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PubMed1992

The usefulness of the Western Aphasia Battery for differential diagnosis of Alzheimer dementia and focal stroke syndromes: preliminary evidence.

We assessed the usefulness of the Western Aphasia Battery for distinguishing the language disturbances caused by Alzheimer dementia (AD) from those caused by stroke. Using discriminant function analyses, the multiple variable "aphasia quotient--reading quotient--writing quotient" classified 29 (72.5%) of the 40 patients correctly. These 29 patients included 8 of 10 patients with left hemisphere infarction and fluent aphasia; 6 of 10 with AD; 5 of 10 patients with right hemisphere infarction; and all 10 of the neurologically normal control subjects. The patients with AD and those with right hemisphere stroke were the most difficult to classify using the aphasia battery.

Alzheimer Disease↗
PubMedDate not supplied

Evolution of phonemic word fluency performance in post-stroke aphasia.

UNLABELLED: In this longitudinal study, quantitative and qualitative changes in responses of people with aphasia were examined on a phonemic fluency task. Eighteen patients were tested at 3-month intervals on the letters F-A-S while they received comprehensive, intensive treatment from 3 to 12 months post-stroke. They returned for a follow-up evaluation at an average of 10 months post-intervention. Mean group scores improved significantly from beginning to end of treatment, but declined post-intervention. Patients produced a significantly greater number and proportion of modifiers (adjectives and adverbs) between the beginning and end of treatment, with no decline afterwards, implying that they had access to a wider range of grammatical categories over time. Moreover, patients used significantly more phonemic clusters in generating word lists by the end of treatment. These gains may be attributed to the combined effects of time since onset and the linguistic and cognitive stimulation that patients received in therapy. LEARNING OUTCOMES: Readers of this paper should (1) gain a better understanding of verbal fluency performance in the assessment of aphasia, (2) recognize the importance of analyzing qualitative aspects of single word production in aphasia, and (3) contribute to their clinical judgment of long term improvement in aphasia.

Aged↗
PubMed1980

Factors influencing type and severity of aphasia.

The influence of etiology and sex on aphasia type and the relation of age to the severity and type of language disorders have been assessed in 718 right-handed aphasic patients. Both trauma and neoplasia are associated with fluent aphasia significantly more often, while sex proved to have no influence on aphasia type. The frequency distribution of age according to type and severity of aphasia - studied in vascular patients only (N = 566) - demonstrated that fluency and severity are significantly associated with older age.

Age Factors↗
PubMed1981

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.

Adult↗
PubMed1982

Schizophrenia and semantic aphasia: a clinical comparison.

In recent years, there has been an emerging body of evidence which suggests that some types of schizophrenia may have a neurologic pathogenesis. This paper is addressed to the exploration of cortical mechanisms in schizophrenia by comparing the language disturbances of chronic schizophrenia with those of semantic aphasia. While there is little commonality between schizophrenic word-salad and jargon aphasia, there are similarities between schizophrenic agrammatism and semantic aphasia in terms of impressive and expressive grammar and in the manifestation of paraphasia and paralogia. It is concluded that while no cortical lesions are likely in schizophrenia, there may be a neurologic arousal/attention abnormality which impairs cortical efficiency, giving rise to a language disturbance symptomatically similar to, but pathogenically different from semantic aphasia.

Aphasia↗
PubMedDate not supplied

[Crossed aphasia in right handed patients].

The very rare aphasia following damage to the right cerebral hemisphere in right-handed subjects is described, with a survey of the views on this problem and presentation of two cases of this so-called crossed aphasia in right-handed subjects. On one of these cases the lesion was cortico-subcortical in a part of the frontal lobe, temporal lobe and a part of the occipital lobe, with sparing of the deep structures of the right hemisphere and with clinical pattern resembling that of Broca aphasia. In the second case the lesion involved the subcortical and deep structures with destruction of the lentiform nucleus, anterior part of the internal capsule and part of the head of the caudate nucleus, and the clinical pattern resembled that of Wernicke aphasia.

Aged↗
PubMed1982

[Broca's area and Broca's aphasia: based on the observations of two cases with the lesions involving Broca's area].

