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PubMed1996

A study on simplification of the Standard Language Test of Aphasia (SLTA).

The Standard Language Test of Aphasia (STLA) was developed for classification and evaluation of severity of aphasia of Japanese speakers in 1975. Now it has become the most reliable test for patient with aphasic condition in Japan. However, the test involves many tasks and assessment is rather complicated. A simplified display of aphasic conditions was created by means of statistical analysis of the features of types of aphasia in order to reduce time and labor involved in SLTA for bed side use. Data were collected from 198 patients, including 40 patients with Broca aphasia (17 severe and 23 moderate cases), 64 patients with Wernicke aphasia (28 severe and 36 moderate cases) and 94 patients with global aphasia (68 severe and 26 moderate cases). A test with simplfied aphasia pattern involved naming objects for daily use (represented by pictures), pronunciation of words written in Kanji (Chinese characters) and in Kana (syllabary), pronunciation of single Kana, dictation of single Kana (oral presentation), repeating simple words presented by the examiner, dictation of words to be written in Kanji (oral presentation), matching words in Kana and a picture (pointing), writing words in Kanji (represented by pictures), writing words in Kana (represented by pictures), and auditory comprehension of words.

Adult↗
PubMed1989

Cerebral glucose metabolism in Wernicke's, Broca's, and conduction aphasia.

Cerebral glucose metabolism was evaluated in patients with either Wernicke's (N = 7), Broca's (N = 11), or conduction (N = 10) aphasia using 18F-2-fluoro-2-deoxy-D-glucose with positron emission tomography. The three aphasic syndromes differed in the degree of left-to-right frontal metabolic asymmetry, with Broca's aphasia showing severe asymmetry and Wernicke's aphasia mild-to-moderate metabolic asymmetry, while patients with conduction aphasia were metabolically symmetric. On the other hand, the three syndromes showed the same degree of metabolic decline in the left temporal region. The parietal region appeared to separate conduction aphasia from both Broca's and Wernicke's aphasias. Common aphasic features in the three syndromes appear to be due to common changes in the temporal region, while unique features were associated with frontal and parietal metabolic differences.

Aphasia↗
PubMed1985

Picture-naming in aphasia.

The distribution of picture-naming errors for Broca's aphasics (n = 9), Wernicke's aphasics (n = 9), conduction aphasics (n = 9), frontal anomics (n = 7), and posterior anomics (n = 9) was examined to determine the diagnostic power of error types in picture-naming. Negated responses were associated with Broca's aphasia, whole-part errors ("hose" for nozzle) were associated with frontal anomia, and poor phonemic cuing was associated with Wernicke's aphasia. In addition, the relative distribution of the three most prominent naming errors-phonemic errors, semantic errors, and multiword circumlocutions-tended to distinguish the two anomic subgroups from the other aphasia subgroups. Anomic aphasics produced the fewest phonemic errors and the most multiword circumlocutions; this pattern suggests minimal word-production difficulty in anomic aphasia relative to the other aphasia syndromes. Despite such group differences, the overall picture indicates that there is considerable similarity among aphasia syndromes in terms of picture-naming behavior.

Anomia↗
PubMed1986

Perseveration in aphasia.

We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13 normal controls). Several major findings emerged: left hemispheric, posteriorly located, aphasia producing lesions also produced abundant perseverations, both verbal and non-verbal, which were primarily recurrent in type; right hemispheric lesions produced few perseverations, and these were primarily of the continuous type; more than half of the verbal recurrent perseverations of aphasia on a naming task were semantic in nature. We conclude that recurrent perseveration has a special, perhaps integral, link to language disorders of aphasia, particularly fluent aphasia associated with posterior lesions.

Anomia↗
PubMedDate not supplied

Regional cerebral blood flow correlates of aphasia outcome in cerebral hemorrhage and cerebral infarction.

The relationship between recovery from aphasia and regional cerebral blood flow (CBF) was compared in 87 patients, 44 with cerebral hemorrhage and 43 with non-embolic cerebral infarction. CBF values correlated poorly with aphasia outcome in patients with cerebral hemorrhage whereas a tight correlation was demonstrated in patients with non-embolic cerebral infarction. A marked variability of CBF values in the acute and subacute stage might account for the poor correlation between CBF and aphasia outcome in patients with cerebral hemorrhage. On the other hand, a sharp discrimination was achieved between those with a good recovery from aphasia and those with a poor recovery by the dimensions of the hematoma on CT. In non-embolic cerebral infarction, a relative frontal ischemia was associated with motor aphasia while a relative temporal ischemia was associated with sensory aphasia. This dichotomy was not demonstrated in the regional CBF values in patients with cerebral hemorrhage.

