Basal ganglia participation in language pathology

Language disturbances were studied in 40 patients with well-demarcated vascular lesions of the speech-dominant hemisphere. Computerized cranial tomography was used for localization of the lesion. Special emphasis was given to the analysis of automatized speech and repetitive verbal phenomena.Subcortical infarctions with basal ganglia involvement led to transient aphasia although long-lasting abnormalities of language could be detected in these patients. Aphasia was more severe if a cortical lesion was combined with a basal ganglia lesion. Automatisms and recurring utterances occurred only with combined cortical and basal ganglia lesions. A lesion of Wernicke's area alone, without involvement of prerolandic structures or subcortical nuclei, was sufficient to produce long-lasting aphasia, whereas lesions of Broca's area alone produced only transient language disturbances. The results are compatible with a recent theory of multiple cerebral representation of function.     

Effect of lexical cues on the production of active and passive sentences in Broca's and Wernicke's aphasia

This study compared the sentence production abilities of individuals with Broca's and Wernicke's aphasia in an attempt to explore the extent to which impaired lexical retrieval impedes sentence production. The ability to produce active and passive reversible and non-reversible sentences was examined when varying amounts of lexical information was provided. The results showed that both Wernicke's and Broca's aphasic individuals were impaired in passive sentence production and that these difficulties were not overcome when lexical cues (the relevant nouns and uninflected verb) were provided. However when auxiliary and past tense morphemes were provided along with the verb stem, production of passive sentences improved drastically for both groups. Analysis of error patterns, however, revealed differences between the two groups, suggesting that Broca's aphasic subjects may find passive sentences difficult due to problems with retrieving the relevant grammatical morphemes. Subjects with Wernicke's aphasia may have been unable to automatically access the passive sentence structure.     

The noun-verb problem in Chinese aphasia.

Previous studies have shown that Broca's aphasics experience a selective difficulty with action naming inside or outside of a sentence context. Conversely, it has been suggested that Wernicke's aphasics are particularly impaired in object naming. A number of explanations have been offered to account for this double dissociation, including grammatical accounts according to which the main verb problem in agrammatic Broca's aphasics is viewed as a by-product of their syntactic and/or morphological impairment, due perhaps to the greater morphological load carried by verbs (compared with nouns). In the Chinese language, there are no verb conjugations and no declensions. Hence there is no reason to expect a relationship between morphological impairment and deficits in action naming. We examined comprehension and production of object and action names, outside of a sentence context, in a sample of Chinese-speaking Broca's and Wernicke's aphasics. There was an interaction between patient group and object/action naming, but no corresponding interaction on the comprehension task. We conclude that action-naming deficits in Broca's aphasia (and/or the corresponding sparing of action names in Wernicke's aphasia) cannot be attributed to morphological differences between nouns and verbs. We also found a sublexical variant of the noun/verb dissociation applied to the internal structure of compound words made up of a verbal and a nominal element: Broca's aphasics tended to lexicalize the verbal portion of these words more often than the nominal compound, while Wernicke's showed the opposite pattern. These sublexical effects are difficult to explain in syntactic terms nor do they fit the standard lexical view. A modified lexical account is proposed, emphasizing semantic/conceptual effects in a distributed lexicon.     

Comparison of the performances of a fluent and a nonfluent aphasic on a pantomimic referential task

The pantomimic performances of a typical Broca's (nonfluent) and Wernicke's (fluent) aphasic were compared with each other and with four normal control subjects on a simple task of nonverbal referential communication. Both aphasic subjects demonstrated only about 50% accuracy in their pantomimic communication. Also, measures were obtained of the motoric fluency of the pantomimes of all subjects and comparisons were made between the fluent and nonfluent aphasics. These measures demonstrated distinct differences in the fluency patterns of the pantomimes of the two aphasic subjects similar to the differences in speech fluency which distinguish and characterize these two types of aphasia; that is, the fluent aphasic pantomimed fluently and like the control subjects and the nonfluent aphasic pantomimed nonfluently. The quantitative and qualitative similarities in the fluency patterns of the speech and the pantomimic behaviors of the aphasic subjects are discussed in terms of their implications for a definition of aphasia.     

