzed with respect to type and amount of linguistic repairs and searching phenomena ("prepairs"). Repairs occurred far less frequently than prepairs, which indicates impaired postarticulatory as opposed to intact prearticulatory monitoring. Prepairs were found to be most frequent in patients with relatively good comprehension, in patients with poor production, and in those who had both good comprehension and poor production. Contrary to expectation, there was no reliable difference in the distribution of prepairs and repairs between patients with Wernicke's and Broca's aphasia, although these two groups differed in performance. Possible mechanisms of linguistic monitoring are discussed.
Adult↗
Errors resembling semantic paralexias in Spanish-speaking aphasics.
Forty-one Spanish-speaking left-hemisphere-damaged patients were selected and divided into seven groups (transcortical, Broca's aphasia, conduction aphasia, Wernicke's aphasia, anomic aphasia, alexia without agraphia, and global aphasia). A reading battery composed of eight different subtests was given to each patient (reading of letters, reading of syllables, reading of pseudowords, reading of words, reading of sentences, understanding commands, reading and comprehension of texts, and logographic reading). Different types of reading errors were analyzed. Only in the logographic reading subtest were some word-recognition errors found, resembling semantic paralexias. It is proposed that semantic paralexias in English (and other languages) depend upon the partial logographic nature of the reading system. The importance of cross-linguistic analysis of reading errors, taking into account reading system idiosyncracies, is emphasized.
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Strategies of decoding actor-object-relations by aphasic patients.
By means of a sentence-picture matching task, 22 Broca-aphasics, 22 Wernicke-aphasics, 16 patients with damage to the right hemisphere and 16 neurologically normal subjects were tested for their ability to understand the actor-object-relation within a sentence. The 4 groups were approximately matched for sex, education, age and general severeness of disease. The stimulus sentences were constructed in such a way that the actor-object-relations were unambiguously clear by morphological means as e.g. case endings; thus, no error should be made by a subject operating on a purely algorithmic grammatical basis. One half of the sentences were irreversible, the other half reversible, i.e. the identification of the actor-object-relation was helped by a semantic cue in one half of the sentences, in the other half not. Crossed with this semantic factor was the syntatic factor "constituent order": one half of the sentences were presented in the normal order "actor-action-object", the other half in the topicalized form "object-action-actor" which is quite possible in German because of its free word order. Overall, the Broca-aphasics made less errors than the Wernicke-patients. The error pattern of the aphasics suggests that both aphasic groups remain responsive to semantic constraints as well as to constituent order: both groups made more errors in reversible than in irreversible sentences and both groups made more errors in topicalized than in normal sentences. There were no significant group differences in these two respects. The only group difference was that Broca-aphasics tended to neglect the syntactic aspect of constituent order if a semantic cue was given, while the Wernicke-aphasics continued to take the constituent order into account even in sentences where a semantic cue was present. In the light of the findings of the experiment, the hypothesis that Broca's aphasia is characterized by a supramodal blockade of syntax is disputed.
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Buccofacial apraxia and left cerebral haemorrhage.
We examined 33 patients with left intracerebral haemorrhage to investigate the relations to buccofacial apraxia (BFA). BFA was present in 18 cases at 1 month and disappeared in 3 cases and persisted in 15 cases at 6 month from the onset. The existence of BFA seems to be partially dependent the haematoma volume which may cause the organic damage in lenticulate nucleus, insula, posterior limb or internal capsule and anterior portion of paraventricle white matter. All patients with BFA had aphasia (Broca 6, Wernicke 1, Total 10, Amnestic 1). Aphasia of the patients with transient BFA improved as well as the patients without BFA after BFA disappeared. We suspected that improvement or aphasia might be affected by BFA.
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Language disintegration in dementia: effects of etiology and severity.
The speech characteristics on a standardized picture description task of 26 subjects with presumed senile dementia of the Alzheimer type (SDAT) and 13 subjects with stroke-related dementia (SRD) were compared to 15 normal subjects over age 59 years. Compared to the normal subjects, the dementia subjects used fewer total words, fewer unique words, fewer prepositional phrases, fewer subordinate clauses, and more incomplete sentence fragments. Lexical deficits tended to be more severe than syntactic ones, confirming prior suggestions that lexicon is more vulnerable to disruption in dementia than syntax. Greater dementia severity among the SDAT subjects was associated with marked difficulties in accessing the mental lexicon (increased use of empty words, indefinite anaphora, and pronouns). Greater dementia severity in the SRD subjects was associated with laconic speech that was syntactially less complex. Diffuse brain injury (as typified by SDAT) appears to disproportionately affect lexicon whereas multifocal injury (as typified by SRD) has a disproportionate effect on syntax (assuming that focal lesions of the posterior language zone have been excluded). The speech characteristics of the mild SDAT subjects showed similarities to those of anomic or semantic aphasia whereas the speech of the more advanced SDAT subjects showed similarities to Wernicke aphasia or transcortical sensory aphasia. The speech of the subjects with more severe SRD showed some similarities to Broca aphasia. The most important nonlinguistic deficit in both the SRD and the SDAT groups was a failure to make relevant observations during the picture description task. Perseverations were present in the speech of both the SRD and SDAT subjects, whereas aposiopesis, logorrhea, and palilalia were more typical of the SDAT subjects. Laconic speech was more characteristic of the SRD subjects.
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Acquired aphasia in children after surgical resection of left-thalamic tumors.