Adult↗
PubMed1982

[Various aspects of personality change in aphasia].

An experimental study of self-estimation of patients with aphasia carried out by the polar profile method in the course of restorative training is described. It is shown that the aphasia causes substantial changes in the patients' self-estimation that manifest themselves in a disparity of the latter during and before the disease. A comparison with a control group of neurological patients without aphasia showed a specificity of the revealed changes for aphasia and their connection with the communication disruption. As the general and verbal communication restore, a positive course of the patients' self-estimation, and approach of the latter to the premorbid level are noted. A relation between the self-estimation shift and the aphasia form was discovered. A conclusion on diagnostic and prognostic importance of personality examination in aphasia is drawn.

Adult↗
PubMed1984

[Localization of lesions in aphasia: clinical-CT scan correlations (Part 1)].

Using a microcomputer, the locus and extent of the lesions, as demonstrated by computed tomography for 127 cases with various types of aphasia were superimposed onto standardized matrices. The relationship between the foci of the lesions and the types of aphasia was investigated. Broca ++aphasics (n = 39): Since the accumulated site of the lesions highly involved the deep structures of the lower part of the precentral gyrus as well as the insula and lenticular nucleus, only 60% of the Broca aphasics had lesions on these areas. This finding has proved to have little localizing value. Wernicke aphasics (n = 23): The size of the lesion was significantly smaller than Broca's aphasia. At least 70% of the patients had the superior temporal lesions involving Wernicke's area and subcortical lesions of the superior and middle temporal gyri. The site of lesion corresponded roughly to the previous clinico-pathological reports but located a little deep. Amnestic aphasics (n = 18): The size of the lesion was smaller than any other types. While there was some concentration of the lesions (maximum 40%) in the area of the subcortical region of the anterior temporal gyrus adjacent to Wernicke's area and the lenticular nucleus, the lesions were distributed throughout the left hemisphere. Amnestic aphasia was thought to be the least localizable. Conduction aphasics (n = 11): The lesions were relatively small in size. Many patients had posterior speech area lesions involving at least partially Wernicke's area. In particular, more than 80% of the conduction aphasics had lesions of the supramarginal gyrus and it's adjacent deep structures. Global aphasics (n = 36): In general, the size of the lesion was very large and 70% of the global aphasics had extensive lesions involving both Broca's and Wernicke's areas. However, there were observations showing that the lesions can be small and confined. Because of the large variability in lesion patterns and speech disturbances, it is necessary to expand the number of cases for relate detailed neuropsychological examinations with morphological CT-findings. Our method permits it easily to process and to analyze a large number of cases. By studying larger series, the better definition in the relationship between anatomic lesion location and aphasia type, even for less common aphasia syndromes could be obtained.

Adolescent↗
PubMed1983

Age, sex, and aphasia type. Evidence for a regional cerebral growth process underlying lateralization.

The incidence of motor and sensory, (nonfluent and fluent) aphasia was studied in 389 patients with a left-sided vascular lesion. The mean age of patients with motor aphasia was 45.3 years, and the mean age of patients with sensory aphasia was 56.5 years. The age difference was also found in a separate analysis of 50 cases of traumatic aphasia. Nonfluent aphasias predominate in early life in both males and females, but are more common in females in the third decade. The relationship between aphasia type and age, and sex, is explained by a process of regional specification of the left language areas that proceeds more slowly in females than males. It is hypothesized that this process reflects the effects of the sex hormones on protein synthesis and brain growth.

Adult↗
PubMed2002

Aphasia severity: Association with cerebral perfusion and diffusion.

BACKGROUND: Previous studies of the relationship between perfusion, diffusion, and stroke suggest that the extent of cerebral hypoperfusion may be a better indicator of neurological status than lesion size in the early phases of recovery. It is not clear how these factors are related to aphasia severity. AIMS: The purpose of this study was to investigate the relationship between cerebral perfusion, diffusion, and aphasia severity in stroke. METHODS #ENTITYSTARTX00026; PROCEDURE: Nine participants were examined within 24 hours of stroke onset and six were re-examined at 1 month post stroke. The examination included administration of an aphasia test, a face recognition task, and a neuroimaging session including T2-, perfusion-, and diffusion-weighted MRI. OUTCOMES #ENTITYSTARTX00026; RESULTS: Participants with a variety of aphasia types and severity were included in the study. Visual inspection suggested larger perfusion abnormality than the actual lesion in eight of nine subjects at day 1. The correlation between aphasia severity and hypoperfusion was significant at day 1 and at 1 month post stroke. However, this was not the case for the relationship between aphasia severity and lesion size where the correlation was not statistically significant at day 1 or at 1 month post stroke. CONCLUSIONS: These results suggest that cerebral hypoperfusion is a more accurate indicator of aphasia severity in early stroke than lesion volume.

