Acquired Crossed Aphasia in Dextral Children Revisited

In contrast to the estimated low incidence of crossed aphasia in dextral adults (among 1%), crossed aphasia in children has been considered a common finding for almost a century. However, reviewing the literature on crossed aphasia in dextrals (CAD) and its related topics from 1975 onward, we encountered only 5 children in a corpus of 180 cases (2.7%). Critical analysis rendered three of the reported cases ambiguous and hence not suitable to draw potentially relevant conclusions. In this review, the neurobehavioral manifestations of the two representative childhood CAD cases are analyzed and compared with adult CAD and acquired childhood aphasia (ACA). In the light of our findings, which support the position of innate cerebral specialization for language, the long-standing controversy as to whether lateralized hemispheric specialization for language is innate or develops progressively during maturation is briefly discussed.     

Impaired artificial grammar learning in agrammatism

It is often assumed that language is supported by domain-specific neural mechanisms, in part based on neuropsychological data from aphasia. If, however, language relies on domain-general mechanisms, it would be expected that deficits in non-linguistic cognitive processing should co-occur with aphasia. In this paper, we report a study of sequential learning by agrammatic aphasic patients and control participants matched for age, socio-economic status and non-verbal intelligence. Participants were first exposed to strings derived from an artificial grammar after which they were asked to classify a set of new strings, some of which were generated by the same grammar whereas others were not. Although both groups of participants performed well in the training phase of the experiment, only the control participants were able to classify novel test items better than chance. The results show that breakdown of language in agrammatic aphasia is associated with an impairment in artificial grammar learning, indicating damage to domain-general neural mechanisms subserving both language and sequential learning.     

Crossed aphasia in Chinese: a clinical survey.

According to our clinical observations from various aspects of stroke patients, such as the total incidence of aphasia, the incidence of aphasia after left brain damage of the dextrals, the aphasia that occurs in patients without hemiplegia, and the types of aphasia, a much higher incidence of crossed aphasia is seen among the stroke patients of the Han (the largest ethnic group in China) as compared with the Uighur-Kazaks (U-K) in China and the Occidentals documented in the literature. Motor aphasia is most common and pure sensory or posterior aphasia is rarely seen in Han patients. The distinct features of the Chinese language is a possible explanation for this difference. We suspect that language function of the Han is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke's area in the left brain of the Chinese people and the neural pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently the universal applicability of the theories of cerebral laterality of the language function and dominant hemisphere established by Dax and Broca are questioned in this paper.     

Anomalous cerebral language organization: acquired crossed aphasia in a dextral child

Following a dramatic change of its reported incidence, it was only recently recognized that acquired crossed aphasia in dextral children represents a highly exceptional phenomenon. We describe in a three epoch time-frame model the aphasic and neurocognitive manifestations of an additional case and focus briefly on its anatomoclinical configurations. In our patient, a right parietal cortico-subcortical hemorrhagic lesion caused an initially severe aphasia. After remission of the global aphasic symptoms in the acute phase, an adynamic output disorder with relatively severe auditory-verbal comprehension disturbances developed. In addition to the adynamia of self-generated speech, formal language investigations performed 3 weeks postonset, revealed agrammatism, hypertonic dysarthria, and dysprosodia. A substantial improvement of the aphasic disorder was objectified 83 days postonset. Neuropsychological investigations disclosed both dominant and nondominant hemisphere dysfunctions. Reassessment of neurocognitive functions after a 10-year period evidenced discrete residual anomia, confined to visual confrontational naming and a discrete visuo-perceptual syndrome. Given the posterior localization of the lesion, the syndrome shift from global to predominantly adynamic aphasia represents a finding beyond the plausible anatomoclinical expectations holding in general for the uncrossed, classic types of childhood and adult aphasia. As the first representative of crossed aphasia in dextral children with an anomalous lesion-aphasia profile, our case provides evidence to enrich the discussion on lateralization and intrahemispherical organization of language functions in both childhood and adult aphasia.     

