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PubMed1998

Conduction aphasia in a 3-year-old with a left posterior cortical/subcortical abscess.

A 3-year-old, right-handed girl developed a conduction-type aphasia following a second generalized seizure in the setting of a developing abscess involving left subcortical and cortical angular gyrus and arcuate fasciculus, and the posterior corpus callosum. The language disorder was fluent, characterized by age appropriate mean length of utterance and syntax, but with markedly reduced spontaneity of output, rapid rate of speech and mild dysarthria. Comprehension was relatively, but not completely spared. Naming, repetition, and reading (letters) were initially markedly impaired. Improvements in naming and repetition were associated with both literal and semantic paraphasias. Writing skills in the form of drawing were spared, but a mild apraxia to verbal command and imitation was initially present. Despite her young age, this child's fluent conduction aphasia and lesion localization were adult-like. Multimodal memory difficulties appeared to underlie what is best described as conduction aphasia.

Abscess↗
PubMed1999

Prosody, linguistic demands, and auditory comprehension in aphasia.

Prosody plays a clear role in the auditory comprehension of narratives by aphasic listeners. Previous research, however, has pointed to questions regarding variables which increase task complexity (e.g., memory, reading level) and the influence of the severity of aphasia. This study examined the role of the severity of aphasia and linguistic complexity in narrative comprehension by aphasic listeners. Findings indicate that while all subject groups improved their auditory comprehension when emphasis was present, people with severe aphasia improved significantly more, but only in a low linguistic complexity condition. However, subjects had additional opportunity for improved performance in both low and high linguistic complexity conditions. These results pose additional questions about perceived task difficulty (and performance) and resource allocation strategies.

Adult↗
PubMed2001

Agrammatic Broca's aphasia is not associated with a single pattern of comprehension performance.

One influential hypothesis posits that the brain regions implicated in Broca's aphasia are responsible for specific syntactic operations that are necessary for the comprehension and production of sentences (Grodzinsky, 1986, 1990, in press). The empirical basis of this hypothesis is the claim that Broca's aphasics have no difficulty understanding sentences in the active voice (and other "canonical" sentence types, such as subject relatives and clefts with negative predicates), but perform at chance level with passive voice constructions (and other "noncanonical" sentences such as object-gap relatives and object clefts). In the face of well-established results indicating that Broca's aphasics can exhibit several different performance patterns on these sentence types, Grodzinsky, Piñango, Zurif, and Drai (1999) argued that these conflicting results do not challenge the theory when the data are analyzed appropriately. They carried out a creative statistical analysis of the comprehension performance of published cases of Broca's aphasia and concluded that all of these cases are in agreement with the predicted pattern: chance on passives and 100% correct on actives. Here we show that the statistical reasoning adopted by Grodzinsky et al. (1999) is flawed. We also show that the comprehension performance of a substantial number of the Broca's aphasics in their own sample does not conform to the pattern required. Rather, contrary to these authors' claim, Broca's aphasia is not associated with a consistent pattern of sentence comprehension performance, but allows for a number of distinct patterns in different patients.

Aphasia, Broca↗
PubMed2000

An open-label trial of bromocriptine in nonfluent aphasia: a qualitative analysis of word storage and retrieval.

Anomia is a commonly found in aphasia and has been attributed to a loss of representations (storage deficit) or to a loss of access to these representations (retrieval deficit). Bromocriptine, a dopamine agonist, was tested on four patients, two men and two women, with nonfluent aphasia. The patients were tested in an open-label ABBA design using a stochastic model that measured the degree of storage and retrieval deficits. All patients showed significant improvements in word retrieval. Bromocriptine may be a useful adjunct in the treatment of selected patients with a nonfluent aphasia in which retrieval deficits play a major role.

Aged↗
PubMed2001

Linguistic and nonlinguistic priming in aphasia.

Studies of real-time processing in aphasia suggest that linguistic symptoms may be due to deficits in activation dynamics rather than loss of linguistic knowledge. To investigate the domain specificity of such processing deficits, we compared performance by Italian-speaking fluent aphasics, nonfluent aphasics, and normal controls in a linguistic priming task (grammatical gender) with their performance in a color-priming task that requires no verbal mediation. Normal or larger than normal color-priming effects were demonstrated in both aphasic groups. Gender priming did not reach significance in either group, even though the patients displayed above-chance sensitivity to gender class and gender agreement in their accuracy scores. The demonstration of spared gender knowledge despite impaired gender priming underscores the utility of on-line techniques in the study of aphasia. The demonstration of spared color priming suggests that priming deficits in aphasia are either (1) specific to speech and language or (2) specific only to those sensorimotor and attentional processes that language shares with other nonlinguistic systems.

