Fluent aphasias Flashcards
Fluent Aphasias
may be referenced as: receptive aphasia, sensory aphasia, posterior aphasia, and semantic aphasia
S/S of fluent aphasias
- language comprehension deficits
- paraphasic speech with poor self-monitoring
- effortless and melodic speech
- good articulation
- decreased use of real words
- decreased amount of information spoken
- tendency to be paragrammatic
- self-initiated output
- may use circumlocuations
Types of fluent aphasias
- Wernickes
- Anomic
- Conduction
- Transcortical Sensory
Wernicke’s Aphasia
- carl wernicke in 1874
- characterized by fluent and sometimes excessive verbal expressions that are grammatically correct
- full of paraphasias (often rendering speech unintelligible)
- significant auditory comprehension deficits
Wernickes- Neuroanatomical Bases
- superior temporal gyrus in the dominant hemisphere
- specifically the posterior portion of the superior temporal gyrus
- common etiologies:
— embolic/thrombolic CVA’s and intracranial hemorrhage; trauma; tumor in the posterior temporal lobe
— even untreated ear infections
- supplied by the posterior branches of the left middle cerebral artery
Wernicke’s General Characteristics
- pt’s may appear “normal”
- do not necessarily have paresis or paralysis
— site of the lesion is away from the motor centers of the brain
- may sound confused: jargon filled, irrelevant speech
- lack insight into their disability: do not seem to be aware of their disorder and its effects on the listener
- lack frustration in failed communicative attempts
- exhibit psychiatric symptoms: may be paranoid, homicidal, suicidal
Wernicke’s Language Characteristics 1
- excessive word output; cocktail party speech
- normal prosody w/good articulation and normal phrase length
- generally intact grammatical forms; pts may exhibit paragrammatism; excess use of grammatical morphemes
- severe word-finding issues; completely fail to name objects shown or may produce a semantic substitution or neologistic response
Wernicke’s Language Characteristics 2
- pts may circumlocute
- empty speech: semantic and literal paraphasias
- may retain grammatical words and omit content words
- very poor auditory comprehension; HALLMARK
- impaired conversational skills; especially w/competing noise; may fail to yield to conversational partners
Wernicke’s Language Characteristics 3
- impaired repetition skills; may correspond to the degree auditory comprehension is impaired
- difficulty with reading comprehension and writing
- unable to monitor speech (feedback loop is broken)
Wernicke’s Aphasia Chart
- lesion site
- verbal expression
- AC
- naming
- posterior portion of the superior/posterior temporal gyrus
- described as excessive w/paraphasias, empty speech and paragrammatism
- severely impaired
- severely impaired w/frequent word substitutions; phonemic priming is not usually helpful
Wernicke’s Aphasia Chart
- repetition
- oral reading
- reading comprehension
- writing
- impaired; will possibly mirror verbal expression
- impaired
- impaired
- impaired; paraphasic; neologistic
Transcortical Sensory Aphasia
- first described in 1881
- aka posterior isolation syndrome and extrasylvian sensory aphasia
- pts will echo and imitate what is heard
- some have even called it Wernicke’s type II
- distinguishing hallmark b/w Wernicke’s and TSA is that pts w/TSA are good at repetition
- fluent counterpart to TMA
Transcortical Sensory Aphasia-Neuroanatomical bases
- lesion in the temproparietal region
- damage to the posterior portion of the middle temporal gyrus is typical
- cortical regions damaged are in the watershed areas of the middle cerebral artery
- head trauma can also cause TSA
Transcortical Sensory Aphasia- General characteristics
- onset is usually w/hemiparesis that resolves
- pts in the initial stages of Alzheimer’s disease mirror symptoms that are similar to those of TSA but continue to worsen into irreversible dementia
- unilateral inattention is common; left neglect is a diagnostic feature of right hemisphere dysfunction
- sensory loss may/may not be present with some pts demonstrating signs of visual problems
Transcortical Sensory Aphasia- Language characteristics 1
- fluent, well-articulated, paraphasic, echolalic, empty speech in the context of poor auditory comprehension
- generally good syntactic skills; no agrammatism
- full of semantic and neologistic paraphasias
- do not exhibit logorrhea or press of speech that characterizes pts w/Wernicke’s aphasia
Transcortical Sensory Aphasia- Language characteristics 2
- impaired naming
- good repetition skills; may not comprehend what they are repeating
- echolalia
- normal automatic speech once initiated
- poor reading comprehension; able to read orally
TSC Aphasia Chart
- Lesion site
- Verbal expression
- AC
- Naming
- lesion in the temporoparietal region; posterior middle temporal gyrus
- good w/paraphasias; echolalic; empty speech; unaware of deficits; speech is parrot-like
- impaired
- Impaired; phonemic priming is not usually helpful
TSC Aphasia Chart
- repetition
- oral reading
- reading comprehension
- writing
- good; echolalic
- good
- impaired
- impaired
Conduction Aphasia
- characterized by paraphasic fluency, good comprehension and impaired repetition
- similar to pts w/Wernicke’s aphasia but with good auditory comprehension
Conduction Aphasia- Neuroanatomical bases
- more controversial than other types
- lesions of the supramarginal gyrus and/or the arcuate fasciculus
- bimodal distribution model
—- more anteriorly located lesions produce less fluent aphasia w/better auditory comprehension skills; more posterior lesions may produce more fluent aphasia w/poorer auditory comprehension
Conduction Aphasia- general characteristics
- present w/varied neurological and other symptoms
- some will have paresis; others will not
- some will exhibit limb dyspraxia; others will not
- some will show signs of right sensory impairment; others will not
Conduction Aphasia- Language characteristics 1
- characterized by impaired repetition w/fluent speech and naming deficits
- marked difficulty in repeating modeled productions even though comprehension is intact
- may use words in speech they cannot repeat when requested to do so
Conduction Aphasia- Language characteristics 2
- varied speech fluency; hence bimodal distribution model
- semantic and neologistic paraphasias are less frequent in this aphasia
- marked anomia
- appear to be aware of errors but cannot correct them
Conduction Aphasia Chart
- Lesion site
- verbal expression
- AC
- naming
- supramarginal gyrus; left parietal lobe; arcuate fasciculus
- good w/pauses and paraphasias
- good; possible mild comprehension
- impaired
Conduction Aphasia Chart
- repetition
- oral reading
- reading comprehension
- writing
- Additional info
- severely impaired
- impaired
- good
- impaired
- cortical stuttering/neurogenic stuttering is sometimes present
Anomic Aphasia
- lesion site is undetermined or highly variable
- anomia: difficulty naming; a symptom present in almost all types of aphasia
- anomic aphasia: syndrome whose overriding feature is persistent and severe naming problems in the context of relatively intact language skills
- important to distinguish anomia as a symptom versus anomia as a syndrome
- anomia is the most commonly found residual symptom in persons who have recovered from all types of aphasia
Anomic Aphasia- Neuroanatomical Bases
- lesion sites are controversial
- some cite issues at the angular gyrus and the second temporal gyrus
Anomic Aphasia- language characteristics
- pts with anomic aphasia tend to have greater success naming words that are:
—nouns
—more frequently used in language
—shorter in length
—personally meaningful
—used more in conversation
—part of sentence completion task
Anomic aphasia chart
- Lesion site
- verbal expression
- AC
- naming
- angular gyrus; second temporal gyrus
- good but w/frequent pauses and some paraphasias
- good; mildly impaired
- severely impaired; lots of circumlocutions
Anomic Aphasia Chart
- repetition
- oral reading
- reading comprehension
- writing
- good
- good
- good
- good; will mirror verbal expression
