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PubMed1988

What do we learn from recovery from aphasia?

1. Recovery rates are different from outcome measures, and therefore paradoxically positive correlation between the recovery of comprehension and lesion size can be found particularly in Broca's aphasia or in populations that are skewed toward nonfluent aphasics. 2. Outcome, in terms of recovery from aphasia, correlates significantly with lesion size in the expected direction regardless of initial severity for the total aphasic group, but not as much in Wernicke's aphasia. 3. Outcome correlates well with initial test scores, but, particularly in Broca's aphasics, lesion size is as good a predictor as initial severity. 4. The rate of recovery differs in different types of aphasia, and Broca's aphasics recover most. 5. The initial recovery period between 0 and 3 months is significantly steeper than subsequent periods, but it does not correlate as well as outcome with lesion size. 6. Cerebral asymmetry or torque may be less typical in more recovered Broca's aphasics, but this failed to reach statistical significance and seems not be a factor for Wernicke's aphasics. 7. Age and gender are not as significant as lesion size and location. 8. Surrounding intact ipsilateral structures are more important for the recovery of some of the language functions, such as motor output and phonemic assembly, than homologous contralateral structures. Comprehension and semantic processing may have more contralateral or right hemisphere compensation than other language functions.

Aphasia↗
PubMedDate not supplied

[Usefulness of the "token test" in the diagnosis of aphasia].

The authors describe a method of aphasia examination, so called Token test, not known in Poland. The method is particularly useful for evaluation of speech perception disturbances, and it may also be used in cases of aphasia with expression disturbances. Speech examination by the Token test was carvied out in 45 patients with damage to the predominating hemisphere caused by stroke and the obtained results were compared with qualitative-quantitative aphasia estimation by the conventional method (determination of spontaneous speech, ordinate speech, denomination, repetition, reading, writing and understanding). A considerable agreement of the results obtained by both methods (correlation coefficient 0.80) indicates the usefulness of the test for clinical practice, especially in cases of diagnostically uncertain aphasia.

Adult↗
PubMedDate not supplied

[The epilepsy aphasia syndrome in children (author's transl)].

The clinical entity epilepsy-aphasia in children begins from an analytical study of cases published in the literature and from the study of eight cases personally observed. This condition is not an univocal syndrome but it must be differentiated into at least three different conditions even if, very often, they are superimposed: 1) a first condition in which the aphasia is critical and transient; 2) a second condition where it acts rather as a serious congenital dysphasia, and 3) a third condition in which it acts as an acquired aphasia, in the strict sense, even though very atypical. The relation between aphasia and epilepsy are discussed especially for what concerns the dynamic of the diffusive forms of epilepsy in the child and psychiatric aspects. Both the pharmacological and reeducative problems of therapy are discussed.

Age Factors↗
PubMed1982

[Crossed aphasia in right-handed patients. II. Neuropsychological and neurolinguistic study of a case. Evolution over a 2 year period].

We present an unusual case of crossed aphasia in a doctor who is totally right handed, following an infarction which almost completely destroyed his right hemisphere. The observations--linguistic and extra linguistic--during a study over two years are presented. The aphasia evolved in three stages, taking semiological and evolutive aspects not commonly met with. In speech and writing there were: 1. an oral agrammatism and a written dyssyntaxia in the initial stage; 2. the evolution of a non-fluent speech typically agrammatic leading to a jargonaphasia; 3. a dissociation between oral and written language, characterised by phonemic paraphasias in speech and dyssyntaxia in writing. Comprehension was good except for a verbal class called "empty signs" of language, in which the lexic which refers to the notion of space and time has a primary role. On an extra linguistic level some of the usual signs of right hemisphere lesions were present indicating disturbances of a spatial type. The patient could no longer grasp the concept of numerical value and showed severe difficulties in relation to time. On a linguistic level, the discussion is first considered from a typological point of view; this allows to compare our patient's disorders with a Broca's then with a conduction aphasia, Secondly, the discussion is considered from a semiological point of view, taking into consideration the 10 selected cases in the literature and adding our own; a semiological formula of crossed aphasia is given: agrammatism and/or dyssyntaxia + phonemic paraphasia and/or dysorthographia. A suggestion concerning the role of each hemisphere in the language of our patient is proposed: the possible role played by a congenital deafness in the right ear (discovered in the patient at the age of 8) to explain this abnormal hemispherical functional specialisation is discussed. Original comprehension difficulties concerning the time-space lexic are replaced by a perspective of a cognitive type. We conclude that in our patient, there was a "breakdown" of time and space which comes close to the "indifferenciation" of spatial order and time which Piaget has described in children.

Aphasia↗
PubMed1984

[Recovery from aphasia and cerebral blood flow: a comparison between cerebral hemorrhage and cerebral thrombosis].