Adult↗
PubMed2001

Supra- and infrasylvian conduction aphasia.

Fifteen cases of conduction aphasia which were tested with the Aachen Aphasia Test (AAT), are presented. The CT lesion data were transformed to a standard 3D-reference brain referring to the ACPC line. According to the lesion profiles a group of 6 patients had pure suprasylvian lesions, a group of 4 patients had pure infrasylvian lesions, and a group of 5 patients had lesions in both supra- and infrasylvian regions. Suprasylvian conduction aphasics are superior to infrasylvian conduction aphasics in the token test and in repetition tasks. Infrasylvian conduction aphasics use more stereotypes in spontaneous speech than suprasylvian conduction aphasics. Conduction aphasics with both lesion sites perform less well in tests of naming, writing, and comprehension than the pure types. Thus conduction aphasia is a heterogeneous syndrome anatomically and linguistically.

Adult↗
PubMed2001

Effect of socioeconomic status on aphasia severity and recovery.

Low levels of educational attainment and low socioeconomic status have been significantly linked to poor health and increased incidence of disease, including Alzheimer's disease and diseases of the cardiovascular, pulmonary, renal, and gastrointestinal systems. Our goal in the present study was to determine the degree to which educational level and socioeconomic status influence initial severity of aphasia and subsequent recovery. We evaluated the records of 39 persons with aphasia twice: at about 4 months and 103 months postonset. We found early severity of aphasia to be significantly greater for subjects in the lower educational and occupational groups. However, rate of recovery (the slope of the recovery curve) was the same regardless of educational or occupational status.

Aphasia↗
PubMed1978

[Broca's aphasia. The clinical picture and a consideration of the neurolinguistic structure (author's transl)].

Broca's aphasia is characterized by disorders on the phonemic, syntactic and lexical level of linguistic description. It is not only the patient's speech which is impaired; abilities to comprehend, read and write are likewise impaired. Articulatory disorders (dysarthria) which are due to an impaired innervation of the phonatory and articulatory musculature may exist. However these disorders do not account for all the linguistic deficits found in cases of Broca's aphasia. The characteristic feature enabling a differential diagnosis of Broca's aphasia is agrammatism.

Adult↗
PubMed1989

Thalamic aphasia. A conceptional critique.

Four patients with aphasia due to small circumscribed thalamic lesions are presented. A review of the literature on thalamic aphasia revealed 16 similar cases. While the general consensus that only left-sided thalmic lesions are associated with aphasia is confirmed, analysis of the sites of the thalamic infarctions and the dysphasia elements did not reveal an unequivocal correlation. The explanation of this finding is that (a) disruption of any circuit, whether taking place in the connections or in the nuclei, leads to dysfunction and (b) thalamofrontal connections are not topographically arranged according to the thalamic nuclei, but show a frontal rostrocaudal/thalamic mediolateral interrelationship irrespective of thalamic nuclear masses.

Adolescent↗
PubMed1986

A case of acquired aphasia in a child.

A 4-year-old child was referred to us from neurology with a possible diagnosis of autism. This form of acquired aphasia is unusual in that our patient did not ever present any clinical seizure in spite of bilateral temporal injury. One of the etiological possibilities that has been retained in those cases has to do with the aphasia being related to the convulsive disorder. Our case suggests that, at least for some of those children suffering from this unusual form of acquired aphasia, one has to look for some other etiological possibilities. This last point will be discussed as well as the value of sleep EEG as a diagnostic procedure.

Aphasia↗
PubMed1990

A case of "crossed aphasia" in which the integrity of the left hemisphere is assessed by MRI.

We describe a 65-year-old right-handed (on the Edinburgh Inventory Test) woman who developed left hemiplegia and language disturbances after right hemisphere lesion. She showed global aphasia and left spatial neglect. To our knowledge, this is the first case of so called "crossed aphasia" in which the integrity of the left hemisphere is assessed by Magnetic Resonance Imaging (MRI). The association of aphasia and neglect is briefly discussed.

