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PubMed1994

Pharmacotherapy of aphasia. A critical review.

BACKGROUND: Communication problems are a common sequela of cerebrovascular disease and other central nervous system disorders. Behavioral treatment of these disorders aims to harness uninjured parts of the brain to improve the communicative life of the individual. While pharmacotherapy has held promise for the treatment of aphasia for over 50 years, it has not fulfilled this promise. This article reviews both the promise and the disappointment of aphasia pharmacotherapy. SUMMARY OF REVIEW: Diverse theories of the underlying neurological deficits in aphasia have led to different pharmacologic rationales for therapy. Animal studies have demonstrated decreased levels of brain catecholamines after cortical stroke and more rapid stroke recovery with therapy aimed at augmenting brain norepinephrine and dopamine. These studies have led to recent attempts to hasten or extend language and sensorimotor rehabilitation after human stroke by administration of catecholaminergic drugs. When used as an adjunct to behavioral therapy, such pharmacotherapy appears to have benefit. CONCLUSIONS: While drug therapy is unlikely to revolutionize the treatment of aphasia, it nonetheless holds promise as an adjunct to behavioral speech and language therapy to decrease performance variability and consequently to improve mean performance in patients with mild to moderate language dysfunction. Additional studies with carefully designed methods are necessary to assess the full potential of aphasia pharmacotherapy.

Animals↗
PubMed1994

Cerebral blood flow in subcortical global aphasia. Perisylvian cortical hypoperfusion as a crucial role.

BACKGROUND AND PURPOSE: Global aphasia after subcortical stroke is very rare, and its pathophysiology remains unsolved. To clarify the mechanism underlying subcortical global aphasia, we investigated lesion sites and cerebral blood flow in patients with subcortical global aphasia and nonaphasic patients with subcortical stroke. METHODS: We examined four patients with global aphasia and four nonaphasic patients. Language testing was performed more than 4 weeks after the onset. Measurement of cerebral blood flow was done between 35 and 75 days after stroke by using single-photon emission computed tomography (SPECT) with N-isopropyl-p[123I]iodoamphetamine as a tracer and three-dimensional surface display generated from SPECT. RESULTS: All aphasic patients had subcortical lesions in the putamen, posterior internal capsule, temporal isthmus, and periventricular white matter in the left hemisphere. No cortical lesions were found on either magnetic resonance imaging or computed tomographic scanning. The nonaphasic patients had smaller periventricular white matter lesions and no temporal isthmus lesions. All aphasic patients showed cortical hypoperfusion mainly in the perisylvian areas, including Broca's and Wernicke's areas. In contrast, cortical cerebral blood flow of the nonaphasic patients was decreased in smaller areas and spared the perisylvian language areas. CONCLUSIONS: These results suggest that cortical hypoperfusion in the perisylvian language areas, presumably due to undercutting of the white matter, is crucial for the development of subcortical global aphasia.

Aged↗
PubMed2002

Aphasia following left putaminal hemorrhage. Statistical analysis of factors affecting prognosis.

Multivariate and single variable analyses were employed to investigate the recovery mode of aphasia in right-handed patients with putaminal hemorrhage on the left side. Speech disturbance was evaluated using the standard language test for aphasia (SLTA) at intervals of 1, 3 and 6 months after the ictus. Recovery was assessed in relation to age, gender, volume and location of hematoma, and treatment modalities. Extension of the hematoma into the corona radiata was the factor that dominated the prognosis of aphasia at all intervals during the follow-up period. Good recovery was documented in patients with less than 2 cm2 of the hematoma volume located in the corona radiata. Recovery was poor, however, in patients with more than 12 cm2 of the hematoma in the corona radiata. While aphasia continued to improve over 6 months after the ictus, recovery was more prominent in the first 3 months. Our study precisely demonstrated that the extension into the corona radiata independently and strongly influenced the outcome of aphasia in patients with left putaminal hemorrhage.

Aphasia↗
PubMed2004

Acute aphasia in multiple sclerosis: A multicenter study of 22 patients.

Aphasia is usually considered to be rare in multiple sclerosis (MS). To determine the clinical and radiologic characteristics of MS patients with acute aphasia, the authors investigated data from 2,700 patients from three MS centers and found 22 patients with acute aphasia (0.81%). Aphasia was the first clinical manifestation of MS in eight patients (36%). Brain MRI showed giant plaques in eight cases (40%). A full recovery was observed in 14 patients (64%). Furthermore, acute aphasia did not appear to be a criterion for poor prognosis.

Acute Disease↗
PubMed1980

Left medial parietal lobe and receptive language functions: mixed transcortical aphasia after left anterior cerebral artery infarction.

