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.     

Auditory-verbal short-term memory impairment and conduction aphasia

The specific impairment of performance on repetition tasks has classically been identified with conduction aphasia. It is argued that this impairment can be subdivided and a deficit in span performance distinguished from that of the reproduction of single words. An explanation of the span deficit in terms of auditory-verbal short-term memory is preferred to hypotheses involving disconnections or damage to order retention systems. It is shown that a short-term memory component is present in many patients previously classified as conduction aphasics.     

Demonstrating a wordlikeness effect on nonword repetition performance in a conduction aphasic patient

The purpose of this study was to identify the nature of the deficit for a conduction aphasic patient in order to evaluate two different theories of conduction aphasia. First, a conduction aphasic patient FS was tested on auditory word-pair discrimination, word-repetition, and picture-naming. The results of these tasks indicated that her deficit was likely to be post-lexical rather than perceptual or lexical. Next, we examined her repetition performance for two types of nonwords (high-wordlike and low-wordlike nonwords) to distinguish the two theories. FS exhibited a wordlikeness effect: she produced more correct moras and more correct combinations of moras for high-wordlike nonwords than low-wordlike nonwords. We conclude that she had difficulty in maintaining stable phonological representations of verbal materials in the output buffer.     

It's either a cook or a baker: patients with conduction aphasia get the gist but lose the trace

Patients with conduction aphasia have been characterized as having a short-term memory deficit that leads to relative difficulty on span and repetition tasks. It has also been observed that these same patients often get the gist of what is said to them, even if they are unable to repeat the information verbatim. To study this phenomenon experimentally, patients with conduction aphasia and left hemisphere-injured controls were tested on a repetition recognition task that required them to listen to a sentence and immediately point to one of three sentences that matched it. On some trials, the distractor sentences contained substituted words that were semantically-related to the target, and on other trials, the distractor sentences contained semantically-distinct words. Patients with conduction aphasia and controls performed well on the latter condition, when distractors were semantically-distinct. However, when the distractor sentences were semantically-related, the patients with conduction aphasia were impaired at identifying the target sentence, suggesting that these patients could not rely on the verbatim trace. To further understand these results, we also tested elderly controls on the same task, except that a delay was introduced between study and test. Like the patients with conduction aphasia, the elderly controls were worse at identifying target sentences when there were semantically-related distractors. Taken together, these results suggest that patients with conduction aphasia rely on non-phonologic cues, such as lexical-semantics, to support their short-term memory, just as normal participants must do in long-term memory tasks when the phonological trace is no longer present.     

Deep dysphasia: An analog of deep dyslexia in the auditory modality

A right-handed patient, with two left hemisphere lesions, a small one in the prefrontal lobe and a larger one in the temporal, presents an unusual syndrome: a massive deficit for oral language (expression and comprehension) contrasting with a fairly good preservation of written language (expression and comprehension). The processing of isolated words and sentences has been extensively tested with repetition and dictation tasks. The patient performs rather well with nouns, verbs, and adjectives, poorly with adverbs and function words, and completely fails with nonsense words. A remarkable feature of his repetition is the frequency of semantic paraphasias. Thus, this patient exhibits a behavior rather similar to deep dyslexia, hence the possible label "deep dysphasia." The paper presents a "preunderstanding" hypothesis to account for such behaviors.     

Neuropsychological analysis of a case of crossed dysphasia verified at postmortem

A case is reported of crossed dysphasia in a right-handed monolingual patient, where neuropathological verification of the unilateral site of the lesion was obtained within a year of detailed neuropsychological assessment. The patient's pattern of language impairment was characterized by agrammatic speech and relatively preserved naming ability. In addition, the patient had good repetition, poor comprehension, and marked impairment on visuospatial tasks. Neuropathological investigations showed a large area of infarction affecting cortex, white matter, and subcortical structures in the right hemisphere. The possibility is discussed of a distinction between two types of crossed dysphasia with either dissociated or simultaneous language and visuospatial deficits due to reversed representation of hemispheric specific functions or transfer of most cognitive functions to the right hemisphere.     

