Language Disorders

Question 1

In which hemisphere do most right-handed adults have their speech centers?

Answer 1

The left one.

Question 2

Review: What important area for speech is in the left inferior frontal lobe? Lesion causes?

Answer 2

Broca’s region -> afluent aphasia

Question 3

Review: What important area for speech is in the superior (usually left) temporal lobe? Lesion causes?

Answer 3

Wernicke’s aphasia -> fluent aphasia.

Question 4

Review: What structure connects Wernicke’s and Broca’s areas?

Answer 4

Arcuate fasciculus.

Question 5

In most right-handers, what difference can be grossly seen in left vs. right Wernicke’s, Broca’s etc.?

Answer 5

Bigger on left where speech centers are.

Question 6

Why do strokes causing aphasia have better prognoses for left-handed people?

Answer 6

Speech tends to be bilateral in left-handers. (it’s also just tends to be better in right hemisphere strokes)

Question 7

What’s one piece of evidence that environmental factors affect the lateralization of speech?

Answer 7

Illiterate people don’t have as strongly lateralized speech: lesion on either side will cause aphasia.

Question 8

Asking a patient to point to a pencil tests…

Answer 8

comprehension

Question 9

What kind of lesion might you suspect if the patient only had problems with repetition (in a cursory exam for aphasia)? Possible site of lesion?

Answer 9

Conductive. Arcuate fibers.

Question 10

3 things wrong in afluent aphasia due to Broca’s lesion?

Answer 10

Difficulty producing speech (labored, simple grammar)
Poor repetition
Mildly impaired naming.
(Comprehension / ability to follow commands tends to be mostly intact)

Question 11

4 things wrong in fluent aphasia due to lesion to Wernicke’s area?

Answer 11

Fluent speech, circumlocutory (if mild) to meaningless (if severe)
Poor single word comprehension (may be able to approximate meaning)
Impaired repetition
Poor naming

Question 12

4 signs of global aphasia? Does it often evolve?

Answer 12

Non-fluent speech
Poor comprehension
Impaired repetition
Poor naming
-Yes, it often evolves to be more focal.

Question 13

What speech area would an anterior MCA stroke most affect?

Answer 13

Broca’s

Question 14

What speech area would a posterior MCA stroke most affect?

Answer 14

Wernicke’s

Question 15

What kind of vascular lesion could produce global aphasia?

Answer 15

MCA, internal carotid.

Question 16

What is prosody?

Answer 16

Melodic pitch variation in speech -> loss of prosody produces flat, boring speech

Question 17

3 right hemisphere language disorders that might occur in right-handers?

Answer 17

Impaired prosody
Poor comprehension of metaphor, humor
Limited grasp of extended discourse

Question 18

Name 2 subcortical language disorders?

Answer 18

Striatal (caudate-putamen) aphasia -apparently quite rare.

Thalamic aphasia - effects vary with location in thalamus

Question 19

Would Broca’s aphasics have a problem with grammatical comprhension and expression?

Answer 19

Yes. Broca’s isn’t all production. Recall “Fran showed her baby the pictures” vs. “Fran showed her the baby pictures.”

Question 20

What kind of aphasia can frontotemporal degeneration lead to? Underlying cause?

Answer 20

Progressive, non-fluent aphasia (PNFA) -often accompanied by personality change. Most commonly caused by Tau buildup.

Question 21

What makes progressive non-fluent aphasia different from isolated Broca’s lesion?

Answer 21

Really poor grammar comprehension. (can’t follow command of “Point at the floor after you point at the ceiling.”)

Question 22

3 characteristics of semantic dementia?

Answer 22

Fluent, empty speech (like Wernicke’s)
Poor single word comprehension
Object comprehension difficulty
(it’s thought to more about losing the concept of the object that causes poor naming, not the loss of the word itself)

Question 23

What areas are most affected in semantic dementia (roughly)?

Answer 23

Anterior and ventral temporal lobes.

Question 24

What is a sign of peripheral alexia?

Answer 24

Letter-by-letter reading

Question 25

What are 2 signs of central alexia?

Answer 25

Pronouncing sight vocab, such as “choir”
Pronouncing novel words, such as “gub”
(i.e. things where the pronunciation doesn’t necessarily follow the usual sounds associated with the letters)

Question 26

How does the localization of peripheral and central alexia differ?

Answer 26

Peripheral: ventral occipito-temporal region…
Central: above and slightly anterior to the peripheral alexia region

Question 27

Contrast the two kinds of agraphia.

Answer 27

Central agraphia: Spelling of site vocab like “choir” or novel words like “gub” (similar to central alexia
Peripheral: loss of automaticity of writing, must take time with each letter, letters often flipped

Question 28

Does amusia (disorder of music) often go along with disorders of language?

Answer 28

Yup.