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PubMed1980

Memory and problem-solving in aphasia.

In a series of experiments, aphasic adults and normal control subjects were presented with problems involving the principle of transitive inference. The design of the problems permitted selective consideration of the subject's logical, as opposed to grammatical, ability and further permitted separate consideration of logical ability and memory. The results of this experimental series showed that, in general, these aphasic patients were capable of successful inferential behavior. In conclusion, the data are interpreted to suggest that certain constraints on intelligence in aphasia occur as a result of defective memory, not defective logical ability.

Adult↗
PubMed1985

CT scan lesion localization and response to melodic intonation therapy with nonfluent aphasia cases.

The purpose of this retrospective study was to investigate the relationship between CT scan lesion localization and good or poor response to Melodic Intonation Therapy (MIT) as measured by pre- and post-MIT treatment scores. The four good response (GR) cases improved in speech characteristics ratings for Phrase Length and Grammatical Form on the Boston Diagnostic Aphasia Examination; the four poor response (PR) cases showed no improvement. The GR cases had lesions which involved Broca's area and/or white matter deep to it plus large superior lesion extension into periventricular white matter deep to the lower motor cortex area for face. These GR cases had no large lesion in Wernicke's area and no lesion in the temporal isthmus or the right hemisphere. The PR cases, however, had bi-lateral lesions or lesion including Wernicke's area or the temporal isthmus.

Adult↗
PubMed1986

Confabulation in aphasia.

We describe a brain-damaged patient who produced two distinctive forms of confabulation, typical and atypical (aphasic), both of which were associated with perseveration, poor self-monitoring, and denial of deficit. We propose that the typical confabulations are triggered by gaps in memory for the period surrounding the onset of his illness, while the aphasic (fantastic) confabulations are triggered by gaps in semantic representation. These observations suggest that confabulations may comprise a portion of the language deficit in patients with other varieties of fluent aphasia.

Aged↗
PubMed1986

Assessment of hemispheric dominance for language in crossed aphasia by two atraumatic methods.

In a right handed patient with crossed aphasia, two atraumatic techniques (regional cerebral blood flow measurements during the performance of a linguistic task and dichotic listening test) were used to assess language lateralization. The prominence of rCBF activation patterns in the right hemisphere and the presence of a clear-cut right ear extinction on the dichotic listening test provide evidence that, is this case, the right hemisphere was dominant for language.

Aged↗
PubMedDate not supplied

Intensive training of phonological skills in progressive aphasia: a model of brain plasticity in neurodegenerative disease.

Three patients with a typical syndrome of nonfluent primary progressive aphasia (Mesulam's syndrome) were trained daily with a remediation protocol including auditory exercises specifically designed to involve several aspects of phonological processing, a domain known to be specifically affected in the condition. The speech content of the exercises was based on the temporal theory of phonological processes according to which increasing the duration of formant transition should facilitate phoneme discrimination and phoneomic awareness. Significantly improved performance on the trained tasks was demonstrated in the three patients. Improvement further generalized to other tasks such as nonword repetition and reading. We conclude that such results (1) argue for using intensive focused therapy of language impairment in neurodegenerative disorders, (2) may constitute a good model of brain plasticity in neurodegenerative disorders in general, and (3) support theories of phonological processing emphasizing temporal features of the auditory signal.

Aged↗
PubMed1984

An experimental analysis of auxiliary and copula verb generalization in aphasia.

Two subjects with chronic Broca's aphasia were taught to produce third person singular auxiliary is in sentence contexts to determine if is production would generalize to untrained auxiliary is items and to copula is contexts. A single subject (ABAB) reversal design was employed. Results revealed that training a few exemplars of the present tense auxiliary is resulted in generalized responding to untrained auxiliary is and copula is plus predicate adjective items. Generalized responding to untrained copula is plus predicate nominative and locative items was marked by individual variability. Although auxiliary and copula is verb production was maintained on 2- and 6-week follow-up probes, transfer to spontaneous speech was negligible. The results were interpreted as providing partial support for the existence of a functional or generative response class between verbal auxiliary and the copula is verbs.

Adult↗
PubMed1987

Experimental analysis of syntax training in Broca's aphasia: a generalization and social validation study.

A multiple baseline design across responses was used to examine the effect of syntax training on the sentence production of 4 individuals with chronic Broca's aphasia. Subjects were trained to produce five exemplars of five sentence types from Helm's Elicited Language Program for Syntax Stimulation (Helm-Estabrooks, 1981). Generalization and maintenance of trained sentence types to novel exemplars and novel stimulus conditions served as dependent measures. In addition, five naïve judges rated subjects' responses before and following the treatment in terms of their "adequacy." Generalization to novel exemplars was demonstrated sequentially by 3 subjects (i.e., following the teaching of all five forms), and the remaining subject demonstrated generalization for three of five sentence types trained. Maintenance was variable across subjects and sentence types. Generalization across stimulus conditions was limited for all subjects. Adequacy judgments revealed improved communication skills for wh-questions but limited changes in the perceived adequacy of subjects' declarative responses. These findings indicate that the effects of syntax training procedures are limited to those grammatical constructions taught, that generalization of learned forms to novel stimulus conditions is not an automatic consequence of acquisition, and that the effect of such training on the adequacy of subjects' responses may be limited.