Aged↗
PubMed1996

Bedside screening for aphasia: a comparison of two methods.

A prospective study was carried out in 50 consecutive patients referred with suspected aphasia in order to compare the Frenchay Aphasia Screening Test (FAST) with the Sheffield Screening Test for Acquired Language Disorders (SST). The study included 32 men and 18 women with a mean (SEM) age 53.9 (2) years. The comprehension scores on the FAST were correlated with receptive skills on the SST r = 0.74 (P < 0.001). For expression, the correlation coefficient was r = 0.92 (P < 0.001) and the total scores of the two tests correlated closely r = 0.89 (P < 0.001). There was a positive correlation between total score on the FAST and the Short Orientation, Memory and Concentration test (SOMC) r = 0.86 (P < 0.001), and the total scores on the SST and SOMC r = 0.91 (P < 0.001). The Barthel index also correlated positively with the FAST r = 0.59 (P < 0.001) and SST r = 0.63 (P < 0.001). The study demonstrated that the two tests are simple, short and similar in their predictive value for the screening and diagnosis of aphasia. The SST was found to have additional advantages, as it does not require any special equipment or stimulus cards, and it was not affected by visual neglect.

Aphasia↗
PubMed2000

Rapidly progressive aphasia and motor neuron disease: a clinical, radiological, and pathological study of an autopsy case with circumscribed lobar atrophy.

This report concerns an autopsy case of rapidly progressive aphasia and motor neuron disease. The patient was a Japanese woman who was 75 years old at the time of death. The family history did not reveal hereditary burden. She developed language disturbances and difficulty in swallowing at age 74. Neurological examination 1 month after the disease onset revealed motor aphasia without dementia and bulbar sign, followed by muscle weakness of the four extremities. Neuroradiological examination revealed progressive atrophy of the anterior part of the left temporal lobe. She died of respiratory difficulty 10 months after the disease onset. Macroscopically, neuropathological examination showed circumscribed atrophy of the left perisylvian region and, histologically, neuronal loss in the cerebral cortex, including the primary motor area, substantia nigra, brain stem motor nuclei, and anterior horns of the spinal cord, in addition to obvious degeneration of the pyramidal tracts and presence of Bunina bodies. Ubiquitin-immunoreactive neuronal inclusions were present in the hippocampal dentate granular cells and frontotemporal cortical layer II neurons. Based on these clinicopathological findings and a review of the literature, we concluded that our case is the first reported case of amyotrophic lateral sclerosis with dementia that clinically showed rapidly progressive aphasia.

Aged↗
PubMed2006

[Present status and future possibilities of adjuvant pharmacotherapy for aphasia].

Aphasia is one of the most frequent and disabling consequences of stroke. Poor spontaneous recovery and the limited success of conventional speech therapy bring up the question of how current treatment approaches can be improved. Besides increasing training frequency-with daily sessions lasting several hours and high repetition rates of language materials ("massed training")-adjuvant drug therapy may help to increase therapy efficacy. In this article, we illuminate the potential of monoaminergic (bromocriptine, levodopa, d-amphetamine) and cholinergic (donepezil) substances for treating aphasia. For a final evaluation of combined massed training and adjuvant pharmacotherapy, randomized, placebo-controlled (multicenter) clinical trials with sufficient numbers of patients are needed. Furthermore, results of experimental animal studies of functional recovery in brain damage raise hopes that neurotrophic factors or stem cells might find a place in recovery from aphasia in the intermediate future.

Aphasia↗
PubMed2003

Primary progressive aphasia as the initial manifestation of corticobasal degeneration and unusual tauopathies.

