Speech/Language Function

BCS 242 Neuropsychology Fall 2004

Brief Anatomy

In >96% of right-handers and 70% of lefthanders, left hemisphere is dominant for speech and language Different areas implicated in different functions

For example, anterior location for speech production (left frontal lobe); posterior for speech comprehension (left temporal-parietal region) Roles played by subcortical structures (basal ganglia, posterior thalamus) and right hemisphere less well understood

Brain areas involved in Language

Basic Language Components

Auditory Comprehension Visual Comprehension Articulation Word Finding Grammar/Syntax Repetition Verbal Fluency Writing Prosody

Language Deficits

Aphasia spoken language Alexia reading Agraphia - writing Anomia - naming Dysarthria - articulation

Types of Language Errors

Paraphasia:

Substitution of a word by a sound, an incorrect word, or an unintended word Paraphasia with a completely novel word Talking with considerable effort Impairment in writing Disturbances in reading

Neologism:

Nonfluent speech:

Agraphia:

Alexia:

19th Century Neuropsychology

Broca (1865) described patients who displayed halting, agrammatic speech

Content words were well preserved Function words (i.e., adjectives, articles) impaired

Brocas Aphasia

Patient Tan Brain tumor in Left frontal brain region Broca: Lesion disrupted speech

Brocas Aphasia

Yes ah Monday er Dad and Peter H (patients name), and Dad er hospital and ah Wednesday Wednesday, nine oclock and oh Thursday ten oclock, ah doctors two an doctors and er teethyah
Goodglass & Geschwind, 1976

Brocas Aphasia

Brocas Aphasia Damage to motor images Language comprehension skills relatively preserved Typically observed in patients with damage to left inferior prefrontal cortex

Wernickes Aphasia

Neologisms Speech appears to have no information content fluent nonsense Preserved function words, impaired content words Comprehension impaired Even simple sentences not well understood Associated with left temporal lobe damage

Wernickes Aphasia

Well this is mother is away here working her work out ohere to get her better, but when shes looking in the other part. One their small tile into her time here. Shes working another time
Goodglass & Geschwind, 1976

Brocas, Wernickes Area, and Connections

Lichtheims (1885) and Geschwinds (1965) model Auditory input mediated by Wernickes area Motor output mediated byBrocas area Regions connected by arcuate fasciculus

Aphasia Syndromes I

Fluent (receptive) Aphasias: All have FLUENT speech and no articulatory disorder; problems with comprehension and/or repetition

Wernicke (aka sensory): neologisms/anomia/ paraphasias, poor comprehension and repetition Transcortical Sensory(aka isolation syndrome): intact repetition; paraphasias/anomia, poor comprehension Conduction: phonemic paraphasias/neologisms, poor repetition, fairly good comprehension Anomic (aka amnesic):anomia and some paraphasias; all else intact

Aphasia Syndromes II

Nonfluent (expressive) Aphasias: All have articulatory disorder but relatively preserved comprehension

Broca (aka motor, expressive, nonfluent): speechlessness with recurring utterances or phonetic disintegration, or phonemic paraphasias with anomia, agrammatism, and dysprosody; poor repetition Transcortical Motor: uncompleted sentences and anomia; naming better than spontaneous speech; repetition fairly intact Global: speechlessness with recurring utterances, poor comprehension, poor repetition

Aphasia Syndromes III

Pure Aphasias selective impairments with NORMAL speech production

Alexia without Agraphia: poor reading Agraphia: poor writing Word Deafness: poor comprehension, poor repetition

Major Aphasia Syndromes

Type Production Comp. Repetition Naming

Global
Brocas Wernickes Anomic

impaired
not fluent fluent/ impaired

impaired
intact impaired

impaired
limited impaired intact

impaired
limited impaired impaired

fluent/ intact circumlocutory

Mixed/ nonfluent
Conduction

impaired

limited

limited
impaired

limited
limited

fluent/ intact circumlocutory

Right Hemisphere Contribution to Language Functions

Good comprehension for gestural language Prosody (inflection, timbre, melody) Semantic language (word recognition, verbal meaning, concepts, and especially visual meaning)

Assessment of Language

Standard Aphasia Batteries (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Exam, Halstead Aphasia Screening Test) Boston Naming Test Token Test Verbal Fluency Written Expression (e.g., Cookie Theft)