Three aphasic patients with infarctions involving the left anterior cerebral artery have been studied. Two had trancortical motor aphasia, and one had mixed transcortical (or isolation) aphasia. Based on computerized tomography in two patients and whole-brain sections in one, the patient with mixed transcortical aphasia had a lesion that went beyond the rolandic fissure to involve the anterior precuneus lobule of the left medial parietal lobe. In the patients with transcortical motor aphasia, the lesion was confined to the frontal lobe. From these cases and other data, it seems likely that the left medial parietal lobe has receptive language functions analogous to the motor language functions of the left medial frontal lobe, thus accounting for the mixed transcortical aphasia observed in the patient whose left anterior cerebral artery infarction involved both the medial parietal and medial frontal lobes.

Aged↗
PubMed2001

The public awareness of aphasia: an international survey.

We surveyed 929 shoppers in Exeter (England), Louisiana (USA) and Sydney (Australia) to determine what they knew of aphasia. Between 10% and 18% said they had heard of aphasia but only between 1.5% and 7.6% had even some basic knowledge of aphasia. We found that more females knew something about aphasia than males and that older people were more likely to have heard of it, although those with some knowledge were significantly younger. Informants had heard of aphasia mainly through their work or the media and were mainly professionals like teachers, nurses, therapists, managers and administrators, followed by a retired/student group. We found some differences in awareness levels in the different locations we sampled. Results have implications for targeting awareness raising and campaigning.

Adolescent↗
PubMed1990

[Course of recovery from motor aphasia in four patients with localized lesions in the vicinity of Broca's area].

The neuropsychological signs and prognosis of patients with localized lesions in the vicinity of Broca's area of the left inferior frontal gyrus have been controversial. We studied periodic changes in the neuropsychological signs of four patients who had relatively localized lesions in the vicinity of Broca's area and manifested aphasia of the non-fluent type. The ages of the four patients at the onset were 62, 66, 30 and 37 years. The localized lesions in their brains were the result of brain infarctions revealed by CT scans, and included so-called Broca's center in the left inferior frontal gyrus along with adjacent brain tissue. The neuropsychological signs of the four patients were periodically assessed by means of the standard language test of aphasia (SLTA). In the early stage of aphasia, they had moderate difficulties in speaking to explain test materials or recall words and mild difficulties in reading aloud, repeating and writing words. One year later, most of their neuropsychological signs disappeared except for mild difficulties in speaking fluently and recalling words. It should be noted, however, that all four patients were able to return to their previous occupations one or two years later, because they had recovered from aphasia. Based on the results of this study, we conclude that the neuropsychological signs of Broca's aphasia caused by relatively localized lesions in the left inferior frontal gyrus are mild and largely disappear within one or two years.

Adult↗
PubMedDate not supplied

[A case of Foix-Chavany-Marie syndrome and crossed aphasia after right corona radiata infarction with history of left hemispheric infarction].

Foix-Chavany-Marie syndrome (FCMS) is a syndrome that presents facio-pharyngo-glosso-masticatory diplegia with automatic voluntary dissociation. Its most common etiology is stroke in the regions of bilateral opercula. We described a 75-year-old woman with FCMS and crossed aphasia. She had cerebral infarction of left middle cerebral artery territory 23 years before. At that time she had transient right hemiparesis, but no aphasia. This time, she suddenly became mute and was brought to our hospital. Neurological examination revealed severe weakness in her bilateral lower face, pharynx, tongue, and sternocleidomastoideus. She had no weakness of limbs. Her listening comprehension was moderately disturbed and handwriting was paragraphic. Her emotional facial movement was maintained despite of disturbed volitional facial movement. CT scan disclosed fresh infarction at the right corona radiata and old infarction at the left middle cerebral artery territory. In this patient, lesions at the left operculum and right corona radiata with the preserved right operculum gave rise to FCMS. This implies following possibilities: 1) the corticobulbar tract and corticospinal tract run separately at the corona radiata, 2) volitional and emotional tracts of facial movement run separately at the corona radiata. It was demonstrated that FCMS is not always caused by bilateral operculum lesions. Our patient did not show aphasia after the first stroke including left language area, but became severely aphasic after the right corona radiata infarction. Simultaneous occurrence of FCMS and aphasia after corona radiata lesion suggested that the corticobulbar tract and a tract that conducts linguistic information are running adjacently in the corona radiata. Our case suggested that restricted corona radiata lesion may cause severe subcortical aphasia and in case of additional contralateral corticobulbar tract lesion, severe dysarthria may occur.

Aged↗
PubMed2000

[A case of motor neuron disease with dementia, presenting motor aphasia as an initial symptom].