To compare cerebral circulation in aphasic patients who had cerebral hemorrhage against those who with cerebral thrombosis, we studies 50 patients with hypertensive intracranial (putaminal) hemorrhage and 20 patients with cerebral thrombosis whose diagnoses were confirmed on repeated CT scan and cerebral angiography. The measurements of regional cerebral blood flow (rCBF) by the 133Xe intraarterial injection method was carried out in 40 patients. The evolution of the aphasic syndrome was analyzed according to Hirano's classification and the patients were divided into two groups: those having a favorable recovery from aphasia; those with a poor recovery. Twelve out of 20 patients with cerebral hemorrhage showed a favorable recovery from aphasia, whose left hemispheric mean blood flow (mCBF) was 33.1 +/- 9.7 ml/100 g/min. The mCBF was 30.8 +/- 10.3 ml/100 g/min in 8 patients with a poor recovery. There was no significant difference in mCBF values between the two groups. The favorable recovery group showed slightly higher regional values in the left frontal and temporal lobes than did the poor recovery group, but no significant difference was found between the two group. Here, rCBF values failed to correlate between the two kinds of recovery from aphasia in patients with cerebral hemorrhage. The marked variability in rCBF values in the acute stage might partly account for the poor correlation in cerebral hemorrhage. In contrast, a series of rCBF studies demonstrated that rCBF values stabilized in the acute and subacute stage in cerebral thrombosis. Nine out of 20 patients with cerebral thrombosis had a favorable recovery from aphasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aphasia↗
PubMed1983

[Aphasia with epilepsy: a new syndrome?].

Three children are described who between 5 and 7 years of age developed behaviour disorders and comprehension deficit for acoustic language. All had associated spike-and-wave discharges in the EEG. Clinical seizures occurred after the onset of aphasia and were easily controlled by anticonvulsant treatment. The aphasia disappeared but without clear-cut correlation to the EEG or control of clinical seizures. The clinical picture resembled the "syndrome of acquired aphasia with convulsive disorder" described by Landau and Kleffner. Previous reports on aphasia in childhood show that this syndrome was already well-known then. The relationship to other acquired language disorders with psychiatric illnesses is discussed.

Age Factors↗
PubMed1980

[Psycholinguistic aspects of aphasia diagnosis and therapy].

A central goal of psycholinguistic research on the diagnosis and therapy of aphasic patients consists of the construction of a series of language tasks which a. can provide guidelines for the development of systematic therapy programs and b. are suited to the evaluation of the recovery process in aphasia, in particular the effectiveness of speech therapy. Since current aphasia tests fall short on both points, a number of requirements are discussed which an aphasia test should minimally meet in order to satisfy the above objectives. Some of these requirements are illustrated in the light of the preliminary results of the Amsterdam Aphasia Test (AAT).

Aphasia↗
PubMed1995

[Comparison between anomia with word comprehension difficulty and Gogi aphasia due to lobar atrophy].

We used naming and pointing tests and a proverb completion task to compare two cases of aphasia that exhibited a selective disturbance of word processing. One patient had anomia with word comprehension difficulty due to partial ablation of the left temporal lobe and the other patient had Gogi aphasia due to lobar atrophy with left temporal predominance. We presented 90 pictures of common objects divided into 9 categories in the naming and pointing tests, and used 10 well-known Japanese proverbs as stimuli in the proverb completion task. Performance of the naming and pointing tests was severely impaired in both patients. In the patient with anomia, words the patient could not name or point to varied from session to session and phonemic cue effects were frequently observed. The proverb completion phenomenon was positive. These findings indicate that the patient had an obstruction of the access route to the intact word store or a partial rarefaction of the word store itself. In the patient with Gogi aphasia, the words the patient could not name or point to were consistent from one occasion to another, and no phonemic cue effects or signs of familiarity were observed at all. The proverb completion phenomenon was totally negative. These findings indicate that the patient has lost the word store itself. MR images in the case of anomia revealed a lesion extending from the anterior to the central portion of the inferior part of the left temporal lobe. In the case of Gogi aphasia, the MR images displayed knife-edged focal atrophy in the anterior aspect of both temporal lobes, more prominently on the left.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Effects of bifemelane hydrochloride on cerebral circulation and metabolism in patients with aphasia.

