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Repetition of affective prosody in mixed transcortical aphasia.

Two patients with mixed transcortical aphasia could repeat propositional speech but not affective prosody. These findings suggest that the intact perisylvian region responsible for propositional speech does not mediate effective prosody. We propose that affective prosody is incorporated into propositional speech by means of an interhemispheric mechanism and that the failure of these patients to repeat affective prosody was caused by a disconnection of the left perisylvian structures from the right hemisphere structures thought to mediate affective prosody.

Aphasia↗

Aphasia following pluridirectional tomography with metrizamide. The effect of patient position.

Eight of 67 patients became transiently aphasic after myelography or cisternography with metrizamide. All eight patients had been placed in the left lateral decubitus position for pluridirectional tomography. Immediate EEGs revealed focal left-sided abnormalities in two patients. In one other patient, a computed tomographic scan showed contrast mainly over the left hemisphere. All of the symptoms resolved within 48 hours. In 34 patients who were placed on the right side, no language disturbance was noted. Aphasia after pluridirectional tomography with metrizamide may be due to local irritation of the perisylvian language centers of the dominant hemisphere. The phenomenon is distinct from syndromes of generalized confusion. The complication may be avoided by placing patients in a right lateral decubitus position for pluridirectional tomography.

Adult↗

Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study.

Aphasic patients who met stringent selection criteria were assigned randomly to three groups: clinic treatment by a speech pathologist for 12 weeks, followed by 12 weeks of no treatment; home treatment by a trained volunteer for 12 weeks, followed by 12 weeks of no treatment; or deferred treatment for 12 weeks, followed by 12 weeks of treatment by a speech pathologist. At 12 weeks after entry, language measures indicated that the clinic-treatment patients made significantly more improvement than did the deferred-treatment patients, and improvement in home-treatment patients did not differ significantly from either clinic- or deferred-treatment patients. At 24 weeks after entry, after deferred-treatment patients had received clinic treatment, there were no significant differences among the groups. These results suggest that clinic treatment for aphasia is efficacious, and delaying treatment for 12 weeks does not compromise ultimate improvement.

Aged↗

Comparison of formal language therapy with supportive counseling for aphasia due to acute vascular accident.

A total of 60 right-handed patients with acute aphasia due to left hemispheral stroke were randomly assigned to two modes of therapy for six months, beginning one month after the ictus. Conventional speech therapy provided by professional speech pathologists twice weekly was compared with emotionally supportive counseling therapy, also provided by professional speech pathologists at the same intervals. Language function was tested periodically by the Porch Index of Communicative Ability. Fifty of the subjects were also tested at ten months after the ictus. There was no difference in the amount of improvement between the two groups.

Adult↗

Treatment of aphasic perseveration (TAP) program. A new approach to aphasia therapy.

We have devised a new approach to the therapy of aphasia. Rather than focus on rehabilitation of linguistic errors, we treat perseveration, which may be an integral component of the aphasic symptoms. In this report we provide key elements of our Treatment of Aphasic Perseveration (TAP) technique, and the successful use of this method with three aphasic patients.

Aphasia↗

Alalia, aphemia, and aphasia.

In the 1860s, vigorous debate followed Paul Broca's seminal aphasiological observations. Scientific, philosophical, and personal disagreements affected ensuing nosological disputes. Competing terms to designate disorders of speech and language were alalia (used by Jacques Lordat), aphemia (coined by Broca), and the ultimately triumphant aphasia (introduced by Armand Trousseau). How these designations came into being, how they were used, and how they were received by the scientific community reflected controversies surrounding the birth of modern aphasiology.

Academies and Institutes↗

An early description of slowly progressive aphasia.

Slowly progressive aphasia without generalized dementia has become an important issue of present-day neuropsychological research. Historically, credit for the first description is usually given to Pick. Another German-speaking author who has published a vivid description of a pertinent cases is Pick's contemporary, Max Rosenfeld. This author has also observed a patient with slowly progressive spatial disorientation and visual recognition deficit, and he has discussed these patients in a remarkably modern way in the context of partial atrophy of the brain.

Aphasia↗

Cognitive neuropsychology. Resolving enigmas about Wernicke's aphasia and other higher cortical disorders.

Cognitive neuropsychology is a young branch of neuroscience whose ancestral influences include a rich pool of experimental (eg, cognitive, psychology), theoretical (eg, epistemology), and clinical (eg, neurology, neuropsychology) disciplines. An essential principle of cognitive neuropsychology is that disorders of higher cortical functions can be understood in terms of breakdowns of one or more information-processing modules. Each module is the most basic element of intelligence that can be defined based on current knowledge. This approach is a refinement of-not a fundamental departure from-the 19th-century "localizationist" view of language disorders. Wernicke's aphasia, for example, classical attributed to a single cognitive deficit (loss of word sounds), is shown in this review to require damage to multiple distinct information-processing modules. Cognitive neuropsychology provides the tools for the type of fine-grained analyses of behavior that are needed to capitalize on recent advances in neuroimaging techniques, including the development of more sophisticated models of brain-behavior relationships.