脑损伤语言认知障碍研究 ——认知神经心理学研究途径

20世纪90年代以来,从认知神经科学的角度揭示语言及其它认知的脑机制成为科学研究的前沿与热点。研究各种脑损伤导致的特异性语言障碍,为探索语言和其它认知的结构、加工,及大脑不同部位在语言和其它认知活动中的功能增添了一条新的途径。同时也对临床失语症的诊断与康复起了很多积极的作用。汉语在世界语言体系中具有其独特性,对汉语的语言障碍及其脑机制的研究将为完善人类语义知识理论、语言的表征与加工模型有重要贡献,也为发展汉语失语症针对性的康复方案提供理论和实践基础     

Test-retest reliability of fMRI during nonverbal semantic decisions in moderate-severe nonfluent aphasia patients

Cortical reorganization in poststroke aphasia is not well understood. Few studies have investigated neural mechanisms underlying language recovery in severe aphasia patients, who are typically viewed as having a poor prognosis for language recovery. Although test-retest reliability is routinely demonstrated during collection of language data in single-subject aphasia research, this is rarely examined in fMRI studies investigating the underlying neural mechanisms in aphasia recovery. The purpose of this study was to acquire fMRI test-retest data examining semantic decisions both within and between two aphasia patients. Functional MRI was utilized to image individuals with chronic, moderate-severe nonfluent aphasia during nonverbal, yes/no button-box semantic judgments of iconic sentences presented in the Computer-assisted Visual Communication (C-ViC) program. We investigated the critical issue of intra-subject reliability by exploring similarities and differences in regions of activation during participants' performance of identical tasks twice on the same day. Each participant demonstrated high intra-subject reliability, with response decrements typical of task familiarity. Differences between participants included greater left hemisphere perilesional activation in the individual with better response to C-ViC training. This study provides fMRI reliability in chronic nonfluent aphasia, and adds to evidence supporting differences in individual cortical reorganization in aphasia recovery.     

对语言神经机制的新认识

本文针对语言神经机制的研究现状,分析了失语症和裂脑人研究的成果,并且较为详细地介绍了最近十年脑功能成像得到的有关语言神经活动的新成就,在此基础上,提出了一种动态分布式竞争的解释理论,用来解释语言神经活动现象和规律,并进一步借以说明言语意识的产生机制。     

Subcortical Aphasia

We critically review the literature on subcortical aphasia, suggest that a number of traditional concepts regarding mechanisms of aphasia are inconsistent with now abundant data, and propose several new hypotheses. The absence of aphasia in 17 reported cases of dominant hemisphere striatocapsular infarction and the finding of nearly every conceivable pattern of language impairment in 33 different reported cases of striatocapsular infarction provide strong evidence against a major direct role of the basal ganglia in language and against disconnection or diaschisis as mechanisms of nonthalamic subcortical aphasia. However, detailed consideration of the vascular events leading to striatocapsular infarction strongly suggests that associated linguistic deficits are predominantly related to sustained cortical hypoperfusion and infarction not visible on structural imaging studies. Thalamic disconnection, as may occur with striatocapsular infarcts with extension to the temporal stem and putamenal hemorrhages, may also contribute to the language deficits in some patients. Review of the literature on thalamic infarction, in conjunction with previously unreported anatomic details of four cases, suggests that what infarcts in the tuberothalamic artery territory and the occasional infarcts in the paramedian artery territory associated with aphasia have in common is damage to the frontal lobe–inferior thalamic peduncle–nucleus reticularis–center median system that may be involved in regulating the thalamic gate in attentional processes. Disruption of attentional gating in the pulvinar and lateral posterior nuclei resulting from such lesions may impair selection of specific neuronal networks in the projection field of these nuclei that serve as the substrate for lexical–semantic function, which is in effect a disruption of a type of working memory, as defined by Goldman–Rakic. We define this as a defect of selective engagement.     

Environmental stimulation, parental nurturance and cognitive development in humans

The effects of environmental stimulation and parental nurturance on brain development have been studied extensively in animals. Much less is known about the relations between childhood experience and cognitive development in humans. Using a longitudinally collected data set with ecologically valid in-home measures of childhood experience and later in-laboratory behavioral measures of cognitive ability, we were able to test hypotheses concerning the effects of environmental stimulation and parental nurturance. A double dissociation was found: On the one hand, there was a selective relation between parental nurturance and memory development, consistent with the animal literature on maternal buffering of stress hormone effects on hippocampal development. On the other hand, there was a selective relation between environmental stimulation and language development. The relevance of these findings to socioeconomic gradients in cognitive ability is discussed.     