The effects of bifemelane hydrochloride on aphasia and on cerebral circulation and metabolism were studied using positron emission tomography (PET) in 10 aphasic patients with cerebrovascular disease. After the first PET scan, bifemelane was administered orally three times in a daily dose of 150 mg. Aphasic features, such as fluency, auditory comprehension, object naming, and repetition, were evaluated by using the Western Aphasia Battery (Japanese edition) before and at least 2 months after bifemelane treatment. Simultaneous with the evaluation of aphasia, the PET scans were performed by using the steady-state method with 15O gases inhalation. All aphasic features, except fluency, improved significantly after bifemelane treatment. Regional cerebral blood flow (rCBF) and the cerebral metabolic rate for oxygen (CMRO2) were increased at every brain region of interest, and the oxygen extraction fraction was decreased. Both rCBF and CMRO2 were significantly increased on the left inferior frontal gyrus, superior temporal gyrus, white matter of the parietal lobe, and insula. These results suggest that bifemelane improves both cerebral oxygen metabolism and cerebral circulation and contributes to the improvement of aphasia caused by cerebrovascular disease.

Adult↗
PubMed1993

[A clinicopathological case of progressive aphasia].

We report the case of a 59-year old right-handed woman presenting with progressive aphasia without any other neurological deficit and characterized by anomia, agramatism and auditory comprehension difficulties. CT scan showed no abnormalities. Four years later, aphasia was complete but neurological examination was normal. CT scan disclosed a mild cortico-subcortical cerebral atrophy with slight widening of both sylvian fissures. The results obtained with the Wisconsin Card Sorting Test and the Raven's Matrices showed only minor deficits. The IQ (WAIS) was 90. During the following 6 years the patient remained fully self-sufficient and carried out her homework normally. At that time MRI showed progression of cerebral atrophy more pronounced on the left side. Besides a rapid deterioration, twelve months later she developed severe dementia and died 13 years after the onset of the illness. Brain examination disclosed a severe atrophy (brain weight: 880 g) prominent in both frontal lobes and in the anterior perisylvian structures, more pronounced on the left side. There were no vascular lesions. Microscopy revealed widespread neuronal loss and astrocytic fibrillary gliosis confined to cortical areas and vacuolation in the superficial layers. Neurofibrillary tangles and neuritic plaques were found in the most atrophic areas but not in sufficient number to fulfill the histological criteria for Alzheimer's disease. There were no neuropathological changes of Pick's disease or subcortical degeneration. Previous microscopical studies of primary progressive aphasia showed non specific, mostly lobar atrophy similar to that observed in our case, although Alzheimer, Pick and Creutzfeldt-Jakob diseases have been reported. This neuropathological heterogeneity confirms that progressive aphasia is a non-specific language disorder mostly observed in lobar forms of brain degeneration.

Aphasia↗
PubMed1995

Bromocriptine is ineffective in the treatment of chronic nonfluent aphasia.

The effect of bromocriptine on chronic nonfluent aphasia was investigated in 4 patients suffering from a stroke 24 to 35 months before the onset of this study (average 29 months). Two patients had Broca, one had global and the other transcortical motor aphasia. CT-scans demonstrated anterior-posterior infarctions in 3 patients and anterior infarction in one. Bromocriptine was given initially at a dosage of 10 mg/day, and of 25 mg/day during the follow ups. By means of aphasia tests, bromocriptine was found to be ineffective for the treatment of any symptoms of chronic nonfluent aphasia.

Adult↗
PubMed1996

[Progressive aphasia without dementia--the onset of an atrophic process of the brain].

Three cases of progressive aphasia were analyzed. Moderate motor aphasia without any cognitive disturbances was observed at an early stage of the disease. Subsequently gradual development of severe motor aphasia, agraphia, alexia, as well as of speech comprehension disorder, intellectual retardation, aspontaneity, and apraxia was observed in such patients. Computer tomography revealed brain fronto-temporal local atrophy which was growing progressively as far as the disease developed. Any cerebrovascular diseases were absent. The conclusion was made that progressive isolated aphasia was the debut of cerebral cortex atrophy.

Aged↗
PubMed1997

[Speech rehabilitation in aphasia in the concept of International Classification of Impairments, Disabilities and Handicaps (ICDH0)].

A neurogenic disorder of acquired speech, aphasia not only is a speech disorder but also implies restriction in communicative independence. In line with the WHO's principle of attending to the consequences of disease as well, speech rehabilitation has to deal not only with aphasia in terms of speech disorder (i.e., impairment) but also with aphasia in terms of communicative ability disorder (i.e., disability) as well as with aphasia in terms of psychosocial interference (i.e., handicap). Current speech therapy orientations can be assigned to these three dimensions and the need for these three levels of approach can be assessed accordingly in light of the course of the condition. Given the speech disorder's frequently limited amenability to therapeutic intervention, a psycholinguistics-communication oriented speech rehabilitation as well as counselling and psychologically focussed measures are increasingly relevant to enable a more appropriate response to reduced communicative independence and ensuing psychosocial handicaps.

