A cross-linguistic study of grammatical morphology in Spanish- and English-speaking agrammatic patients

To account for cross-linguistic differences in agrammatism, Bates and her colleagues have employed the Competition Model, proposing that the cue validity and cue costs of a grammatical morpheme in a particular language will directly affect how agrammatism is manifested. Using Goodglass et al.'s (1993) Morphosyntax Battery in English and a translated version in Spanish, we analyzed the use of equivalent grammatical structures in production and comprehension by agrammatic speakers of the two languages. Wilcoxon signed-rank tests revealed that the relative order of difficulty in both production and comprehension of various grammatical morphemes was the same for both Spanish- and English-speaking agrammatic patients, with two exceptions (1) the Spanish-speaking agrammatics were relatively better at producing subject-verb agreement, and (2) the Spanish speakers were significantly worse at comprehending both active and passive voice sentences. The Competition Model can explain the performance differences regarding subject-verb agreement and comprehension of active voice sentences, but it cannot account for the differences seen in comprehending passive voice sentences.

First-pass versus second-pass parsing processes in a Wernicke's and a Broca's aphasic: electrophysiological evidence for a double dissociation

The present paper is a first attempt to integrate the classical brain lesion behavioral impairment approach of functional neuroanatomy and the electrophysiological brain mapping approach in the domain of syntactic processing. In a group of normal age-matched controls we identified three electrophysiological components previously observed in correlation with language comprehension processes: an early left anterior negativity normally seen in correlation with syntactic first-pass parsing processes (ELAN), a centroparietal negativity seen in correlation with processes of lexical-semantic integration (N400), and a late centroparietal positivity observed in correlation with secondary syntactic processes of reanalysis and repair (P600). The early left anterior negativity was absent in a patient with an extended lesion in the anterior part of the left hemisphere sparing the temporal lobe, although the late centroparietal positivity and the centroparietal N400 were present. In a patient with a left temporal-parietal lesion the early left anterior negativity was found to be present, whereas the N400 component was absent. These findings suggest that first-pass parsing and secondary processes are subserved by distinct brain systems.

The interaction of preserved pragmatics and impaired syntax in Japanese and English aphasic speech

Elicited narrative studies have shown that the underlying pragmatic factor of empathy is relatively preserved in aphasic speakers of Japanese and English (7 Japanese and 14 English-speaking aphasics of varied diagnostic types). Occasional "reversal errors" can be explained in terms of a conflict between the normal encoding of the empathic characteristics of an event and the syntactic limitations imposed by impaired production processes. To account for these findings, we propose a production model following Levelt (1989) for making pragmatic choices among syntactic forms. We also suggest that preferential access to "canonical form" might be a matter of surface morphosyntax, rather than involving semantics or more abstracts levels of syntax.

On-line processing of filler-gap construction in aphasia

Two experiments were conducted exploring on-line processing of filler-gap construction in aphasia. An auditory-auditory lexical decision paradigm was used to investigate whether Broca's and Wernicke's aphasic patients show, as do normals, reactivation of the filler at the gap site. Experiment I investigated the processing of a number of filler-gap constructions including wh-questions, relative clauses as subject, relative clauses as object, and embedded wh-questions. Broca's aphasics showed reactivation of the filler at the gap site, whereas Wernicke's aphasics did not. Experiment II examined object relative clauses and their processing by Broca's aphasics. In addition, we investigated whether the presence (or absence) of the relative pronoun played any role in on-line processing. Broca's aphasics performed as did normals. In addition, their performance was unaffected by the presence or absence of the relative pronoun. The results of these experiments suggest that Broca's aphasics do not have an impairment in processing or representing thematic relationships of NP arguments to predicates or relating traces to their antecedents.

Transcortical sensory aphasia following left frontal infarction

Two right-handed patients who exhibited language disability after left frontal infarction are described. The patients spoke fluently and exhibited excellent repetition ability from the onset of infarction without exhibiting any oral apraxia, but had deficits in auditory comprehension, naming, reading and writing. In both patients, brain magnetic resonance imaging (MRI) revealed infarction in the left inferior frontal gyrus, the middle frontal gyrus and the anterior part of the lower precentral gyrus. Single photon emission computed tomography (SPECT) revealed decreased blood flow in the same regions as those shown to be infarcted by MRI. The MRI and SPECT findings and the symptoms of these patients suggest that left frontal lesions that encompass Broca's area produce fluent aphasia if the posterior part of the left precentral gyrus or motor cortex remains intact and that lesions anterior to Broca's area and the middle frontal gyrus produce a deficit in auditory comprehension of single words as well as sentences.

