Chapter 8 Aphasias

Question 1

Argument for classifying aphasias

Answer 1

Different areas of the brain control different functions so,
different types of aphasias have different lesion sites and,
different lesion sites produce distinctively different types of symptoms
Different types of aphasias require different forms of Tx

Question 2

Arguments against classifying aphasias

Answer 2

Brain is thought to function as integrated unit in controlling language

Question 3

Factors used in classifying aphasias

Answer 3

Speech fluency
Paraphasias
Repetitions
Language comprehension
Site of lesion

Question 4

Classification by fluency

Answer 4

Non-Fluent and Fluent aphasias

Question 5

Non Fluent aphasias

Answer 5

Speaking is slow, halting, and with effort:
Broca's
Transcortical Motor Aphasia (TMA)
Mixed Transcortical Aphasia (MTA)
Global Aphasia

Question 6

Fluent Aphasia

Answer 6

Speaking is smooth and effortless:
Wernicke's
Transcortical Sensory Aphasia (TSA)
Conduction Aphasia
Anomic Aphasia

Question 7

Classification by comprehension

Answer 7

Receptive Aphasia & Expressive Aphasia

Question 8

Receptive Aphasia

Answer 8

Primary difficulties are in area of comprehension

Question 9

Expressive Aphasia

Answer 9

Primary difficulties are in the area of expression

Question 10

Classification by site of lesion

Answer 10

Damage to the cortical centers for language (served by the middle cerebral artery)
Damage to the association fiber tracts important for language
Damage to the subcortical area
Anomic aphasia does not have a clear localization

Question 11

Aphasia caused by damage to the cortical area

Answer 11

Broca’s, Wernicke’s, and Global

Question 12

Aphasia caused by damage to the association fiber tract

Answer 12

Conduction & Transcortical sensory, motor, and mixed aphasias

Question 13

Broca’s (motor) Aphasia

Answer 13

Damage to lower part of the premotor cortex important for planning and performing expressive language
Damage to the anterior portion of the middle cerebral artery
Often accompanied by right sided hemiplegia or hemiparesis

Question 14

Broca’s aphasia language characteristics

Answer 14

Nonfluent 
Agrammatic
Monotonous speech 
May have misarticulations 
Lacking function words
Impaired repetition
Written language similar to spoken 
Comprehension better than their expressive spoken and written language
Good self-monitoring

Question 15

Wernicke’s (sensory) aphasia

Answer 15

Damage to posterior superior temporal lobe of language dominant hemisphere
Damage to posterior branch of the cerebral middle artery

Question 16

Wernicke’s aphasia language characteristics

Answer 16

Fluent
Impaired auditory comprehension is dominant characteristic
Paraphasias, neologisms, jargon
Empty speech
May have circumlocution
Press of speech (logorrhea)
Handwriting resembles speech
If aphasia is mild, may be aware of errors
Less concern with speech than Broca’s

Question 17

Global aphasia

Answer 17

Damage to trunk of middle cerebral artery which causes massive damage to the entire perisylvian area
Broca’s or Wernicke’s sometimes spared
Severe deficits are demonstrated in all areas of language function

Question 18

Global aphasia language characteristics

Answer 18

Language limited to few words, exclamations
stereotypical utterances
overlearned phrases (How are you?). May perseverate on these words,
Severely impaired comprehension
Reading and writing also terrible
Usually attentive, alert socially appropriate – different than dementia
May be able to perform nonverbal tasks OK – picture matching, etc.
Performance is better when dealing with personal information

Question 19

Conduction aphasia

Answer 19

Rare (5-10%), Probable sites of lesions: lesions in insula,

upper temporal or lower parietal lobe Damage arcuate fasiculus and /or supramarginal gyrus.

