Semantic aphasia: A neglected entity

Three cases of semantic aphasia are reported. Computerized brain tomography showed bilateral temporo-parieto-occipital junction hemorrhages in one patient, and left parieto-occipital junction infarctions in the other two patients. The auditory comprehension defect of the three patients was characterized by preserved understanding of single words and impaired understanding of grammatically complex constructions. It is suggested that this comprehension defect reflects an inability to fully grasp the meaning of words and grammatical constructions imbued with spatial or quasi-spatial significance. Each of the three patients showed a complex spatial disorder that included constructional apraxia, spatial agnosia, and elements of Gerstmann's syndrome. The aphasic as well as the spatial disorder of semantic aphasics may be manifestations of a common defect in the perception of spatial relationships produced by left temporo-parieto-occipital region damage.     

Dichotic listening in the recovery of aphasia after stroke

Three different dichotic listening tests were given to a group of aphasic patients at various stages of the recovery process. Results were different for each test and in the course of time fluent aphasics demonstrated a tendency to increase right ear preference while nonfluent aphasics showed an increase of left ear preference in the test of dichotic words. The importance of these findings to the understanding of recovery of function is discussed in terms of the role played by the right hemisphere.     

Developmental changes in face processing: results from multidimensional scaling

Multidimensional scaling procedures were used to investigate developmental changes in the ability to process previously unfamiliar faces. Eighty male subjects, aged 7, 9, 12, or adult, rated the similarity of pairs of faces. The faces were presented to subjects in either the upright or the inverted orientation. Multidimensional scaling analyses suggest that subjects of all ages use similar information in judging the similarity of faces. However, for upright faces, individual subjects under age 10 seem to use fewer features at a time. The results argue against a qualitative shift in face processing at age 10, and suggest that the improvement in face recognition ability noted at this age is due at least in part to an increased ability to consider more features simultaneously.     

Affordances and infant learning: A reply to Horowitz

We reply to three major points made by F. Horowitz (1983, Developmental Review, 3, 405–409) in her commentary on the ecological approach to infant knowing presented by E. Goldfield (1983, Developmental Review, 3, 371–404). We first clarify the relation between perceiving and acting from an ecological perspective, and distinguish between affordances as environmental properties scaled to the perceiver/performer and representations as mental structures. We then present a critique of the process of association offered by Horowitz as an explanation of infant learning. Association fails to specify the constraints on what is learned, while the ecological process of noticing affordances, presented by Goldfield, considers such constraints. We conclude by presenting operational criteria for measuring affordances and evidence that perception is scaled to the perceiver/performer.     

Intrusions and perseverations

Twenty-two subjects with presumed senile dementia of the Alzheimer's type (SDAT), twenty-two with dementia other than SDAT, twenty with aphasia, and seventeen healthy controls over 50 years of age were examined for intrusions and perseverations. Perseverations were defined as the immediate inappropriate repetition of a prior response whereas intrusions were defined as the inappropriate repetition of prior responses after intervening stimuli. Intrusions and perseverations occurred in demented and aphasic subjects, but were rare in controls. Intrusions occurred most often in SDAT or Wernicke aphasia, but also in dementia other than SDAT. Intrusions were not correlated with dementia severity. Intrusions are a useful sign of dementia, but they cannot be considered pathognomonic of SDAT. They appear to arise when subjects are unable to access correct responses from long-term memory and instead substitute erroneous responses selected from short-term memory. Perseverations were most common in the Wernicke aphasics and subjects with dementia due to communicating hydrocephalus. Although frontal lobe dysfunction is prominent in communicating hydrocephalus, it is absent in cases of Wernicke aphasia. Thus, we have confirmed prior suggestions that perseveration can occur in the absence of frontal lobe injury. Failure to self-monitor speech as well as an inability to change mental set probably plays an important role in the genesis of perseverations. There was no statistically significant correlation between dementia severity and number of perseverations. Low correlations were found between intrusions and perseverations suggesting that these seemingly similar behaviors are distinct and are probably produced by separate neuropsychological mechanisms.     

Correlations of glucose metabolism and structural damage to language function in aphasia

Studies of aphasic patients using [18F]fluorodeoxyglucose positron computed tomographs have shown areas of metabolic depression in the left hemisphere larger than the area of infarction noted on CT. To evaluate these metabolic differences in relationship to language abnormalities, 11 patients had metabolic scans, CT, and were administered the Boston Diagnostic Aphasia Battery and the Porch Index of Communicative Ability. Correlation analyses were computed between metabolic, CT, and language data. CT demonstrated reliable correlations of speaking, oral reading, and repetition to Wernicke' area, consistent with current anatomic language models, while metabolic data from areas posterior, inferior, and superior to the traditional Wernicke's area and the head of the caudate nucleus also had reliable correlations with aphasic language function. The utilization of both structural and metabolic brain measures may improve our understanding of the anatomy of language as related to aphasia.     

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.