Flying under the radar: figurative language impairments in focal lesion patients

The scope of using pragmatic language tests for early detection of dementia: A systematic review of investigations using figurative language

INTRODUCTION

Dementia cases are expected to rise to 81.1 million in 2040. Efforts are underway to develop diagnostic methods to facilitate early detection of the disease. Herein we review research findings focusing on pragmatic dysfunction in patients with dementia and evaluate the usefulness of assessing dementia and its progress with a battery of tests assessing figurative language skills.

METHODS

A total of 74,778 article titles were identified from EMBASE, PubMed, and Google Scholar databases. After systematic screening, 51 journal articles were selected for the final review.

RESULT

The review suggests that impaired figurative language might be a marker for early cognitive decline. Different forms of figurative language may be impaired at different stages of the disease and in different types of dementia involving different neuropathologies.

CONCLUSION

The use of pragmatic tests in combination with the existing diagnostic protocols might increase the probability of early diagnosis. HIGHLIGHTS Pragmatic impairment could be a marker of early cognitive impairment. Figurative language-an important pragmatic aspect-is disrupted in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Figurative language impairment might precede literal language impairment. Pragmatic tests could be more sensitive than standard neuropsychological tests. Inclusion of pragmatic tests in diagnostic guidelines might bolster early detection.

Non-literal language processing is jointly supported by the language and theory of mind networks: Evidence from a novel meta-analytic fMRI approach

Going beyond the literal meaning of language is key to communicative success. However, the mechanisms that support non-literal inferences remain debated. Using a novel meta-analytic approach, we evaluate the contribution of linguistic, social-cognitive, and executive mechanisms to non-literal interpretation. We identified 74 fMRI experiments (n = 1,430 participants) from 2001 to 2021 that contrasted non-literal language comprehension with a literal control condition, spanning ten phenomena (e.g., metaphor, irony, indirect speech). Applying the activation likelihood estimation approach to the 825 activation peaks yielded six left-lateralized clusters. We then evaluated the locations of both the individual-study peaks and the clusters against probabilistic functional atlases (cf. anatomical locations, as is typically done) for three candidate brain networks-the language-selective network (Fedorenko, Behr, & Kanwisher, 2011), which supports language processing, the Theory of Mind (ToM) network (Saxe & Kanwisher, 2003), which supports social inferences, and the domain-general Multiple-Demand (MD) network (Duncan, 2010), which supports executive control. These atlases were created by overlaying individual activation maps of participants who performed robust and extensively validated 'localizer' tasks that selectively target each network in question (n = 806 for language; n = 198 for ToM; n = 691 for MD). We found that both the individual-study peaks and the ALE clusters fell primarily within the language network and the ToM network. These results suggest that non-literal processing is supported by both i) mechanisms that process literal linguistic meaning, and ii) mechanisms that support general social inference. They thus undermine a strong divide between literal and non-literal aspects of language and challenge the claim that non-literal processing requires additional executive resources.

Hemispheric Processing of Chinese Scientific Metaphors: Evidence via Hemifield Presentation

The role of the two hemispheres in processing metaphoric language is controversial. In order to complement current debates, the current divided visual field (DVF) study introduced scientific metaphors as novel metaphors, presenting orientation mapping from the specific and familiar domains to the abstract and unfamiliar domains, to examine hemispheric asymmetry in metaphoric processing. Twenty-four Chinese native speakers from science disciplines took part in the experiment. The participants were presented with four types of Chinese word pairs: scientific metaphors, conventional metaphors, literal word pairs, and unrelated word pairs. The first word in each pair was presented centrally, and the second was presented to the left visual field (the Right Hemisphere) or the right visual field (the Left Hemisphere). Event-related potentials (ERPs) were recorded when participants read the target words and judged whether words in each pair were related. The data demonstrated that both hemispheres were involved at the initial stage of metaphor processing, but the right hemisphere took a more privileged role. The significant activation of the left hemisphere for scientific metaphoric processing supports the fine-coarse coding hypothesis. During right-visual-field presentation, the left hemisphere, responsible for the processing of closely related domains, has to integrate the loosely associated domains of scientific metaphor, which greatly increased cognitive taxes. Moreover, the data of late positive components (LPCs) revealed different hemispheric activation between scientific metaphors and conventional metaphors. Compared with literal pairs, conventional metaphors elicited significantly higher LPCs during right visual field presentation, while the scientific metaphor elicited significantly lower LPCs during left visual field presentation. These results suggest different processing mechanisms between novel metaphors and conventional metaphors and the special role of the right hemisphere in novel metaphoric processing at the later mapping stage.

