Incongruous oral and written naming: Evidence for a subdivision of the syndrome of Wernicke's aphasia

A 28-year-old man developed the fluent paraphasic speech characteristic of Wernicke's aphasia after an episode of necrotizing temporal lobe encephalitis. He exhibited an unexpected, and heretofore unreported, superiority of written naming over oral naming. His reading comprehension was modestly superior to his auditory comprehension as well. These findings are at variance with the traditional view of Wernicke's aphasia as an undissociable syndrome of defective reading, writing, and speech. They suggest that an appropriately placed lesion can partially spare reading and writing while still producing fluent paraphasic speech.     

Enhancement of naming in nonfluent aphasia through gesture

In a number of studies that have examined the gestural disturbance in aphasia and the utility of gestural interventions in aphasia therapy, a variable degree of facilitation of verbalization during gestural activity has been reported. The present study examined the effect of different unilateral gestural movements on simultaneous oral-verbal expression, specifically naming to confrontation. It was hypothesized that activation of the phylogenetically older proximal motor system of the hemiplegic right arm in the execution of a communicative but nonrepresentational pointing gesture would have a facilitatory effect on naming ability. Twenty-four aphasic patients, representing five aphasic subtypes, including Broca's, Transcortical Motor, Anomic, Global, and Wernicke's aphasics were assessed under three gesture/naming conditions. The findings indicated that gestures produced through activation of the proximal (shoulder) musculature of the right paralytic limb differentially facilitated naming performance in the nonfluent subgroup, but not in the Wernicke's aphasics. These findings may be explained on the view that functional activation of the archaic proximal motor system of the hemiplegic limb, in the execution of a communicative gesture, permits access to preliminary stages in the formative process of the anterior action microgeny, which ultimately emerges in vocal articulation.     

语素意识、快速命名对汉字听写和抄写的作用

书写是小学阶段书面语发展的重要目标之一,受到多种认知技能的影响。采用追踪研究考察了127名小学五年级儿童的语素意识和快速命名对其五、六年级时的汉字听写和抄写的影响。控制了非言语智力、语音意识后,结果发现：(1)儿童汉字听写和抄写能力随时间发展均有显著增长;(2)五年级语素意识显著预测了五、六年级两个时间点的听写,五年级快速命名仅显著预测了五年级听写;(3)五年级语素意识和快速命名预测了五年级抄写。研究表明语素意识和快速命名对汉字听写和抄写存在不同的影响作用。     

Analyzing aphasia data in a multidimensional symptom space

The utility of single-case vs. group studies has been debated in neuropsychology for many years. The purpose of the present study is to illustrate an alternative approach to group studies of aphasia, in which the same symptom dimensions that are commonly used to assign patients to classical taxonomies (fluency, naming, repetition, and comprehension) are used as independent and continuous predictors in a multivariate design, without assigning patients to syndromes. One hundred twenty-six Italian-speaking patients with aphasia were first classified into seven classic aphasia categories, based on fluency, naming, auditory comprehension, and repetition scales. There were two goals: (1) compare group analyses based on aphasia types with multivariate analyses that sidestep classification and treat aphasic symptoms as continuous variables; (2) present correlation-based outlier analyses that can be used to identify individuals who occupy unusual positions in the multivariate "symptom space." In the service of the first goal, group performance on an external validation measure (the Token Test) was assessed in three steps: analyses of variance based on aphasia type, regressions using the same cut-offs for fluency, naming, comprehension and repetition as independent but dichotomous predictors, and regressions using the same subscales as continuous predictors (with no cut-offs). More variance in Token Test performance was accounted for when symptoms were treated as continuous predictors than with the other two methods, though use of independent but dichotomous predictors accounted for more variance than aphasia taxonomies. Thus, if we by-pass classical taxonomies and treat patients as points in a multidimensional symptom space, better predictions are obtained. Outlier analyses show that group results depend on heterogeneity among patients, which can be used as a search tool to identify potentially interesting dissociations. Hence this multivariate group approach is complementary to and compatible with single-case methods.     