Immediate memory span, recognition memory for subspan series of words, and serial position effects in recognition memory for supraspan series of verbal and nonverbal items in Broca's and Wernicke's aphasia

Four Broca's aphasics, four Wernicke's aphasics, and four matched controls were investigated on three verbal and one visual short-term memory tasks. Experiment 1 considered memory span and subspan recognition memory for verbal items and Experiment 2 assessed serial position effects in supraspan verbal recognition memory. The Broca's aphasics demonstrated verbal memory deficits, which could not be attributed to linguistic disturbances, while the verbal memory deficiencies seen with the Wernicke's aphasics could be regarded as secondary to linguistic defects. In Experiment 3, where visual recognition memory was investigated, only the Broca's aphasics showed deficient performance. The wider context of deficient mnemonic performance in aphasia is discussed.     

Verbal self-correction behaviors of fluent and nonfluent aphasic subjects

This investigation examined the use of six explicitly defined verbal self-correction behaviors by fluent and nonfluent aphasic subjects of high and low verbal ability, and by subjects further classified into six groups according to type of aphasia (Broca's, Anomic, Wernicke's etc.). Aphasic groups, on the average, generated some type of verbal self-correction effort on more than half of their initially erroneous responses, and the proportions of these efforts did not differ between aphasic patient groups. Significant differences in self-correction success were found, however, between groups classified according to fluency and severity, as well as among the six groups based on type of aphasia. In the former case, distinctions in self-correction skill favored high-verbal-ability groups regardless of fluency classification. In the latter instance, the subgroups typically formed by less severely impaired patients (Anomic and Broca's) had significantly higher proportions of successful self-correction behaviors than those comprised of individuals with more severe involvement (Wernicke's and Broca's plus severely limiting apraxia of speech). Between-group differences for specific types of self-correction behaviors occurred rarely, but those which were found could be related to characteristics of the particular aphasic groups under consideration. Verbal self-correction behavior is discussed as a behavioral reaction to an erroneous response or dissatisfaction with the quality of an intended response. These behaviors are viewed as indicators of the intactness of an aphasic individual's self-monitoring system, and of his tolerance for responses that are qualitatively limited by his verbal deficits.     

Aphasia type and aging in Hindi-speaking stroke patients

In this study, the clinical profile of Hindi-speaking stroke patients with aphasia from northern India has been investigated. We examined the interactional effect between age and gender with aphasia type in 97 Hindi-speaking right-handed individuals, the majority of them with a confirmed diagnosis of a cerebrovascular accident. The subjects included in the study ranged from 3 weeks to two years post-onset with a diagnosis of a common classical aphasia (Broca's, Wernicke's, anomic, global, conduction, and transcortical) types involving both males and females. Also examined was the interaction between literacy and aphasia type since the subjects had varied exposures to education (total illiteracy to professional/university education). While the data reported here about Hindi-speaking aphasics are relatively in agreement with the age-aphasia type patterns discussed in western countries, nonetheless some differences were also observed. The mean age of Indian patients with aphasia was significantly lower. Also, in addition to some gender and literacy related differences, an outstanding difference was that many clinical symptoms that are known to co-occur with aphasia were not readily reported by subjects with stroke.     

Syntactic and semantic processes in aphasic deficits: The availability of prepositions

The availability of a specific category of closed class items (prepositions) was examined in Broca's and Wernicke's aphasia. The role of prepositions was varied (syntactic/semantic) in two tasks: one requiring production of prepositions and the other acceptability judgments. Overall, it was easier to perform the acceptability task than to produce the target item. In the judgment task, Wernicke's aphasics more accurately determined the acceptability of prepositions in their syntactic role than in their semantic role, but Broca's aphasics showed no such difference. In the production task, Wernicke's aphasics again were more likely to produce prepositions which were in a primarily syntactic role. Broca's aphasics, however, failed to produce such syntactically based prepositions. The results suggest that the availability of a given closed class vocabulary form is not merely a function of its class membership but also of its functional role, and this fact serves to distinguish aspects of Broca's and Wernicke's aphasics' deficit.     

Aphasia type and aging

We analyzed the relationship between age and clinical type of aphasia in 167 right-handed men who had suffered cerebrovascular accidents. Patients with unequivocal diagnoses as Broca's, Wernicke's, anomic, conduction, and global aphasics were considered. The median age of the Broca's group (51 years old) was significantly lower than that of the total group (55.8 years old), while the median age of the Wernicke's group was significantly higher (63 years old). Moreover the incidence of Wernicke's aphasia increased steadily with age, while incidence of the other types of aphasia peaked in the sixth decade and then diminished with increasing age.     