We report a case of motor neuron disease (MND) with dementia, presenting motor aphasia as an initial symptom. A 67-year-old man was admitted to our hospital because of speech disturbance slowly progressing for 2 years. On physical examination, he showed no neurological abnormalities except for non-fluent aphasia and increased deep tendon reflexes without laterality. MRI demonstrated bilateral fronto-temporal atrophy, dominating the left hemisphere. This finding was confirmed by surface anatomy scanning (SAS), showing an obvious atrophy in the left inferior frontal gyrus, compared with the right one. SPECT with 123I-IMP revealed some irregular defects in the bilateral frontotemporal region. Because he showed dementia, bulbar palsy with tongue atrophy, weakness of upper extremities and facial muscles, snout reflex, and the atrophy and fasciculation in limbs in addition to motor aphasia soon after the discharge from our hospital, he was diagnosed as having MND with dementia. At age 68, he died of a respiratory failure 3 years after the onset of the disease. MND with dementia seldom shows motor aphasia as an initial symptom. We must include, however, the MND with dementia as an differential diagnosis when we see the patients with progressive aphasia.

Aged↗
PubMedDate not supplied

[Crossed aphasia: description of a case].

We describe a new case of crossed aphasia in a right-handed patient with a right hemispheric lesion. A right-handed man, 76 year-old, developed a sudden left hemiparesis with sensitive impairment and mutism. He has neither family history of left handeness or ambidexterity or vascular risk factors. CT cerebral scan showed a large infarct of the middle cerebral artery on the right side, with haemorrhagic suffusion. Cerebral MRI and EEG-cartography confirmed the indemnity of the left hemisphere. Aphasia studies confirmed a mutism with spared verbal comprehension, but alexia was present. A year later, left hemiparesis was recovered but aphasia remained. Crossed aphasia is rarely seen. It is caused by a right hemispheric lesion in right-handed subjects. Fluency is most commonly impaired. At onset, mutism is the common symptom, which evolves to expressive aphasia. Several hypothesis have been raised about the possible mechanisms involved. The few number of PET or SPECT studies performed in these patients have disclosed extensive areas of hypometabolism in the right hemisphere, that exceed the size of the image observed with CT scan or MRI.

Aged↗
PubMed2003

[Mixed aphasia with jargonographia in a right-handed patient].

We report a case of crossed aphasia with jargonagraphia in a forty-eight year old right handed monolingual man without family history of handedness or prior neurological illness. He developed a right temporo-insulo-parietal hamatomae documented by CT scan and accompanied by aphasia, left hemineglect, left hemiplegia, left lateral homonymous hemianopsia. The oral language was reduced and writing language was characterised by jargon. The writing and oral comprehension were preserved. This aphasia suggested a relationship between cerebral lateralization of language function and manual preference and the similarity between childhood aphasia and crossed aphasia in right-handed patients.

Aphasia↗
PubMed2004

[Symptomatology of aphasia].

Recently, some standard test batteries such as Boston Diagnostic Aphasia Examination and Western Aphasia Battery are frequently used to assess language abnormalities and to identify individual types of aphasia. Aphasia is, however, a neurologic disorder and differential diagnosis of the type should be made naturally in the neurological examination. Characteristics of verbal output are most important clinically for the classification. The table shows core symptoms of classical aphasic types. The figure presents a systematic approach to aphasia diagnosis based on several different patterns of aphasic output.

Aphasia↗
PubMed2004

Word learning can be achieved without feedback: implications for aphasia therapy.

PURPOSE: Children acquire new words through exposure, without the necessity for explicit feedback by caregivers. In aphasia therapy, feedback to the patient is considered an important asset even though the empirical base demonstrating superior learning with online feedback is lacking. The present study examined if healthy adults and patients with chronic aphasia can acquire a new lexicon by intense frequency of exposure alone. METHODS: We compared learning rates with "frequency of exposure alone" (no-feedback condition: n=19 healthy adults; two patients with chronic Broca's and Wernicke's aphasia, respectively) with a condition where subjects additionally received online feedback (feedback condition; n=19). The learning principle was higher statistical co-occurrences of "correct" picture-pseudoword pairings as compared to "incorrect" pairings. In the feedback condition, immediate online feedback on the correctness of respective choices was additionally provided. RESULTS: Both healthy groups successfully acquired the vocabulary. Feedback led to a slight initial acceleration of learning but did not improve latency to peak performance or long-term retention of lexical knowledge. These findings show that high frequency interactive exposure is a potent word learning mechanism in adults and that feedback is not crucial. This is further corroborated by our successful training of two patients with chronic aphasia without online feedback. CONCLUSIONS: Our findings demonstrate that word re-learning in aphasia could benefit from maximizing on the frequency of exposure and exploiting the therapeutic principle of "massed practice", which has been successful in physical rehabilitation after stroke. Additionally, economizing on feedback may prevent patients becoming discouraged by continuous confrontation with their deficits.

