Mechanisms underlying writing and speech in aphasia

As a parallel to the dual decoding concept for processing of written language we proposed that phonological encoding does not necessarily occur in writing and that the phonemic and graphemic subsystems can be independent on the one-word level. This hypothesis was tested by comparing oral and written performance in a picture-naming task in Broca's and Wernicke's aphasics. In addition, the residual tacit knowledge of the orthographic properties of the names of the pictures was examined with a multiple-choice recognition task. The principal finding is that Broca's aphasics who were better in written than in oral naming showed more graphemically and semantically motivated errors than aphasics who were better in oral than in written naming, the latter producing more phonemically motivated errors. This result supports the dual encoding concept for writing on the singleword level, implying a direct route from the mental lexicon to the graphemic system in parallel with a route mediated by the phonemic system. Multiple-choice recognition was found to be superior to both oral and written performance in both Broca's and Wernicke's aphasics.     

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.     

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.     

Bilateral capacity for speech sound processing in auditory comprehension: evidence from Wada procedures

Data from lesion studies suggest that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated words better than one would expect if their speech perception system had been largely destroyed (70-80% accuracy). Further, when comprehension fails in such patients their errors are more often semantically-based, than-phonemically based. The question addressed by the present study is whether this ability of the right hemisphere to process speech sounds is a result of plastic reorganization following chronic left hemisphere damage, or whether the ability exists in undamaged language systems. We sought to test these possibilities by studying auditory comprehension in acute left versus right hemisphere deactivation during Wada procedures. A series of 20 patients undergoing clinically indicated Wada procedures were asked to listen to an auditorily presented stimulus word, and then point to its matching picture on a card that contained the target picture, a semantic foil, a phonemic foil, and an unrelated foil. This task was performed under three conditions, baseline, during left carotid injection of sodium amytal, and during right carotid injection of sodium amytal. Overall, left hemisphere injection led to a significantly higher error rate than right hemisphere injection. However, consistent with lesion work, the majority (75%) of these errors were semantic in nature. These findings suggest that auditory comprehension deficits are predominantly semantic in nature, even following acute left hemisphere disruption. This, in turn, supports the hypothesis that the right hemisphere is capable of speech sound processing in the intact brain.     

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.     

Conduction aphasia, sensory-motor integration, and phonological short-term memory - an aggregate analysis of lesion and fMRI data

Conduction aphasia is a language disorder characterized by frequent speech errors, impaired verbatim repetition, a deficit in phonological short-term memory, and naming difficulties in the presence of otherwise fluent and grammatical speech output. While traditional models of conduction aphasia have typically implicated white matter pathways, recent advances in lesions reconstruction methodology applied to groups of patients have implicated left temporoparietal zones. Parallel work using functional magnetic resonance imaging (fMRI) has pinpointed a region in the posterior most portion of the left planum temporale, area Spt, which is critical for phonological working memory. Here we show that the region of maximal lesion overlap in a sample of 14 patients with conduction aphasia perfectly circumscribes area Spt, as defined in an aggregate fMRI analysis of 105 subjects performing a phonological working memory task. We provide a review of the evidence supporting the idea that Spt is an interface site for the integration of sensory and vocal tract-related motor representations of complex sound sequences, such as speech and music and show how the symptoms of conduction aphasia can be explained by damage to this system.     

Temporal dimensions of consonant and vowel production: an acoustic and CT scan analysis of aphasic speech

This study explored a number of temporal (durational) parameters of consonant and vowel production in order to determine whether the speech production impairments of aphasics are the result of the same or different underlying mechanisms and in particular whether they implicate deficits that are primarily phonetic or phonological in nature. Detailed analyses of CT scan lesion data were also conducted to explore whether more specific neuroanatomical correlations could be made with speech production deficits. A series of acoustic analyses were conducted including voice-onset time, intrinsic and contrastive fricative duration, and intrinsic and contrastive vowel duration as produced by Broca's aphasics with anterior lesions (A patients), nonfluent aphasics with anterior and posterior lesions (AP patients), and fluent aphasics with posterior lesions (P patients). The constellation of impairments for the anterior aphasics including both the A and AP patients suggests that their disorder primarily reflects an inability to implement particular types of articulatory gestures or articulatory parameters rather than an inability to implement particular phonetic features. They display impairments in the implementation of laryngeal gestures for both consonant and vowel production. These patterns seem to relate to particular anatomical sites involving Broca's area, the anterior limb of the internal capsule, and the lowest motor cortex areas for larynx and tongue. The posterior patients also show evidence of subtle phonetic impairments suggesting that the neural instantiation of speech may require more extensive involvement, including the perisylvian area, than previously suggested.     

Apractic agraphia in a patient with normal praxis

Most right-handed crossed aphasics are not apractic. They usually have agraphia characterized by misspellings but retain the ability to write well-formed graphemes. We describe a right-handed patient with a right parietal lesion who was aphasic and not apractic. He was unable to write any formed graphemes despite a relatively preserved ability to spell aloud. We postulate that praxis and writing are dissociated in this patient because the motor engrams for praxis were located in his left hemisphere and the engrams for writing were in his right hemisphere. In addition, he comprehended commands for limb motor activities (praxis) far better than he comprehended other speech. This suggests that in this patient the areas used to comprehend limb motor commands may be anatomically distinct from areas important in comprehending other aspects of speech.     

