Speech and Aphasia Flashcards
how do you work up patient with aphasia
use PET, mental status, history, physical exam because can’t always give history
components of mental status exam
1) arousal and attention
2) memory
3) language
4) visuospatial function
5) mood and affect
6) complex cognition
what is importance of comprehensive and systemic mental status exam
core of neurology for syndrome diagnosis, etiology, location, treatment
distinguish between aphasia and amnesia
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)
relationship btwn handedness and cerebral language dominance
99% of right handed are left dominant for language and 67% of left handed
ambidextous = mixed language
most people left dominant for language
define syndrome of aphasia
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
different components of aphasia
1) disordered spontaneous speech due to labored speech,
what aphasia is not define schizo dysarthria dysphonia mutism
1) schizo = thought disorder
2) dysarthria = motor/voice problem
3) dysphonia = laryngitis
4) mutism from aphasia or other
language located where
perisylvian zone including Wernicke’s and broca’s
define broca’s aphasia
location
behavior
prone to
1) in left frontal region
2) nonfluent, effortful speech with preserved auditory comprehension
telegraphic (short, incomplete sentence) and no grammar
3) prone to depression
left frontal lobe lesion telegraphic speech agrammatic good hearing prone to depresion
broca’s aphasia
wernicke’s aphasia
location
behavior
prone to
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
describe paraphasias
seen in wernicke’s due to unintended syllables or words
literal = pipe --> hike verbal = my wife --> mother neologism = new/useless words = jargon aphasia
left posterior superior temporal lobe
fluent speech
meaningless
paranoia
wernicke’s aphaasia
conduction aphasia
location
behavior
1) damage arcuate fasciculus connecting wernicke’s and broca’s or supramarginal gyrus damage
2) difficulty with repetition, normal spontaneous speech and auditory comprehension
Arcuate fasciculus damage, repetition problem,
naming problem,
Broca’s and Wernicke’s can’t coordinate
conduction aphasia
global aphasia
location
behaviro
1) destroyed entire perisylvian language zone usu d/t middle cerebral infarct
2) most severe, no language and right hemiplegia,
total language loss
right hemiplegia
MCA infarct
destroy perisylvian zone
global aphasia
repetition/naming abilities for patients with aphasia
which diseases have good spontaneous speech
which diseases have good auditory comprehension
1) poor for all
2) broca’s, global
3) broca’s, conduction
how to treat aphasia
1) treat causative lesion
2) most improvement in first year except FTL dementia aphasia
3) speech/language therapy
what does right brain do?
1) auto speech
2) prosody
3) music
4) humor
5) metaphor
6) recovery
7) attention
define acute vs chronic aphaisa
acute = may change depend on brain circumstance
Define apraxia
Define agnosia
Define visuospatial impairment
Define personality change
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
MMSE vs Montreal
both 1-30
MMSE abnormal
dysarthria vs dysphonia
dysarthria = disorder of speech from motor system involvement
dysphonia = disorder of voice from laryngeal disease
at the time of onset, there may be confounding factors to aphasia including
1) edema
2) hemorrhage
3) diaschisis
4) meds
5) stress
transcortical motor deficit
transcortical sensory
anomic
mixed transcortical
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)
alexia
reading aloud impaired deficit where?
reading comprehension impaired deficit where?
reading aloud = anterior lesions
reading comprehension = posterior lesions
alexia with agraphia localizes where?
left angular gyrus
