The roles of sequencing and verbal working memory in sentence comprehension deficits in Parkinson's disease

Studies of sentence comprehension deficits in Parkinson's disease (PD) patients suggest that language processing involves circuits connecting subcortical and cortical regions. Anatomically segregated neural circuits appear to support different cognitive and motor functions. To investigate which functions are implicated in PD comprehension deficits, we tested comprehension, verbal working memory span, and cognitive set-switching in a non-linguistic task in 41 PD patients; we also obtained speech measurements reflecting motor sequencing processes that may be involved in articulatory rehearsal within working memory. Comprehension of sentences with center-embedded or final relative clauses was impaired when they could not be understood from lexical semantic content alone. Overall comprehension error rates correlated strongly with impaired set-switching and significantly with reduced working memory span and speech motor sequencing deficits. Correlations with comprehension of different sentence structures indicate that these impairments do not represent a single deficit; rather, PD comprehension deficits appear to arise from several independent mechanisms. Deficits in cognitive set-switching or underlying inhibitory processes may compromise the ability to process relative clauses. Deficits in verbal working memory appear to impair comprehension of long-distance dependencies. Speech sequencing correlated with neither set-switching nor verbal working memory span, consistent with their being supported by independent, segregated cortico-subcortical circuits.     

Testing idiom comprehension in aphasic patients: the effects of task and idiom type

Idiom comprehension in 15 aphasic patients was assessed with three tasks: a sentence-to-picture matching task, a sentence-to-word matching task and an oral definition task. The results of all three tasks showed that the idiom comprehension in aphasic patients was impaired compared to that of the control group, and was significantly affected by the type of task and type of idiom. Whilst performance on the oral definition and sentence-to-picture matching tasks was similarly impaired, the patients performed significantly better on the sentence-to-word matching task. The results confirm the relevance of task and idiom type in drawing conclusions about figurative language interpretation in brain-damaged patients.     

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.     

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.     

Right-hemisphere speech representation and comprehension of syntax after left cerebral injury

Comprehension of language and visuo-spatial abilities were studied in 12 surgical patients with left cerebral lesions and right-hemisphere speech representation verified by sodium amobarbital tests. When left-hemisphere symptoms preceded the acquisition of speech, impaired understanding of syntactically complex sentences was associated with an early, but not late, onset of convulsive seizures. Other behavioral measures did not show a similar effect of age at seizure onset. Sparing or loss of comprehension could not be related to any aspects of the neurological histories in cases with right-hemisphere speech acquired before the onset of left-hemisphere symptoms. Factors which may have influenced the development of right-hemisphere language comprehension are discussed.     

Sentence Comprehension Deficits in Alzheimer''s Disease: A Comparison of Off-Line vs. On-Line Sentence Processing

Two studies explored whether sentence comprehension impairments in Alzheimer's disease (AD) are due to deficits in syntactic processing or memory. Study 1 used a picture-pointing sentence comprehension task to measure the final outcome of comprehension in an off-line fashion. It showed the comprehension of 30 patients with AD to be impaired, but suggested that the deficits could not be attributed solely to syntactic impairments. Study 2 investigated the effects of memory on sentence comprehension by comparing off-line (grammaticality judgment) with on-line (cross-modal naming) language processing in 11 AD and 9 control subjects. The results revealed impaired performance in the off-line task but normal performance in the on-line task using the same sentences. Performance on the off-line task correlated with independent measures of verbal working memory. These data are used to argue that sentence comprehension impairments are related to verbal working memory deficits in AD.     

Pantomime, praxis, and aphasia.

The production and comprehension of pantomimed movements by asphasic subjects were studied with respect to their relationship to the aphasic deficit on one hand and apraxia on the other. At issue was whether impaired use of pantomime is a manifestation of reduced symbolic capacity or purely a manifestation of an apraxic impairment of purposeful movement or both. Tests of pantomime included a Pantomime Recognition Test, a nonverbal Transitive Pantomime Production Test, and an Intransitive Pantomime Production Test (to oral command). Imitation of Nonmeaningful Movements served as a measure of apraxia, uncontaminated by symbolic or linguistic factors. Imitation of Meaningful Movements taken from the pantomime tasks was also tested. Independent measures of auditory comprehension, picture naming, and reading comprehension were used as indices of language impairment. Intellectual function was measured by the Performance scale of the WAIS. Thirty aphasic subjects were examined. Twenty healthy age-matched normals served to establish scoring standards for the pantomime tests. Multiple regression analysis revealed significant, independent contributions from both auditory comprehension and imitation of Nonmeaningful Movements to all of the tests of pantomime production and pantomime recognition. All measures of pantomime production and pantomime recognition were strongly intercorrelated. While the three language measures were strongly correlated with each other, auditory comprehension was the only one of them that was significantly and consistently related to the pantomime tests. None was related to the imitation of nonmeaningful movement. The results are taken as indicating (1) that pantomime production and imitation share common factors with both praxis and auditory comprehension; (2) apraxia entails impairment of both production and interpretation of purposeful movements. Possible theoretical accounts for these results are offered.     

