Speech and Aphasia

Question 1

Recognize the importance of a comprehensive and systematic mental status examination.

Answer 1

Can localize problems of the brain, particularly good with language.
Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are 30-point measures often used for brief assessment of mental status, not totally sufficient.
-arousal/attn, memory, language, visuospatial function, mood and affect, complex cognition.

Question 2

Recognize the distinction between aphasia and amnesia

Answer 2

aphasia: an acquired disorder of language resulting from damage to brain areas subserving linguistic capacity
amnesia: impaired recent memory with deficient new learning

Question 3

Explain the relationship between handedness and cerebral language dominance.

Answer 3

Language is lateralized, so that in most people it is represented in the left hemisphere.

About 90% of the population is right-handed and 10% left-handed. However, whereas 99% of right-handed people are left dominant for language, about 67% of left-handers are also left dominant for language.

SO: pts with aphasia usually have a left hemisphere lesion.

Question 4

Define the syndrome of aphasia

Answer 4

-an acquired disorder of language caused by brain damage.
-language is the capacity to communicate using verbal symbols.
-Language is a means to communicate thought.
(Whereas speech is a mechanial act; uses motor cortices, corticobulbar tracts, basal ganglia, cerebellum, LMNs innervating pharynx and larynx, and pharyngeal and laryngeal muscles. Speech is necessary but not sufficient for language)

Question 5

Broca’s aphasia

Answer 5

Broca’s aphasia: infarct in left frontal region including Broca’s area; charcterized by nonfluent, effortful speech with relatively preserved auditory comprehension. Speech is telegraphic and agrammatic.

Question 6

behavioral neurology

Answer 6

subspecialty of neurology concerned with the effects of structural brain disease or injury on behavior

Question 7

dysarthria

Answer 7

dysarthria a disorder of speech due to motor system involvement

Question 8

dysphonia

Answer 8

disorder of voice related to laryngeal disease

Question 9

Mutism

Answer 9

can be due to severe aphasia.

Can be due to anarthria, aphonia or can be a psychiatric disease.

Question 10

Aphasia examination

Answer 10

spontaneous speech: nonfluency is characterized by labored, effortful speech and

Question 11

Language regions of the brain

Answer 11

Perisylvian zone, including Broca’s (Brodmann areas 44, 45) and Wernicke’s areas (Brodmann area 22; responsible for auditory cognition; left posterior superior temporal lesion)
-Adjacent extrasylvian/transcortical cortex also participates

Question 12

Paraphasias

Answer 12

Unintended syllables or words, more easily heard in a fluent speaker.

Three types:

1. literal (phonemic): pipe becomes hike
2. verbal (semantic): my wife becomes my mother
3. Neologism (new and meaningless word): may lead to jargon aphasia

Question 13

Wernicke’s aphasia

Answer 13

Wernicke’s aphasia: subacute ischemic infarct in left superior temporal region; characterized by fluent, paraphasic seech with poor auditory cognition. Speech may be very rapid, with “press of speech” or logorrhea

Question 14

Conduction aphasia

Answer 14

Conduction Aphasia: involves damage to the arcuate fasciculus, a white matter tract connecting Wernicke’s and Broca’s areas. Many cases also have supramarginal gyrus damage. Repetition deficit is salient feature. T2 weighted MRI shows focal ischemic region in left hemisphere that extends into the subcortical white matter and thus involves the arcuate fasciculus.

Question 15

Global aphasia

Answer 15

**the most severe form of aphasia.
Results from destruction of the entire perisylvian language zone. Patients have essentially no language function and right hemiplegia.
CT shows large ischemic infarct involving almost entire left hemisphere. Most cases: left middle cerebral territory infarct is responsible, as with most aphasias.

Question 16

Broca’s aphasia

spont speech, comprehension, repetition, naming, localization

Answer 16

spont speech: nonfluent, comprehension: good, repetition: poor, naming: poor, localization: Broca’s area

Question 17

Wernicke’s aphasia

spont speech, comprehension, repetition, naming, localization

Answer 17

spont speech: fluent, comprehension: poor, repetition: poor, naming: poor, localization: Wernicke’s area

Question 18

Conduction aphasia

spont speech, comprehension, repetition, naming, localization

Answer 18

spont speech: fluent, comprehension: good, repetition: poor, naming: poor, localization: arcuate fasciculus

Question 19

Global aphasia

spont speech, comprehension, repetition, naming, localization

Answer 19

spont speech: nonfluent, comprehension: poor, repetition: poor, naming: poor, localization: perisylvian zone

Question 20

What do most aphasics also have?

Answer 20

alexia (acquired disorder of reading)
reading aloud impaired in anterior lesions, reading for comprehension more impaired in posterior lesions.

agraphia
written output parallels spoken output (sparse, effortful with anterior lesions; expansive and paragraphic with posterior lesions)

Question 21

Right hemisphere contributions to language

Answer 21

automatic speech (expletives), prosody (inflection w/ emotion), music, humor, metaphor, recovery

Question 22

Treatment of Aphasia

Answer 22

• treat causative lesion
• most functional improvement in first year
• no drug therapy
• speech/language therapy offered as early as possible
• psychiatric care
• adaptation to disability