[Auditory evoked magnetic fields in patients of pure word deafness]

Auditory evoked magnetic fields (AEF) were recorded in 2 cases with pure word deafness. AEF examination were performed with a novel 129-channel vector neuromagnetic imaging system (SBI 100). The latency and the location of equivalent current dipole (ECD) of N100 m after 1,000 Hz tone burst stimulation, one of the most prominent peak of AEF, were evaluated. One patient, 59-year-old man, suffered from left putaminal hemorrhage and the other, 59-year-old man, had a history of bilateral putaminal hemorrhage. There was no N100 m detected in the left temporal lobe with the right ear stimulation in both patients. However normal N100 m was obtained in the right hemisphere with the left ear stimulation in both cases. And the position of ECD of N100 m in the right hemisphere were correctly superimposed on the Heschl gyrus in brain MRI. The pathophysiology of pure word deafness has been postulated that a disconnection between Wernicke area and bilateral auditory inputs played one of important roles in progression of pure word deafness. Because there was no pathological lesion in temporal lobe verified by MRI study in both patients, N100 m in the left could not be evoked due to interception of the auditory pathway to the Heschl gyrus, but not due to destruction of Heschl gyrus. AEF test is one of the most useful tools in order to estimate central auditory function in patients with pure word deafness.

Imaging in primary progressive aphasia

Primary progressive aphasia (PPA) presents with aphasia, with or without other minor cognitive dysfunction. We report five patients with PPA to show the correlation between their clinical signs and imaging findings. The patients can be divided into those with nonfluent (group 1) and those with fluent (group 2) aphasia. The characteristic speech impairment was bradylalia in group 1 and word amnesia in group 2. Impairment of comprehension was common but mild in both groups. On MRI, patients in group 1 showed predominantly left frontal and perisylvian atrophy with reduced uptake in the same region on single photon emission computed tomography (SPECT) using technetium-99m hexamethyl propyleneamine oxime (99mTc HMPAO). Patients in group 2 showed left temporal atrophy involving the superior, middle and inferior temporal gyri, hippocampus and parahippocampal gyrus on MRI and reduced uptake in the same region on SPECT. These findings correlated well with the functional anatomy of speech impairment.

Subcortical aphasia(s): a controversial and promising topic

Many aspects of subcortical aphasias are not accounted for by a unique pathophysiological mechanism; rather the diversity of the observed symptoms suggests that many functional ensembles, more or less related, to language functions may be disturbed by subcortical lesions. However, such disorders are only moderate in intensity and subcortical aphasias certainly constitute an interesting model for studying the dynamics of recovery of language functions and related neural systems, combining neurolinguistic concepts with advanced functional imaging techniques.

Subcortical aphasia

We critically review the literature on subcortical aphasia, suggest that a number of traditional concepts regarding mechanisms of aphasia are inconsistent with now abundant data, and propose several new hypotheses. The absence of aphasia in 17 reported cases of dominant hemisphere striatocapsular infarction and the finding of nearly every conceivable pattern of language impairment in 33 different reported cases of striatocapsular infarction provide strong evidence against a major direct role of the basal ganglia in language and against disconnection or diaschisis as mechanisms of nonthalamic subcortical aphasia. However, detailed consideration of the vascular events leading to striatocapsular infarction strongly suggests that associated linguistic deficits are predominantly related to sustained cortical hypoperfusion and infarction not visible on structural imaging studies. Thalamic disconnection, as may occur with striatocapsular infarcts with extension to the temporal stem and putamenal hemorrhages, may also contribute to the language deficits in some patients. Review of the literature on thalamic infarction, in conjunction with previously unreported anatomic details of four cases, suggests that what infarcts in the tuberothalamic artery territory and the occasional infarcts in the paramedian artery territory associated with aphasia have in common is damage to the frontal lobe-inferior thalamic peduncle-nucleus reticularis-center median system that may be involved in regulating the thalamic gate in attentional processes. Disruption of attentional gating in the pulvinar and lateral posterior nuclei resulting from such lesions may impair selection of specific neuronal networks in the projection field of these nuclei that serve as the substrate for lexical-semantic function, which is in effect a disruption of a type of working memory, as defined by Goldman-Rakic. We define this as a defect of selective engagement.