Sensitive Measures of Cognition in Mild Cognitive Impairment

BACKGROUND

Sensitive measures of cognition are needed in preclinical and prodromal Alzheimer's disease (AD) to track cognitive change and evaluate potential interventions. Neurofibrillary tangle pathology in AD is first observed in Brodmann Area 35 (BA35), the medial portion of the perirhinal cortex. The importance of the perirhinal cortex for semantic memory may explain early impairments of semantics in preclinical AD. Additionally, our research has tied figurative language impairment to neurodegenerative disease.

OBJECTIVE

We aim to identify tasks that are sensitive to cognitive impairment in individuals with mild cognitive impairment (MCI), and that are sensitive to atrophy in BA35.

METHODS

Individuals with MCI and cognitively normal participants (CN) were tested on productive and receptive experimental measures of semantic memory and experimental tests of figurative language comprehension (including metaphor and verbal analogy). Performance was related to structural imaging and standard neuropsychological assessment.

RESULTS

On the experimental tests of semantics and figurative language, people with MCI performed worse than CN participants. The experimental semantic memory tasks are sensitive and specific; performance on the experimental semantic memory tasks related to medial temporal lobe structural integrity, including BA35, while standard neuropsychological assessments of semantic memory did not, demonstrating the sensitivity of these experimental measures. A visuo-spatial analogy task did not differentiate groups, confirming the specificity of semantic and figurative language tasks.

CONCLUSION

These experimental measures appear sensitive to cognitive change and neurodegeneration early in the AD trajectory and may prove useful in tracking cognitive change in clinical trials aimed at early intervention.

The Neural Basis of Metaphor Comprehension: Evidence from Left Hemisphere Degeneration

Despite the ubiquity of metaphor in cognition and communication, it is absent from standard clinical assessments of language, and the neural systems that support metaphor processing are debated. Previous research shows that patients with focal brain lesions can display selective impairments in processing metaphor, suggesting that figurative language abilities may be disproportionately vulnerable to brain injury. We hypothesized that metaphor processing is especially vulnerable to neurodegenerative disease, and that the left hemisphere is critical for normal metaphor processing. To evaluate these hypotheses, we tested metaphor comprehension in patients with left-hemisphere neurodegeneration, and in demographically matched healthy comparison participants. Stimuli consisted of moderately familiar metaphors and closely matched literal sentences sharing the same source term (e.g., The interview was a painful crawl / The infant's motion was a crawl). Written sentences were presented, followed by four modifier-noun answer choices (one target and three foils). Healthy controls, though reliably better at literal than metaphor trials, comprehended both sentence conditions well. By contrast, participants with left-hemisphere neurodegeneration performed disproportionately poorly on metaphor comprehension. Anatomical analyses show relationships between metaphor accuracy and patient atrophy in the left middle and superior temporal gyri, and the left inferior frontal gyrus, areas that have been implicated in supporting metaphor comprehension in previous imaging research. The behavioral results also suggest deficits of metaphor comprehension may be a sensitive measure of cognitive dysfunction in some forms of neurodegenerative disease.

