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Aphasia: Symptoms and Syndromes

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Title: Aphasia: Symptoms and Syndromes


1
Aphasia Symptoms and Syndromes
Ling 411 04
2
Simple Functions / Complex Functions
A question came to me in class when you mentioned
that localization does not work for complex
functions (e.g. rats navigating mazes), because
the brain can compensate with other brain areas.
It seems to me that "understanding speech,
localized in Wernicke's area, is actually a
pretty complex process...how is
simplicity/complexity determined? This is a
general question, but I'm interested in the
implications of this question to also the Broca's
area and any other relevant areas. Either a
general explanation or a point in the right
direction to what sort of researchers work I want
to look at would be greatly appreciated. Thanks!
Halle
3
Simple Functions / Complex Functions
Complex function
Simple function
4
Phonological Production / Speaking
  • Speaking is a complex process
  • Therefore, involves multiple areas
  • Phonological production is a simple process
  • Brocas area
  • together with parts of primary motor area and
    subcortical areas
  • Other processes in speaking
  • (other than phonological production)

5
Phonological Recognition / Understanding
  • Understanding speech is a complex process
  • Therefore, involves multiple areas
  • Phonological recognition is a simple process
  • Wernickes area
  • together with primary auditory area and
    subcortical areas
  • Other processes in understanding
  • (other than phonological recognition)

6
Doubts about Wernickes Area
Steven Pinker Wernickes area was once
thought to underlie language comprehension. But
that would not explain why the speech of these
patients sounds so psychotic. The
Language Instinct (1994) Friedemann
Pulvermüller patients with Wernickes aphasia
have difficulty speaking. These deficits are
typicaland cannot be easily explained by
assuming a selective lesion to a center devoted
to language comprehension. The
Neuroscience of Language (2002)
7
Erratic Speech in Wernickes Aphasia
I feel very well. My hearing, writing been doing
well. Things that I couldnt hear from. In other
words, I used to be able to work cigarettes. I
didnt know how. Chesterfeela, for 20 years I
can write it. From Harold Goodglass
Understanding Aphasia (1993)
8
Lessons from Carl Wernicke
Carl Wernicke Primary functions alone can be
referred to specific areas. All processes which
exceed these primary functionsare dependent on
the fiber bundles, that is, association.
Aphasia Symptom Complex (1874) Any higher
psychic processes exceeding these primary
assumptions cannot be localized but rest on the
mutual interaction of these fundamental psychic
elements which mediate their manifold relations
by means of the association fibers.
Recent Works on Aphasia (1885-86)
9
Wernicke and Connectionism
Kandel, Schwarz, and Jessel Wernicke proposed
(1876) that only the most basic mental functions,
those concerned with simple perceptual and motor
activities, are localized to single areas of the
cortex, and that more complex intellectual
functions result from interconnections between
several functional sites. In placing the
principle of localized function within a
connectionist framework, Wernicke appreciated
that different components of a single behavior
are processed in different regions of the brain.
He thus advanced the first evidence for the idea
of distributed processing, which is now central
to our understanding of brain function.
Essentials of Neural Science and Behavior
(199513)
10
Basic functions and complex functions
  • Phonological recognition is a basic function
  • It is located in Wernickes area
  • along with, perhaps, the area intermediate
    between primary auditory area and Ws area
  • Speaking is a complex function
  • It is a cooperative effort of several areas,
    including Brocas area and Wernickes area
  • Phonological recognition is a necessary component
    of speaking

11
Wernickes Area and Speaking
  • Phonological images guide speech production
  • Phonological recognition monitors production
  • Compare..
  • Painting without visual perception
  • Playing a piano without auditory perception
  • Conclusion Of course phonological recognition
    (i.e. Wernickes area) plays a role in speech
    production

12
Pulvermüllers Statement
patients with Wernickes aphasia have difficulty
speaking. These deficits are typicaland cannot
be easily explained by assuming a selective
lesion to a center devoted to language
comprehension. The Neuroscience of
Language (2002)
13
Paraphrasing Pulvermüller
patients with Wernickes aphasia have difficulty
speaking. These deficits are typicaland cannot
be easily explained by assuming a selective
lesion to a center devoted to language
comprehension. The Neuroscience of
Language (2002)
Altered quote patients with damage to the
occipital lobe have difficulty drawing pictures.
These deficits are typicaland cannot be easily
explained by assuming a selective lesion to a
center devoted to visual perception.
14
Aphasic Symptoms
  • Varieties of language deficits
  • Inferences from language deficits
  • Problems of interpretation

15
Some speech of a Broca aphasic
Examiner What brought you to the
hospital? Patient Yes ... Monday ... Dad, and
Dad ... hospital, and ... Wednesday, Wednesday,
nine o'clock and ... Thursday, ten o'clock ...
doctors, two, two ... doctors and ... teeth, yah.
And a doctor ... girl, and gums, and I (Patient
was trying to explain that his father had brought
him into the hospital on Wednesday to have some
work done on his teeth.)
16
Speech production a complex process
  • The motor realization of speech involves the
    smooth coordination of a number of separate
    neuromuscular systems
  • Sensory feedback and monitoring enter this
    process at many points
  • Coordination
  • Activity of different systems must be coordinated
  • Planning of neural activity has to precede
    low-level activation by varying amounts of time
  • Lead time from neural activity to muscle activity
    differs from system to system