The occurrence of paraphasias in the spontaneous speech of children with an acquired aphasia

Two children with an acquired aphasia were observed during the recovery process. In the spontaneous speech, paraphasias belonging to different categories, such as neologisms, verbal paraphasias, and literal paraphasias, were found. Especially with regard to neologisms the time of investigation was very important. In addition, one child with a phonemic jargon aphasia and one child with a fluent aphasia and empty speech were observed. These observations implicate a modification of the current clinical picture of childhood aphasia. Some aspects are discussed in relation to adult aphasia.     

Acquired epileptiform aphasia: a dimensional view of Landau-Kleffner syndrome and the relation to regressive autistic spectrum disorders.

Acquired epileptiform aphasia (AEA) is characterized by deterioration in language in childhood associated with seizures or epileptiform electroencephalographic abnormalities. Despite an extensive literature, discrepancies and contradictions surround its definition and nosological boundaries. This paper reviews current conceptions of AEA and highlights variations in the aphasic disturbance, age of onset, epileptiform EEG abnormalities, temporal course, and long-term outcome. We suggest that AEA, rather than being a discrete entity, is comprised of multiple variants that have in common the features of language regression and epileptiform changes on EEG. Viewed this way, we argue that AEA can be conceptualized on a spectrum with other epileptiform neurocognitive disorders that may share pathophysiological features. The implications of this viewpoint are discussed, with emphasis on parallels between the AEA variants and regressive autistic spectrum disorders.     

The systematic misrepresentation of bilingual-crossed aphasia data and its consequences

The evidence from bilingual-crossed aphasia which has been used to support a bilingualism-right hemisphere effect for language representation and/or processing is critically reevaluated. Data gathered by the case survey method are shown to have been misrepresented in the literature. The argument based on a single group study of right-lesioned subjects is shown to rest upon a fundamental misinterpretation of those data. The consequences of such misrepresentation and misinterpretation as reflected in recent research are discussed.     

Working memory in multilingual children: Is there a bilingual effect?

This research investigates whether early childhood bilingualism affects working memory performance in 6- to 8-year-olds, followed over a longitudinal period of 3 years. The study tests the hypothesis that bilinguals might exhibit more efficient working memory abilities than monolinguals, potentially via the opportunity a bilingual environment provides to train cognitive control by combating interference and intrusions from the non-target language. A total of 44 bilingual and monolingual children, matched on age, sex, and socioeconomic status, completed assessments of working memory (simple span and complex span tasks), fluid intelligence, and language (vocabulary and syntax). The data showed that the monolinguals performed significantly better on the language measures across the years, whereas no language group effect emerged on the working memory and fluid intelligence tasks after verbal abilities were considered. The study suggests that the need to manage several language systems in the bilingual mind has an impact on children's language skills while having little effects on the development of working memory.     

Working memory in multilingual children: is there a bilingual effect?

This research investigates whether early childhood bilingualism affects working memory performance in 6- to 8-year-olds, followed over a longitudinal period of 3 years. The study tests the hypothesis that bilinguals might exhibit more efficient working memory abilities than monolinguals, potentially via the opportunity a bilingual environment provides to train cognitive control by combating interference and intrusions from the non-target language. A total of 44 bilingual and monolingual children, matched on age, sex, and socioeconomic status, completed assessments of working memory (simple span and complex span tasks), fluid intelligence, and language (vocabulary and syntax). The data showed that the monolinguals performed significantly better on the language measures across the years, whereas no language group effect emerged on the working memory and fluid intelligence tasks after verbal abilities were considered. The study suggests that the need to manage several language systems in the bilingual mind has an impact on children's language skills while having little effects on the development of working memory.     

Cross-language lexical connections in the mental lexicon: evidence from a case of trilingual aphasia

Despite anecdotal data on lexical interference among the languages of multilingual speakers, little research evidence about the lexical connections among multilinguals' languages exists to date. In the present paper, two experiments with a multilingual speaker who had suffered aphasia are reported. The first experiment provides data about inter-language activation during natural conversations; the second experiment examines performance on a word-translation task. Asymmetric patterns of inter-language interference and translation are evident. These patterns are influenced by age of language learning, degree of language recovery and use, and prevalence of shared lexical items. We conclude that whereas age of language learning plays a role in language recovery following aphasia, the degrees of language use prior to the aphasia onset and of shared vocabulary determine the ease with which words are accessed. The findings emphasize the importance of patterns of language use and the relations between the language pair under investigation in understanding lexical connections among languages in bilinguals and multilinguals.     