Adult↗
PubMed1991

Spouse attitudes toward the person with aphasia.

This investigation evaluated the attitudes of individuals towards their aphasic spouse. Using modified Q-methodology, 15 spouses of fluent aphasic patients, 15 spouses of nonfluent aphasic patients, and 30 matched controls completed a 70-item Q-sort. The spouses of nonfluent aphasic patients had a significantly greater number of negative attitudes toward their spouses than the spouses of fluent aphasic patients. The spouses of patients in both aphasia groups had a significantly greater number of negative attitudes toward their spouses than the matched controls. The most common attitudes of spouses of patients in both aphasic groups divided into six factors: compliance, desirability, egocentricity, independence, maturity, and sociability.

Aphasia, Broca↗
PubMed1988

Impaired grammar with normal fluency and phonology. Implications for Broca's aphasia.

Extensive testing of grammatical function, including assessment of spontaneous language, inflectional morphology, ability to produce grammatical structures, syntactic comprehension and grammatical judgement, was carried out in 2 patients with large dominant frontal lobe lesions, including but not confined to, the third frontal convolution. Both patients were fluent and had normal articulation and phonological production and neither was agrammatic, suggesting that even very large frontal lesions do not produce Broca's aphasia and that language cortex proper is confined to the postcentral perisylvian region. Both patients were impaired in the use of more complex syntactic structures and one, who in addition had severe generalized impairment in frontal lobe function, also had impaired judgement regarding the use and placement of functors. These data provide further support for the dissociability of syntactic and morphological aspects of grammar in aphasic patients and, together with other studies, link these functions with the frontal lobe and the postcentral perisylvian cortex, respectively. The sparing of grammatical judgement in 1 patient, despite a very extensive lesion, suggests that very large portions of the frontal lobe are involved in grammatical function. The nature of frontal lobe function in syntax appears to be congruent with the role of the frontal lobes in other aspects of behaviour.

Adult↗
PubMed1989

Direct dyslexia. Preserved oral reading of real words in Wernicke's aphasia.

A 70-yr-old man was able to read aloud, without comprehending what he read, following a stroke that caused Wernicke's aphasia with severely impaired comprehension of speech. Tested on admission, and at 3 and 9 months, he could read aloud both orthographically simple and orthographically complex real words, and showed neither semantic errors, preference for nouns, nor difficulty with function words. He could not, however, read aloud orthographically simple nonwords. His disorder thus appears to be the first pure example of 'direct dyslexia', which, in contrast to previously well-documented examples of 'deep' and 'surface' dyslexia, implies the existence in reading of a direct route, independent of phonology or semantics, between visual and oral word representations.

Aged↗
PubMed1991

Transcortical aphasia. Importance of the nonspeech dominant hemisphere in language repetition.

While a relative preservation of repetition in acute transcortical aphasia (TA) has usually been associated with the functional integrity of the speech dominant (left) perisylvian area, recent amytal data (Bando et al., 1986) have suggested a fundamental role of the nondominant (right) hemisphere in language repetition. The neuroradiological correlates of repetition were studied in a consecutive series of 21 patients with acute TA. A similar frequency of either perisylvian or extraperisylvian pathology was found. In 2 patients with perisylvian pathology, the injection of amytal in the hemisphere contralateral to the lesion abolished repetition. Positron emission tomography (PET) in another patient revealed marked hypometabolism over the entire left cortical mantle ipsilateral to a basal ganglia lesion, suggesting that preserved repetition was carried out by right hemisphere structures. This was confirmed in a second patient with left extraperisylvian pathology, in whom a second lesion in the right hemisphere resulted in impaired repetition. These findings suggest that the spared contralateral hemisphere may subserve residual repetition in some transcortical aphasic patients with a lesion within or outside the speech-dominant perisylvian area.

Aged↗
PubMed2003

Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula.

Progressive non-fluent aphasia (PNFA) is a syndrome in which patients lose the ability to communicate fluently in the context of relative preservation of single word comprehension and non-linguistic cognitive abilities. Neuroimaging in case studies with PNFA has failed to identify a consistent neural substrate for the language disorder. In this study of a group of patients (n=10) whose presenting complaint was progressive dysfluency, resting cerebral metabolism was measured using [18F]fluorodeoxyglucose-PET and analysed with the technique of statistical parametric mapping (SPM). Regional atrophy was assessed with voxel-based morphometry (VBM). Seven patients had a 'pure' PNFA syndrome, while the remaining three had additional features of a more pervasive dementia. Compared with controls, the patients showed hypometabolism in several regions that, most notably, included the left anterior insula/frontal opercular region. The VBM analysis revealed only one small area of atrophy in the left peri-Sylvian region. Analysis of the pure PNFA cases (n=7) relative to controls yielded qualitatively similar results to those of the whole group, suggesting that these cases were also at risk of a more generalized dementia, a finding borne out in subsequent follow-up of two cases to date. The PNFA group was then compared with a group with Alzheimer's disease (n=10) whose clinical profile did not include non-fluent aphasic features. In this analysis, the only persisting hypometabolic region was that centred over the left anterior insula. VBM did not identify any regional differences in atrophy between PNFA and Alzheimer's disease. In the light of current theories of fluent language production, the findings offer anatomical evidence that the breakdown in fluency is due to a motor articulatory planning deficit (speech apraxia) combined with a variable degree of agrammatism.