Language production and comprehension in an adult with ACoA syndrome

This study explored the prediction that cases with anterior communicating artery (ACoA) syndrome will exhibit deficits in higher-level language production and comprehension. A 65-year-old adult male with a history of ACoA syndrome was tested on higher-level linguistic tasks. The patient's performance on discourse comprehension. discourse production, and linguistic ambiguity comprehension tasks was impaired.     

Syntactic comprehension deficits in Alzheimer's disease

Syntactic comprehension of German patients with dementia of the Alzheimer type was investigated and compared to healthy controls matched with respect to age, sex, and education. Special attention was directed at syntactic structures, which, in contrast to a language like English, are feasible in a grammatically rich language like German. In a sentence picture matching paradigm, only semantically reversible sentences were used. Syntactic complexity ranged from simple active voice sentences to more complex sentences like center-embedded object relative sentences. In comparison to their controls, patients showed a deficit in nearly all categories. Their performance was not influenced by age, but was heavily influenced by the degree of cognitive impairment. Patients with mild cognitive impairment, as defined by a MMSE score of 20 or higher, showed only slight difficulties in syntactic processing, whereas patients with moderate to severe impairment (MMSE < 20) did not perform above chance limits in most syntactic categories. It appears as though syntactic comprehension is only mildly affected in the early stages of Alzheimer's disease and is rather severely impaired in more advanced stages. In the present report, results are discussed in terms of working memory demands for syntactic processing.     

Anomia with and without lexical comprehension disorders

Anomic patients are usually described as free from language comprehension disorders, but the status of lexical comprehension in anomia is still controversial. Most anomic patients are impaired on tasks of semantic-lexical discrimination, but some of them do not present clear signs of semantic-lexical deficit at the receptive level. The aim of the present research was to elucidate the nature of word-finding disturbances by contrasting results obtained by anomic patients with and without lexical comprehension disorders on a number of variables, namely severity of anomia, implicit knowledge of words that patients failed to name, presence of verbal-semantic paraphasias, and scores obtained on a test of phoneme discrimination and on the "Token Test." The results of our investigation seem to suggest that there are two types of anomia, caused by the impairment of two different sets of mechanisms. In "purely expressive anomia" the locus of defect seems to be near to the stage in which the selected lexical item is specified into the appropriate phonological form. In "anomia with lexical comprehension disturbances" the locus of defect seems to be much deeper within the lexicon, so that the semantic disorder affects both the expressive and the receptive levels in a roughly comparable manner.     

An overview on Primary Progressive Aphasia and its variants

We present a review of the literature on Primary Progressive Aphasia (PPA) together with the analysis of neuropschychological and neuroradiologic profiles of 42 PPA patients. Mesulam originally defined PPA as a progressive degenerative disorder characterized by isolated language impairment for at least two years. The most common variants of PPA are: 1) Progressive nonfluent aphasia (PNFA), 2) semantic dementia (SD), 3) logopenic progressive aphasia (LPA). PNFA is characterized by labored speech, agrammatism in production, and/or comprehension. In some cases the syndrome begins with isolated deficits in speech. SD patients typically present with loss of word and object meaning and surface dyslexia. LPA patients have word-finding difficulties, syntactically simple but accurate language output and impaired sentence comprehension. The neuropsychological data demonstrated that SD patients show the most characteristic pattern of impairment, while PNFA and LPA overlap within many cognitive domains. The neuroimaging analysis showed left perisylvian region involvement. A comprehensive cognitive, neuroimaging and pathological approach is necessary to identify the clinical and pathogenetic features of different PPA variants.     

Impaired Interpretation of Others’ Behavior is Associated with Difficulties in Recognizing Pragmatic Language in Patients with Schizophrenia

Much attention has been paid to the pragmatic language function in schizophrenia. This study of Japanese patients with schizophrenia examined the relationship between impaired interpretation of the behaviors of other people in social contexts and the ability to recognize metaphor and irony. We assessed 34 patients with schizophrenia and 34 normal subjects using first- and second-order theory of mind tasks, the Metaphor and Sarcasm Scenario Test, and the Dewey Story Test (which tests the ability to judge others’ social behaviors). We compared the performance between the groups and analyzed correlations between the tasks. All tasks revealed significant deficits in the patients compared with the controls. In the patient group, metaphor comprehension was correlated with the ability to judge normal behaviors, and irony comprehension was correlated with the ability to judge abnormal behaviors, suggesting that deficits of social cognition in schizophrenia include these two types of factors associated with pragmatic language.     