The neural basis of syntactic deficits in primary progressive aphasia

Patients with primary progressive aphasia (PPA) vary considerably in terms of which brain regions are impacted, as well as in the extent to which syntactic processing is impaired. Here we review the literature on the neural basis of syntactic deficits in PPA. Structural and functional imaging studies have most consistently associated syntactic deficits with damage to left inferior frontal cortex. Posterior perisylvian regions have been implicated in some studies. Damage to the superior longitudinal fasciculus, including its arcuate component, has been linked with syntactic deficits, even after gray matter atrophy is taken into account. These findings suggest that syntactic processing depends on left frontal and posterior perisylvian regions, as well as intact connectivity between them. In contrast, anterior temporal regions, and the ventral tracts that link frontal and temporal language regions, appear to be less important for syntax, since they are damaged in many PPA patients with spared syntactic processing.     

An overview on Primary Progressive Aphasia and its variants

We present a review of the literature on Primary Progressive Aphasia (PPA) together with the analysis of neuropschychological and neuroradiologic profiles of 42 PPA patients. Mesulam originally defined PPA as a progressive degenerative disorder characterized by isolated language impairment for at least two years. The most common variants of PPA are: 1) Progressive nonfluent aphasia (PNFA), 2) semantic dementia (SD), 3) logopenic progressive aphasia (LPA). PNFA is characterized by labored speech, agrammatism in production, and/or comprehension. In some cases the syndrome begins with isolated deficits in speech. SD patients typically present with loss of word and object meaning and surface dyslexia. LPA patients have word-finding difficulties, syntactically simple but accurate language output and impaired sentence comprehension. The neuropsychological data demonstrated that SD patients show the most characteristic pattern of impairment, while PNFA and LPA overlap within many cognitive domains. The neuroimaging analysis showed left perisylvian region involvement. A comprehensive cognitive, neuroimaging and pathological approach is necessary to identify the clinical and pathogenetic features of different PPA variants.     

Language Promotes False-Belief Understanding: Evidence From Learners of a New Sign Language

ABSTRACT— Developmental studies have identified a strong correlation in the timing of language development and false-belief understanding. However, the nature of this relationship remains unresolved. Does language promote false-belief understanding, or does it merely facilitate development that could occur independently, albeit on a delayed timescale? We examined language development and false-belief understanding in deaf learners of an emerging sign language in Nicaragua. The use of mental-state vocabulary and performance on a low-verbal false-belief task were assessed, over 2 years, in adult and adolescent users of Nicaraguan Sign Language. Results show that those adults who acquired a nascent form of the language during childhood produce few mental-state signs and fail to exhibit false-belief understanding. Furthermore, those whose language developed over the period of the study correspondingly developed in false-belief understanding. Thus, language learning, over and above social experience, drives the development of a mature theory of mind.     

The etiology of variation in language skills changes with development: a longitudinal twin study of language from 2 to 12 years

The present study is the first long-term longitudinal examination of the etiology of individual differences in language from early childhood through to adolescence. We applied a multivariate latent factor genetic model to longitudinal data from the Twins Early Development Study in order to (a) compare the magnitude of genetic and environmental influences on language skills in early childhood (2, 3 and 4 years), middle childhood (7, 9 and 10 years), and early adolescence (12 years); and (b) determine to what extent the same genetic and environmental factors underlie variation in language skills at these three stages of language development. We found that while shared environmental influences appear to be dominant (latent factor c2 = .74) in early language, with a smaller though significant role for genetic factors (latent factor a2 = .24), the pattern is reversed by middle childhood such that genetic influences are substantially more important (latent factor a2 = .57-.63 at 7, 9 and 10 years and .47-.57 at 12 years) and shared environmental influences less so (latent factor c2 = .31-.37 at 7, 9 and 10 years and .31-.32 at 12 years). The increase in the heritability of language skills between early and middle childhood appears to be due to new genetic factors that come into play at that transition. In contrast, genetic factors remain stable from middle childhood through to early adolescence, and account for the phenotypic continuity in language skills across these two stages.