Aphasia↗
PubMed1997

Imaging in primary progressive aphasia.

Primary progressive aphasia (PPA) presents with aphasia, with or without other minor cognitive dysfunction. We report five patients with PPA to show the correlation between their clinical signs and imaging findings. The patients can be divided into those with nonfluent (group 1) and those with fluent (group 2) aphasia. The characteristic speech impairment was bradylalia in group 1 and word amnesia in group 2. Impairment of comprehension was common but mild in both groups. On MRI, patients in group 1 showed predominantly left frontal and perisylvian atrophy with reduced uptake in the same region on single photon emission computed tomography (SPECT) using technetium-99m hexamethyl propyleneamine oxime (99mTc HMPAO). Patients in group 2 showed left temporal atrophy involving the superior, middle and inferior temporal gyri, hippocampus and parahippocampal gyrus on MRI and reduced uptake in the same region on SPECT. These findings correlated well with the functional anatomy of speech impairment.

Aged↗
PubMed1981

Contiguity versus similarity paraphasic substitutions in Broca's and in Wernicke's aphasia.

The present research was carried out to determine whether Jakobson's claim that Broca's aphasic patients emit chiefly semantic paraphasias of the similarity type, whereas Wernicke's aphasic patients produce mainly paraphasic substitutions of the contiguity type, can be supported by data gathered for clinical purposes under controlled conditions. Semantic paraphasias produced by 96 aphasic patients on a standard test of visual naming were taken into account. Three independent judges, blind to aphasia type, classified all responses retained as semantic substitutions into one of the following four categories: those having 1) a strong similarity, 2) a strong contiguity, 3) a mild similarity, and 4) a mild contiguity relation to the correct word. No relationship was found between type of semantic paraphasias and clinical form of aphasia. Furthermore, irrespective of the clinical form of aphasia, aphasics tend to give more similarity substitutions than contiguity substitutions.

Anomia↗
PubMed1984

The nature of the phonological disorder in conduction aphasia.

Sequences of attempts to name pictured objects were used to examine phonological dysfunction in three diagnostic subgroups of aphasia. A prevalence of "phonologically-oriented sequences" (i.e., those sequences that contained only attempts with a phonological resemblance to the target word) was found to be a diagnostic criterion for conduction aphasia. When compared to a group of Broca's (n = 7) and Wernicke's (n = 5) aphasics, all the conduction aphasics (n = 6) produced proportionately more of such phonologically-oriented sequences on a picture naming test. An examination of the phonologically-oriented sequences produced by the conduction aphasics indicates that speech production in conduction aphasia involves dysfunction at an early stage of sound-encoding. The theoretical implications of this view are discussed.

Adult↗
PubMed1985

Anatomoclinical correlations of the aphasias as defined through computerized tomography: exceptions.

We have studied the frequency of exceptions to classical aphasia localizations in right-handed, literate, adult, native speakers of Italian with focal vascular left-hemisphere lesions, correlating clinical and computerized tomography data. Two hundred sixty-seven subjects were given computerized tomography (CT) examinations; lesions were mapped onto lateral diagrams and the sites of the lesions were defined. Patients were then classified as nonfluent aphasics, fluent aphasics, and nonaphasics. Patients with negative CT scans (n = 10) or only "deep" lesions (n = 50) were not studied for anatomoclinical correlations. Of the remaining 207 patients, 36 presented unexpected findings. There were seven cases of fluent aphasia and "anterior" CT lesions and six cases with nonfluent aphasia and "posterior" CT lesions among them. The significance of these findings is discussed.

Aged↗
PubMed1985

The effects of slowed speech on auditory comprehension in aphasia.

The present study investigates the effects of slowed speech on auditory comprehension in aphasia. Specifically, an attempt was made to isolate the effects of added time on comprehension at the language processing stages of auditory perception, by increasing the duration of the vowel segments in each word; word recognition and semantic analysis, by adding silences between words; and syntactic analysis, by adding silences at constituent phrase boundaries. Sentences were also read at a slow rate to see the effects of naturally slowed speech on sentence comprehension. Test sentences consisted of simple active and passive declarative sentences, and complex sentences with embedded medial and final relative clauses. Sentences were either semantically reversible or nonreversible. Thirty-four aphasic patients who varied in both severity and type of aphasia were tested on a picture verification task. Results indicated that slowing facilitated language comprehension significantly only in the syntactic condition. Neither syntactic complexity nor semantic reversibility interacted with slowed speech to facilitate auditory language comprehension. Further, it was only the Wernicke's aphasics who showed significant improvement with time added at constituent boundaries. These results suggest that time alone does not facilitate language comprehension in aphasia, but that rather it is the interaction of time with syntactic processing which improves comprehension.

Aphasia↗