Speech and Aphasia

Question 1

Appreciate the importance of a comprehensive and systematic mental status examination

Answer 1

Mental status examination can provide insight into the pathology and brain region involved in behavioral/cognitive/psychiatric disorders. Diagnosis requires more thorough mental status examination than brief exams like the Mini-Mental State Examination and the Montreal Cognitive Assessment. These exams are useful for monitoring a patient with a known cognitive disorder, but not for diagnosis.

A complete mental status examination assesses:

1. Arousal and attention
2. Memory
3. Language
4. Visuospatial fxn.
5. Mood and affect
6. Complex cognition

Question 2

Recognize the distinction between aphasia and amnesia

Answer 2

Aphasia: acquired disorder of language caused by brain damage
•Language is distinct from thought, it is the means by which thought is communicated and is the capacity to communicate using verbal symbols
•Distinct from a motor disorder of speech (i.e. dysarthrias)
•May contribute to mutism, but is not synonymous with mutism

Amnesia: impairment of recent memory, with deficient new learning. Not related to a deficit in language

Question 3

Know the relationship between handedness and cerebral language dominance

Answer 3

Language is represented in the left hemisphere in most people and patients with aphasia usually have a left hemisphere lesion. 99% of right-handed people and 67% of left-handed people are left dominant for language. Ambidextrous people may have mixed (right and left hemisphere) language dominance.

Question 4

Define the syndrome of aphasia

Answer 4

A disorder of language resulting from damage to brain areas subserving linguistic capacity.

There are several different presentations, including:

• Disordered spontaneous speech
• Decreased auditory comprehension (cannot perform complex verbal commands)
• Difficulty with repetition (“no ifs, ands, or buts”)
• Difficulty naming common and less common objects (look for pausing in conversation due to difficulty trying to remember the name of the object

Question 5

Understand the neuroanatomy of Broca’s aphasia

Answer 5

• Broca’s area is responsible for language fluency
• Broca’s area is made up of Broadmann’s areas 44 and 45
• Characterized by nonfluent, effortful speech with preserved auditory comprehension
• Speech is telegraphic (short, incomplete sentences with paucity of words) and agrammatic (loss of grammatical structure—loss of verbs in sentences)
• Pts. often develop depression

Question 6

Understand the neuroanatomy of Wernicke’s aphasia

Answer 6

• Wernicke’s area is involved in auditory comprehension (but not audition)
• Wernicke’s area is in the left posterior superior temporal lesions in the posterior part of Broadmann’s area 22
• Can hear speech but can’t interpret it—similar to listening to a foreign language

*Characterized by fluent, paraphasic speech with poor auditory comprehension
(Paraphasias are unintended syllables or words (more easily heard in a fluent speaker)
• Literal: pipe becomes hike
• Verbal: my wife becomes my mother
• Neologism: new and meaningless words)

• Often rapid, pressed speech (possibly due to anxiety)
• Often very frightened and paranoid
• Speech has many well articulated words but lacks meaning or sounds empty

Question 7

Understand the neuroanatomy of conduction aphasia

Answer 7

• Damage to arcuate fasciculus connecting Wernicke’s and Broca’s areas; many cases also have supramarginal gyrus damage
• Difficulty with repetition is the most salient feature
• Normal spontaneous speech and auditory comprehension

Question 8

Understand the neuroanatomy of global aphasia

Answer 8

• Most severe form of aphasia
• Destruction of entire perisylvian language zone
• Essentially no language
• Right hemiplegia