Aphasia, Wernicke↗

Broca's aphasia following damage to Wernicke's area. For or against traditional aphasiology?

Classic aphasiology has been challenged by studies that have employed cranial computed tomography to test predicted anatomic-behavioral correlations. We treated a patient who developed a classic Broca's aphasia but whose computed tomographic scan revealed damage to Wernicke's area, thus seeming to contradict the principles of traditional aphasiology. However, subsequent information obtained by magnetic resonance imaging, intracarotid amobarbital (Amytal) testing, and electrophysiologic studies, including cortical stimulation, demonstrated that the brain-behavior correlations in this patient can be understood in terms of the formulations of traditional aphasiology.

Adult↗

Left hemicranial hypoplasia in 2 patients with primary progressive aphasia.

BACKGROUND: Primary progressive aphasia (PPA) leads to a gradual and relatively isolated dissolution of language function. The factors that determine the selectivity of the disease process remain unknown. We had speculated that PPA may occasionally arise as a tardive manifestation of genetic or acquired vulnerabilities involving the language network of the brain. OBJECTIVE: To explore predisposing factors for PPA. RESULTS: In 2 patients, PPA developed with a background of mild left hemicranial hypoplasia. CONCLUSION: In keeping with other observations of PPA in patients with dyslexia and childhood injury to the left temporal lobe, these 2 patients support the contention that some cases of PPA may arise in settings where the language network has become a locus of least resistance.

Activities of Daily Living↗

Progranulin mutations in primary progressive aphasia: the PPA1 and PPA3 families.

BACKGROUND: Primary progressive aphasia (PPA) is a language-based dementia characterized by fluent or nonfluent language disorder as its principal feature. OBJECTIVE: To describe progranulin gene mutations in 2 families with PPA. DESIGN: Report of affected families. SETTING: Academic research. PATIENTS: Two families, PPA1 and PPA3, were studied. Genomic DNA was isolated from 3 of 4 siblings in PPA1, from all 3 siblings in PPA3, and from more than 200 control subjects. MAIN OUTCOME MEASURES: All 12 coding exons of the progranulin gene and the 5" and 3" untranslated regions were amplified by polymerase chain reaction and were sequenced in both directions using relevant primers. RESULTS: Both affected members of PPA1 for whom DNA was available and both affected sisters of PPA3 had a progranulin gene mutation not found in the unaffected siblings or in the controls. The mutations likely cause a null allele and a reduction in the level of functional progranulin protein. Both affected members of PPA1 with autopsies had frontotemporal lobar degeneration with tau-negative ubiquinated inclusions. CONCLUSIONS: To our knowledge, these are the only known families in which affected members display phenotypical homogeneity for PPA in the initial stages of the disease. In both families, the disease segregated with progranulin gene mutations. Whether progranulin dysfunction also extends to sporadic PPA and how it affects the initial anatomical specificity of neurodegeneration remain to be determined.

Aged↗

A comparison of empirically derived groups of aphasic patients on the Neurosensory Center Comprehensive Examination for Aphasia.

Rating scales were used to identify characteristic aphasic phenomena in a sample of natural language from aphasic patients. These variables were used to derive empirically four groups of aphasic patients. These groups showed significant multivariate differences on the basis of their performance on the Neurosensory Center Comprehensive Examination for Aphasia. Seven subtests showed significant univariate differences among the four groups: Visual Naming, Description of Use, Sentence Repetition, Repetition of Digits, Reversal of Digits, Identification by Sentence, and Oral Reading Sentences. Two of the groups reflected Howes dichotomy of articulate-nonarticulate language disorders. Another group was thought to reflect Schuell's single dimension of language disorders that could be differentiated only in terms of severity. Afourth group was characterized by a major impairment of memory. These results indicated that aphasic phenomena could be identified reliably on the basis of rating of verbal output on scales that reflect language disorders. These scales were used in a statistical fashion to derive empirically oriented groups that were identified on the basis of psychometric measures of language skills.

Adolescent↗

Aphasia Screening Test performance in patients with lateralized brain damage.

Patients with lateralized stroke (N = 36) or tumor (N = 14) were compared in the frequency of errors on specific test items of the Aphasia Screening Test (Reitan, 1984). Right- and left-hemisphere damaged patients showed a statistically significant difference on only 1 of the 33 items of this measure. When items were categorized according to task type (e.g., spelling, reading, calculation, etc.) only 1 of 9 comparisons was significant. Several possible explanations for the lack of differences are discussed and suggestions offered for potential modifications to this measure.

Adult↗

A comparison of language deficits in learning-disabled, head-injured, and nondisabled young adults: results from an abbreviated Aphasia Screening Test.