The clinical, neuroradiological, neuropathological and biochemical findings in four patients with primary progressive aphasia and tauopathy are described. The aphasic syndrome preceded by several years the appearance of other symptoms in every case. Asymmetrical apraxia with alien hand phenomenon occurred in one case. Frontotemporal symptoms occurred in three cases, but progressed to dramatic cognitive devastation in only one of these. Generalized dementia consistent with probable Alzheimer's disease (AD) developed with time in another. Cerebral computer tomography scans, magnetic resonance imaging and SPECT studies revealed marked asymmetries in one case, and showed nonspecific cerebral atrophy in the remaining ones. The neuropathological examination revealed typical corticobasal degeneration (CBD) in one case; CBD and AD in another; and atypical CBD, argyrophilic grain disease (AGD) and alpha-synucleinopathy consistent with Parkinson's disease in a third. Unique neuropathological findings were found in the remaining case. This was characterized by severe cerebral atrophy, marked neuronal loss in the cerebral cortex and abnormal tau deposition in neurons of the cerebral cortex, diencephalon and brain stem. Ballooned neurons, Pick bodies, generalized cortical neurofibrillary tangles and astrocytic plaques were absent. However, massive globular inclusions, containing phospho-tau, occurred in glial cells, mainly oligodendrocytes, in the white matter. Biochemical studies of frontal homogenates revealed four bands of 73/74, 68, 64 and 60 kDa of phosphorylated tau (using antibodies recognizing phospho-tau Thr181, Ser262 and Ser422) in the patient with AD and CBD, suggesting a predominant AD pattern in this case. Two bands of 68 and 64 kDa of phospho-tau were recovered in the sarkosyl-insoluble fraction in the other three cases. This pattern is similar to that found in CBD, progressive supranuclear palsy and AGD. Taken together, the present series further supports pure and combined CBD as causes of primary progressive aphasia, and they extend the hypothesis that primary progressive aphasia may be the initial symptom of distinct tauopathies.

Aged↗
PubMed1999

Functional magnetic resonance imaging to word generation task in a patient with Broca's aphasia.

We describe the findings of functional magnetic resonance imaging (fMRI) in a patient with Broca's aphasia. The patient was a 45-year-old, right-handed woman who developed Broca's aphasia after infarction in the left frontal lobe. The first fMRI showed no signals in the left frontal lobe during verbal tasks, 2 weeks after the onset of infarction. Four weeks later, when the patient's symptom had improved, the second fMRI showed some increase in the fMRI signals in the left frontal lobe. Seven months later, she had completely recovered the ability to speak. The last fMRI then showed that the increment in signal activity in the left frontal lobe during verbal tasks had recovered to the level seen in normal subjects. There was a good correlation between the increase in task-related signals in Broca's area and the recovery of language function. Our findings show that fMRI has can be important in assessing cognitive functions in patients with Broca's aphasia.

Aphasia, Broca↗
PubMed2003

Crossed aphasia with left spatial neglect and visual imperception: a case report.

A 64-year-old right-handed woman with no left-handers in the family developed aphasia associated with moderate left hemiparesis and dense left homonymous hemianopia following rupture of a right middle cerebral artery aneurysm and subsequent selective surgery confined to the right hemisphere. Severe left spatial neglect and constructional apraxia were also present. The patient was an achondroplasic dwarf whose previous medical and neurological history was otherwise unremarkable. Computed tomography of the brain showed a large right temporo-insulofrontoparietal lesion. Language and nonverbal cognitive functions were assessed after 2 and 6 months, and then four years later. A reportedly overall language disruption in the acute period evolved into Wernicke's aphasia and then into a mild form of conduction aphasia. The associated left spatial neglect eventually shrank to a minimum. The patient never had clinically detectable visual agnosia, but on specific tests of visual recognition and perception some impairment was found four years after onset. The left hemiparesis disappeared in time while the left hemianopia persisted. This case is a convincing example of an entirely righthanded person in whom both linguistic and visuospatial functions are represented in the right hemisphere.

Achondroplasia↗
PubMed1993

Behavioral and neuronal changes during treatment of mixed transcortical aphasia: a case study.

The development of language mechanisms outside the traditional language regions is evidenced by the case of K.S., a patient with chronic mixed transcortical aphasia, that is, good repetition performance compared to all other language abilities. The aphasia was caused by an infarction of the left a. carotis interna that completely destroyed the left perisylvian language region and adjacent structures. Five years post onset the patient underwent intensive aphasia therapy. In the treatment setting chosen, both speech production and comprehension abilities improved as demonstrated by adequacy and reaction time scores. It is argued that the behavioral changes observed are likely to be due to (a) newly acquired communicative strategies and (b) neuronal changes within K.S.'s brain. The behavioral changes are explained in terms of strengthening of synaptic connections and formation of Hebbian cell assemblies corresponding to words.

Aged↗