Frontal-opercular aphasia.

The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehension into Broca's aphasia and transcortical motor aphasia. We report on a patient with a persistent nonfluent aphasia from a discrete, primarily cortical, frontal-opercular lesion who had impaired syntax but intact repetition and, therefore, did not conform to the traditional classification. Based on this patient's behavior and a review of other cases, we have divided the nonfluent aphasias with intact comprehension into five disorders. (1) Verbal akinesia-exhibiting diminished intention or drive to speak and associated with medial frontal lesions (supplementary motor area and cingulate gyrus) or with lesions damaging the efferent projections from these areas. (2) Disorders of syntax-telegraphic and agrammatic utterances that may be associated with dominant pars opercularis lesions. (3) Phonemic disintegration-a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access-patients who struggle to find words and are impaired at timed word-generation tasks. Defects of lexical access may be associated with lesions of the pars triangularis and adjacent prefrontal cortex. (5) Mixed defects. According to this model, the traditional patient with Broca's aphasia would exhibit disorders of syntax, phonemic disintegration, and defects of lexical access, whereas the traditional patient with transcortical motor aphasia would have verbal akinesia or defects of lexical access or both. Our patient had defects of lexical access and syntax, but only mild symptoms of phonemic disintegration, suggesting that his opercular primary motor cortex was relatively intact. Our patient's ability to repeat normally while his propositional speech remained telegraphic suggests that different neural mechanisms subserve these functions.     

Aphasia following a right thalamic hemorrhage

A left-handed patient with a right thalamic hemorrhage and disordered speech is described. Sequential examinations and aphasia testing were done during a 1-year follow-up period and the results are reported. This case supports those authors who have described characteristics they feel are helpful in diagnosing disordered speech associated with thalamic lesions. Paucity of speech, reduced voice volume, anomia, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were relatively preserved. She showed modest improvement with time. This case also confirms that thalamic involvement in speech is a dominant, rather than a specifically left hemispheric function.     

Recognition of Affective Speech Prosody and Facial Affect in Deaf Children with Unilateral Right Cochlear Implants

Cochlear implant (CI) devices provide the opportunity for children who are deaf to perceive sound by electrical stimulation of the auditory nerve, with the goal of optimizing oral communication. One part of oral communication concerns meaning, while another part concerns emotion: affective speech prosody, in the auditory domain, and facial affect, in the visual domain. It is not known whether childhood CI users can identify emotion in speech and faces, so we investigated speech prosody and facial affect in children who had been deaf from infancy and experienced CI users. METHOD: Study participants were 18 CI users (ages 7–13 years) who received right unilateral CIs and 18 age- and gender-matched controls. Emotion recognition in speech prosody and faces was measured by the Diagnostic Analysis of Nonverbal Accuracy. RESULTS: Compared to controls, children with right CIs could identify facial affect but not affective speech prosody. Age at test and time since CI activation were uncorrelated with overall outcome measures. CONCLUSION: Children with right CIs recognize emotion in faces but have limited perception of affective speech prosody.     

Lesion localization in acquired deficits of emotional expression and comprehension

This study investigated the relationship between intrahemispheric location of lesion and disturbances of emotional expression and comprehension. Twenty-eight right hemisphere strokes, 18 left hemisphere strokes, and 20 controls were examined on a standardized test of the expression, repetition, and comprehension of emotional prosody as well as the visual recognition of emotional situations and faces. The patients were classified into aprosodic syndromes according to the test scores. The lesions were independently traced, and overlapped for each aprosodic syndrome. The results, for lesions in either hemisphere, indicated involvement of the basal ganglia most frequently in aprosodic syndromes followed by anterior temporal lobe and insula lesions. Basal ganglia damage was also seen most frequently in patients with impaired comprehension of emotional facial expressions and situations. The anterior temporal lobe was also frequently involved in patients with such deficits. The basal ganglia emerged as a structure of particular importance in the mediation of emotional expression and comprehension.     

Cerebral mechanisms for understanding emotional prosody in speech

Hemispheric contributions to the processing of emotional speech prosody were investigated by comparing adults with a focal lesion involving the right (n = 9) or left (n = 11) hemisphere and adults without brain damage (n = 12). Participants listened to semantically anomalous utterances in three conditions (discrimination, identification, and rating) which assessed their recognition of five prosodic emotions under the influence of different task- and response-selection demands. Findings revealed that right- and left-hemispheric lesions were associated with impaired comprehension of prosody, although possibly for distinct reasons: right-hemisphere compromise produced a more pervasive insensitivity to emotive features of prosodic stimuli, whereas left-hemisphere damage yielded greater difficulties interpreting prosodic representations as a code embedded with language content.     