Nonverbal categorization in fluent and nonfluent anomic aphasics

This study aimed to demonstrate that the naming difficulties of a particular group of aphasics, namely, fluent aphasics, are related to an underlying inability to organize feature set information. In order to test this hypothesis, the performance of fluent aphasics, nonfluent aphasics, and a nonaphasic brain-injured control group, was examined on a nonverbal categorization task, which was carefully structured in terms of instance typicality. Scores of visuoperceptual and naming tests were correlated with categorization task errors. As predicted, fluent aphasics showed a significant deficit in performance on the categorization task in comparison with other subjects. Differences in the nature of the errors the fluent aphasics made suggested that their problems were related to difficulties in abstracting the prototype for each category and in sorting category members with reference to these prototypes. For fluent aphasics, but not other subjects, a significant correlation was found between categorization task performance and naming ability.     

Cerebellar-induced apraxic agraphia: a review and three new cases

Apraxic agraphia is a writing disorder due to a loss or lack of access to motor engrams that program the movements necessary to produce letters. Clinical and functional neuroimaging studies have demonstrated that the neural network responsible for writing includes the superior parietal region and the dorsolateral and medial premotor cortex. Recent studies of two cases with atypical lesion localisations in the left thalamus and the right cerebellum support the hypothesis that the written language network is larger than previously assumed. The aim of this study is twofold: (1) to provide a survey of cases of apraxic agraphia published between 1973 and June 2010, and (2) to provide further evidence for a role of the cerebellum in writing via three additional cases who presented with apraxic agraphia after ischemic damage in the cerebellum. Functional neuroimaging studies by means of brain perfusion SPECT showed perfusional deficits in the anatomoclinically suspected supratentorial areas, subserving language dynamics, syntax, naming, writing and executive functioning.     

Verbal reaction time patterns in aphasic adults: consideration for apraxia of speech

Verbal reaction time patterns were compared in aphasic adults presenting anterior and posterior left hemisphere lesions. Reaction Times were measured from simultaneous recording of the subjects' verbal responses and electromyographic activity from three oral-facial sites. Total Reaction Time was fractionated into Premotor Time and Motor Time components to assess latencies associated with motor speech planning and execution. The results suggested that only anterior lesions result in deficits in motor speech planning and/or execution while posterior lesion patients perform no differently than normal. The evidence supports traditional concepts regarding apraxia of speech as being associated with frontal lobe lesions.     

Semantic dementia and persisting Wernicke's aphasia: linguistic and anatomical profiles

Few studies have directly compared the clinical and anatomical characteristics of patients with progressive aphasia to those of patients with aphasia caused by stroke. In the current study we examined fluent forms of aphasia in these two groups, specifically semantic dementia (SD) and persisting Wernicke’s aphasia (WA) due to stroke. We compared 10 patients with SD to 10 age- and education-matched patients with WA in three language domains: language comprehension (single words and sentences), spontaneous speech and visual semantics. Neuroanatomical involvement was analyzed using disease-specific image analysis techniques: voxel-based morphometry (VBM) for patients with SD and overlays of lesion digitized lesion reconstructions in patients with WA. Patients with SD and WA were both impaired on tasks that involved visual semantics, but patients with SD were less impaired in spontaneous speech and sentence comprehension. The anatomical findings showed that different regions were most affected in the two disorders: the left anterior temporal lobe in SD and the left posterior middle temporal gyrus in chronic WA. This study highlights that the two syndromes classically associated with language comprehension deficits in aphasia due to stroke and neurodegenerative disease are clinically distinct, most likely due to distinct distributions of damage in the temporal lobe.     

The nature of the phonological disorder in conduction aphasia

Sequences of attempts to name pictured objects were used to examine phonological dysfunction in three diagnostic subgroups of aphasia. A prevalence of "phonologically-oriented sequences" (i.e., those sequences that contained only attempts with a phonological resemblance to the target word) was found to be a diagnostic criterion for conduction aphasia. When compared to a group of Broca's (n = 7) and Wernicke's (n = 5) aphasics, all the conduction aphasics (n = 6) produced proportionately more of such phonologically-oriented sequences on a picture naming test. An examination of the phonologically-oriented sequences produced by the conduction aphasics indicates that speech production in conduction aphasia involves dysfunction at an early stage of sound-encoding. The theoretical implications of this view are discussed.     

Left posterior auditory-related cortices participate both in speech perception and speech production: Neural overlap revealed by fMRI

Recent neuroimaging studies and neuropsychological data suggest that there are regions in posterior auditory cortex that participate both in speech perception and speech production. An outstanding question is whether the same neural regions support both perception and production or whether there exist discrete cortical fields subserving these functions. Previous neurophysiological studies suggest that there is indeed regional overlap between these systems, but those studies used a rehearsal task to assess production. The present study addressed this question in an event-related fMRI experiment in which subjects listened to speech and in separate trials, performed a covert object naming task. Single subject analysis revealed regions of coactivation for speech perception and production in the left posterior superior temporal sulcus (pSTS), left area Spt (a region in the Sylvian fissure at the parietal-temporal boundary), and left inferior frontal gyrus. These results are consistent with lesion data and previous physiological data indicating that posterior auditory cortex plays a role in both reception and expression of speech. We discuss these findings within the context of a neuroanatomical framework that proposes these neural sites are a part of an auditory-motor integration system.     

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.