Aphasia and Agnosia

Question 1

Wernicke-Gershwind model of Language

Answer 1

• Left hemisphere dominant in language (Hemispheric Lateralization)
• Many are also bilateral, meaning R side has small role.

Question 2

Brain Areas for Language Functioning (5)

Answer 2

• Brocas: language prod.
• Motor Cortex: Move. of lips/mouth
• Wernickes: Comprehension
• Arcuate Fasciculus: fibrous connection btwn Wern. + Broc.
• Angular Gyrus: Visual process of lang. (Writing)

Question 3

Arteries Involved in Language

Answer 3

• Anterior cerebral artery
• Middle cerebral artery
• Posterior cerebral artery

Question 4

Steps in Assessing Aphasia

Answer 4

1. Locate injury (Deep struc, prod. area, comprehension area, motor area?)
2. Fluent or nonfluent output?
3. Expressive? (sustain convo or writing?)
4. Comprehension? (understand commands)
5. Repetition/Sequencing? (repeat words/sentences, finish # seq.)
6. Naming (objects by sight)

Question 5

Anomic aphasia

Answer 5

• Fluent
• Damage to Posterior temporal/inferior parietal(angular gyrus) or frontal
• Difficulty spontaneously finding words (mostly low freq.)
• Engages in circumstantial speech

Question 6

Wernicke’s Aphasia

Answer 6

• Fluent
• Maintains:
• prosody (rhythm)
• sentence struc, w/ neologisms (new words), malapropisms (confusing word w/ similar sounding word),
• proper words w/ agrammatic speech.

Question 7

Transcortical Sensory Aphasia

Answer 7

• Fluent
• Damage to area overlapping Wern w/ somatosensory cortex
• Less rapid & fluent
• repetition intact

Question 8

Conduction Aphasia

Answer 8

• Fluent
• Damage to Arcuate Fasciculus
• Decent comprehension
• Meaningful speech
• Poor repetition

Question 9

Transcortical Motor Aphasia

Answer 9

• Nonfluent
• good repetition
• decent convo + naming
• Dmage to Cingulate Gyrus + Motor Cortex (motor initiation)
• Abulia=poor initiation of speech
• Speech must be coaxed out
• limited in content but understandable

Question 10

Broca’s Aphasia

Answer 10

• Nonfluent
• Speech halted/barren but comprehensible
• Missing verbs, adjectives, morphologies
• Good comprehension

Question 11

Mixed Transcortical Aphasia

Answer 11

• Nonfluent
• Damage to motor + sensory cortices
• “isolation syndrome”: Good repetition
• No spontaneous speech
• No comprehension of own speech or speech of others

Question 12

Global Aphasia

Answer 12

• Nonfluent
• Damage to entire language area
• Spontaneous language (mostly grunts)
• No comprehension, naming, rep.

Question 13

Etiology/Prevalence of Aphasia

Answer 13

• 85% caused by CVA
• 1/3 CVA result in an aphasia
• Inc. in age associated w/ Wernicke’s and Global
• Males>Wernicke’s
• Females>Broca’s
• Worst Prognosis: Wernicke’s/Global
• Best Prognosis: Broca’s/Anomic

Question 14

Less prevalent aphasias

Answer 14

Thalamic aphasia:

• btwn transcortical and anomic
• speech less spontaneous
• comprehension mildly impaired

White Matter Disease:

• MS, PML, or basal ganglia hemorrage
• rare

Primary Progressive Aphasia:

• degenerative
• begins w/ anomia, then fluent aphasia, then global
• Associated w/ alzheimers

Question 15

Treatment (Tx)

Answer 15

Communication Book:

• Nonverbal and verbal matching, gestural communication

Letterboard:

• slow identification + recreation of letters/words

Cognitive Remediation:

• rep. of simple activities increasing in complexity
• letter/word/sentence sequencing
• Picture/word matching

Language Pathology

• Cog. Rem. w/ buccofacial rehab
• deal w/ sequelae affecting motor cortex (disarthria, speech articulation, swallowing)
• Melodic intonation therapy (use of melody (R hem) for simple speech problems

Question 16

Diagnosis (Dx)

Answer 16

• mix of different symptoms

Often will have

• Disarthria: muscle strength
• Oral Apraxia: muscle coordination
• Cranial Nerve Damage: Facial, hypoglossal, trigeminal, glossopharyngeal or vagus.

Question 17

Differential Diagnosis

Answer 17

• Cortical and/or word deafness: bilat dam. to primary auditory cortices. Ears register sound but brain doesn’t process. can read/talk.
• Apraxia: cant coordinate muscles. Still comprehension/reading.
• Alexia: Damage to left lat occipital. Can comprehend/speak.
• Akinetic mutism: Damage to frontal/basal ganglia.Can’t initiate speech. Looks lethargic. Use single words.
• Agnosia: Cant recognize words/objects Only identify objects nonverbally/with a description.

Question 18

Agnosia

Answer 18

• Inability to percieve sensory input
• occurs in any sensory domain
• VERY RARE
• Difficult to identify unless pt has true agnosia.

Question 19

Visual Object Agnosia

2 types

How to test

Answer 19

• Inability to identify objects in visual field
• Damage to bilat occipital
• Apperceptive=cannot name, draw, point, copy, match
• Associative=can draw, copy, match
• Use Boston Naming Test

Question 20

Simultagnosia (2)

Answer 20

• Visual object agnosia
• Inability to see more than 1 object at time
• Dorsal=cannot name, point to etc. (dam to bilat occipitoparietal)
• Ventral=can name objects if pressent seperately. Cannot name in relation. (dam to left inferior occipital)

Question 21

Prosopagnosia

Answer 21

• visual object agnosia
• inability to recognize faces

Question 22

Category agnosia

Answer 22

• Visual object agnosia
• Cannot name objects of certain category

Question 23

Anopsia

Answer 23

• not able to see out of specific visual field
• damage to sensory pathway/cranial nerves
• Homonymous=same side
• heteronymous=opposite side
• hemi=half
• quadrant=quarter
• mix and match

Question 24

Neglect

Answer 24

more serious sensory loss
involving sight, movement, tactile sensation

Question 25

Treatment (Tx)

Answer 25

• Focus on compensation, using aids to make up for deficit
• labels
• identifying object by location or feel (tactile cue)

Question 26

Agnosia Prognosis

Answer 26

• Doesnt remit but may improve a bit