Testing comprehension abilities in users of British Sign Language following CVA

Recent imaging (e.g., MacSweeney et al., 2002) and lesion (Hickok, Love-Geffen, & Klima, 2002) studies suggest that sign language comprehension depends primarily on left hemisphere structures. However, this may not be true of all aspects of comprehension. For example, there is evidence that the processing of topographic space in sign may be vulnerable to right hemisphere damage (e.g., Hickok, Say, Bellugi, & Klima, 1996), and the influence of iconicity on comprehension has yet to be explored. In this study, comprehension testing was conducted with 15 signers with unilateral brain damage, and with elderly Deaf controls. Four tests were administered: a test of iconic and non-iconic noun comprehension, a test of verb and sentence comprehension, a test of locative sentence comprehension, and a test of classifier comprehension. All tests were administered in British Sign Language (BSL), a language that has only recently been explored with lesioned signers (see Atkinson, Marshall, Thacker, & Woll, 2004; Marshall, Atkinson, Thacker, Woll, & Smulevitch, 2004; Marshall, Atkinson, Woll, & Thacker, in press). People with left hemisphere damage were impaired relative to controls on all tests. Those with right hemisphere damage performed well in the first two tests, but were impaired on locative sentences and classifiers. Neither group showed any effect of iconicity. The results shed further light on the laterality of sign language comprehension.     

Short-term memory and sentence processing: Evidence from neuropsychology

Traditional models of memory assume that short-term memory, as measured by memory span, plays an important role in linguistic processing and the learning ofverbal information. Contradicting this view are findings from a brain-damaged patient, E.A., who, despite a verbal memory span of about two items, demonstrated normal sentence comprehension in a variety oftasks. She was, however, impaired whenever verbatim phonological information had to be maintained or learned. These results and those from other patients with reduced span suggest that the phonological storage capacity that is critical to memory span plays only a limited role in language processing, specifically in the maintenance and learning of phonological forms. Implications for models of short-term memory are discussed. It is argued that short-termmemory should be seen as deriving from the processing and retentive capacities of language processing modules, with span tasks drawing on only a subset of these modules.     

The Role of Dichotic Listening Performance and Tasks of Executive Functions in Reading Impairment: A Discriminant Function Analysis

This study focused on the role of dichotic listening performance for the identification of reading impaired subtypes. Dichotic listening (DL), using verbal stimuli, has shown to be a valid measure of language lateralization. Usually, lateralization is estimated from the proportion of right ear over left ear accuracy during a free recall test procedure. However, it has been suggested that a more accurate estimate of laterality can be obtained by using a directed attention procedure. A sample of 43 reading disabled children of whom 18 showed signs of impaired language comprehension skills and 25 without language comprehension impairments, were compared to 20 age, and gender, matched controls on dichotic listening performance in both an unbiased free recall task and in a directed attention task using consonant-vowel syllables as dichotic stimuli. A laterality index was calculated for left and right ear stimuli reported during both the free recall condition and the attended ear-scores for the two directed attention conditions. Although both DL procedures yielded significant group differences, with a lower laterality score for the reading disabled compared to the controls, there was no main effect of DL-procedure or group × procedure interaction. Taken alone, DL performance could correctly classify 42% of the reading impaired samples, but together with other measures of executive functions, discriminant function analyses yielded 90.74% accuracy in classifying reading impaired children. The result indicates that DL together with tests of executive functions are valuable tools for assessment of reading impaired subjects.     

The role of dichotic listening performance and tasks of executive functions in reading impairment: a discriminant function analysis.

This study focused on the role of dichotic listening performance for the identification of reading impaired subtypes. Dichotic listening (DL), using verbal stimuli, has shown to be a valid measure of language lateralization. Usually, lateralization is estimated from the proportion of right ear over left ear accuracy during a free recall test procedure. However, it has been suggested that a more accurate estimate of laterality can be obtained by using a directed attention procedure. A sample of 43 reading disabled children of whom 18 showed signs of impaired language comprehension skills and 25 without language comprehension impairments, were compared to 20 age, and gender, matched controls on dichotic listening performance in both an unbiased free recall task and in a directed attention task using consonant-vowel syllables as dichotic stimuli. A laterality index was calculated for left and right ear stimuli reported during both the free recall condition and the attended ear-scores for the two directed attention conditions. Although both DL procedures yielded significant group differences, with a lower laterality score for the reading disabled compared to the controls, there was no main effect of DL-procedure or group x procedure interaction. Taken alone, DL performance could correctly classify 42% of the reading impaired samples, but together with other measures of executive functions, discriminant function analyses yielded 90.74% accuracy in classifying reading impaired children. The result indicates that DL together with tests of executive functions are valuable tools for assessment of reading impaired subjects.     