Word order and finiteness in Dutch and English Broca's and Wernicke's aphasia

The effect of two linguistic factors in Broca's and Wernicke's aphasia was examined using Dutch and English subjects. Three tasks were used to test (1). the comprehension and (2). the construction of sentences, where verbs (in Dutch) and verb arguments (in Dutch and English) are in canonical versus non-canonical position; (3). the production of finite versus infinitive verbs. Proportions of errors as well as types of errors made by each aphasic group are similar on the sentence comprehension and sentence anagram tasks. On the verb production task the performance pattern is, again, the same, but the error types are different. The discussion focuses on how the similarities and differences across languages and across aphasia types may be interpreted with respect to the underlying deficit in Broca's and Wernicke's aphasia.     

The validity of aphasic subtypes

The validity of aphasic subtypes derived by the Norwegian Basic Aphasia Assessment, NBAA, is discussed. 193 aphasic patients were reclassified according to the criteria of classification used by the Western Aphasia Battery. 85% agreement was established with mixed cases held apart, Wernicke's and Counduction aphasia being the least stable groups. Cluster analysis produced 9 clusters, of which 8 proved statistically valid through discriminant analysis and clinically valid through inspection of the derived test profiles. These were: Global, Broca's, Wernicke's and Anomic aphasia, each separated in a major and a minor impaired group. Accepting unclassifiable cases and specifying the desired domain of validity when classifying aphasia, are discussed.     

Syntactic component in language responsible cognitive structure: Neurological evidence

From the results of a broad ranging comprehension test, a hierarchy of difficulty emerged that is shared by the two groups of aphasics (Broca's and Wernicke's aphasics) and by the control group of normal subjects. The parallelism has been interpreted as a confirmation of the hypothesis that syntactic competence is not inaccessible either in Wernicke's or in Broca's aphasia. The Minimal Distance Principle, as a relevant recognition principle, has been studied, and although not confirmed by the scores has been brought to the fore both by the correlations between the variables under study and by the correlations with the concomitant variables of age and level of education.     

Nasal consonant production in Broca's and Wernicke's aphasics: speech deficits and neuroanatomical correlates

The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three acoustic measures were analyzed corresponding to different properties of articulatory implementation: murmur duration (a measure of timing), amplitude of the first harmonic at consonantal release (a measure of articulatory coordination), and murmur amplitude over time (a measure of laryngeal control). Results showed that Broca's aphasics displayed impairments in all of these parameters, whereas Wernicke's aphasics only exhibited greater variability in the production of two of the parameters. The lesion extent data showed that damage in either Broca's area or the insula cortex was not predictive of the severity of the speech output impairment. Instead, lesions in the upper and lower motor face areas and the supplementary motor area resulted in the most severe implementation impairments. For the Wernicke's aphasics, the posterior areas (superior marginal gyrus, parietal, and sensory) appear to be involved in the retrieval and encoding of lexical forms for speech production, resulting in increased variability in speech production.     

Vowel perception: A neuroradiological localization of the perception of vowels in the human cortex

Whether the perception of vowels takes place in the right or left cerebral hemisphere, or is dependent on bilateral cortical processes, is of importance in our treatment of patients with language deficiencies. To investigate this problem a phonetic test with a series of vowellike stimuli was administered to 68 right-handed adult patients with cerebral lesions, mainly of vascular origin. The results were compared to the results in a control group of 19 speech therapists. Second, a neuroradiologic method was developed in order to visualize the anatomic site of Wernicke's area in the left hemisphere on CT scans. This method formed the basis for an evaluation of the extent and localization of the patients' lesions in Wernicke's area. Of 46 patients with lesions in the left hemisphere, 19 had no perceptual disturbances and 27 had severe perceptual disturbances with lesions predominantly located in Wernicke's area. Twenty-two patients with lesions in the corresponding area in the right hemisphere showed no perceptual disturbances. The results of this investigation appear to indicate that the perception of vowels in right-handed persons is unilaterally located in Wernicke's area in the left hemisphere.     