Oral language deficits in dyslexic children: weaknesses in working memory and verbal planning

This paper focuses on the relationships among language processing (word- and sentence-level), working memory, and verbal/nonverbal linguistic output. The study examined oral language abilities in a group of 26 French-speaking dyslexic children, compared to two control groups (26 normally developing age-matched children and 26 normally developing younger children). The experimental procedure consisted of tasks involving auditory memory skills (digit span, unfamiliar word repetition, sentence repetition), word retrieval (with semantic, phonological and grammatical criteria), and sentence processing (with verbal and act-out production). The major findings reveal that (a) compared with their age-mates, the dyslexic children exhibited a significant deficit affecting all tasks; and (b) the dyslexic children and the younger controls performed similarly on several tasks. The results are consistent with the processing limitation hypothesis and suggest that the core deficit is the formulation of cognitive plans from auditory input to verbal output.     

The repetition defect in conduction aphasia: Mnestic or linguistic?

Repetition difficulty is the cardinal feature of conduction aphasia. Traditionally this disorder has been considered secondary to a deficit in linguistic processing but recently a number of investigators have interpreted such cases as consequent upon a short-term memory difficulty in the auditory—verbal domain. We present here the case of a 24-year-old patient with conduction aphasia, whose symptom picture closely resembles those patients whose difficulties have been attributed to mnestic factors. Our patient's performance improved dramatically when stimuli were presented more slowly or when they were familiar, when the task involved matching rather than language production, and when multiple choices were provided for missed items. More crucially the patient's errors in repetition were primarily paraphasic and sequential; and repetition of single nonsense words was severely impaired. Taken together these results suggest that the patient's disorder, and perhaps that of other cases as well, would be better viewed as a linguistic deficit, specifically in the processing, synthesis, and ordering of phonemes. A tentative model for repetition disorder is proposed.     

Interruption of phonological coding in conduction aphasia

A case study of conduction aphasia, investigating single word repetition, phonological coding, and short-term memory, is reported. Evidence from intact adults suggests that repetition can occur through either a lexical route or a direct auditory-articulatory link. For this conduction aphasic, E.A., the direct link was impaired, although the lexical route could be used to produce accurate single word repetition. Several experiments demonstrated a significant impairment in the generation and maintenance of an abstract phonological code. The consequences of a disruption of phonological coding on speech perception and on verbal short-term memory are discussed.     

Dynamic action units slip in speech production errors

In the past, the nature of the compositional units proposed for spoken language has largely diverged from the types of control units pursued in the domains of other skilled motor tasks. A classic source of evidence as to the units structuring speech has been patterns observed in speech errors--"slips of the tongue". The present study reports, for the first time, on kinematic data from tongue and lip movements during speech errors elicited in the laboratory using a repetition task. Our data are consistent with the hypothesis that speech production results from the assembly of dynamically defined action units--gestures--in a linguistically structured environment. The experimental results support both the presence of gestural units and the dynamical properties of these units and their coordination. This study of speech articulation shows that it is possible to develop a principled account of spoken language within a more general theory of action.     

Interaction between verbal and gestural language in progressive aphasia: a longitudinal case study.

The objective of this longitudinal study is to investigate the on-line interaction between praxis and linguistic abilities in a progressive aphasia case. During 3 years of evolution, procedural discourse of a progressive aphasic patient was videotaped five times, allowing us to analyze the progression of both language and gestural production as well as the interaction between these two. We anticipated that, in the absence of apraxia, the patient would compensate for her speech deficit by producing progressively more and more meaningful gestures. Our compensatory hypothesis was confirmed but the compensation was not as efficient as one would expect given the absence of apraxia. With the progression of the speech deficit, the patient could not replace some verbs by pantomimes that were otherwise accompanying her discourse in the preceding testing sessions. We suggest that such a compensatory ability may constitute one important characteristic of the progressive aphasia syndrome.     

A procedural approach to the study of aphasia

Linguistic models have a fundamental weakness in the study of aphasia in that as models of a single linguistic competence they cannot in principle explain dissociations in language disturbances. Procedural (i.e., computational) models of specific language abilities/tasks are to be preferred in that they can explain dissociation data and they are necessarily very detailed to account for varied patterns of disrupted behavior. A procedural model of sentence production is outlined and the model is applied to account for some aspects of agrammatic speech.     