Context matters: Novel metaphors in supportive and non-supportive contexts

Creative language is defined as linguistic output that is both novel and appropriate. Metaphors are one such example of creative language in which one concept is used to express another by highlighting relevant semantic features. While novelty is an inherent property of unfamiliar metaphors, appropriateness depends on the context. The current study tests the hypothesis that the context in which metaphors are encountered affects their processing. We examined the neural effects of comprehending metaphors in context by comparing neural activations in response to novel metaphors and literal sentences that were either embedded in a meaningful narrative or in matched jabberwocky contexts. We found that the neural correlates of processing metaphoric sentences and their literal counterparts are indistinguishable when embedded in a narrative: both conditions activate bilateral areas along the anterior temporal poles, middle temporal gyri, superior temporal sulci, and the angular gyri. Metaphors embedded in a narrative as compared to their identical counterparts embedded in jabberwocky show increased responses in sensorimotor areas that correspond to the modality of the literal meaning of the target word, perhaps reflecting deeper semantic processing. Our results confirm that context affects neural mechanisms for understanding creative ideas.

From action to abstraction: The sensorimotor grounding of metaphor in Parkinson's disease

Embodied cognition theories propose that the semantic representations engaged in during language comprehension are partly supported by perceptual and motor systems, via simulation. Activation in modality-specific regions of cortex is associated with the comprehension of literal language that describes the analogous modalities, but studies addressing the grounding of non-literal or figurative language, such as metaphors, have yielded mixed results. Differences in the psycholinguistic characteristics of sentence stimuli across studies have likely contributed to this lack of consensus. Furthermore, previous studies have been largely correlational, whilst patient studies are a critical way of determining if intact sensorimotor function is necessary to understand language drawing on sensorimotor information. We designed a battery of metaphorical and literal sentence stimuli using action and sound words, with an unprecedented level of control over critical psycholinguistic variables, to test hypotheses about the grounding of metaphorical language. In this Registered Report, we assessed the comprehension of these sentences in 41 patients with Parkinson's disease, who were predicted to be disproportionately affected by the action sentences relative to the sound sentences, and compared their performance to that of 39 healthy age-matched controls who were predicted to show no difference in performance due to sensory modality. Using preregistered Bayesian model comparison methods, we found that PD patients' comprehension of literal action sentences was not impaired, while there was some evidence for a slowing of responses to action metaphors. Follow up exploratory analyses suggest that this response time modality effect was driven by one type of metaphor (predicate) and was absent in another (nominal), despite the fact that the action semantics were similar in both syntactic forms. These results suggest that the conditions under which PD patients demonstrate hypothesized embodiment effects are limited. We offer a critical assessment of the PD action language literature and discuss implications for the embodiment debate. In addition, we suggest how future studies could leverage Bayesian statistical methods to provide more convincing evidence for or against embodied cognition effects.

Selective Metaphor Impairments After Left, Not Right, Hemisphere Injury

The relative contributions of the left and right hemispheres to the processing of metaphoric language remains unresolved. Neuropsychological studies of brain-injured patients have motivated the hypothesis that the right hemisphere plays a critical role in understanding metaphors. However, the data are inconsistent and the hypothesis is not well-supported by neuroimaging research. To address this ambiguity about the right hemisphere's role, we administered a metaphor sentence comprehension task to 20 left-hemisphere injured patients, 20 right hemisphere injured patients, and 20 healthy controls. Stimuli consisted of metaphors of three different types: predicate metaphors based on action verbs, nominal metaphors based on event nouns, and nominal metaphors based on entity nouns. For each metaphor (n = 60), a closely matched literal sentence with the same source term was also generated. Each sentence was followed by four adjective-noun answer choices (target + three foil types) and participants were instructed to select the phrase that best matched the meaning of the sentence. As a group, both left and right hemisphere patients performed worse on metaphoric than literal sentences, and the degree of this difficulty varied for the different types of metaphor - but there was no difference between the two patient groups. Tests for literal-metaphor dissociations at the level of single cases revealed two types of impairments: general comprehension deficits affecting metaphors and literal sentences equally, and selective metaphor impairments that were specific to different types of metaphor. All cases with selective metaphor deficits had injury to the left hemisphere, and no known comprehension difficulties with literal language. Our results argue against the hypothesis of a specific or necessary contribution of the right hemisphere for understanding metaphoric language. Further, they reveal deficits in metaphoric language comprehension not captured by traditional language assessments, suggesting overlooked communication difficulties in left hemisphere patients.

