Speech and aphasia Flashcards
What does a thorough mental status exam test?
Arousal and attention – level of consciousness, digit span, serial sevens
Memory – orientation, 3 words at 5 minutes, remote events
Language – fluency, comprehension, repetition, naming, reading, writing
Visuospatial function – clock drawing, tests for hemineglect
Mood and affect – inquiries about feelings, observations of affect
Complex cognition – executive function, similarities, proverbs, judgment, insight
Aphasia
Acquired disorder of language (capacity to communicate using verbal symbols) caused by brain damage
Most asphasics also have alexia and agraphia
Amnesia
Impaired recent memory, with deficient new learning
What is the relationship between handedness and cerebral language dominance?
99% of dextrals (right-handers) are left dominant for language, and 67% of sinistrals (left-handers) are also left dominant for language
Neuroanatomy of Broca’s aphasia
Nonfluent, effortful speech with relatively preserved auditory comprehension
Damage to the left inferior frontal lobe (Broca’s area- Brodmann areas 44 and 45)
Nonfluent speech, good comprehension, poor repetition, poor naming
Neuroanatomy of Wernicke’s aphasia
Left posterior superior temporal lesions (Wernicke’s area- posterior part of Brodmann area 22)
Impaired auditory comprehension
Characterized by fluent, paraphasic speech with poor auditory comprehension
Fluent speech, poor comprehension, poor repetition, poor naming
A pt with this won’t understand his own speech!
Neuroanatomy of conduction aphasia
Involves damage to the arcuate fasciculus (white matter tract connecting Wernicke’s and Broca’s areas)
Repetition deficit is the salient feature
Fluent speech, good comprehension, poor repetition, poor naming
Neuroanatomy of global aphasia
Most severe form of aphasia, and results from destruction of the entire perisylvian language zone
Patients have essentially no language function and right hemiplegia
Nonfluent speech, poor comprehension, poor repetition, poor naming
Speech vs language
Speech is necessary but not sufficient for language, which requires cerebral cortical regions dedicated to linguistic function
Speech is the mechanical act of uttering words using the neuromuscular apparatus responsible for phonation and articulation
Dysarthria
A disorder of speech due to motor system involvement
Dysphonia
Disorder of voice related to laryngeal disease
The Aphasia Examination (components) and how you test them
Spontaneous speech – Nonfluency is characterized by labored, effortful speech and
What causes most cases of aphasia?
A left middle cerebral territory infarct
Treatment of aphasia
Treat the causative lesion so as to maximize spontaneous recovery
Most functional improvement occurs in the first year
No drug therapy has yet been shown effective
Speech/language therapy is offered as early as possible
Psychiatric care is often helpful
Substantial benefit can be achieved by adaptation to disability
