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To cite this article: T. V. Akhutina & E. V. Malakhovskaya (1986) The Connotative Meaning of
Words in Aphasia, Soviet Psychology, 24:3, 26-42
26
THE MEANING OF WORDS IN APHASIA 27
sentation.
This view is not generally accepted, however. There are dis-
agreements in the literature about the clinical picture of disorders
in meaning and, in particular, about their mechanisms. This is
due especially to the lack of comparative studies of the extent to
which these two components of meaning are intact in the different
forms of aphasia.
Contemporary foreign investigators of aphasia also distinguish
between the reference of a word and its sense. The possible
dissociation of these two components of meaning in cerebral
pathology is a problem dealt with in a number of studies. Most
attention, however, is devoted to two other questions. First, are
defects in operating with word meanings related to disorders in
semantic representation of words or with difficulties in extracting
it? Second, what are the specific features of disorders in semantic
representat ion?
It is significant that in analyzing these questions, foreign ex-
perts on aphasia divide patients into two types: patients with even
or uneven speech (with more posterior or more anterior localiza-
tion of the lesion, respectively). Their studies have shown that
word meaning is more deeply disturbed in patients with lesions of
the posterior sections of the brain than in those with lesions of the
anterior sections. Word associations are more grossly disturbed
in them, i.e., the structure of the semantic field is impaired
(Howes, 1967; Lhermitte, 1971; Rinert & Whitaker, 1973;
Goodglass & Baker, 1976), and neither the categorical nor the
referential components of meaning remain i n t a ~ ti.e.,
, ~ both cate-
30 L !l AKHUTINA & E. V MALAKOVSKAH
Procedure
the cards in this stage. In the second stage we asked the subject to
check the groups formed and pointed out that a group had to
contain only objects of the same kind, i.e., those that could be
named by the same word. In the third stage, the subject was given
the following problem: to combine the groups in such a way that
one had as few groups as possible (three or four), but each could
be given a common name.
2 . Verbal classicution. In the first stage the subject was given
35 cards with words written on them and asked to match them.
For the control group, cards were laid out in seven groups with
five words on each card. In the second stage, after all the cards
were laid out in groups, the subject was given another nine cards:
seven with group names (trees, bushes, grasses, in-
sects, birds, fish, and mammals) and two with gener-
alizing names for several groups (plants, animals). The
instructions were to place these cards in the groups formed; in
addition, it was pointed out that the new cards also contained
some that could belong to several groups.
Inclusion in the experimental study of two classification tests
was dictated, first, by the need to compare the patients ability
to operate with word meanings with and without a visual sup-
port, respectively. In some patients (especially those with tem-
poral lesions) the phenomenon of alienation of the sense of a
word was possible; this impedes producing a words object
reference. Presentation of a visual support made it much easier
for such patients to produce and retain word meanings. Second,
the use of two classifications enabled us to vary the complexity
32 T !L AKHUTINA & E. P! M A A K O V S K A H
Subjects
A total of 10 persons without linguistic disorders (control group)
and 37 patients with aphasia participated in the study. The pa-
tients were divided into the following groups according to differ-
THE MEANING OF WORDS IN APHASIA 33
group, and in the patients of the other groups it varied from mild
to gross (for more detailed data, see the tables). The severity of
the aphasia was assessed using a procedure described by Tsvet-
kova and co-workers (1981).
The etiology of the condition was a disorder of cerebral circu-
lation in 25 patients, injury in 7, removal of a tumor in 3, removal
of an abscess in 1, and temporal epilepsy in 1.
Treatment of results
I(=
.(7s 10) -+ (7 x I0 4-2 x 10) -
- 10.
7+7+2
Thus, the average score for verbal classification (KJ for the
control group was 10.
The results of the third test, finding words with a given mean-
ing, were scored by giving 0.1 points for each correct answer.
Since the subjects did 2 problems with each of the 50 test words,
i.e., finding a word independently and choosing a word from the
list, the maximum score was 10 points. The control group did this
test without mistakes, and their average score was therefore ten
points.
