Lecture 34: Aphasia Flashcards
What is aphasia?
A disorder of language
Where is speech lateralized in right handed adults?
Right-handed people have speech represented in the left hemisphere
-experience also impacts lateralization
Where is speech represented in left-handers? Significance?
Left-handers have speech represented bilaterally
Significance: good prognosis and outcome in aphasia in left-handers and aphasia following right hemisphere stroke
How does lateralization manifest in cortex?
Wernicke’s area larger in left hemisphere than right hemisphere for right handers
Broca’s area is larger in left hemisphere in right handers
What are the four types of aphasias?
Non-fluent i. Brocas ii. global Fluent i. Wernicke’s ii. Conduction
What are the four ways to measure aphasia?
- Fluency
- Comprehension
- Repetition
- Naming
What is Non-fluent speech?
- effortful (speaks really slowly)
- telegraphic
- agrammatic (leaves out shit that forms complete sentences like the verb; agrammatic writing as well)
What is fluent speech?
- melodic
- circumlocutory
- empty content
What is Single world comprehension?
- [Point to the pencil]
- point to the pencil (out of presenting two objects)
- present one object and ask is this a pencil?
What defines the repetition examination in testing for aphasia?
- multisyllabic words (ask patient to say constitutional)
- phrases (Methodist episcopal)
- sentences (no ifs, ands or buts)
What are the different types of naming?
- Confrontation naming
- Recognition naming
- Prompts
- semantic (choir)
- phonemic
What is Broca’s Aphasia? MOA and symptoms?
MOA: lesion in Broca’s area in frontal lobe…branch artery stroke
Symptoms:
Non-fluent speech
Impaired repetition
Impaired Naming (hard to find names for objects)
BUT
Intact single world comprehension
ALSO
Impaired grammatical expression/comprehension
What is MOA for Wernicke’s Aphasia? What are the symptoms?
MOA: lesion in Wernicke’s area in superior temporal gyrus…branch artery stroke Symptoms: Impaired word comprehension Impaired repetition Impaired Naming Fluent Speech -Is NOT a auditory problem -Problem with the lexicon
What is the MOA of Conduction Aphasia? What are symptoms?
Lesion to the arcuate fasciculus
Lesion to the connection between Wernicke and Broca’s area
Impaired repetition
Fluency, comprehension, naming are all good
What is MOA of Global Aphasia? What are symptoms?
MOA: occlusion to the carotid artery
Problems in both Wernicke and Broca’s area
Poor comprehension, speech, naming, repetition
What are the problems with the classic approach of language (Wernicke’s to arcuate fasciculus to Broca’s on left hemisphere?
a. language disturbance following
- right hemisphere stroke
- subcortical stroke
b. other language impairments
c. primary progressive aphasia
Prosody
the rhythmic and intonatonal aspect of speech
Right hemispheres language disorders in Right hander’s
Symptoms:
- impaired prosody
- poor comprehension of metaphor, humor (so can’t get a joke)
- limited grasp of extended discourse
Subcortical language disorders
What types of subcortical language disorders are there and what are their symptoms?
i. Striatal (caudate-putamen) aphasia
- non-fluent
- preserved repetition
ii. Thalamic aphasia
- depends on specific location with thalamus
What are aspects of language that are NOT ascertained during clinical aphasia exam?
Grammatical comprehension
Example: Broca’s apahsics have difficulty with grammatical expression AND grammatical comprehension
-difference between “Fran showed her baby the pictures” and “Fran showed her the baby pictures”
How are majority of aphasias (Broca, Conduction, Wernicke’s, Global) caused?
Stroke
What is another MOA that results in aphasia?
Neurodegeneration
Example: frontotemporal degeneration that leads to progressive aphasia
What is Progressive Non-Fluent Aphasia?
Expression has grammatical simplification, effortful, hesitant
Comprehension
-agrammatic sentence comprehension
Example: point to the door AFTER pointing to the ceiling
Diagnose with MRI because this guy is atrophy rather than stroke
Similar to Broca’s
What is Semantic Dementia?
Object comprehension difficulty Fluent, empty speech Poor single word comprehensive MOA: cortical atrophy in temporal lobe Diagnose with MRI Similar to Wernicke’s
What are the two types of alexia?
i. Peripheral component alexia
-alexia without agraphia
-letter-by-letter reading
Lesion in ventral-caudal temporal lobe
ii. Central component alexia
- difficulty pronouncing sight vocabulary (shit that isn’t pronounced the way it is spelled)– “choir”
- pronouncing novel words – “gub”
What are the two types of agraphia (writing disorders)?
i. Peripheral component agraphia
- apractic agraphia (difficulty writing letters as in they write the letter a in different ways for same word)
ii. Central component
- spelling sight vocabulary like “choir”
- difficulty spelling novel words like gub
Amusia
disorder of music
- deficits in comprehension, expression
- often depends on level of expertise
- selective deficits of pitch, rhythm
- selective deficits of music syntax (structure), meaning
