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Disturbances of affective prosody in patients with schizophrenia; a cross sectional study.

The objective was to determine whether disturbances of affective prosody constitute part of the symptomatology of schizophrenia. Affective prosody is defined here as a neuropsychological function that encompasses all non-verbal aspects of language that are necessary for recognising and conveying emotions in communication. Twenty six schizophrenic outpatients and twenty four normal controls underwent a standardised prosody test, assessing four different aspects of affective prosody: spontaneous prosody, prosodic recognition, prosodic repetition, and facial affect recognition. Patients scored significantly worse than controls on three of the four subtests: spontaneous prosody, prosodic recognition, and prosodic repetition. There were no significant differences on a subtest for facial affect recognition. Differences in educational level between patients and controls could not account for these differences.

Adult↗

Language differences in young children with myelomeningocele and shunted hydrocephalus.

OBJECTIVE: This comparative cohort study examined language differences in young children (preschool to first grade) with myelomeningocele and shunted hydrocephalus (MM/SH). METHOD: A well-validated, standardized language test was administered to 17 children with MM/SH (age range 4-6 years) and 16 age-matched, nonaffected children. RESULTS: Standard scores were obtained within lexical/semantic, syntactic, and pragmatic domains. An analysis of performance on individual subtests within the lexical/semantic domain was striking. Children with MM/SH performed significantly worse (p<0.01) on a test measuring the comprehension of words representing important early learning concepts and on pragmatic tasks that measured their ability to use language functionally in social situations. CONCLUSIONS: Words representing basic precepts and concepts are commonly used in instructions to children in early childhood. Difficulty with functional pragmatic language results in suboptimal communication skills. Academic and community implications are discussed.

Age Factors↗

Prognostic value of computed tomography in aphasic stroke patients.

In order to evaluate the prognostic value of CT scan in aphasic stroke patients, a prospective study was performed during the first 3 months of the disease. The severity of the language disorders was assessed by means of a quantitative method. In cortico-subcortical lesions, the verbal expression recovery rate and the final verbal expression and comprehension status depended on the infarct size. No relation was observed between the latter and the verbal comprehension recovery rate. In deep-seated lesions, computed tomography provided no information concerning the prognosis.

Aged↗

Aphasic status epilepticus.

We studied a case of focal status epilepticus with aphasia as the sole manifestation, lasting 21 days. A 77-year-old woman developed aphasic seizures followed by aphasic status epilepticus 10 months after a left temporo-occipital hemorrhage. The diagnosis was made only after EEG, and seizures were stopped by anticonvulsant medication. Aphasic status epilepticus may be only a reflection of cerebral irritability, suggesting the possibility of a functional etiology for prolonged language disorders also in adults.

Aged↗

Pathogenesis of aphasia in deep-seated lesions: likely role of cortical diaschisis.

In order to study the pathophysiology of language disorders due to deep-seated left-hemisphere lesions not involving the cortex, a population of 43 right-handed stroke patients (29 aphasic) presenting with such lesions was studied clinically and by regional cerebral blood flow measurements (two-dimensional xenon-133 inhalation method). Most of the patients were studied sequentially between the 1st and 3rd months after stroke. Cortical diaschisis did not account for the whole clinical picture: the remote effect on the cortex could explain the occurrence of aphasia and its severity but not the type of aphasia. Furthermore, the clinical improvement observed in most cases was not accompanied by the disappearance of the diaschisis.

Adult↗

Prevention of conductive hearing loss in cleft palate patients.

One of the most common complications of cleft palate patients is the high frequency of otitis media episodes that they present, due to eustachian tube dysfunction. This is not only a problem for the otolaryngologist who must handle these patients, but just as well for the phoniatrician, who must evaluate and rehabilitate the speech and language disorders which can be enhanced by conductive hearing loss. Thus, we designed an isometric exercise to achieve an artificial drainage of the secretions produced in the middle ear, by means of opening the lumen of the eustachian tube, which, when done frequently enough, proved to be an excellent way to prevent secretions from remaining long enough in the middle ear cavity so as to have a secondary infection, that would lead to otitis media and subsequent conductive hearing loss. Isometric exercise also develops the muscles of each hemi-uvula.

Audiometry↗

The areas of language: critical analysis.

To determine the degree of linguistic maturity of a child, a series of areas that are usually formally tested in the assessment of language were analyzed. Specifically, an individual test of the assessment of language was applied to a sample of 204 children of Granada (Spain) ranging in age from 2.6 to 6.6 years. This test consists of six areas: comprehension, memory, fluency, vocabulary, knowledge, and judgement and intelligence. A factorial analysis of the data was carried out to check the classification of the above-mentioned areas. It is found that in the three following factors the analyzed variables get saturated: 'learned behaviors', 'behaviors which are being learned' and 'memory'.

Child↗

Headache in transient or permanent cerebral ischemia. Dutch TIA Study Group.