Aged↗
PubMed1982

Transcortical aphasia from ischaemic infarcts of the thalamus: a report of two cases.

Thalamic injury from various natural causes, including tumours an haemorrhage, has been reported to lead abnormalities of language. The pathophysiology of these language disorders remains controversial because the naturally occurring thalamic lesions often are associated with mass effects. Two patients are described with hypodense left thalamic lesions, shown by computed tomography, probably representing infarction. Both patients had aphasia, but neither had evidence of appreciable brain swelling or distortion, nor were cortical language areas damaged.

Adolescent↗
PubMed1986

Mechanism of repetition in transcortical sensory aphasia.

A typical case of transcortical sensory aphasia (TSA) is presented, in which the Wada test suggests that it is the right hemisphere which enables the patient to repeat orally. It is supposed that one of the mechanisms of preserved repetition in TSA is linked to an exceptional ability for repetition of the right hemisphere, which may help to explain why cases of TSA are so rare.

Aged↗
PubMed1987

Deep left parietal lobe syndrome: conduction aphasia and other neurobehavioural disorders due to a small subcortical lesion.

A patient with sudden onset of conduction aphasia in the context of an ischaemic stroke is reported. Other neurological and neuropsychological findings included bilateral ideomotor apraxia, right hemisensory defect and paradoxical left ear extinction on a dichotic listening test. Lesion location, as inferred from magnetic resonance imaging, involved a restricted subcortical area in the left parietal lobe, near the lateral wall of the cerebral ventricle. The anatomical correlate for each of the clinical findings is discussed in the light of classical anatomo-clinical correlations. It is concluded that this tetrad constitutes a specific syndrome which may be easily recognised and ascribed to a single lesion in the deep white matter of the left parietal lobe.

Aged↗
PubMed2005

Subcortical aphasia: a longitudinal PET study.

BACKGROUND AND PURPOSE: Very few neuroimaging studies have focused on follow-up of subcortical aphasia. Here, overt language production tasks were used to correlate regional cerebral blood flow (rCBF) changes and language performance in patients with vascular subcortical lesions. METHODS: Seven aphasic patients were scanned twice with positron emission tomography (PET) at 1-year interval during a word-generation task. Using SPM2, Language-Rest contrast at PET1 was correlated to language performance and to time-lag from stroke. The same contrast was performed at PET2 and session effect (PET2-PET1) was correlated with performance improvement. RESULTS: At PET1, correlation between rCBF and delay from stroke involved mainly ventral regions of the left temporal cortex and mesial frontal cortex. Correlations between rCBF and performance showed predominantly left dorsal regions in the frontal, temporal, and parietal lobes, but also the left ventral temporal cortex. One year apart, language performance improved and rCBF increased in perisylvian regions bilaterally. Best performers at PET2 showed an increase of activity in left ventral temporal cortex as well as in right middle temporal gyrus. CONCLUSIONS: On follow-up, expected language improvement and increase of activation in the classical language areas and their counterparts were observed. Moreover, all correlational analyses both at PET1 and on follow-up implicated the anterior part of the left inferior temporal gyrus, suggesting a disconnection between the superior and inferior parts of the left temporal cortex and a specific role for this region in lexical semantic processing.

Adult↗
PubMed2001

Procedural learning in Broca's aphasia: dissociation between the implicit acquisition of spatio-motor and phoneme sequences.

Procedural learning of spatio-motor and phoneme sequences was investigated in patients with Broca's and Wernicke's aphasia and age-matched controls. In Experiment 1, participants performed a standard serial reaction task (SRT) in which they manually responded to a repeating sequence of stimulus locations. Both Broca's and Wernicke's aphasics showed intact sequence learning, as indicated by a reliable response time (RT) cost when the repeating sequence was switched to a random sequence. In Experiment 2, Broca's aphasics and controls performed a new serial search task (SST), which allowed us to investigate the learning of a spatio-motor sequence and a phoneme sequence independently from each other. On each trial, four letters were presented visually, followed by a single auditorily presented letter. Participants had to press one of four response keys to indicate the location of the auditory letter in the visual display. The arrangement of the visual letters was changed from trial to trial such that either the key-presses or the auditory letters followed a repeating pattern, while the other sequence was random. While controls learned both the key-press and the phoneme sequences, Broca's aphasics were selectively impaired in learning the phoneme sequence. This dissociation between learning of spatio-motor and phoneme sequences supports the assumption that partially separable brain systems are involved in procedural learning of different types of sequential structures.

Adult↗