Recently, the relation between Broca's area and Broca's aphasia has come into notice again. We investigated two right-handed patients without Broca's aphasia in spite of the presence of lesions involving Broca's area after hemorrhagic infarction. In addition, the clinical findings, the clinical courses and the sites of lesions of two cases were quite similar as follows. They showed no motor deficits and no other abnormal neurological findings from the beginning of the strokes. From the near muteness in the initial stage, speech began to improve gradually. And then, they demonstrated so called transcortical motor aphasia. Namely, repetition and reading aloud were excellent and articulations were normal without phonetic disintegration and dysprosody in contrast to the sparse and limited spontaneous speech. Comprehension was well preserved. Anomia was present and the ability to generate word lists was so poor that, for instance, only two animal names were listed in one minute. Mild to moderate agraphia was present. Agrammatism and buccofacial apraxia were not associated. Afterwards, the two patients showed rapid amelioration. About one month later after the stroke, only a slight difficulty in word finding and mild agraphia remained. In both cases, the lesions confined predominantly to the cortical and subcortical areas in the left posterior part of both the third and the second frontal gyri were confirmed by computerized tomography. According to the evidence from our two cases and to the literature, it may be concluded that the lesion restricted to the posterior part of the third and second frontal gyri in the dominant hemisphere produces a subtype of transcortical motor aphasia and that the lesion restricted to the posterior part of the third frontal gyrus (Broca's area) does not lead to phonetic disintegration.

Aged↗
PubMed1977

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.

Aphasia↗
PubMed1978

Regional cerebral blood flow in aphasia.

Regional cerebral blood flow (rCBF) was studied in 13 aphasic patients with left hemisphere lesions, using the intracarotid xenon 133 injection method and a 254-detector gamma camera system. The rCBF was measured during rest and during various function tests, including a simple speech test. In motor (nonfluent) aphasia, the rCBF method showed areas of cortical dysfunction that always included the lower part of the rolandic area while Broca's area was not consistently affected. In sensory (fluent) aphasia, the superior-posterior temporal cortex was involved in all cases. In global aphasia, the abnormalities included both regions consistently involved in the other types of aphasia. The 133Xe injection method for mapping abnormalities relevant for localizing the cortical speech areas was superior to the classical neuroradiological methods in that several cases failed to show any relevant lesion whatsoever. This is probably related to the functional nature of the rCBF method: subnormal flow values and lack of the normal flow increase during function tests apparently may disclose functionally inactivated but structurally intact cortex.

Aged↗
PubMed1982

Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule.

Atypical aphasia syndromes were associated with circumscribed nonhemorrhagic infarctions of the anterior limb of the internal capsule and of the striatum, in the dominant hemisphere. None of the several cases could be classified in terms of the classic cortical aphasia syndromes, nor did they correspond to the description of aphasia produced by hemorrhage in the thalamus or putamen. Control subjects without aphasia had lesions in the same structures of the nondominant hemisphere, or they had comparably circumscribed damage, which was located lateral or caudal to the previously indicated locus. The findings raise the question of participation of the dominant striatum, and of the connectional systems that course in the anterior limb of the internal capsule, in language processing.

Adult↗
PubMed1982

Conduction aphasia, syntactic alexia, and the anatomy of syntactic comprehension.

Syntactic alexia is the inability to comprehend graphically presented sentences when the meaning depends on syntax. Although previously described in association with Broca's aphasia and attributed solely to the frontal lobe portion of the lesions, syntactic alexia has not been reported to accompany conduction aphasia. We studied three patients who had conduction aphasia from temporoparietal lesions and syntactic alexia. None of them had lesions in Broca's area. Broca's aphasics and our patients with conduction aphasia have a syntactic comprehension disturbance. Since Broca's aphasics and our patients have lesions that may extend into the supramarginal gyrus, we postulate that this area may be critical for comprehending syntax.

Aphasia↗
PubMed1983

Aphasia in subdural hematoma.

The occurrence of aphasia as the only or dominant symptom of subdural hematoma (SDH) has not been emphasized in the literature. The possible confusion of traumatic aphasia with transient ischemic attacks or stroke has been the object of most recent investigations. Four patients with subacute SDH had aphasia as an initial symptom; the relevant pathophysiologic characteristics were noted in each. These patients had a rapid response to decompression with marked resolution of the aphasia irrespective of immediate or delayed drainage.

Aged↗
PubMed1990

Temporoparietal cortex in aphasia. Evidence from positron emission tomography.

Forty-four aphasic patients were examined with (F18)-fluorodeoxyglucose positron emission tomography in a resting state to determine whether consistent glucose metabolic abnormalities were present. Ninety-seven percent of subjects showed metabolic abnormalities in the angular gyrus, 89% in the supramarginal gyrus, and 87% in the lateral and transverse superior temporal gyrus. Pearson product moment correlations were calculated between regional metabolic measures and performance on the Western Aphasia Battery. No significant correlations were found between the Western Aphasia Battery scores and right hemisphere metabolic measures. Most left hemisphere regions correlated with more than one score from the Western Aphasia Battery. Temporal but not frontal regions had significant correlations to the comprehension score. The left temporoparietal region was consistently affected in these subjects, suggesting that common features in the aphasias were caused by left temporoparietal dysfunction, while behavioral differences resulted from (1) the extent of temporoparietal changes, and (2) dysfunction elsewhere in the brain, particularly the left frontal and subcortical areas.