Journal Article↗
PubMedDate not supplied

[Anomic aphasia in a 5-year-old child following herpetic encephalitis].

Aphasia is a rare neurologic disorder in childhood. Nevertheless some authors believe that some subtle aphasic syndromes as anomic aphasia are not always identified and the real prevalence of aphasia in childhood is higher. We observed a case of aphasia during the acute period of Herpes Simplex Encephalitis in a 5 years old, right handed, boy with a good level of fluent speech. Six weeks after his initial assessment language was spontaneous, fluent, with normal prosodhy and articulation, but reduced, without content words, with frequent circunlocutory speech, semantic paraphasias, anomic latencies, real anomias, "pass partout" words. This picture was suggestive for anomic aphasia in a normally fluent context. Anomic aphasia can be produced by the disconnection between cortical and subcortical systems. Documented cases of anomic aphasia in childhood are rare. Our case present great similarities with adult cases in terms of localisation and denomination difficulties.

Adult↗
PubMed2000

Patient Tan revisited: a case of atypical global aphasia?

Broca's first patient presented in support of a relationship between a lesion of the frontal lobe and aphasia was patient Tan. Although Pierre Marie refers to this case as "indisputably aphasia of Broca," the clinical diagnosis of Tan's aphasia has not been re-examined in light of current clinical criteria. Superficially, the patient's extremely limited verbal output and intact comprehension appear to fit with the diagnosis of Broca's aphasia, but a more thorough examination of the onset, evolution and nature of the patient's speech symptoms suggests alternate interpretations. Contemporary evidence in support of a robust relationship between stereotypical utterances and Global aphasia suggests that patient Tan may have suffered from a Global rather than Broca's aphasia.

Aphasia↗
PubMed1989

Creutzfeldt-Jakob disease presenting as isolated aphasia.

Progressive aphasia without dementia (primary progressive aphasia) is increasingly recognized as an important neurobehavioral syndrome. Clinical diagnosis of progressive aphasia is difficult early in its course, and the differential diagnosis is usually said to include Alzheimer's and Pick's diseases. We report a 61-year-old man with autopsy-proven Creutzfeldt-Jakob disease (CJD) whose major initial manifestation was a progressive, fluent aphasia. Myoclonus was absent, and characteristic EEG abnormalities appeared relatively late. We believe that this case of CJD is unique in its presentation of profound and isolated aphasia. CJD should be considered in the differential diagnosis of the progressive aphasia syndrome.

Aphasia↗
PubMed1994

Thalamic aphasia syndrome.

Eighteen patients (11 male, 7 female) with left thalamic haemorrhage confirmed by CT-scan of the brain were investigated for their language function. Aphasia Test for Turkish Citizens modified from Mayo Clinic Aphasia Test and Boston Diagnostic Aphasia Examination were given for evaluating the language modalities. Fluent aphasia was observed in 16 subjects (with paraphasia in 8 and hypophonia in 3). Dysarthric speech output was seen in 2 cases. Repetition and naming were well preserved while comprehension was moderately affected. This type of aphasia differs considerably from the classical aphasias and its rapid recovery is a very prominent feature.

Adult↗
PubMed1979

The resolving stroke and aphasia. A case study with computerized tomography.

A 39-year-old man suffered an intracerebral hemorrhage in the region of the left internal capsule deep to Wernicke's area. The location of the lesion was confirmed by computerized tomography (CT) performed two days postictally. Two weeks after admission, the Boston Diagnostic Aphasia Examination (BDAE) diclosed Wernicke's aphasia. We hypothesize that the hematoma exerted pressure on Wernicke's cortical area, thus causing the resulting Wernicke's aphasia at that time. A CT scan three months later showed absorption of the hematoma, with a residual low-density lesion deep to Wernicke's area, in the region of the arcuate fasciculus. At that time, BDAE testing disclosed a mild conduction aphasia. Serial CT scanning combined with discriminating clinical evaluation of aphasia provides a valuable opportunity for study of the processes underlying stroke resolution and aphasia.

Adult↗
PubMed1990

Primary progressive aphasia. Longitudinal course, neuropsychological profile, and language features.