We studied headache features in 3,126 patients with acute cerebral or retinal ischemia. Headache occurred in 18% of these patients (in 16% of all patients with transient ischemic attacks, in 18% of patients with reversible ischemic neurologic deficits, and in 19% of patients with minor strokes) and was mostly continuous in all types of attacks. Headache was present in 16% of patients with monocular visual symptoms. The occurrence of headache was not related to the mode of onset, mode of disappearance, or duration of the attack. Patients with headache more often were known to have heart disease. Headache was less frequent in patients with small deep infarcts, who were more often hypertensive, and in patients with infarcts in the anterior circulation; headache was more frequent in patients with cortical infarcts and in patients with infarcts in the posterior circulation. Patients with a relevant small deep infarct on computed tomographic scan and accompanying headache relatively often reported symptoms compatible with cortical ischemia, such as language disorders or a visual field defect. We conclude that headache is a frequent accompanying symptom in patients with acute cerebral and retinal ischemia and that the occurrence of headache is partly related to the underlying cause of the ischemic lesion.

Brain Ischemia↗

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↗

Sex differences in language dysfunction in schizophrenia.

OBJECTIVE: Normal sex differences in language functions are disrupted in schizophrenia. However, identification of specific language components most vulnerable in schizophrenia and how they may differ by sex remain unexamined. The current study investigated this issue in the domains of phonology, semantics, and grammar, which have been closely linked with neuroanatomic regions for which sex differences have been identified. METHOD: Thirty-one outpatients with DSM-III-R schizophrenia and 27 healthy subjects comparable within sex on age, handedness, parental socioeconomic status, and ethnicity were systematically ascertained from a Boston catchment area. The subjects were administered an extensive language battery in the context of a comprehensive neuropsychological battery that included measures of phonology, semantics, and grammar. RESULTS: Male patients performed significantly worse than their healthy counterparts on all three domains, with phonology least affected. In contrast, language function was relatively preserved in the female patients, compared to their healthy counterparts, with phonology most affected. Across domains, the effect sizes in comparisons of male patients and healthy male subjects had a twofold difference, whereas the difference in effect sizes in comparisons of female patients and healthy female subjects was less in all areas. CONCLUSIONS: Findings were consistent with prior evidence of overall language dysfunction in schizophrenia and may have implications for understanding sex differences in neuroanatomic abnormalities in regions associated with phonological processing.

Adult↗

Correlations between SPECT regional cerebral blood flow and psychometric testing in patients with Alzheimer's disease.

Thirty-nine patients with probable Alzheimer's disease (AD) were studied with [99mTc]HMPAO SPECT and a standardized neuropsychological battery testing intellect, memory, attention, language, motor and praxis functions, and depression. Spearman rank correlations and multivariate regression analyses were performed to correlate quantitative regional perfusion deficits to these tests. Patients were found to have decreased perfusion of left frontal, parietal, and temporal regions relative to right. WAB repetition scores and bilateral temporal flow were significantly correlated (P < 0.01). Correlations between visual memory and bilateral temporal flow and those between Mini-Mental State/ Geriatric Depression Scale scores and bihemispheric flow approached significance. Although in this study regional cerebral blood flow was relatively insensitive to neuroanatomical abnormalities underlying specific cognitive deficits, it may have some specificity for identifying the language disorder in AD.

Aged↗

Language deficiency in children.

Research in cognition and language has provided useful constructs which suggests that specific deficits underlie language deficiencies in children. In addition, this research has provided procedures that the determine what a child knows about language at a particular level of development and has established a sequence of linguistic development that maps the specific content and structure of training programs. Two new areas of research offer additional approaches to assessment and remediation. One approach focuses on the actual principles and strategies that normal children use to learn language, making it possible to determine which methods are most efficient. The second research approach looks at the contextual conditions adults and children provide the first language learner. Preliminary work suggests that the natural conditions found universally in first language learning may be the best indicators of how to proceed with language-deficient children.

Child↗

Patterns of physical and sexual abuse of communicatively handicapped children.

Evidence suggests that handicapped children are at increased risk for abuse and neglect. Communicatively impaired youngsters are particularly vulnerable because of their limited ability to report the maltreatment. Of 482 abused handicapped children evaluated at Boys Town National Research Hospital, 212 had hearing impairment, 87 speech language disorders, 39 learning disorders, 43 behavioral-emotional disturbances, 74 mental retardation, 5 visual impairment, 3 cleft lip or palate, and 19 other disorders. The perpetrator was either a relative or a "trusted other" in 97.2% of sexual abuse cases. Handicapped males were much more likely to be victims of sexual abuse than nonhandicapped males in the general population. Children being educated in residential schools were more likely to be sexually abused than mainstreamed youngsters. These children may be at risk for abuse from a wide variety of potential perpetrators, including teachers, dormitory counselors, van drivers, clergy, classroom aides, older students, peer siblings, scout leaders, abused peers, baby-sitters, and custodians.

Adolescent↗