Comprehension of Spatial Metaphors After Right Hemisphere Stroke: A Case Report

Studying how spatial information interacts with figurative language processing in right-hemisphere (RH) stroke patients is a relatively neglected area of research. The goal of the present case study was to establish whether an ischemic lesion in the right temporo-parietal region causing spatial neglect would affect comprehension of sentence-level spatial metaphors, since some evidence indicates the crucial role of the RH in metaphor processing. The patient under study showed some degree of cognitive impairment (e.g., in spatial and verbal working memory, executive control, visuo-spatial matching skills). However, his comprehension of spatial metaphors was preserved. This case illustrates that RH damage does not necessarily affect comprehension of sentence-level spatial metaphors.

Narratives of focal brain injured individuals: A macro-level analysis

Focal brain injury can have detrimental effects on the pragmatics of communication. This study examined narrative production by unilateral brain damaged people (n=36) and healthy controls and focused on the complexity (content and coherence) and the evaluative aspect of their narratives to test the general hypothesis that the left hemisphere is biased to process microlinguistic information and the right hemisphere is biased to process macrolinguistic information. We found that people with left hemisphere damage's (LHD) narratives were less likely to maintain the overall theme of the story and produced fewer evaluative comments in their narratives. These deficits correlated with their performances on microlinguistic linguistic tasks. People with the right hemisphere damage (RHD) seemed to be preserved in expressing narrative complexity and evaluations as a group. Yet, single case analyses revealed that particular regions in the right hemisphere such as damage to the dorsolateral prefrontal cortex (DLPFC), the anterior and superior temporal gyrus, the middle temporal gyrus, and the supramarginal gyrus lead to problems in creating narratives. Our findings demonstrate that both hemispheres are necessary to produce competent narrative production. LHD people's poor production is related to their microlinguistic language problems whereas RHD people's impaired abilities can be associated with planning and working memory abilities required to relate events in a narrative.

The role of left and right dorsolateral prefrontal cortex in semantic processing: A transcranial direct current stimulation study

For complex linguistic strings such as idioms, making a decision as to the correct meaning may require complex top-down cognitive control such as the suppression of incorrect alternative meanings. In the study presented here, we used transcranial direct current stimulation to test the hypothesis that a domain general dorsolateral prefrontal cognitive control network is involved in constraining the complex processing involved. Specifically, we sought to test prominent theoretical stances on the division of labour across dorsolateral prefrontal cortex in the left- and right-hemispheres of the brain, including the role of salience and fine vs. coarse semantic coding. 32 healthy young adult participants were randomly allocated to one of two stimulation montage groups (LH anodal/RH cathodal or RH anodal/LH cathodal). Participants were tested twice, completing a semantic decision task after either receiving active or sham stimulation. The semantic decision task required participants to judge the relatedness of an idiom and a target word. The target word was figuratively related, literally related, or unrelated to the idiom. Control non-literal non-idiomatic sentences were also included that only had a literal meaning. The results showed that left-hemisphere dorsolateral prefrontal cortex is highly involved in processing figurative language, whereas both left- and right- dorsolateral prefrontal cortex contributed to literal language processing. In comparison, semantic processing for the non-idiomatic control sentences did not require domain general cognitive control as it relates to suppression of the rejected alternative meaning. The results are discussed in terms of the interplay between need for domain general cognitive control in understanding the meaning of complex sentences, hemispheric differences in semantic processing, and salience detection.

Isolated, relative aproverbia without focal lesion

We have seen a patient with a profound, isolated, and quite selective deficit in proverb interpretation-aproverbia. The patient presented to us after an anoxic brain injury with aproverbia. Interestingly, the aproverbia appeared to be premorbid to the presenting event. Furthermore, the patient had no brain lesion that has been associated or even proposed as a cause of deficit in proverb or metaphor interpretation. The patient did have acute bilateral hippocampi lesions and associated severe anterograde amnesia, but he retained good retrograde memory with which he is able to give good, logical but concrete explanations for proverbs. This case highlights the need, importance, and interest in further neuropsychologic, imaging and functional studies of proverb and interpretation in patients and normal subjects populations.