Subcortical aphasia and the problem of attributing functional responsibility to parts of distributed brain processes

N&C's discussion is, in places, an exemplar of the sort of rigor and attention to detail that will bring us closer to an understanding of the functional organization of the brain. Indeed, it is this level of work that pushes us to reflect on the assumptions that undergird our research efforts. Our criticisms have developed four main points. First, the level of rigor applied to the consideration of basal ganglionic aphasia should extend to each application of the CPC method (thalamic aphasia included). Second, in our haste to identify specific brain systems with distinct cognitive functions we should not neglect the more basic question of the causal mechanisms by which the brain organizes behavior. Questions of "direct" versus "indirect" involvement of a particular organ in a cognitive function are only likely to distract our attention from this more basic and less inferentially perilous issue. Third, pure cases should no longer be considered touchstones against which all behavioral disturbances are measured. Reifying such ideals is more likely to shroud than reveal the brain's true complexity. Finally, the functions that we enshrine in particular brain regions should explain the particular character of the symptoms observed when they are damaged and should admit of independent verification.

The importance of word-initial phonology: error patterns in prolonged naming efforts by aphasic patients

Whether multiple conscious efforts at word search bring a subject closer to an elusive word and to eventual successful retrieval remains a subject of debate. Previous work with normal participants has shown that multiple attempts eventuating in correct retrieval are not usually associated with a systematic progression toward target word phonology in the intervening attempts. In this study we analyzed the naming errors produced by 30 aphasic patients who had received the Boston Naming Test. The analyses were designed to elucidate the characteristics of responses that led to eventual success. Our data showed that among aphasics, as with normal subjects, the presence of target-initial phonology in the subject's first response was the most important predictor of correct retrieval. Moreover, progression towards target phonology in the course of multiple attempts was unrelated to eventual correct retrieval.

Nonfluent progressive aphasia and semantic dementia: a comparative neuropsychological study

Two patients with nonfluent progressive aphasia, who have been studied longitudinally, are contrasted with a group of 5 patients with fluent progressive aphasia or semantic dementia. The most prominent feature of the nonfluent syndrome is the severe distortion of speech output with phonological errors and agrammatic sentence structure. This contrasts with the fluent, well articulated and syntactically correct, but empty, anomic speech found in semantic dementia. Performance on tests of comprehension separates the patient groups: The nonfluent patients show normal single-word comprehension, but marked impairment on tests of syntactic comprehension, while those with semantic dementia demonstrate the opposite pattern. Category fluency is severely defective in semantic dementia, but initial letter-based fluency is more impaired in the nonfluent syndrome. Performance on nonverbally mediated tests of semantic knowledge is impaired in semantic dementia only. The 2 forms of progressive aphasia have in common the sparing of perceptual and visuospatial skills, nonverbal problem solving abilities, and day-to-day (episodic) memory. Neuroradiological investigations have shown marked selective and striking inferolateral left temporal lobe atrophy in all 5 patients with semantic dementia. The changes in nonfluent progressive aphasia appear to be less focal and involve left perisylvian structures more diffusely. These 2 forms of progressive aphasia are, we argue, distinct in their manifestations.

Disconnected phonology: a linguistic analysis of phonemic jargon aphasia

This paper reports on indications of the nature of the neurolinguistic connection between phonological and lexical components of language, based on a case of phonemic jargon aphasia. Following bihemispheric embolic infarcts, the subject presented with severe fluent aphasia, characterized by fluent strings of phonemes, with virtually no intelligible utterances. Despite nearly total jargonized output, the fundamental phonological processes of speech were largely intact. Specifically she demonstrated: (1) English phonotactics and English stress-timed rhythmic principles, (2) aspirated stops word-initially and glottalized stops word-finally, (3) utterance final declination of pitch, and (4) stressed syllable vowel lengthening. Additionally, regional-specific (Southern American English) phonological processes, including monophthongization, in-gliding, and front vowel backing, were also preserved. Overall, the investigation reveals an example of an intact phonological rule system operating on a grossly disturbed input (lexical representation).

