Speech and Aphasia

Question 1

how do you work up patient with aphasia

Answer 1

use PET, mental status, history, physical exam because can’t always give history

Question 2

components of mental status exam

Answer 2

1) arousal and attention
2) memory
3) language
4) visuospatial function
5) mood and affect
6) complex cognition

Question 3

what is importance of comprehensive and systemic mental status exam

Answer 3

core of neurology for syndrome diagnosis, etiology, location, treatment

Question 4

distinguish between aphasia and amnesia

Answer 4

aphasia = acquired language disorder due to brain damage (can’t use verbal/written)

• distinct from motor disorder of speech (dysarthria)
• may contribute to mutism but not the same
• language distinct from thought since language is how thought comm and use verbal symbols

amnesia = impaired recent memory with deficient new learning (not due to deficit language)

Question 5

relationship btwn handedness and cerebral language dominance

Answer 5

99% of right handed are left dominant for language and 67% of left handed

ambidextous = mixed language

most people left dominant for language

Question 6

define syndrome of aphasia

Answer 6

disorder of language from damage to brain areas serving linguistic capacity but not always due to particular brain part not working

may or may not have problem with thought

Question 7

different components of aphasia

Answer 7

1) disordered spontaneous speech due to labored speech,

Question 8

what aphasia is not
define schizo
dysarthria
dysphonia
mutism

Answer 8

1) schizo = thought disorder
2) dysarthria = motor/voice problem
3) dysphonia = laryngitis
4) mutism from aphasia or other

Question 9

language located where

Answer 9

perisylvian zone including Wernicke’s and broca’s

Question 10

define broca’s aphasia
location
behavior
prone to

Answer 10

1) in left frontal region
2) nonfluent, effortful speech with preserved auditory comprehension

telegraphic (short, incomplete sentence) and no grammar

3) prone to depression

Question 11

left frontal lobe lesion
telegraphic speech
agrammatic
good hearing
prone to depresion

Answer 11

broca’s aphasia

Question 12

wernicke’s aphasia
location
behavior
prone to

Answer 12

1) left posterior superior temporal in area 22

2) fluent, paraphasic speech with poor auditory comprehension
- rapid pressed speech d/t anxiety and logorrhea
- well articulated words but sounds empty

3) prone to paranoia b/c can’t interpret heard speech

Question 13

describe paraphasias

Answer 13

seen in wernicke’s due to unintended syllables or words

literal = pipe --> hike
verbal = my wife --> mother
neologism = new/useless words = jargon aphasia

Question 14

left posterior superior temporal lobe
fluent speech
meaningless
paranoia

Answer 14

wernicke’s aphaasia

Question 15

conduction aphasia
location
behavior

Answer 15

1) damage arcuate fasciculus connecting wernicke’s and broca’s or supramarginal gyrus damage
2) difficulty with repetition, normal spontaneous speech and auditory comprehension

Question 16

Arcuate fasciculus damage, repetition problem,
naming problem,
Broca’s and Wernicke’s can’t coordinate

Answer 16

conduction aphasia

Question 17

global aphasia
location
behaviro

Answer 17

1) destroyed entire perisylvian language zone usu d/t middle cerebral infarct
2) most severe, no language and right hemiplegia,

Question 18

total language loss
right hemiplegia
MCA infarct
destroy perisylvian zone

Answer 18

global aphasia

Question 19

repetition/naming abilities for patients with aphasia

which diseases have good spontaneous speech

which diseases have good auditory comprehension

Answer 19

1) poor for all
2) broca’s, global
3) broca’s, conduction

Question 20

how to treat aphasia

Answer 20

1) treat causative lesion
2) most improvement in first year except FTL dementia aphasia
3) speech/language therapy

Question 21

what does right brain do?

Answer 21

1) auto speech
2) prosody
3) music
4) humor
5) metaphor
6) recovery
7) attention

Question 22

define acute vs chronic aphaisa

Answer 22

acute = may change depend on brain circumstance

Question 23

Define apraxia

Define agnosia

Define visuospatial impairment

Define personality change

Answer 23

apraxia = impairment of learned movement

agnosia = impaired visual, auditory, or tactile recog

visuospatial impair = diff interpreting spatial relationship

personality change = departure from normal temperament or character

Question 24

MMSE vs Montreal

Answer 24

both 1-30

MMSE abnormal

Question 25

dysarthria vs dysphonia

Answer 25

dysarthria = disorder of speech from motor system involvement

dysphonia = disorder of voice from laryngeal disease

Question 26

at the time of onset, there may be confounding factors to aphasia including

Answer 26

1) edema
2) hemorrhage
3) diaschisis
4) meds
5) stress

Question 27

transcortical motor deficit

transcortical sensory

anomic

mixed transcortical

Answer 27

transcortical motor deficit = like Broca’s but primary deficit in speech initiation

transcortical sensory = like Wernicke’s but auditory comprehension less affected

anomic = deficit in naming

mixed transcortical = only function left is repetition (echolalia)

Question 28

alexia
reading aloud impaired deficit where?

reading comprehension impaired deficit where?

Answer 28

reading aloud = anterior lesions

reading comprehension = posterior lesions

Question 29

alexia with agraphia localizes where?

Answer 29

left angular gyrus