Adult↗
PubMed1992

The Landau-Kleffner syndrome or 'acquired aphasia with convulsive disorder'. Long-term follow-up of six children and a review of the recent literature.

We present six patients with acquired aphasia with convulsive disorder (Landau-Kleffner syndrome) and distill the main clinical features from a review of the recent literature. Our series showed that the clinical picture can vary at onset, as well as during the course of the illness, and that the long-term outcome of the aphasia is quite unpredictable, despite the fact that epilepsy and electroencephalographic abnormalities usually regress or disappear with the years. We also call attention to the electroencephalographic phenomenon of electrical status epilepticus during slow sleep, and we suggest that the course of the aphasia may well be linked to the appearance and disappearance of electrical status epilepticus during slow sleep. Therefore, we recommend a sleep electroencephalogram in all children with Landau-Kleffner syndrome. Finally, our findings did not demonstrate the beneficial effect of treatment with anticonvulsants on the aphasia, but recent studies have shown that treatment with corticosteroids, whether combined with anticonvulsants, is effective.

Aphasia↗
PubMed1993

Cerebral glucose metabolism as a predictor of recovery from aphasia in ischemic stroke.

OBJECTIVE: The recovery of language function seen in poststroke aphasia is significantly related to the severity of the initial neurologic deficit. However, a great deal of variability still remains in the improvement that is actually achieved. To detect predictors that will help in explaining this variability, positron emission tomography (PET) and fluorodeoxyglucose F 18 (18-F-fluorodeoxyglucose) were used and the results were analyzed by stepwise regression. DESIGN: Using PET imaging after injection of fluorodeoxyglucose F 18, the regional changes in glucose metabolism in 26 patients at a period of 12 to 18 days following an ischemic stroke involving the left middle cerebral artery were examined. A second PET examination was performed on 17 of our 26 patients who were able to perform speech activation exercises. All patients received an initial and a 4-month follow-up evaluation of language performance. SETTING: During the two PET studies and the first language assessment, the patients were hospitalized in a neurologic clinic. The follow-up evaluation of language performance was performed when the patients were ambulatory. PATIENTS: Twenty-six patients (10 women, 16 men; aged 38 to 77 years; mean +/- SD, 60 +/- 9.2 years) were selected in the study. Their aphasias were of various types and of varying severity ranging from mild impairment to severe global aphasia. MAIN OUTCOME MEASURES: For the stepwise regression analysis of variables, the following variables were analyzed in resting and activation PET to explain residual variance from the first to the second Token Test: regional cerebral metabolic rate for glucose of infarct and mirror region, left and right cerebral and cerebellar hemispheres, left and right Broca's area, left and right Wernicke's area, and left and right temporoparietal cortex. RESULTS: As was expected, early and late Token Tests exhibit a high correlation (.85). The stepwise regression analysis shows that only the left cerebral hemisphere glucose value of the resting PET had significant effect on the residual variance of the Token Test regression. Regional metabolic rates during speech activation had the largest contribution to a significant recovery from aphasia. The infarct area and its corresponding mirror region, the left Broca's area, and the entire left cerebral hemisphere accounted for 80% of the residual variance. CONCLUSIONS: These results emphasize not only the application of PET activation studies in the prediction of a tissue's potential reserve capacity but also the importance of left hemisphere integrity in the recovery of functional language.

Adult↗
PubMed1997

Bilateral temporal lobe volume reduction parallels cognitive impairment in progressive aphasia.

BACKGROUND: Patients with isolated aphasia in the absence of other cognitive abnormalities have been the focus of several studies during the past decade. It has been called primary progressive aphasia (PPA), and the typical features of this syndrome are marked atrophy of the left temporal lobe according to the radiological examination and a language disorder as the initial symptom. In previous studies of PPA, the selection of the patients was based mainly on linguistic symptoms. Now, when computed tomography or magnetic resonance imaging scans are part of the routine investigation of cognitive impairment and suspected dementia, the patients with lobar atrophy will be found at an earlier stage. In the present study, we used a new approach and defined the study group by selecting patients with obvious left temporal lobe atrophy, assessed by MRI, and we referred to them as patients with temporal lobe atrophy (TLA). OBJECTIVE: To identify the features that distinguish TLA from other primary neurodegenerative disorders. PATIENTS: Six patients with TLA were compared with patients with Alzheimer disease (AD), patients with frontal lobe dementia (FLD), and healthy control subjects. METHODS: The investigations included magnetic resonance imaging volumetry, single photon emission computed tomography, and neuropsychologic and linguistic evaluations. RESULTS: In the TLA group, the mean volume of the left temporal lobe was 35% smaller than the right, while in the AD and FLD groups, the atrophy was symmetrical and bilateral. In the TLA group, the absolute volumes of the temporal lobes were significantly smaller on the left side compared with the AD and FLD groups, whereas there was no difference on the right side. The cerebral blood flow pattern in TLA was asymmetric and differed from that in the other study groups. All patients with TLA had a history of progressive Wernicke-type aphasia, ranging from 2 to 6 years. They showed primary verbal memory impairment but had preserved visuospatial functions. The clinical condition of all patients with TLA deteriorated during the study period; severe aphasia developed, and the patients exhibited signs of frontal lobe dysfunction. Serial volumetric measurements in 4 of 6 patients showed an annual 8% to 9% decrease of both left and right temporal lobes. CONCLUSIONS: The initial marked asymmetry in cognitive function found in patients with TLA contrasts with the general decline found in patients with AD. The bilateral degenerative process evident in patients with TLA paralleled the clinical deterioration, indicating TLA to be a non-AD lobar atrophy that develops into generalized cognitive dysfunction and dementia.