Four patients with the clinical syndrome of primary progressive aphasia and a nonfluent aphasia profile were followed up over a period of 3 to 5 years. Extensive neuropsychological data for three patients revealed a progressive, quantitative decline of language with relative stability of memory, visuospatial skills, and reasoning. Comportment and most activities of daily living were preserved even when speech was unintelligible. Although several aphasia types may be associated with primary progressive aphasia, a nonfluent aphasia profile and phonemic paraphasic errors are most useful in differentiating it from the much more common clinical syndrome, "probable Alzheimer's disease." The clinicopathological correlates of probable Alzheimer's disease differ from those associated with primary progressive aphasia. Therefore, the clinical distinction between the two syndromes may be important for predicting the underlying pathophysiologic changes during the life of the patient.

Adult↗
PubMed1994

Wernicke and Alzheimer on the language disturbances of dementia and aphasia.

Signs of language dysfunction in dementia of the Alzheimer's type (DAT) and in the aphasic syndromes of transcortical sensory aphasia and Wernicke's aphasia are superficially similar. The unresolved question concerning the extent to which the language disturbances of DAT are "aphasic" is linked to a more fundamental question concerning the relation of language to thought, given that aphasia is often defined as language disturbance without disturbance of intellect, and dementia as dissolution of intellectual function, of which language forms an integral part. In this paper we explore the historical roots of today's debate by analyzing the original case studies of Wernicke (1874) and Alzheimer (1907, 1911). Although each of these neurologists described similar patterns of language disturbance, they drew different conclusions. Wernicke argued for a distinction between language and thought and between the language disturbances of aphasia and those of dementia. Alzheimer continued the then dominant paradigm of aphasia in describing the language disturbances of his demented patients as aphasic. Paradoxically his conclusion makes him appear, in contrast to Wernicke, to argue for the identity of the language disturbances of aphasia and dementia. Yet he himself acknowledged that the presence of focal language symptoms arising from diffuse degenerative pathology was indeed problematic. We conclude that today's discussion could profitably be refocused on the question which emerges from the original works of Wernicke and Alzheimer, which Alzheimer himself asked, and which remains unanswered: How can diffuse cerebral pathology give rise to a pattern of language deficit virtually identical to that of a focal lesion?

Aged↗
PubMed1999

Frontal-opercular aphasia.

The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehension into Broca's aphasia and transcortical motor aphasia. We report on a patient with a persistent nonfluent aphasia from a discrete, primarily cortical, frontal-opercular lesion who had impaired syntax but intact repetition and, therefore, did not conform to the traditional classification. Based on this patient's behavior and a review of other cases, we have divided the nonfluent aphasias with intact comprehension into five disorders. (1) Verbal akinesia-exhibiting diminished intention or drive to speak and associated with medial frontal lesions (supplementary motor area and cingulate gyrus) or with lesions damaging the efferent projections from these areas. (2) Disorders of syntax-telegraphic and agrammatic utterances that may be associated with dominant pars opercularis lesions. (3) Phonemic disintegration-a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access-patients who struggle to find words and are impaired at timed word-generation tasks. Defects of lexical access may be associated with lesions of the pars triangularis and adjacent prefrontal cortex. (5) Mixed defects. According to this model, the traditional patient with Broca's aphasia would exhibit disorders of syntax, phonemic disintegration, and defects of lexical access, whereas the traditional patient with transcortical motor aphasia would have verbal akinesia or defects of lexical access or both. Our patient had defects of lexical access and syntax, but only mild symptoms of phonemic disintegration, suggesting that his opercular primary motor cortex was relatively intact. Our patient's ability to repeat normally while his propositional speech remained telegraphic suggests that different neural mechanisms subserve these functions.

Aged↗
PubMed1993

Evolution of severe aphasia in the first two years post onset.

In this longitudinal recovery study of severe aphasia, subjects were tested five times at 6-month intervals with the Boston Assessment of Severe Aphasia (BASA), for a period of 2 years post onset. The majority of subjects had global aphasia (n = 17), but five had severe Wernicke's aphasia, and two had other varieties of severe aphasia. Significant improvements in communicative functions were noted for up to 18 months post onset, but the greatest improvement occurred in the first 6 months post onset. Most subjects did not change aphasia classification during the 2-year period. Initial individual BASA cluster (subtest) scores were less accurate than the 6-month scores in the prediction of later BASA Total scores. Cluster scores obtained at 6 months post onset could reliably predict BASA Total scores at 24 months post onset.

Adult↗