Adult↗
PubMed2006

Aphasia awareness among the Honolulu Chinese population.

Chinese residents of Hawai'i were surveyed regarding their knowledge about aphasia. Only 14 of 85 respondents had heard the term aphasia, and only three were able to provide acceptable suggestions for facilitating communication with people who have aphasia. These findings highlight the need for community education about aphasia to facilitate community re-entry for Chinese survivors of stroke and aphasia.

Aphasia↗
PubMed1991

Analysis of auditory comprehension performance in individuals with severe aphasia.

This research compared the performance of 20 individuals with global and mixed nonfluent aphasia across the four auditory comprehension subtests of the Boston Diagnostic Aphasia Examination (Word Discrimination, Body Part Identification, Commands, and Complex Ideational Material) and across the six subcomponents of the Word Discrimination Subtest (objects, actions, letters, colors, forms, and numbers). As expected, group means revealed severely reduced performance which was equally observable across all auditory comprehension tasks. To determine whether individual subjects demonstrated a pattern of consistently reduced performance for auditory comprehension tasks, z-scores and chi-square statistics were also calculated for each subject and task. The individuals with global aphasia demonstrated a greater number of statistically significant z-scores than was expected by chance. This was not true for the subjects with mixed nonfluent aphasia. Results of this research indicate that although as a group individuals with global aphasia may demonstrate consistently reduced auditory comprehension, when considered on an individual basis, this group may comprise a somewhat divergent population with respect to the configuration of preserved and impaired auditory comprehension skills.

Adult↗
PubMed1991

[Two cases of cerebral embolism showing global aphasia without hemiparesis].

We report two cases of typical global aphasia without hemiparesis due to cerebral embolism. Case 1 was a 65-year-old right-handed man with a history of old myocardial infarction. No spontaneous speech was noted by his family. Neurological examination upon admission revealed confusional state, global aphasia, conjugate deviation to the left and slight drift of the outstretched right limbs. The right hemiparesis rapidly recovered after admission. CT scan performed on the second hospital day showed discrete low density areas in the left posterior frontal lobe and left temporo-parietal regions. The extent and severity of his global aphasia were unchanged. The second case was an 82-year-old right-handed man with a history of atrial fibrillation. He was admitted to our hospital one hour after he was found unable to speak. Neurological examination upon admission revealed global aphasia, conjugate deviation to the left and suspected right homonymous hemianopia by confrontation. There was no sign of hemiparesis. CT scan showed extensive low density area in the left temporo-parietal regions. In both cases, cerebral angiography failed to demonstrate any occlusion of intra- and extra-cranial blood vessels. IMP-SPECT showed a depression of cerebral blood flow in the left anterior and posterior watershed areas in case 1 and 2. In the literature, there have been 20 cases of global aphasia without hemiparesis including our two cases. In many cases, the initial symptom was inability or difficulty in speaking.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Aphasia associated with verified subcortical lesions: three case reports.

Aphasia classically has been described as an acquired impairment of language behavior subsequent to cortical brain injury to the dominant hemisphere. Traditionally, lesions in the internal capsule have been described as resulting in pure motor deficits, which may be accompanied by dysarthria without aphasia. Only recently has the literature suggested that lesions in the putamen and internal capsule may result in aphasia. We describe three clinical cases in which aphasia resulted from left subcortical lesions. The lesions were demonstrated using computed tomographic (CT) scan; language deficits were measured objectively using the Porch Index of Communicative Ability (PICA). Two of the three patients experienced excellent recovery of language skills, suggesting that subcortical lesions may have a more favorable prognosis in recovery from aphasia than do cortical lesions. The encouraging recovery may be related to fiber pathway disruption rather than cortical destruction.

Adult↗
PubMed1986

[A case of jargon aphasia--a clinicopathological study].

An autopsied case of jargon aphasia by multiple cerebral infarction was reported. A 75-year-old right-handed woman developed a Wernicke's aphasia with the first attack of cerebral infarction in the left hemisphere in July 1980. With the second attack of infarction in October 1980, she developed a neologistic and semantic jargon aphasia, in which her speech consisted of neologisms, literal paraphasias, empty phrases and so-called "misused words". CT-findings showed two low density areas; one was in the left hemisphere and the other in the posterior region of the right hemisphere. Her jargon aphasia persisted for about one year. In November 1981, she suffered a third attack of infarction and developed an apallic syndrome. Neuropathological examination confirmed that the lesion of the right hemisphere played a decisive role in the outbreak of jargon aphasia in this case.

Aged↗