Aged↗
PubMed2001

Pharmacological treatment for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of drugs on language abilities when given to people with aphasia following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Register (last searched: May 2001), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. MEDLINE was searched from 1966-1998, and CINAHL from 1982-1998. We searched the International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. SELECTION CRITERIA: Randomised controlled trials comparing: ~bullet~Any drug given to improve language, versus no treatment, or versus placebo ~bullet~Any drug given to improve language versus speech and language therapy ~bullet~One drug given to improve language versus another drug given with the same aim DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. We sought missing data from authors, or where appropriate, a drug company. MAIN RESULTS: We considered fifty two studies in detail, from which we identified ten trials suitable for the review. In most cases the methodological quality was unassessable, and only one trial reported sufficient detail for us to complete a description and analysis. This study did lose a large number of patients during its course. Drugs used in the trials identified were piracetam, bifemalane, piribedil, bromocriptine, idebenone, and Dextran 40. We found weak evidence that patients were more likely to have improved on any language measure at the end of the trial if they had received treatment with piracetam (odds ratio 0.46, 95% confidence interval 0.3 to 0.7). The evidence is considered weak because of the large numbers of drop outs from the trials identified, who were lost to follow up. Patients who were treated with piracetam were no more likely (considering statistical significance) than those who took a placebo to experience unwanted effects, including death (odds ratio 1.29, 95% confidence interval for difference 0.9 to 1.7). However, the differences in death rates between the two groups, even though not not statistically significant, do give rise to some concerns that there may be an increased risk of death from taking piracetam. We could not determine if drug treatment is more effective than speech and language therapy. We could not determine whether one drug is more effective than another. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that drug treatment with piracetam may be effective in the treatment of aphasia after stroke. Further research is needed to explore the effects of drugs for aphasia, in particular piracetam. If a trial is done, this must be large enough to have adequate statistical power. The safety of the drug should be of primary interest. Researchers should examine the long term effects of this treatment, and whether it is more effective than speech and language therapy.

Aphasia↗
PubMed2000

Speech and language therapy for aphasia following stroke.

BACKGROUND: Aphasia describes language impairment associated with a brain lesion. OBJECTIVES: The objective of this review was to assess the effects of formal speech and language therapy and non-professional types of support from untrained providers for people with aphasia after stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched: March 1999), and reference lists of relevant articles to December 1998. We also contacted academic institutions and other researchers to identify further published and unpublished trials. We searched The International Journal of Disorders of Communication by hand (known by other names in the past), from 1969 to 1998. Date of most recent searches: January 1999. SELECTION CRITERIA: Randomised controlled trials comparing: 1. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus no treatment. 2. Any type of formal speech and language therapy in any setting administered by trained speech and language therapists versus any type of informal support for aphasia, given by speech and language therapists or volunteers, whether these were trained or untrained. 3. One type of speech and language therapy versus another type. Outcome measures included measures of any type of communication, other measures of functioning, numbers of drop-outs, and other non-clinical outcomes. DATA COLLECTION AND ANALYSIS: The principal reviewer collected the data, and assessed the quality of the trials with independent data checking and methodological advice. If we could not perform a statistical combination of different studies, we sought missing data. Failing that we provided a description. MAIN RESULTS: We considered sixty studies in detail, from which we identified twelve trials suitable for the review. Most of these trials were relatively old with poor or unassessable methodological quality. None of the trials was detailed enough for us to complete description and analysis. We could not determine whether formal speech and language therapy is more effective than informal support. REVIEWER'S CONCLUSIONS: The main conclusion of this review is that speech and language therapy treatment for people with aphasia after a stroke has not been shown either to be clearly effective or clearly ineffective within a RCT. Decisions about the management of patients must therefore be based on other forms of evidence. Further research is required to find out if effectiveness of speech and language therapy for aphasic patients is effective. If researchers choose to do a trial, this must be large enough to have adequate statistical power, and be clearly reported.

Aphasia↗