Development of speech and language following bilateral frontal lesions

Language and speech were studied in a young child with perinatally acquired bifrontal lesions. Bilateral frontal pathology seriously interfered with the development of intelligible speech and resulted in a persistent expressive aphasia. Analysis of the neuropsychological profile indicated impairments in intelligence and language comprehension. These deficits, however, were considered secondary to the profound speech programming disorder. The findings indicate that, despite the plasticity of the immature central nervous system, bilateral frontal injury sustained at an early age precludes the development of intelligible speech. Furthermore, structurally intact cortical regions outside the territories of the speech zones fail to mediate normal speech and language development.     

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.     

旋律语调疗法及其对失语症的临床应用

失语症是当今人类面临的一个重要的健康问题。旋律语调疗法被认为是治疗失语症的有效手段之一。传统旋律语调疗法强调严格的程序和材料,改编版本则依据患者情况进行调整,二者均能提高失语症者的自发言语产生、言语复述以及命名等能力。研究还表明,旋律语调疗法不仅能提高失语症者相关脑区的激活水平,而且也能通过影响失语症者的相关神经结构改善其言语功能。未来研究需要进一步确定该疗法的干预机制及其对汉语失语症的适用性。     

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.     

Three variant forms of subcortical aphasia in Chinese stroke patients

Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.     

Neural systems for recognition of emotional prosody: a 3-D lesion study

Which brain regions are associated with recognition of emotional prosody? Are these distinct from those for recognition of facial expression? These issues were investigated by mapping the overlaps of co-registered lesions from 66 brain-damaged participants as a function of their performance in rating basic emotions. It was found that recognizing emotions from prosody draws on the right frontoparietal operculum, the bilateral frontal pole, and the left frontal operculum. Recognizing emotions from prosody and facial expressions draws on the right frontoparietal cortex, which may be important in reconstructing aspects of the emotion signaled by the stimulus. Furthermore, there were regions in the left and right temporal lobes that contributed disproportionately to recognition of emotion from faces or prosody, respectively.     

Neurofunctional correlates of expressed vocal affect in social phobia

We investigated the neural correlates of expressed vocal affect in patients with social phobia. A group of 36 patients performed an anxiogenic public-speaking task while regional cerebral blood flow (rCBF) was assessed using oxygen-15 positron emission tomography. The patients’ speech was recorded and content masked using low-pass filtering (which obscures linguistic content but preserves nonverbal affective cues). The content-masked speech samples were then evaluated with regard to their level of vocally expressed nervousness. We hypothesized that activity in prefrontal and subcortical brain areas previously implicated in emotion regulation would be associated with the degree of expressed vocal affect. Regression analyses accordingly revealed significant negative correlations between expressed vocal affect and rCBF in inferior frontal gyrus, putamen, and hippocampus. Further, functional connectivity was revealed between inferior frontal gyrus and (a) anterior cingulate cortex and (b) amygdala and basal ganglia. We suggest that brain areas important for emotion regulation may also form part of a network associated with the modulation of affective prosody in social phobia.     

情绪韵律调节情绪词识别的ERP研究

采用韵律/词汇干扰范式和延迟匹配任务, 通过两个ERP实验, 考察了汉语口语中情绪韵律能否、以及如何调节情绪词的识别。实验一中, 不同类型的情绪韵律分组呈现, ERP结果显示, 同与情绪韵律效价一致的情绪词相比, 与情绪韵律效价不一致的情绪词诱发了走向更负的P200、N300和N400成分; 实验二中, 不同类型的情绪韵律随机呈现, 上述效价一致性效应依然存在。实验结果表明, 情绪韵律能够调节情绪词识别, 主要表现在对情绪词的音韵编码和语义加工的双重易化上。     

Transcortical sensory aphasia: Evidence for subtypes

Impaired auditory comprehension and fluent but semantically empty speech in conjunction with preserved repetition characterize the syndrome of transcortical sensory aphasia (TSA). Repetition, however, may be mediated by at least two distinct processes--a lexical process that may involve the recognition and subsequent activation of discrete stored word representations and a nonlexical process that involves phonologic decoding and immediate phonologic encoding from immediate memory. We investigated the spontaneous speech, reading, and tendency to recognize and spontaneously correct syntactic errors in four patients with TSA: this analysis suggests there are two subtypes of TSA. We contend that in one subtype both the lexical and direct repetition (or speech production) mechanisms are preserved, but in the second subtype the lexical mechanism is disrupted and repetition is mediated by the nonlexical 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.     