Pragmatic aspects of communication and language comprehension in groups of children differentiated by teacher ratings of inattention and hyperactivity

Children with attention‐deficit hyperactivity disorder (ADHD) experience pragmatic language deficits, but it is not known whether these difficulties are primarily associated with high levels of inattention, hyperactivity, or both. We investigated pragmatic aspects of communication and language comprehension in relation to poor attention and/or high hyperactivity in a nondiagnosed population of 7‐ to 11‐year olds. Classroom teachers rated their pupils' attention and hyperactivity/impulsivity on the ADD‐H Comprehensive Teacher Rating scale (ACTeRS). Three groups were formed: children with poor attention and low hyperactivity (poor attention group), children with good attention and high hyperactivity (high hyperactivity group), and children with both poor attention and high hyperactivity (poor attention/high hyperactivity group). Their performance was compared with that of same‐age controls in two studies: Study 1 (N = 94) investigated the comprehension of figurative language in and out of context and Study 2 (N = 100) investigated the pragmatic aspects of communication using the Children's Communication Checklist – Second Edition. Two groups, the poor attention and the poor attention/high hyperactivity groups, were impaired in both their comprehension of figurative language and their communication skills. The high hyperactivity group was impaired in their comprehension of figurative language but they did not exhibit communication impairments. The findings extend work with clinical populations of children with ADHD: even in a nondiagnosed sample of children, poor attention and elevated levels of hyperactivity are associated with pragmatic language weaknesses.     

Visual impairment, verbal humor, and conservation

Through a cerebral hemispheric specialization model, I speculated that the reported discrepancy between visually impaired children's competency in language development and lags in cognition may be explained by the use of visual-spatial measurements of cognition. The performance of 51 visually impaired and 51 sighted children, ages 7 to 15 years, on a task of joke comprehension and conservation of weight scores was analyzed. I hypothesized that the ability to comprehend verbal humor would reflect the function of the left hemisphere of the brain and the ability to perform a Piagetian visual-spatial task would reflect the function of the right hemisphere. The findings indicate that although age and IQ contributed significantly to predicting joke comprehension, the ability to conserve did not have a unique contribution. In conclusion, I suggest that the cerebral hemispheric specialization model be considered when investigating language and cognition of visually impaired children.     

Hemispheric contributions to pragmatics

Twenty-seven patients with right-hemisphere damage (RBD) and thirty-one patients with left-hemisphere damage (LBD) received a new pragmatics battery in Hebrew consisting of two parts: (1) comprehension and production of basic speech acts (BSAs), including tests of assertions, questions, requests, and commands, and (2) comprehension of implicatures, including implicatures of quantity, quality, relevance, and manner. Each test had a verbal and a nonverbal version. Patients also received Hebrew versions of the Western Aphasia Battery and of the Right Hemisphere Communication Battery. Both LBD and RBD patients were impaired relative to controls but did not differ from each other in their overall scores on BSAs and on Implicatures when scores were corrected by aphasia and neglect indices. There was a systematic localization of BSAs in the left hemisphere (LH) but not in the right hemisphere (RH). There was poor localization of Implicatures in either hemisphere. In LBD patients, BSAs were associated with language functions measured with the WAB, suggesting the radical possibility that the classic localization of language functions in aphasia is influenced by the localization of the BSAs required by aphasia language tests. Both BSAs and implicatures show greater functional independence from other pragmatic, language and cognitive functions in the RBD than in the LBD patients. Thus, the LH is more likely to contain an unmodular domain-nonspecific set of central cognitive mechanisms for applying means-ends rationality principles to intentional activity.     

Role of the left hemisphere in sign language comprehension

We investigated the relative role of the left versus right hemisphere in the comprehension of American Sign Language (ASL). Nineteen lifelong signers with unilateral brain lesions [11 left hemisphere damaged (LHD) and 8 right hemisphere damaged (RHD)] performed three tasks, an isolated single-sign comprehension task, a sentence-level comprehension task involving simple one-step commands, and a sentence-level comprehension task involving more complex multiclause/multistep commands. Eighteen of the participants were deaf, one RHD subject was hearing and bilingual (ASL and English). Performance was examined in relation to two factors: whether the lesion was in the right or left hemisphere and whether the temporal lobe was involved. The LHD group performed significantly worse than the RHD group on all three tasks, confirming left hemisphere dominance for sign language comprehension. The group with left temporal lobe involvement was significantly impaired on all tasks, whereas each of the other three groups performed at better than 95% correct on the single sign and simple sentence comprehension tasks, with performance falling off only on the complex sentence comprehension items. A comparison with previously published data suggests that the degree of difficulty exhibited by the deaf RHD group on the complex sentences is comparable to that observed in hearing RHD subjects. Based on these findings we hypothesize (i) that deaf and hearing individuals have a similar degree of lateralization of language comprehension processes and (ii) that language comprehension depends primarily on the integrity of the left temporal lobe.