Five children (three males, two females; four right-, one left-handed; age range 6 to 14 years) who developed aphasia after gross-total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the importance of the thalamus and other subcortical structures in developing cognition.
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[Verbal comprehension in aphasic and in normal subjects with a shortened version of the token test (author's transl)].
A 36-item version of the token test is described together with its administration and scoring instructions. 215 normal subjects, 130 right brain-damaged patients, 50 non aphasic left brain-damaged patients and 106 aphasic patients were given the test. Years of schooling were found to affect significantly the performance of normal subjects; normal data were therefore examined with reference to individual educational background. Cutting scores differentiating normal from pathological performance were determined substracting 2 standard deviations from the means of normals subjects subdivided into four educational groups. Below these scores fell 4.2% of normal subjects, 14% of right brain-damaged patients, 18% of non-aphasic left brain-damaged patients and 90.48% of aphasic patients. Aphasic patients were classified as suffering from Global, Wernicke or Broca aphasia on the grounds of their performance on a Standard Aphasia Battery and the Token test scores of these three groups were compared. A score of 14 points was found to differentiate Broca from Global aphasics and severe from moderate and mild Wernicke aphasics. Broca aphasics were more impaired than Wernicke aphasics on the Token test. When compared to the Sentence Comprehension Test of the Standard Aphasia Battery, the Token test was found to be far more sensitive to detect impairment in aphasic subjects.
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Aphasia type and aging in Hindi-speaking stroke patients.
In this study, the clinical profile of Hindi-speaking stroke patients with aphasia from northern India has been investigated. We examined the interactional effect between age and gender with aphasia type in 97 Hindi-speaking right-handed individuals, the majority of them with a confirmed diagnosis of a cerebrovascular accident. The subjects included in the study ranged from 3 weeks to two years post-onset with a diagnosis of a common classical aphasia (Broca's, Wernicke's, anomic, global, conduction, and transcortical) types involving both males and females. Also examined was the interaction between literacy and aphasia type since the subjects had varied exposures to education (total illiteracy to professional/university education). While the data reported here about Hindi-speaking aphasics are relatively in agreement with the age-aphasia type patterns discussed in western countries, nonetheless some differences were also observed. The mean age of Indian patients with aphasia was significantly lower. Also, in addition to some gender and literacy related differences, an outstanding difference was that many clinical symptoms that are known to co-occur with aphasia were not readily reported by subjects with stroke.
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[Broca's aphemia versus Wernicke's aphasia and Chaslin's verbal mania].
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Aphasia↗
A study on simplification of the Standard Language Test of Aphasia (SLTA).
The Standard Language Test of Aphasia (STLA) was developed for classification and evaluation of severity of aphasia of Japanese speakers in 1975. Now it has become the most reliable test for patient with aphasic condition in Japan. However, the test involves many tasks and assessment is rather complicated. A simplified display of aphasic conditions was created by means of statistical analysis of the features of types of aphasia in order to reduce time and labor involved in SLTA for bed side use. Data were collected from 198 patients, including 40 patients with Broca aphasia (17 severe and 23 moderate cases), 64 patients with Wernicke aphasia (28 severe and 36 moderate cases) and 94 patients with global aphasia (68 severe and 26 moderate cases). A test with simplfied aphasia pattern involved naming objects for daily use (represented by pictures), pronunciation of words written in Kanji (Chinese characters) and in Kana (syllabary), pronunciation of single Kana, dictation of single Kana (oral presentation), repeating simple words presented by the examiner, dictation of words to be written in Kanji (oral presentation), matching words in Kana and a picture (pointing), writing words in Kanji (represented by pictures), writing words in Kana (represented by pictures), and auditory comprehension of words.
Adult↗
Crossed aphasia: one or more syndromes?
Seven strongly right-handed patients developed aphasia following a right hemisphere vascular lesion documented by computerized tomography. One patient had a severe unilateral neglect, indication of its presence were evident in three and absent in three patients. The Token Test scores were significantly higher than in matched controls. Two patients had Broca aphasia, four had Wernicke aphasia and one had agraphia. The correlation between type of aphasia and locus of lesion was not much different from that normally found in standard left hemisphere brain damaged aphasics.
Aphasia↗
Paul Broca and the history of aphasia: Roland P. Mackay Award Essay, 1980.
Paul Broca is one of the founding fathers of aphasiology. Broca aphasia, now a well-defined clinical entity, has been a focus in the study of acquired language disorders for over a century. It was the first syndrome of aphasia to be correlated with a specific focal brain lesion. Broca contributed a fresh outlook and a reasonable methodology to the study of aphasia. A review of of Broca's accomplishments and his place in the history of aphasia is an appropriate way to commemorate the hundredth anniversary of his death.
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The third alexia.
A variety of alexia has been demonstrated that can be distinguished from the two classically recognized types of alexia. This reading disorder is seen in patients with a dominant frontal lobe pathologic condition that has produced a motor language disturbance (Broca aphasia) and is sufficiently disabling to deserve consideration as a variety of alexia. Functionally, the frontal reading disturbance differs from the other two types in that the patient comprehends meaningful content words better than relational or syntactic structures. Four factors that may underly frontal alexia have been noted: (1) gaze paresis, (2) inability to maintain verbal sequences; (3) inability to comprehend syntactic structure, and (4) literal alexia.
Agraphia↗