Squaring the round: An unusual progressive graphomotor impairment with post‐mortem findings

Investigations of neurodegenerative disorders may reveal functional relationships in the cognitive system. C.S. was a 63‐year‐old right‐handed man with post‐mortem confirmed Pick's disease with a range of progressive impairments including non‐fluent aphasia, speech, limb, oculomotor, and buccofacial apraxia, but mostly intact intelligence, perception, orientation, memory, semantics, and phonology. During progression, agrammatism in writing with impairments in syntactic comprehension emerged in parallel with an unusual graphomotor deficit in drawing and writing, with an increasing deterioration of graphic short‐term memory. We investigated C.S.'s graphomotor deficit longitudinally using tests of writing and drawing on letters, words, and sentences and drawing to command and copying. We also tested C.S.'s short‐term graphemic buffer experimentally. Analysis showed deficits on selective aspects of graphomotor implementation of writing and drawing, mainly affecting the production of circles and curves, but not short straight lines in drawing and writing, and graphomotor short‐term memory, which paralleled impairments of written syntax and syntactic comprehension. We believe this to be the first detailed analysis of such an unusual progressive impairment in graphomotor production, which may be related to problems with agrammatic agraphia and impairments affecting shared components of cognition reflecting damage to shared neural networks. Alternatively, they may simply reflect the effects of coincidental damage to separate mechanisms responsible for aspects of writing, drawing, and syntactic processing. Longitudinal investigations of emerging deficits in progressive conditions like C.S.'s provides an opportunity to examine the progressive emergence of symptoms in an individual with multiple progressive impairments as they appear and examine putative relationships between them.     

Self-reported inner speech relates to phonological retrieval ability in people with aphasia

Many individuals with aphasia report the ability to say words in their heads despite spoken naming difficulty. Here, we examined individual differences in the experience of inner speech (IS) in participants with aphasia to test the hypotheses that self-reported IS reflects intact phonological retrieval and that articulatory output processing is not essential to IS. Participants (N = 53) reported their ability to name items correctly internally during a silent picture-naming task. We compared this measure of self-reported IS to spoken picture naming and a battery of tasks measuring the underlying processes required for naming (i.e., phonological retrieval and output processing). Results from three separate analyses of these measures indicate that self-reported IS relates to phonological retrieval and that speech output processes are not a necessary component of IS. We suggest that self-reported IS may be a clinically valuable measure that could assist in clinical decision-making regarding anomia diagnosis and treatment.     

Phoneme-based rehabilitation of anomia in aphasia

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.     

Support for anterior temporal involvement in semantic error production in aphasia: new evidence from VLSM

Semantic errors in aphasia (e.g., naming a horse as “dog”) frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were found in the left anterior temporal lobe (L-ATL), in the mid- to anterior MTG region. The absence of findings in Wernicke’s area was surprising, as were indications that ATL voxels made an essential contribution to the post-semantic stage of lexical access. In this follow-up study, we sought to validate these results by re-defining semantic errors in a manner that was less theory dependent and more consistent with prior lesion studies. As this change also increased the robustness of the dependent variable, it made it possible to perform additional statistical analyses that further refined the interpretation. The results strengthen the evidence for a causal relationship between ATL damage and lexically-based semantic errors in naming and lend confidence to the conclusion that chronic lesions in Wernicke’s area are not causally implicated in semantic error production.     

Naming of grammatical classes in frontotemporal dementias: linguistic and non linguistic factors contribute to noun-verb dissociation

We studied noun and verb naming in three main variants of frontotemporal dementia: the frontal variant(Fv-FTD), primary progressive aphasia (PPA) and semantic dementia (SD). We further distinguished PPA in nonfluent and fluent forms and restricted diagnosis of SD to subjects with progressive semantic breakdown leading to agnosia for words and objects. Fv-FTD and nonfluent-PPA named objects better than actions, SD showed an inverse dissociation and no specific pattern emerged in fluent-PPA. In this last group, in spite of the broad definition of fluent aphasia, quite heterogeneous patterns of language disorders and word class dissociation emerged when single-subject analyses were performed. In fv-FTD correlations between executive tasks and action naming were stronger than between executive tasks and object naming. We conclude that both linguistic and non linguistic factors, in particular an executive deficit, contribute to grammatical class dissociation. We also suggest that the fluent vs. nonfluent distinction does not reflect the complexity of primary aphasia.     

Comprehending homographs in aphasia

This study assessed 13 aphasic subjects' knowledge of the multiple meanings of homographs. The results indicated that the various meanings were less available to aphasic subjects than to normal subjects. In addition, specific meanings became less available as they became less typical although the number of meanings associated with a homograph did not influence performance. Aphasia type also did not influence performance. Performance on the experimental test was significantly correlated with auditory comprehension level and picture naming ability. The results were related to recent findings on semantic organization in aphasia.     