Perception of speech and nonspeech stimuli by children with and without reading disability and attention deficit hyperactivity disorder

The auditory temporal deficit hypothesis predicts that children with reading disability (RD) will exhibit deficits in the perception of speech and nonspeech acoustic stimuli in discrimination and temporal ordering tasks when the interstimulus interval (ISI) is short. Initial studies testing this hypothesis did not account for the potential presence of attention deficit hyperactivity disorder (ADHD). Temporal order judgment and discrimination tasks were administered to children with (1) RD/no-ADHD (n=38), (2) ADHD (n=29), (3) RD and ADHD (RD/ADHD; n=32), and (4) no impairment (NI; n=43). Contrary to predictions, children with RD showed no specific sensitivity to ISI and performed worse relative to children without RD on speech but not nonspeech tasks. Relationships between perceptual tasks and phonological processing measures were stronger and more consistent for speech than nonspeech stimuli. These results were independent of the presence of ADHD and suggest that children with RD have a deficit in phoneme perception that correlates with reading and phonological processing ability. (c) 2002 Elsevier Science (USA).     

Case study of a Thai conduction aphasic

A case study of a 55-year-old nonfamilial left-handed monolingual Thai patient with clinical and pathoanatomic evidence of major infarction in the left temporoparietal region is presented. He was studied at 9 years poststroke with a Thai adaptation of the Boston Diagnostic Aphasia Exam and supplementary tests. His language characteristics included fluent spontaneous speech, near-normal auditory language comprehension, and poor repetition, leading to a diagnosis of conduction aphasia. In regard to this aphasic syndrome, issues concerning classification, neuroanatomic correlates, and underlying neuropsychological mechanisms are addressed. The nature of his grammatical disturbance is examined critically in light of the notion of “information load.”     

Sequences of phonemic approximations in aphasia

The trends of sequences of phonemic approximations to a single target were studied in three types of aphasia (Broca's, conduction, and Wernicke's), as gathered in five tasks (spontaneous speech, repetition of meaningful words, repetition of nonsense words, reading aloud, and automatized sequences). A phonemic error ratio was defined in order to quantify the distance between each approximation of a given sequence and its target. The results of a computer analysis based on this ratio were analyzed according to three parameters. A study of three types of patients revealed that conduction aphasics exhibited the most regular trend toward the target in sequences of phonemic approximations; the analysis of the various tasks indicated that sequences produced in repetition by conduction aphasics form an exception to the regularity of this trend, and an examination of the various lengths of sequences indicated that longer sequences showed a less decisive trend toward the target than shorter sequences. The discussion bears on some theoretical aspects of the phonological production mechanism and its control: the initial strength and permanence of the internal representation of the target emerge as important factors required for the good functioning of this mechanism.     

Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion

A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with diffusion-weighted imaging underwent language testing and perfusion-weighted imaging < 24h from onset of symptoms. Specific regions in perisylvian cortex were rated for the percentage of the region that was hypoperfused. Aphasia type was determined on the basis of speech fluency, comprehension, and repetition performance on the language tests. Association between aphasia type/language impairment and regions of hypoperfusion were identified with Fisher's exact tests. Results demonstrated that in patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasia types.     

Language disorders in dementia of the Alzheimer type

The language profile of a group of 18 Alzheimer patients is documented and their performance on a standard aphasia test battery compared to a group of institutionalized, nonneurologically impaired control subjects matched for age, sex, and educational level. The Alzheimer patients scored significantly lower than the controls in the areas of verbal expression, auditory comprehension, repetition, reading, and writing. Articulation abilities were the same in each group. A language deficit was evident in all Alzheimer patients. The language disorder exhibited resembled a transcortical sensory aphasia. Syntax and phonology remained relatively intact but semantic abilities were impaired. The results support the inclusion of a language deficit as a diagnostic criterion of Alzheimer's disease.     

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.     

Phonological transformations in conduction aphasia

Different explanations and subtypes of conduction aphasia are analyzed. Characteristics of literal paraphasias in parietal-insular conduction aphasia are discussed, emphasizing that paraphasias in conduction aphasia are articulatory-based (articulatory literal paraphasias) and due mainly to phoneme substitutions and phoneme deletions; they result basically in switches in phoneme manner and place of articulation. Similarities between errors in ideomotor apraxia and conduction aphasia language deficits are presented. It is proposed that language deviations (in oral as in written language) in conduction aphasia can be understood as a segmentary apraxia of speech.