Memory dysfunction in mild aphasics

The effect of mild aphasia (n = 9), as a result of subarachnoid haemorrhage (SAH), was evaluated against one matched (sex, age, and education) control group suffering from SAH of unknown origin without aphasia, and against one matched healthy control group. According to aphasia testing (Reinvang & Engvik, 1980), criteria for a classical diagnosis were not met. Therefore, the patients were characterized as mild aphasics: They generally displayed intact audo-verbal comprehension and repetition abilities, and they demonstrated a fluent, spontaneous speech. However, they showed phonemic and semantic paraphasias, with self-corrections; a few patients displayed alexia and agraphia. Memory performance of these three groups was evaluated by a neuropsychological test battery, designed to tap various components of verbal memory function. From the results it was concluded that: (a) Short-term memory is impaired, as regards the phonological loop and the central executive in working memory, whereas maintenance rehearsal is unaffected, given that the demands on phonological coding is minimized, (b) long-term memory is also generally impaired, whereas long-term learning and forgetting by means of subject-performed tasks proceeds within a normal range. Impairments were hypothesized to reflect less efficient central executive functions of working memory, involving generation of less appropriate semantic codes and phonological representations, (c) mildly aphasic patients are not subjectively aware of their own memory deficits, and (d) aphasia classification by means of standard procedures do not sufficiently characterize the nature of a mildy aphasic patient's memory problems.

[Relation between defect in comprehension and frontal lobe lesion]

We assessed anatomical findings and language defects in 14 right handed patients who had fluent aphasia following left frontal lobe lesion. From the onset of aphasia all of the patients showed fluent speech and excellent repetition but difficulty in word finding and impairment in language comprehension. We administered to all of the patients the Western Aphasia Battery, a 50-item pointing task using line drawings representing single words selected from among common Japanese words for language training for aphasics, and the Token Test. Anatomical analysis was performed using brain CT and/or MRI. The patients were divided into three groups on the basis of the extent of impairment in comprehension of single words: one group showed no impairment, another showed slight impairment and the other showed severe impairment. The lesion site differed among the groups. Each group had a different lesion site. We concluded the following: first, lesions in Brodmann's areas 6 and 9 produce impairment in comprehension of single words, with lesions extending to anterior to Broca's area producing more impairment than those without the extending lesions. Second, lesions in the frontal lobe produce impairment in comprehension of complex sentences.

Coherence violations and propositional usage in the narratives of fluent aphasics

Aphasic patients have been generally assumed to produce coherent narratives, despite their numerous surface structure deficits. The current study is designed to analyze three types of coherence violations (i.e., information gaps, repetitions of propositions, and irrelevant propositions) in the narratives of mildly impaired conduction, anomic, and Wernicke's aphasics. Results reveal that the three aphasic groups produce qualitatively different patterns of coherence violations. It is hypothesized that these coherence violations reflect adaptive strategies used by the aphasic patients to compensate for their underlying impairments. While the anomic and conduction aphasics appear to compensate for surface structure deficits, the Wernicke's aphasics seem to have an underlying coherence deficit.

Processing of number and gender inflections by French-speaking aphasics

This study investigates French-speaking aphasics' sensitivity to gender (of human nouns) and number marking in a sentential context. Using a forced picture choice task, we tested sentences in which grammatical marking surfaced either on a function word or on a content word, within or outside a noun phrase (NP) whose gender or number was required to be identified. Ten fluent and 10 nonfluent aphasics together with 20 adults without neurological history were tested. Results showed that neither group of aphasics presented an across-the-board deficit. Nonfluent patients were strongly impaired when marking surfaced on a content word outside NP (verbs and adjectives), but their sensitivity to grammatical marking was relatively well preserved in the within NP condition (determiners and nouns) and for function words in the outside NP condition (the copula). Fluent patients showed a specific impairment in dealing with semantic gender (as opposed to number information); and their difficulty was exacerbated when the information conveyed by the suffix of a content word must be integrated into an higher order semantic representation, as in the outside NP condition (adjectives). These results are consistent with the view that for both nonfluent and fluent aphasics, the functional locus of their impairment lies on a reduction in the computational resources available to the language processor, which is more severe in the former than in the latter group.

Objects and properties: a study of the breakdown of semantic memory

This paper reports a study of the breakdown of semantic memory in the case of a subject with semantic dementia. The first experiment shows that the subject failed to comprehend words of low familiarity and word frequency, even though the spoken word forms were recognised as familiar. Experiments 2 and 3 showed (a) that the recall of word meanings in definition tasks did not vary with the generality of the word meaning (e.g. category, basic level, or subordinate property) but varied instead with the concept familiarity and frequency of the name; (b) that the ability to verify properties of basic-level objects was not affected by the ability to comprehend the property name, but depended instead on the degree of knowledge demonstrated for the object name in definition tasks; (c) that properties were frequently verified correctly when the object had been defined only to the superordinate level. It is argued that the results do not support the widely held view that, in general, specific information is lost first when semantic memory breaks down. The selective failure to recall specific information for some word meanings is discussed with reference to two theoretical accounts.

