Speech and Aphasia

Question 1

What subspecialty of medicine does aphasia seem to highlight?

Answer 1

• Behavioral neurology

* If the brain is an organ, than abnormal behavoir is a symptom of organ dysfunction

Question 2

What is the pathway of diagnostics using the mental status exam?

Answer 2

• Cognitive deficits found
		○ Syndrome diagnosis
	• Explore for etiology with rest of neuro exam
		○ Site of pathology determination
		○ Etiology diagnosis
	• Explore for appropriate treatment
		○ Based off of site and on etiology
	• For behavioral neurology the neuro exam and mental status exam is more specific and sensitive than any scan or image

Question 3

What is MMSE?

Answer 3

• Mini-mental state examination

* 30 point measures often used for brief assessment of mental status

Question 4

What is MoCA?

Answer 4

• Montreal cognitive assessment

* 30 point measures often used for brief assessment of mental status

Question 5

What are the major cognitive domains that are tested in mental status examinations?

Answer 5

• Arousal and attention
		○ Level of consciousness
		○ Digit span
		○ Serial sevens
	• Memory
		○ Orientation
		○ Three words at five minutes
		○ Remote events
	• Language
		○ Fluency
		○ Comprehension
		○ Repetition
		○ Naming
		○ Reading
		○ writing
	• Visuospatial fluctuation
		○ Clock drawing
		○ Tests for hemineglect
	• Mood and affect
		○ Inquires about feelings
		○ Observations of affect
	• Complex cognition
		○ Executive function
		○ Similarities
		○ Proverbs
		○ Judgment
		○ insight

Question 6

What are the syndromes that can be ID’d by bedside examination?

Answer 6

• Acute confusional state
○ Common and often reversible disorder of attention
• Amnesia
○ Impaired recent memory
○ Deficit in new learning
• Aphasia
○ Acquired disorder of language
• Apraxia
○ Impairment of learned movement, often associated with aphasia
• Agnosia
○ Impaired recognition in the visual, auditory, or tactile modality
• Visuospatial impairment
○ Difficulty interpreting spatial relationships
• Hemineglect
○ Failure to attend to one side of the body or extrapersonal space
*personalitiy change
*dementia

Question 7

What is the definition of aphasia?

Answer 7

• Acquired disorder of language
• Resulting from brain damage in the areas subserving linguistic capacity
○ PET and fMRI are helpful in further defining

Question 8

What are three complications to the differential dx of aphasia?

Answer 8

• Dysarthria - muscle problem with speech
• Mutism (can be aphasia but can also be:)
○ Anarthria
○ Aphonia

Question 9

What is the definition of speech?

Answer 9

• Mechanical act of uttering words
  
  • Using neuromuscular apparatus responsible for phonation and articulation
  • Depends on motor cortices, corticobulbar tracts, basal ganglia, cerebellum, LMNs to pharynx and larynx, pharyngeal and laryngeal muscles
  • Aphasia is NOT disarthria, which is motor-system loss of speech

Question 10

Using handedness as an example, what is the cerebral dominance of language?

Answer 10

• A bit misleading to say any hemisphere is just “dominant” but it’s better to say “dominant for language”
  
  • Vast majority of population is left dominant for language
  • 99% of RH people have left dominant language brains
  • 67% of LH people have left dominant language brains

Question 11

What are the elements of the aphasia examination?

Answer 11

• Assess:
	• Speech
	• Auditory comp
	• Repetition
	• Naming
	• Reading/writing (literate people)
		○ Agraphia and alexia accompany aphasia much of the time

Question 12

What are the varieties of aphasia?

Answer 12

• Naming is impaired in all forms, so inability to name common items is the most sensitive indicator of language impairment
• First and more important 4:
○ Broca’s aphasia
§ Nonfluent speech good comp
○ Wernicke’s aphasia
§ Fluent speech, bad comp
○ Conduction aphasia
§ Loss of repetition in the presence of preserved fluency and comp
○ Global aphasia
§ Disabling disruption of ALL aspects of language

Question 13

How does sensory hearing loss typically manifest?

Answer 13

• Changes in pure tone hearing thresholds
Inner hair cell loss is considered what type of hearing loss?
• Neural (they consider it the same as the nerves)
How does neural hearing typically present?
• Changes in word recognition scores or the clarity of hearing

Question 14

How do you make the dx of acute otitis media?

Answer 14

• Rapid onset of signs and symptoms
		○ Inflammation of TM
		○ Drainage
		○ Perforation
		○ Pain
		○ Fullness/pressure
		○ Hearing loss
	• Ear infection
	• Presence of middle ear effusion