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.     

Variable solutions to the same problem: aberrant practice effects in object naming by three aphasic patients

Although deficits in confrontation naming are a common consequence of damage to the language areas of the left cerebral hemisphere, some patients with aphasia show relatively good naming ability. We measured effects of repeated practice on naming latencies for a set of pictured objects by three aphasic patients with near-normal naming ability and by neurologically intact young and older adults. While the non-injured participants showed a systematic reduction in overall mean latencies and reduced trial-to-trial latency variability, the aphasic patients did not. Examination of the latency distributions suggests that successful naming by aphasic patients may come about by different underlying operations.     

Word imageability effects on naming: a pilot investigation of beginning readers of Turkish

Word imageability, a semantic variable, in naming by beginning readers of English is well documented particularly with poor readers naming high imageable words more accurately than low imageable words. The present study examined the role of imageability on word naming by 20 good and 20 poor beginning readers as a function of orthographic transparency by utilizing the peculiarities of the transparent Turkish writing system. Neither good nor poor beginning readers show any evidence of imageability for Turkish suggesting that the contribution of imageability to word naming may indeed be determined by orthographic transparency. Implications of these findings are discussed.     

Superadditive effects of multiple lesions in a connectionist architecture: implications for the neuropsychology of optic aphasia

Neuropsychological disorders have traditionally been understood in terms of a focal lesion to a single component of a cognitive architecture. Optic aphasia (OA) defies explanation in this way. In OA, naming of visual stimuli is impaired in the absence of general visual agnosia or anomia. OA has been explained by positing multiple semantic systems or multiple functional pathways to visual naming. M. J. Farah (1990) instead sketched a parsimonious account based on multiple lesions--to pathways mapping visual input to semantic and semantics to naming responses--and the assumption that the effects of the lesions are superadditive. The authors demonstrate superadditive effects of damage in a connectionist architecture and model other phenomena associated with OA. Multiple lesions with superadditivity provide a novel class of explanations for neuropsychological deficits that previously seemed to imply the existence of highly specialized processing components.     

Feature-processing deficits following brain injury. II. Classification learning, categorical decision making, and feature production

The claim that overselectivity in feature processing underlies the disorders that aphasics display in processing both visual and verbal material was directly tested by exploring the relationships between the behavior of brain-injured subjects on three experimental tasks: classification learning, categorical decision making, and feature production. From each of these tests a score selected as being indicative of overselective responding was entered into a principal components analysis, together with measures of visual recognition and memory, visual reasoning, naming skills, and severity of aphasia. This analysis supported the assumption that feature-processing disability is a specific and separable deficit, although related both to naming ability and to severity of aphasia. The relevance of the overselectivity hypothesis to naming difficulties following brain injury is discussed.     

Supra- and infrasylvian conduction aphasia

Fifteen cases of conduction aphasia which were tested with the Aachen Aphasia Test (AAT), are presented. The CT lesion data were transformed to a standard 3D-reference brain referring to the ACPC line. According to the lesion profiles a group of 6 patients had pure suprasylvian lesions, a group of 4 patients had pure infrasylvian lesions, and a group of 5 patients had lesions in both supra- and infrasylvian regions. Suprasylvian conduction aphasics are superior to infrasylvian conduction aphasics in the token test and in repetition tasks. Infrasylvian conduction aphasics use more stereotypes in spontaneous speech than suprasylvian conduction aphasics. Conduction aphasics with both lesion sites perform less well in tests of naming, writing, and comprehension than the pure types. Thus conduction aphasia is a heterogeneous syndrome anatomically and linguistically.     

Speech sound errors in patients with conduction and Broca's aphasia

Speech sound errors exhibited by three conduction and three Broca's aphasic patients on naming and word-repetition tasks were subjected to phonemic and subphonemic analyses. In the conduction aphasic patients, errors occurred equally often on consonants and vowels in both the naming and word-repetition tasks, while in the Broca's aphasic patients errors occurred selectively on consonants. Transposition errors occurred almost as often as substitution errors in the conduction aphasic patients, while substitution errors constituted the majority of errors in the Broca's aphasic patients. The Broca's aphasic patients, as compared to the conduction aphasic patients, exhibited a markedly higher number of substitution errors occurring between phonemes separated by a single subphonemic feature on the naming task. On the basis of these findings, it was hypothesized that the differences in the error patterns of the two types of aphasia reflected differences in the underlying mechanisms of the impairment in each type.