The effects of slowed speech on auditory comprehension in aphasia

The present study investigates the effects of slowed speech on auditory comprehension in aphasia. Specifically, an attempt was made to isolate the effects of added time on comprehension at the language processing stages of auditory perception, by increasing the duration of the vowel segments in each word; word recognition and semantic analysis, by adding silences between words; and syntactic analysis, by adding silences at constituent phrase boundaries. Sentences were also read at a slow rate to see the effects of naturally slowed speech on sentence comprehension. Test sentences consisted of simple active and passive declarative sentences, and complex sentences with embedded medial and final relative clauses. Sentences were either semantically reversible or nonreversible. Thirty-four aphasic patients who varied in both severity and type of aphasia were tested on a picture verification task. Results indicated that slowing facilitated language comprehension significantly only in the syntactic condition. Neither syntactic complexity nor semantic reversibility interacted with slowed speech to facilitate auditory language comprehension. Further, it was only the Wernicke's aphasics who showed significant improvement with time added at constituent boundaries. These results suggest that time alone does not facilitate language comprehension in aphasia, but that rather it is the interaction of time with syntactic processing which improves comprehension.     

外显和内隐情绪韵律加工的脑机制：近红外成像研究

准确识别言语中的情绪韵律信息对社会交往非常重要。本研究采用功能近红外成像技术, 探索外显和内隐情绪加工条件下愤怒、恐惧、快乐三种情绪韵律加工过程中的大脑皮层神经活动。结果表明, 对愤怒、恐惧、快乐韵律进行特异性加工的脑区分别为左侧额极/眶额叶、右侧缘上回、左侧额下回, 其中右侧缘上回脑区同时受到情绪和任务的调控。此外, 右侧颞中回、颞下回和颞极在情绪外显任务中的激活明显强于内隐任务。本研究的结果部分支持了情绪韵律的层次模型, 也对该模型的第三层次, 即“额区对语音情绪信息的精细加工需要外显性情绪加工任务参与”提出了质疑。     

Emotional processing following cortical and subcortical brain damage: contribution of the fronto-striatal circuitry

The present study examined the differential contribution of cortical and subcortical brain structures in emotional processing by comparing patients with focal cortical lesions (n = 32) to those with primarily subcortical dysregulation of the basal ganglia (Parkinson's disease n = 14). A standardized measure of emotional perception (Tübingen Affect Battery) was used. Only patients in the more advanced stages of Parkinson's disease and patients with focal damage to the (right) frontal lobe differed significantly from controls in both facial expression and affective prosody recognition. The findings imply involvement of the fronto-striatal circuitry in emotional processing.     

Theodor Meynert′s Contribution to Classical 19th Century Aphasia Studies

Carl Wernicke (1848-1905) is traditionally considered the first to have described the features of, and the brain pathology underlying, impaired auditory comprehension and related symptoms. Although Wernicke (1874) clearly and repeatedly indicates his indebtedness to Theodor von Meynert (1833-1892). this is usually understood as an acknowledgment that Meynert taught Wernicke neuroanatomy (Eggert, 1977); Wernicke′s own words in part support this interpretation. A more sophisticated historical analysis notes that, prior to Wernicke, both Johann Schmidt in 1871 and Charlton Bastian in 1869 had described the concept of receptive aphasia, but neither had supported their analyses with autopsy evidence as did Wernicke, thus not dislodging Wernicke′s claim of priority. However, a virtually unknown work by Theodor von Meynert, published in 1866, has recently been rediscovered by us ["Ein Fall von Sprachstörung, anatomisch begründet." Medizinische Jahrbücher. XII Band der Zeitschrift der K. K. Gesellleschaft der Ärzte in Wien, 22.Jahr. Pp. 152-189]. In this paper Meynert analyzes the anatomical basis for localizing the comprehension of language in the superior temporal gyros, he argues that lesions in this area should (by analogy to Broca′s earlier observations on language expression) cause impairments in language comprehension, and he presents a case of receptive aphasia with autopsy evidence of destruction of the superior temporal gyros in the left hemisphere. The patient′s aphasia was classic: impaired auditory comprehension, and fluent speech with paraphasias. It is clear that Meynert should be given historical credit for his work.     

Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases?

Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study. The scores for the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Gülhane Aphasia Test were recorded. The patients were scheduled randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level of improvement in the clinical parameters and aphasia scores was compared between the two groups. All patients had large lesions and severe aphasia. No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS, BI and mRS scores at the end of the treatment. The improvements observed in spontaneous speech, reading fluency, auditory comprehension, reading comprehension, repetition, and naming were not significantly different in the piracetam and placebo groups, the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders.