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Neuropsychological analysis of a case of crossed aphasia: implications for reversed laterality.
We present a case of crossed aphasia and reversed laterality in a 60-year-old right-handed man. Neuropsychological assessment was conducted both prior, and three months subsequent, to the removal of a right temporal lobe tumor. Results, using the Luria-Nebraska Neuropsychological Battery, Wechsler Memory Scale and WAIS Block Design, plus various drawings from copy and to command revealed: (1) presurgery Luria profile very close to the mean profile for dominant temporal lobe dysfunction, (2) preserved visuospatial and visuoperceptive skills, (3) preserved limb praxis, and, (4) good postsurgery functional recovery. These findings are discussed in relation to literature on crossed aphasia and reversed laterality.
The double dissociation of short-term memory for lists and sentences. Evidence from aphasia.
We document the sentence and list repetition skills of 3 aphasic patients. Cases 1 and 2 were classified as span-impaired conduction aphasics and Case 3 was classified as a span-preserved transcortical sensory aphasic. We found that repetition by the span-impaired cases was facilitated by increasing the 'meaningfulness' of lists, whereas this had no effect on the performance of the span-preserved case. The patients' ability to repeat sentences was contrasted with their ability to repeat three words contained in the sentences, and a double dissociation was obtained: the span-impaired cases were better at repeating sentences than in repeating three word lists whereas the span-preserved case showed the opposite pattern of difficulty. The repetition of sentences containing a known and unknown vocabulary was tested in the span-preserved case. His repetition of sentences containing words which he still knew was significantly better than his ability to repeat sentences containing a vocabulary of words which he had 'forgotten' as a consequence of his aphasia. The patients' ability to repeat complete, incomplete, and nonsense sentences was contrasted: overall the span-impaired patients were somewhat better at repeating complete sentences than incomplete sentences. Finally we examined the patients' ability both to comprehend and repeat word strings in an abbreviated 'naming from description' task: the span-impaired patients were able to comprehend three word strings, but unable to repeat them, the span-preserved case was able to repeat but not comprehend. On the basis of these double dissociations we conclude that the evidence indicates two dissociable short-term memory systems, one a relatively passive phonological store subserving list repetition, the other a dynamic, anticipatory, and integrative memory system which underpins sentence repetition.
The validity of functional assessments of communication and the Activity/Participation components of the ICIDH-2: do they reflect what really happens in real-life?
UNLABELLED: This paper aims to provide a better understanding of the nature of functional communication activities so that assessment and treatment efforts are based on a theoretical framework and empirical data. Three sources of information are discussed. The first is the Activity/Participation dimensions of the World Health Organization's International Classification of Functioning, Disability, and Health. The second source is existing assessments of functional communication. The final source is data obtained from observational studies conducted in our research unit. The studies have observed the everyday communication of people with aphasia, people with Traumatic Brain Injury (TBI), and patients in hospital. The simplification of real-life communication in the WHO classification scheme, the variability of item sampling in existing assessments, and the complexity of communication observed in real-life settings has led to the conclusion that there are three levels of functional communication assessment: generic, population-specific, and individualized. Clinicians may choose which level suits their purpose. When clinicians routinely choose from a range of sophisticated functional assessments to inform their therapy, the seed that Martha Taylor Sarno planted and nourished for the past 30 years or more will truly flourish throughout the world of speech-language pathology. LEARNING OUTCOMES: As a result of this activity, participants will (1) understand the theoretical framework and data base that motivates assessment and treatment of functional communication activities, (2) be able to discuss the World Health Organization's Classification of Functioning, Disability and Health and (3) gain information about functional assessment and observational sampling of real world communication activities across three levels.
Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder.
OBJECTIVE: To provide an overview of the animal and human research literature on the link between fetal alcohol spectrum disorder (FASD) and attention-deficit hyperactivity disorder (ADHD). METHOD: We conducted a comprehensive literature review that addressed the history of, and current research on, fetal alcohol syndrome (FAS) and FASD, as well as that on ADHD in children. RESULTS: In animal and human research, there is emerging clinical, neuropsychological, and neurochemical evidence of a link between FASD and ADHD. CONCLUSIONS: The evidence of the link between these 2 conditions has implications for clinical management. The clinical quality of ADHD in children with FASD often differs from that of children without FASD. For children with FASD, ADHD is more likely to be the earlier-onset, inattention subtype, with comorbid developmental, psychiatric, and medical conditions. Children with FASD are commonly not mentally retarded but present complex learning disabilities, especially a mixed receptive-expressive language disorder with deficits in social cognition and communication (reminiscent of sensory aphasia and apraxia), working memory problems, and frequently, a mathematics disorder. Comorbid psychiatric conditions include anxiety, mood, conduct, or explosive disorders. As well, cardiac, renal, or skeletal problems are more likely to be present. Because these children have a disturbance in brain neurochemistry, or even brain structure (that is, in the corpus callosum), their response to standard psychostimulant medication can be quite unpredictable.
Case study of a Thai conduction aphasic.
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Prion protein codon 129 genotype prevalence is altered in primary progressive aphasia.
The prion protein (PrP) is central to the prion diseases, although a role in other neurodegenerative diseases has been postulated. A common polymorphism (Met or Val) at codon 129 of the PrP gene (PRNP) features prominently in the risk and phenotype, of prion disease, and an abnormality in its distribution frequency may signal a role for PrP in other diseases. We conducted a case-control study to compare the PRNP codon 129 genotype distribution in Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and primary progressive aphasia (PPA), including 281 AD, 256 ALS, 39 PPA, and 415 healthy control subjects. Statistical analysis was applied to determine the presence or absence of disease-specific genotype associations. The distribution of codon 129 genotypes was similar among healthy control, AD, and ALS subjects, although the heterozygous state was significantly overrepresented (age-adjusted odds ratio, 8.47) in PPA, a rare condition of unknown cause. Although these findings do not entirely exclude a role for PrP in AD or ALS, they do not support the codon 129 genotype as a risk factor for either disease. However, the strong association between heterozygosity and PPA raises new questions about its cause and the role of PrP in other neurodegenerative diseases.
Isotope localization of infarcts in aphasia.
Radionucleide localization of infarcts producing aphasia was undertaken in 65 patients with a scan-test and onset-test interval of one months or less. The scans were traced on anatomical templates without knowledge of the aphasias. A phasics were classified by their test scores according to taxonomic criteria, independently from localization. Scans belonging to each clinically distinct group were overlapped "blindly". The results showed distinct areas for Broca's conduction and Wernicke's aphasics along the parasylvian axis of the lateral templates. Lesions of global aphasics covered all these areas, while transcorticals were outside of them. Lesion size and severity of aphasia showed significant correlation. It is concluded that a brief systematic survey of aphasia like ours is useful in predicting the anteroposterior location and often the depth and extent of lesions.
Voice onset time in aphasia: Thai. II. Production.
The aim of this study was to investigate voice onset time (VOT) production in homorganic word-initial stops in Thai in order to explore the nature of speech production deficits across clinical varieties of aphasia. Thai exhibits a three-category distinction in bilabial (/b,p,ph/) and alveolar (/d,t,t,h/) stops, and a two-category distinction in velar (/k,kh/) stops. Subjects included three Broca asphasics, one transcortical motor asphasic, two global asphasics, one conduction aphasic, one Wernicke aphasic, one nonaphasic dysarthric patient, one right-brain-damaged patient, and five normal controls. Test stimuli consisted of eight monosyllabic real words. The results of VOT measurements indicated that Broca and global asphasics exhibited a more severe production disorder than Wernicke, conduction, or transcortical motor asphasics. The right-brain-damaged patient showed no impairment in VOT production. Comparisons are drawn to earlier studies of VOT production in aphasia in two-category languages. Issues concerning the underlying basis of the production deficit for nonfluent aphasics, fluent aphasics, and nonaphasic dysarthrics as well as the relation between perception and production of VOT are discussed.
[Early prediction of functional outcome one year after initial unilateral hemispheric stroke].
BACKGROUND AND PURPOSE: Several prognostic factors have been identified for outcome after stroke. We conducted a study to determine early predictive factors of functional outcome one year after stroke and to evaluate which factors are independent predictors, with an aim of specifying the role of age, aphasia, unilateral neglect, cognitive impairment and family social support. METHODS: Observational cohort study of 156 patients. All patients admitted to the university hospital for initial unilateral hemispheric stroke were included. The study duration was two years (inclusion, one year, and follow-up, one year) . The initial evaluation of stroke was conducted at day 2 and day 15 and included the Motricity Index and Trunk Control Test, New Functional Ambulation Classification, Frenchay arm test, Mini-Mental State Examination, Boston Diagnostic Aphasia Examination, unilateral neglect evaluation, and depression. Data on functional recovery (Barthel Index) were collected at day 360. RESULTS: The average age of patients was 72 years. Age was correlated to social situation (P<0.01) and previous neurological impairment (P<0.01). A multiple regression analysis, including 14 initial clinical factors correlated with the Barthel Index score at day 360, revealed 4 independent early predictive factors of outcome: initial score of Barthel Index at day 2 and its progression from day 2 to day 15, disorders of the executive functions and previous neurological impairment. CONCLUSION: In our cohort, in accordance with previous studies, age, cognitive impairment, unilateral neglect, aphasia, depression and social situation are not independent factors of poor outcome after stroke as evaluated by the Barthel Index.
[Diagnostic criteria for fronto-temporal lobe degeneration].