Syntactic processing in aphasia

In this report we comment upon subject selection and methodology, and we describe some recent studies of syntactic processing in aphasia. Our data show that, like neurologically intact subjects, Wernicke's patients reactivate moved constituents (instantiate coreference) at the site of their extraction (even for sentences that they do not understand). Broca's patients, by constrast, are shown not to create such syntactically governed links (even for sentences that they do understand). These data isolate the processing bottleneck in Broca's aphasia and more generally suggest that syntactic comprehension limitations can be traced to changes in cortically localizable resources that sustain lexical processing.

Syntactic processing in agrammatic aphasia by speakers of a Slavic language

It is widely believed that agrammatic aphasics have lost the ability to assign complete syntactic representations. This view stems from indications that agrammatics often fail to comprehend complex syntactic structures, as for example, some types of relative clauses. The present study presents an alternative account. Comprehension by Serbo-Croatian-speaking agrammatic aphasics was tested on four types of relative clause structures and on conjoined clauses. The relative clauses varied in type of embedding (embedded vs. nonembedded) and in the location of the gap (subject position vs. object position). There were two control groups: Wernicke-type aphasics and normal subjects. The findings from a sentence-picture matching task indicated that agrammatic aphasics were able to process complex syntactic structures, as evidenced by their well-above chance performances. The success rate varied across different types of relative clauses, with object-gap relatives yielding more errors than subject-gap relatives in all groups. Each group showed the same pattern of errors: agrammatic subjects were distinguished from Wernicke subjects and normal subjects only in quantity of errors. These findings are incompatible with the view that the agrammatics are missing portions of the syntax. Instead, their comprehension deficits reflect varying degrees of processing impairment in the context of spared syntactic knowledge.

[Pure word deafness after cerebral hemorrhage in the left temporal lobe: a case report]

We report a patient with pure word deafness after subcortical hemorrhage in the left temporal lobe. Repetition and auditory comprehension were severely impaired, while reading and visual comprehension of the same material were almost normal. He did not show hearing loss, but speech discrimination and melody recognition was poor. On the speech discrimination test, his score was low especially in the right ear. The threshold on the directional hearing test was mildly elevated. There was no temporal summation by click sounds. CT and MRI disclosed a subcortical hematoma in the left superior temporal gyrus. PET demonstrated hypoperfusion in the surrounding area, which was not activated by hearing a story. It was considered that pure word deafness in this case was due to the interruption of auditory inputs to Wernicke's area from both hemisphere by the hematoma. After 5 months, auditory comprehension recovered so that he did not have difficulty in conversation. Speech discrimination improved in both ears, probably due to the recovery of two auditory pathways; the ipsilateral pathway through the left auditory radiation and the contralateral pathway through the right auditory radiation and the corpus callosum. This case suggests that in pure word deafness due to a unilateral lesion, the improvement in speech discrimination during follow-up period may provide a clue as to the site of the responsible lesion and its recovery.

Aphasia and infarction of the posterior cerebral artery territory

Spoken language disorders are rarely mentioned in superficial infarction of the posterior cerebral (PCA) territory. Two clinical types have been reported: transcortical sensory and amnesic aphasia. Between 1979 and 1990, we studied retrospectively 76 patients suffering from an occipitotemporal infarction located in the superficial territory of the posterior cerebral artery, all well documented by CT. Aphasia was one of the first and prominent signs in 18 cases. Middle cerebral artery concomitant infarction could have been the cause of language impairment in 10. In 8 patients aphasia was only explained by a PCA territory infarct. Three patients showed features of transcortical sensory aphasia. CT localization showed internal lobe and thalamic involvement of the dominant hemisphere. Five patients exhibited word finding impairment with various degrees of amnestic syndrome. The dominant internal temporal lobe was always affected. Dominant thalamus involvement was found in one case only. Some correlations between clinical features and anatomical support (vascular supply and anatomical structure) might be suggested in our 8 cases of aphasic disorders due to PCA infarcts. They are discussed and compared with data in the literature.

Visual agnosia and optic aphasia: are they anatomically distinct?

A patient with left infero-medial occipital-temporal infarct suffered a visual agnosia that, by a minor change of the task, could be manipulated to optic aphasia. Tools in actual use and pantomimes of tool use were better named than stationary tools, a dissociation that suggests differences in the ability of stimuli to evoke associations over multiple modalities. Based on this case and analysis of previous reports we suggest that optic aphasia differs from visual agnosia primarily in the degree of callosal disconnection and that the preserved demonstration of tools use and semantic classification of optic aphasia reflect right hemisphere contribution to visual processing.