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Table 1
Average Scores for Object (KO) and Verbal (KV)Classification for a Control Group and for Patients with Different
Forms of Speech Disorder of Varying Severity
Type of Acoustic-
aphasia Motor mnemonic Semantic Sensorimotor
Control
Severity Mild Moderate Severe Mild Moderate Severe Mild Mild Moderate Severe group
Number of
subjects 3 3 4 3 5 2 8 3 4 1 10
KO 7.4 6.3 3.4 7.1 5.2 3.0 3.3 6.2 4.8 3.1 9.9
K 7.8 6.5 4.6 6.0 4.2 1.9 2.85 5.0 3.8 1.8 10
36 T K AKHUTINA & E. V MALAKOVSKAB
Results
Table 2
Acoustic-
Motor mnemonic
aphasia aphasia
Group of Control (mild (mild Semantic
subjects group subgroup) subgroup) aphasia
Number of subjects 10 3 3 5
Score 10 9.8 8.7 7.4
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were less important for patients with motor aphasia. On the other
hand, these characteristics of verbal classification were most
significant for patients with acoustic-mnemonic .aphasia, for
whom word meaning is easily alienated: patients of the second
group performed much more poorly in verbal classification than
in object classification.
Patients with semantic aphasia (third group) received poorer
scores than the first two groups, with the same degree of aphasia,
i.e., mild. Like the patients of the second group, they also had
more difficulty doing verbal classification. Since signs of alien-
ation of word meaning are absent in patients with semantic
aphasia, their poorer performance in verbal classification can be
explained only by the greater difficulty of categorization in this
test. It may thus be concluded that categorization itself, i.e.,
operating with meaning in the strict sense, is more difficult for
patients with semantic aphasia.
The results of problems involving finding words with a given
meaning are summarized in Table 2. This table shows the scores
of patients with only mild aphasia since the marked nominative
difficulties experienced by patients with grosser disorders make
this task somewhat unsuitable for our purposes. In addition,
Table 2 contains scores only of patients with secondary and higher
education. As the results indicate, the level of education had a
more significant influence on performance in this test than in
preceding ones (thus, for patient S.,with primary education, the
scores fell from 0.8 in the first and second tests to 0.6 in the third
38 I: K AKHVTINA & E. k! MALAKOVSKAR
test compared with the average score for other subjects of his
subgroup).
The analysis showed that, as in the first two tests, the worst
results among patients with mild aphasia were obtained by those
with semantic aphasia. Performance on the second test was very
interesting in this respect: patients with motor forms of aphasia
made no mistakes choosing words from a list, patients with
acoustic-mnemonic aphasia made only a few mistakes, but pa-
tients with semantic aphasia erred on up to 50% of the items.
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Even after they had correctly produced the word in the first test,
these patients would make a mistake in choosing a word from the
list. For example, they would say that several or all of the words
in the list were suitable. In contrast, patients in the other
groups usually corrected a [prior] incorrect independent word
choice in the word choice test.
Discussion of results
The results for the different groups showed that patients with
semantic aphasia, compared with patients with other forms of
aphasia of equal severity, had the most difficulties operating with
meaning in the strict sense. We assume that these difficulties are
primary in patients with semantic aphasia, i.e., that they derive
directly from defects in simultaneous synthesis, which are char-
acteristic of patients with lesions in the zone where the parietal,
temporal, and occipital sections of the left hemisphere overlap. If
we visualize a categorical meaning matrix as a hierarchical
tree (or another diagram: relations of similarity, for example, are
more simply described by a nonhierarchical diagram) and regard
the search for word meanings as a simultaneous addition of
semes4of different levels, we may presume that a defect in simul-
taneous synthesis must inevitably hinder the normal functioning
of such a matrix. Although we are quite aware of the meta-
phorical quality of expressions such as meaning matrix and
diagram when applied to psychological mechanisms, we nev-
ertheless consider this to be the most workable explanation.
For example, it fits in with both clinical observations of the
THE MEANING OF WORDS IN APHASIA 39
Notes
1 . Motor forms of aphasia (efferent and afferent) occur when the premotor
and postcentral zones of the left hemisphere are injured; their mechanism
involves disorder in the kinetic or kinesthetic bases of speech acts (Luria, 1969.
Pp. 178-85, 196-203).
2. Sensory forms of aphasia (acoustic-gnostic and acoustic-mnemonic) oc-
cur when the temporal sections of the left hemisphere are damaged; they
involve defects in phonemic hearing and in auditory-speech memory (Luria,
1969. Pp. 101-118). Semantic aphasia is the consequence of a lesion of that
area of the brain where the parietal, occipital, and temporal sections of the left
(dominant) hemisphere overlap. According to Luria (1969. P. 152-57), diffi-
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