Relating selective brain damage to impairments with voicing contrasts

Research is reviewed concerning the performance of several neurological groups on the perception and production of voicing contrasts in speech. Patients with cerebellar damage, Parkinson's disease, specific language impairment, Broca's aphasia, apraxia, and Wernicke's aphasia have been reported to be impaired in the perception and articulation of voicing. The types of deficits manifested by these neurologically impaired groups in creating and discriminating voicing contrasts are discussed and the respective contributions of separate neural areas are identified. A model is presented specifying the level of phonemic processing thought to be impaired for each patient group and critical tests of the model's predictions are identified.     

Speech prosody in Broca's aphasia

Because speech prosody is thought to be impaired in Broca's aphasia, we conducted three experiments using Broca's aphasics and nonneurological control subjects in order to determine to what extent this statement is accurate. Using three acoustic measures of speech prosody—sentence-final fundamental frequency (F₀) fall, F₀ declination, and sentence-final lengthening—we found that some aspects of prosody were spared while others were abnormal. All Broca's aphasics, regardless of degree of impairment, exhibited sentence-final F₀ fall. F₀ declination was present in simple sentences but was absent over longer domains; moreover, the amount of declination was correlated with the degree of linguistic impairment. Sentence-final lengthening was clearly absent in Broca's aphasia; in fact, sentence-terminal words were actually shorter than their sentence-initial and medial counterparts.     

Lexical creativity during instances of word-finding difficulty: Broca's vs. Wernicke's aphasia

Lexical innovation--the creation of a word by combining existing morphemes in a novel way (e.g. "map ball" for "globe")--was evaluated as a method for circumventing word-finding difficulty in Broca's and Wernicke's aphasia. Aphasic groups were matched for naming performance and compared to a control group of normal adults matched for age and education. Lexical innovations were collected during the administration of a confrontation naming test, and were then analyzed in terms of the correctness of morpheme combination, semantic accuracy, novelty, and communicative effectiveness. An innovation was considered to be communicatively effective when its intended referent was understood by a naive judge. The lexical innovations of the two aphasic groups were diametrically opposed: as compared to both Broca's aphasics and normal adults, Wernicke's aphasics innovated significantly less often, and their innovations were significantly inferior in terms of: semantic precision, the proper construction of morpheme combination, and communicative effectiveness. This pattern suggests that lack of verbal fluency may be compatible with lexical creativity, while empty logorrheic speech may be an impediment to lexical creativity. Similarly, we conclude that the agrammatism of Broca's asphasia does not interfere with lexical innovation, while the paragrammatism of Wernicke's aphasia does interfere with lexical innovation, thus suggesting that paragrammatism affects morpheme combination at the word level as well as the sentence level.     

Selective deficit of conceptual structures in aphasia: Class versus thematic relations

Conceptual structures in aphasia were investigated by means of a nonverbal test. The understanding of class and thematic relationships was demonstrated to be selectively impaired according to varieties of aphasic deficit. Broca's aphasics showed difficulty evaluating a thematic relationship and did not differ from normal controls as far as class relationships were concerned. The opposite happened for Wernicke's aphasics whose defect seems to be selectively restricted to class relationships.     

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.     

The crucial role of tense for verb production

The case of an aphasic patient whose spontaneous speech contains very few lexical verbs is reported. Instead of sentences with lexical verbs, the patient produces many (grammatical) copular constructions. He also substitutes lexical verbs with the copula. Although this results in ungrammatical utterances, by doing so, a resemblance of sentence structure and a degree of grammaticality of his utterances are preserved. Although the patient is more impaired in naming action than object pictures, it is unlikely that lexical retrieval difficulties are solely responsible for the paucity of lexical verbs in his speech. A series of tests revealed a profound deficit in producing tense marking inflections and in understanding their significance. We argue that the unavailability of tense features is the primary reason for the lack of lexical verbs in his speech. An alternative possibility, that the tense deficit interacts with the verb retrieval deficit, is also discussed. The patient has a complex lesion and language profile, with features associated with both Broca's and Wernicke's aphasia. However, since the study focuses on his verb and tense deficits and the grammaticality of his utterances, issues that are often discussed in relation to agrammatic Broca's aphasia, the literature that is relevant to these topics and to Broca's aphasia is reviewed, despite the different diagnostic profile of the patient.