Speech and Aphasia

Question 1

Define behavioral neurology.

Answer 1

The subspecialty of neurology concerned with the effects of structural brain disease or injury on behavior

Question 2

Define neuropsychiatry.

Answer 2

The subspecialty of psychiatry with essentially the same interests as behavioral neurology (behavioral neurology and neuropsychiatry are now formally affiliated).

Question 3

What is neuropsychology?

Answer 3

The branch of psychology devoted to the study of brain-behavior relationships (neuropsychologists are PhDs who conduct neuropsychological testing, not neuropsychiatric testing).

Question 4

Mental status exams –this lecture mentioned two –are good at tracking ____________, but they cannot __________.

Answer 4

decline over time; diagnosis conditions in the absence of other information

Question 5

A person who has forgotten how to do a movement (or can no longer perform that movement because of an injury) is said to have ___________.

Answer 5

apraxia

Question 6

Acute confusional state is also known as __________.

Answer 6

delirium

Question 7

Impaired recognition –whether visual, auditory, or tactile – is called ___________.

Answer 7

agnosia

Question 8

One way to describe the difference between neurology and psychiatry is that neurology deals with conditions that have __________, while psychiatry deals with conditions that __________.

Answer 8

identifiable structural lesions (such as Lewy bodies or neurofibrillary tangles); do not have an identified structural cause

Question 9

What is aphasia?

Answer 9

An acquired disorder of language caused by brain damage

Question 10

Dysarthria is a __________ disorder.

Answer 10

motor disorder (that is, the brain can still process language fine)

Question 11

Dysphonia is due to impaired function of what structure?

Answer 11

The larynx!

Question 12

Most people are _______ hemisphere dominant for language.

Answer 12

left (99% of right-handed people and 67% of left-handed people)

Question 13

What does “parcellate” mean?

Answer 13

(v.) to divide into parcels

Question 14

A person who has intact understanding of speech but whose speech is telegrammatic and effortful likely has a lesion/stroke in which part of the brain?

Answer 14

The left middle cerebral artery supplying Brodmann’s areas 44 and 45 (Broca’s aphasia)

Question 15

Impaired understanding of language is processed in which Brodmann area?

Answer 15

22 (Wernicke’s aphasia)

Question 16

Paraphasias are _____________.

Answer 16

unintended words or syllables

Question 17

Someone with paraphasias might have a lesion in _________ area.

Answer 17

Wernicke’s

Question 18

What is the band of white matter that connects Broca’s area to Wernicke’s area?

Answer 18

Arcuate fasciculus

Question 19

Global aphasia often presents concurrently with ___________.

Answer 19

right-sided hemiparesis

Question 20

Alexia with agraphia often localizes to the ____________.

Answer 20

left angular gyrus

Question 21

Prosody is the ____________.

Answer 21

inflection of language with emotion

Question 22

Impairments in what usually accompany aphasia?

Answer 22

Reading and writing

Question 23

Those with Broca’s area deficits have good ______________.

Answer 23

understanding –their deficit is in producing language

Question 24

Ischemia to the perisylvian region will lead to what kind of aphasia?

Answer 24

Global – perisylvian basically means the whole region next to the lateral fissure

Question 25

There are two widely used mental status surveys: the MMSE and the MoCA. Which is newer?

Answer 25

The MoCA

Question 26

“Extracortical” refers to regions that ______________.

Answer 26

are adjacent to the perisylvian region

Question 27

“Press of speech” (i.e., rapid, unbridled speech) is called ____________.

Answer 27

logorrhea

Question 28

What linguistic ability is spared in patients with transcortical aphasia?

Answer 28

Repetition

Question 29

Describe the four types of transcortical aphasia.

Answer 29

Transcortical motor: problems initiating speech
Transcortical sensory: like Wernicke’s but less severe
Anomic: problem naming things
Mixed: only ability left is repetition (echolalia)

Question 30

What are the broad principles of treating aphasia?

Answer 30

Treat the underlying lesion/mass/ischemia
Offer speech/language therapy as early as possible
Offer psychiatric care if needed

Most improvement occurs in the first year
No drug has been shown to be effective