Question 20

Conduction aphasia language characteristics

Answer 20

Wernicke’s thought by most to be spared Comprehension somewhat spared
Most dominant feature - great difficulty with repetition
Multisyllabic words more difficult than monosyllabic words
Repetition impairment is disproportionate to other impairments.
Rate, intonation and stress are usually normal
May produce paraphasias.
Difficulties reading out loud because oral reading depends on communication between Wernicke’s and Broca’s.
Word retrieval problems are usually quite evident – resulting in inappropriate pauses and/or empty speech.
Writing is usually legible but may contain spelling errors & letter omissions.
Alert and attentive and aware of errors.
self-correction aren’t typically successful

Question 21

Transcortical aphasias

Answer 21

Spares Broca’s, Wernicke’s, and arcuate fasciculus

Defining characteristic is that repetition is preservered

Question 22

Transcortical Motor Aphasia (TMA)

Answer 22

Damage to anterior superior frontal lobe and association pathways
Areas affected are supplied by anterior cerebral artery and anterior branch of middle cerebral artery

Question 23

TMA language characteristics

Answer 23

Markedly reduced speech output
Good repetition (this differentiates it from Broca’s)
Good auditory comprehension
Disturbed writing
Difficulty initiating speech- inertia
May have right sided hemiparesis or hemiplegia
Attentive and alert

Question 24

Transcortical Sensory Aphasia (TSA)

Answer 24

Damage to posterior temporoparietal region sparing Wernicke’s

Question 25

TSA language characteristics

Answer 25

Preserved repetition – unlike Wernicke’s No problem with inertia in initiating speech (unlike TMA) May often have echolalia Lesion isolates Wernickes area from rest of brain, so major deficits in comprehension of spoken & written language occur. Visual cortex is isolated from Wernicke’s causing difficulty in reading. Fluent but empty speech (like Wernicke's) Don’t have press of speech (not like Wernicke's) Difficulty following commands

Question 26

Mixed Transcortical Aphasia (MTA)

Answer 26

Rare, Damage that spares the major language areas but separates them from rest of brain Damage often occurs in watershed area Often occurs following conditions that reduce blood flow through cerebral arteries such as: carbon monoxide poisoning, cerebral hypoxia, etc.

Question 27

(MTA) language characteristics

Answer 27

Similar to global aphasia except with better repetition Parrot like repetition of what others say - like an echolalia Nonfluent - very limited spontaneous output NO functional auditory comprehension Severely impaired writing and reading skills

Question 28

Anomic aphasia

Answer 28

Naming difficult, no clear localization, damage may occur to angular gyrus or inferior temporal gyrus

Question 29

Anomic aphasia language characteristics

Answer 29

Sever word retrieval May have mild auditory comprehension impairment Circumlocution and substitutions Reading and writing is good

Question 30

Subcortical aphasias

Answer 30

Anterior syndrome Posterior syndrome Anterior-posterior syndrome Thalamic aphasia

Question 31

Anterior syndrome

Answer 31

Caused by damage to internal capsule & lenticular process extending into anterior white matter

Question 32

Anterior syndrome language characteristics

Answer 32

``` Hemiplegic Slow dysarthric speech Good comprehension Good repetition Poor oral reading and writing ```

Question 33

Posterior syndrome

Answer 33

Damage to putamen and internal capsule extending into posterior white matter

Question 34

Posterior syndrome language characteristics

Answer 34

``` Hemiplegic Fluent speech without dysarthria Poor comprehension Good single word repetition Impaired reading and writing Poor confrontational naming ```

Question 35

Anterior-posterior syndrome

Answer 35

Damage to internal capsule and putamen with both anterior and posterior extensions of white matter

Question 36

Anterior-posterior language characteristics

Answer 36

Mixture of symptoms consistent with both Broca’s and Wernicke’s aphasia.

Question 37

Thalamic aphasia

Answer 37

Damage to the thalamus

Question 38

Thalamic aphasia language characteristics

Answer 38

``` Hemiplegic Difficulty initiating speech Speech is echolalic and neologistic Auditory comprehension and reading is good Writing is impaired Word-finding problems are common ```

Question 39

Aphasia a with fair to good comprehension

Answer 39

Broca's, conduction, anomic, and transcortical motor

Question 40

Aphasia with poor comprehension

Answer 40

Wernicke's, transcortical sensory, global

Question 41

Aphasias with poor repetition

Answer 41

Broca's (labored), global