Circumscribed atrophy of the frontal and temporal lobes (frontotemporal lobar degeneration) accounts for about one fifth of cases of primary degenerative dementia occurring before the age of 65. It produces three prototypical clinical syndromes. The most common is frontotemporal dementia, characterized by personality change and profound alteration in social conduct and associated with bilateral atrophy of the frontal and anterior temporal lobes. Progressive non-fluent aphasia is characterized by difficulty in verbal expression, anomia and phonemic errors in the presence of relative preservation of comprehension and associated with atrophy predominantly of the left hemisphere. In semantic dementia there is fluent speech with semantic errors and severely impaired comprehension and naming, together with a visual associative agnosia, resulting from bilateral atrophy of the inferior and middle temporal gyri. The clinical syndromes occur with either of two main histological types: prominent microvacuolar change, without specific histological features (frontal lobe degeneration-type), severe astrocytic gliosis with or without ballooned cells and inclusion bodies (Pick-type). To improve clinical recognition and advance understanding of this relatively common form of cerebral degeneration, members of an international workshop on Frontotemporal Lobar Degeneration developed consensus criteria, building upon earlier published clinical diagnostic guidelines for frontotemporal dementia. The consensus criteria reported here specify core and supportive features for each of the prototypical clinical syndromes: frontotemporal dementia, progressive aphasia and semantic dementia, as well as providing broad inclusion and exclusion criteria for the generic entity of frontotemporal lobar degeneration.
[Left unilateral apraxia].
A 32-year-old right-handed man suffered a traffic accident with head injury, resulting in loss of spontaneity, right hemiparesis, severe aphasia, and unilateral apraxia, which was noticed on his non-paralyzed left hand. An MRI scan conducted 11 months after onset revealed a large lesion in the left frontal lobe, a small lesion in the right frontal lobe and a striking thinning of the trunk of the corpus callosum with remarkable dilatation of the lateral ventricles. An IMP-SPECT scan, performed 1 year after onset, showed a diffuse hypoperfusion extending to the left temporo-parietal area further than the MRI verified abnormal density areas. The patient's praxic abilities were precisely evaluated 1 year after onset. The performance on the object use task was characterized by content errors. For example, when using a match with his left hand, he always treated with it like a cigarette. The right hand performance of this task was clumsy due to his right hemiparesis but successful. The performance on his left hand did not improved even when the patient was given visual examples. The term "ideational apraxia" proposed by Liepmann, which was characterized by content errors, implies a conceptual deficit. Morlaas defined ideational apraxia as a agnosia of usage. Ideational apraxia has been so far investigated mainly on patients with these difficulties in both hands. On the other hand, left unilateral apraxia has been explained by callosal disconnection. Liepmann and Maas thought that a lesion of the corpus callosum would prevent the space-time engrams in the left hemisphere from reaching the right sensorimotor area necessary to carry out the skilled act with the left hand, thereby inducing apraxia.(ABSTRACT TRUNCATED AT 250 WORDS)
A real-time approach to spoken language processing in aphasia.
The study is based on an on-line investigation of spoken language comprehension processes in 25 French-speaking aphasics using a syllable-monitoring task. Nonsense syllables were presented in three different conditions: context-free (embedded in strings of nonsense syllables), lexical context (where the target nonsense syllable is the initial, medial, or final syllable of real three-syllable words), and sentence context. This study builds on an earlier one that explored the relationship between the acoustic-phonetic, lexical, and sentential levels of spoken language processing in French-speaking normals and gave evidence of top-down lexical and sentential influence on syllable recognition. In the present study, aphasic patients from various diagnostic categories were classified as high (N = 13) or low (N = 12) comprehenders. The results show that low comprehending aphasics make no use of sentence information in the syllable-recognition task. As for top-down effect at the single word level that is observed in normal listeners. However, a subgroup analysis shows that the Broca's are the only high comprehending aphasics who perform in the same way as normal listeners; this sets them apart from the anomics and conduction aphasics.
[Clinical characteristics and long-term prognosis of Landau-Kleffner syndrome].