(Goodglass, 62)
17
More, from a (different) Brocas apasic
"Me ... build-ing ... chairs, no, no cab-in-ets.
One, saw ... then, cutting wood ... working ..."
18
Attempt to describe cookie theft picture
(Brocas aphasic)
Cookie Okay the cookie jar and the kid is a
uh stool bump the skool skool uh
hurt and girl I dont know Goodglass
139
19
Agrammatism in Brocas aphasia
Examiner Can you tell me about why you came back
to the hospital? Patient Yes eh Monday eh
dad Peter Hogan and dad .. hospital. Er two
er doctors and er thirty minutes and
er yes hospital. And .. Er Wednesday
Wednesday. Nine oclock. And er Thursday, ten
oclock doctors two two doctors and
er teeth fine. E Not exactly your teeth
your g- P Gum gum E What did they do to
them? P And er doctor and girl and er .. And
er gum (Goodglass 105)
20
Some speech of a Wernicke aphasic
Examiners question Who lives at home with
you? Patient My wife, she goes her work to work
on it but her heffle is all about it. On
testing for comprehension of single words,
patient can point to only one of six objects that
are named for him. His attempts to write result
in a jargon similar to his speech. Goodglas
s 2
21
Another Wernicke aphasic
Attempt to describe a picture showing a young
woman standing with books in her arms, portrayed
in a farm scene with family members engaged in
farm labor Well, all I know is, somebody is
clipping the kreples and some wha, someone here
on the kureping arm why I dont know.
22
Examples of anomia
I gave him a Oh God! I know it! Why cant I say
it? I lost my I keep my money in it.
23
Some speech of a conduction aphasic
Patient I came into the hospital for some tecs
... Some secs tesk T E S tests.
Goodglass 73
24
Paraphasia
  • Verbal paraphasia
  • Use of one word instead of the intended one
  • Usually, same part of speech
  • Phonemic paraphasia
  • Unintended phonemes or sequences of phonemes
  • paker for paper, sisperos for rhinoceros
  • Neologistic paraphasia
  • tilto for table
  • See, my refkid is are bad. Oh, my cathopes noe
    too good. Well, my gupa wasnt too good. (85)

25
Examples from a picture-naming test
Patient Target Word Response Mr.
W. stethoscope telescope not right
(Broca) asparagus carrot no pinwheel kite
nozzle hose no Father L. seahorse mandarin
(Wernicke) globe atlas stethoscope octopus
no hourglass its a weather A
picture of an octopus had been presented
earlier in the test (Goodglass 78)
26
Phonemic paraphasia in a conduction aphasic
Target Word (picture) Response__________
Dart cart part chart Broom broo croo
broom Scroll scrip screl scrit
roll it up sholl scroll Bench fence
park bence bench Pinwheel pan .. P E A
peanwheel pinwill penwhale pinfin
no pinwheel (Goodglass 88)
27
Perisylvian Aphasic Syndromes
28
The most common perisylvian aphasiasin order of
frequency of occurrence
  1. Broca Aphasia
  2. Wernicke Aphasia
  3. Conduction Aphasia

29
Characteristics of Broca Aphasia
  • Non-fluent speech
  • Sparse verbal output
  • Poorly articulated
  • Consists of short phrases
  • Produced with effort
  • Mostly nouns and other content words
  • Deficiency or absence of inflectional affixes
  • Absent or deficient syntactic structure

30
Word classes in Broca aphasia
  • Mostly nouns
  • Some adjectives
  • A few verbs
  • Generally uninflected or in -ing form
  • Function words few or non-existent

31
Comprehension in Broca aphasia
  • Generally good
  • More or less impaired for syntactically complex
    sentences
  • Difficulty in comprehending the same words that
    are omitted in speech production
  • Also, difficulty with repetition of these words
  • Difficulty understanding relational words
  • E.g. bigger/smaller, up/down, within/without

32
Verbal short-term memory deficit(in Broca
aphasia)
  • Patients can readily point to individual objects
    or body parts named by the examiner
  • But when asked to point to the same items in a
    specific sequence they often fail at the level of
    only two or three items

Benson Ardila 124
How to explain?
33
Subtypes of Broca aphasia
  • Type I
  • A.k.a. little Broca aphasia
  • Milder defects
  • Less extensive damage
  • Better prognosis
  • Type II
  • Symptoms worse
  • More extensive damage
  • These are not distinct, but variations
  • Two spans along a scale

34
Conduction Aphasia
  • Originally postulated by Wernicke
  • Good comprehension
  • Poor repetition
  • Many phonemic paraphasias
  • Defective production
  • Many phonemic paraphasias
  • Different subtypes
  • Different areas of damage
  • 5 to 10 percent of all aphasias

35
Pronunciation deficits
  • Brocas aphasia
  • Correct phonemes, faulty articulation
  • The problem is more phonetic than phonemic
  • Conduction aphasia
  • Correct articulatory realization of phonemes
  • But incorrect phonemes
  • The problem is phonemic, not phonetic
  • I.e., phonemic paraphasia
  • (BA call it literal paraphasia)

How to explain?
36
Areas of damage in conduction aphasia
  • Different areas for different subtypes
  • Arcuate fasciculus
  • Left parietal lobe
  • Goldstein central aphasia
  • Probably the supramarginal gyrus (?)
  • Lower postcentral gyrus
  • Luria afferent motor aphasia
  • Insula
  • More than one of these areas can be damaged in
    individual cases

37
Coronal section, showing Sylvian fissure, insula,
etc.
38
end
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