This study used an Aphasia Screening Test (AST) abbreviated to its naming, pronunciation, and sentence interpretation items to compare groups of 60 learning-disabled (LD), 30 head-injured (HI), and 30 nondisabled (ND) young adults matched for FISQ and balanced for gender composition. The LD and HI, who did not differ, made significantly more AST errors than the ND. One-quarter to one-third of the LD and HI subjects exhibited language deficits. For the clinical groups only, AST errors, particularly pronunciation errors, were related negatively to WRAT reading and spelling scores. The Reitan and Wolfson (1988) severity ratings for AST items did not improve group discrimination.

Achievement↗

Fact and theory in recovery from the aphasias.

Clinical evidence has suggested that the form of an aphasia--and perhaps potential for recovery therefrom--can be related to an exceedingly wide range of variables. Such anatomico-physiological considerations as size, depth, location and nature (e.g. penetrating missile injury, stroke, tumour, closed head injury) of the injury are frequently held to be crucial correlates, as are associated neurological deficits (e.g. presence of hemiplegia, sensory and visual field defects). Subject variables, such as age, sex and 'handedness" (including familial handedness), complicate the picture still further, as may differences in education personality and cognitive style. Given a multidimensional problem of this magnitude the first objective of theory is to indicate putative constrainst on patterns of impaired performance. Studies of the normal population--that is, the population from which cases of brain injury are later drawn--may, we believe, aid in the elucidation of individual differences seen after injury. A more detailed knowledge of the range of possibilities concerning cerebral specialization of function and variations in task strategies seems to be required. In this context we shall review some recent reports on dichotic listening and split visual field experiments with both normal and brain-damaged subjects and also consider the role that linguistic descriptions of aphasic impairment could play in suggesting retraining procedures appropriate to the individual patient.

Aphasia↗

Primary progressive aphasia: PPA and the language network.

Primary Progressive Aphasia (PPA) is a behaviorally focal dementia syndrome with deterioration of language functions but relative preservation of other cognitive domains for at least the first two years of disease. In this study, PPA patients with impaired word finding but intact comprehension of conversational speech and their matched control subjects were examined using voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI). fMRI compared signal changes during phonological and semantic language tasks with those during a control task (matching letters). PPA patients showed longer reaction times and reduced accuracy versus controls on the language tasks, but no performance differences on the control task. VBM demonstrated reduced gray matter in left superior temporal and inferior parietal regions in the PPA group. However, these patients showed a normal pattern of activation within the classical language regions. In addition, PPA patients showed activations, not seen in normals, in fusiform gyrus, precentral gyrus, and intra-parietal sulcus. These activations were found to correlate negatively with measures of naming and task performance. The additional activations in PPA may therefore represent a compensatory spread of language-related neural activity or a failure to suppress activity in areas normally inhibited during language tasks.

Aged↗

Axonal injury within language network in primary progressive aphasia.

Primary progressive aphasia (PPA) is characterized by an isolated progressive impairment of word use and comprehension reflecting the distribution of pathological processes within the left hemisphere. We used proton magnetic resonance spectroscopy (1H-MRS) to study in vivo the integrity of axonal fibers connecting perisylvian language areas in 11 patients with PPA, 11 subjects with Alzheimer's disease, and 22 controls. Brain metabolites (N-acetylaspartate, myoinositol, choline, creatine) were measured bilaterally within a volume of interest located in the central portion of the superior longitudinal fasciculus, a long associative bundle connecting Broca's area with Wernicke's area, and other language regions of the temporal lobe. In the PPA group, there was an asymmetrical N-acetylaspartate to creatine ratio reduction compared with Alzheimer's disease and controls, with greater changes on the left side. The myoinositol to creatine ratio was increased in the PPA group bilaterally compared with controls. The choline to creatine ratio did not differ among the three groups. These results indicate an asymmetrical focal axonal injury within the language network in PPA. The marked difference in the distribution of N-acetylaspartate to creatine between PPA and Alzheimer's disease suggests that proton magnetic resonance spectroscopy may help to differentiate between these two conditions.

Aged↗

Paradoxical features of word finding difficulty in primary progressive aphasia.

Impaired word retrieval is a main symptom of primary progressive aphasia (PPA). The cognitive features of this impairment in PPA are poorly understood. We studied 12 patients with PPA (6 English-speaking and 6 Dutch-speaking), 7 patients with early-stage clinically probable Alzheimer's disease (PRAD), 5 patients with mild cognitive impairment (MCI), and 15 age-matched, cognitively intact, control subjects. Subjects had to name a picture (the probe), which was preceded by a written word (the prime) that could be the correct name of the picture, a noun belonging to the same semantic subcategory (related prime), a semantically unrelated noun (unrelated prime), or a pseudoword (neutral control). Naming latencies were longer in PPA and PRAD patients than in control subjects. Critically, the interaction between group and prime type was highly significant. PPA patients named the probe more slowly after a related compared with an unrelated prime. In contrast, PRAD patients, mild cognitive impairment patients, and healthy control subjects tended to name the probe faster when it was preceded by a related prime. The semantic interference effect in PPA generalized across languages and PPA subtypes. Selection among competing word forms sharing a same semantic field is abnormal in PPA. The semantic interference effect constitutes a positive distinguishing feature between PPA and PRAD.

Aged↗