OBJECTIVE: To investigate the clinical and electroencephalographic (EEG) characteristics, therapeutic response and long-term prognosis of Landau Kleffner syndrome (LKS). METHODS: The clinical and EEG data of 10 children with LKS were analyzed, and therapeutic response and long-term outcome were followed up. RESULTS: The age of onset was from 2 to 10.5 years of age. All patients had acquired aphasia, characterized by verbal auditory agnosia. All patients had epileptic seizures. Partial motor seizures during sleep occurred in 8 patients, and other seizure type including atypical absence seizure and generalized tonic-clonic seizure were also observed. Psychological and behavioral abnormalities occurred in 9 patients. There were no abnormalities of hearing and neuro-imaging tests in all patients, and family histories were negative. All the patients had EEG abnormalities. Focal spike and waves of temporal lobe were recorded in 9 patients. Electrical status epilepticus during sleep (ESES) was observed on Video-EEG (VEEG) monitoring in 4 patients. Anti-epileptic drugs (AEDs) showed favorable effects on epileptic seizures, but no effects on aphasia. All patients responded to corticosteroid, and got language improved. Eight patients were followed up for long-term outcome. All patients were seizure free, while the level of language development was abnormal in 5 patients. The VEEG follow-up was conducted in 6 patients. Continuous epileptic discharges in slow sleep recurred in 2 patients after the discontinuation of steroid therapy. CONCLUSIONS: LKS is one of the childhood epileptic encephalopathy, and acquired aphasia and epileptic seizures are two main clinical characteristics. Aphasia is characterized by verbal auditory agnosia. Psychological and behavioral abnormalities are very common in children with LKS. Focal epileptic discharges were often located in temporal area, and usually generalized, and could be continuous during sleep. AEDs could control seizure but had no effects on aphasia. Early use of full dose corticosteroids could improve the language significantly. Long-term follow up showed that language impairments often remained, but the outcome in terms of EEG and epileptic seizure was good.
The effects of grammatic class and cue type on cueing responsiveness in aphasia.
This study investigated the effects of two types of cues (semantic and phonemic) and two grammatic classes (noun and verb) on cueing responsiveness. Subjects consisted of 10 Broca's, 10 Wernicke's, 8 conduction, and 8 anomic aphasics. Cues were administered following failure to name on confrontation. Responsiveness to the two types of cues was dependent on aphasic type and grammatic class. Broca's and conduction aphasics responded better to phonemic cueing, while anomic aphasics were more responsive to semantic cueing. With regard to grammatic class, aphasics responded better to phonemic cueing on nouns; however, no significant difference between types of cues was demonstrated on verbs. Neuropsychological implications for the cueing and naming processes are discussed.
Crossed aphasia: analysis of a case with special reference to the nature of the lesion.
We report a case of crossed aphasia in a strongly right-handed woman due to a parieto-occipital tumor in the right hemisphere, documented by CT and MR images. Neuropsychological assessment was conducted on four different occasions: results revealed an uncommon feature in our case, because of the nature of the lesion and the evolution of the clinical picture. These findings are discussed in relation to the literature.
Syntactic processing deficits in aphasia.
Four aphasic patients were tested in several tasks to determine their ability to use syntactic information. Two patients classified as Broca's aphasics and presenting markedly different levels of severity of aphasia were deficient in their ability to use syntactic information in sentence comprehension and construction. It is argued that the syndrome of Broca's aphasia undermines patients' ability to perform the syntactic analyses that are necessary to understand and to produce sentences in both language modalities. A third patient was a conduction aphasic who presented a pattern of sentence comprehension similar to the Broca patient, but produced no other evidence of syntactic impairment. The argument is advanced that the conduction patient's apparently selective impairment of syntactic processing in comprehension is actually a reflection of a severe auditory-verbal short-term memory deficit. The fourth patient was classified as a mildly-impaired Wernicke's aphasic, who presented no evidence of a selective disturbance of syntactic processing abilities. These results are interpreted as support for the hypothesis that the syndrome of Broca's aphasia results from an impairment to the syntactic component of the language processing system.
[Depression, nonverbal intellectual impairment and quality of life following left-brain ischemic insult--results of a catamnestic study].
The purpose of the present study was to establish the relationship between persisting aphasia and the extent of overall disability in the long-term outcome following left hemisphere ischaemic stroke. 55 right-handed patients who had sustained an initial left-sided cerebral infarction, verified by CT scan, were investigated after a mean observation period of six years. 39 patients were categorized as being non-aphasic, and 16 as being aphasic (3 Global, 6 Broca's, 1 conduction, 1 transcortical motor and 5 anomic aphasics) at the end of the follow-up period. Regarding motor and sensory functions, a correlation between the presence of aphasia and the severity of deficits could be established at the end of the follow-up period. With respect to activities of daily living, a significantly larger number of aphasic stroke victims had to rely on help by others. Furthermore, the persistence of aphasia also negatively influenced the subsequent occupational capacity. With regard to social participation and leisure activities, a significant reduction was found in aphasic long-term stroke survivors as compared to non-aphasics. Concerning quality of life, both groups reported a marked decline at the end of the observation period; the presence of aphasia had an additional negative effect. However, as regards the long-term non-verbal cognitive impairment, statistical analysis revealed no significant differences between both groups. In addition, aphasic stroke survivors did not demonstrate a higher incidence of depressive states than those without language deficit. On the basis of our results it is concluded that the presence of aphasia in left-hemispheric ischaemic stroke survivors indicates a more severe stroke, resulting in greater physical disability and social handicap in the long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)