A Neurolinguistic Introduction to Aphasia

Cognitive Sciences 2006

Outline
Aphasia and language Double dissociations Localization of (linguistic) function Broca, Wernicke, and the syndrome approach to aphasia Behavioral studies of aphasia Neuroimaging studies of aphasia

Aphasic language production

Patient A: (Points to the water and
laughs) "Ah . . . ah . . . girl and boy, ah oh er er dear . . . girl (points to the woman) cof (points to the cloth) and, er oh er dear me . . . er (points to the stool) er steps um window, curtains . . . a pot and an er (points to the water) oh dear me . . . OK" Patient B: "Well it's a it's a place and it's a g-girl and a boy . . . and the-they've got obviously something which is made made made well it's just beginning to go and be rather unpleasant ha! ha! And this is in the this is the the woman and she's putting some stuff and the it's it's that's being really too big to do and nobody seems to have got anything there at all and it's . . . I'm rather surprised that but there you are this this stuff this is coming they were both being one and another put here and um I suppose the idea is that the two people should be fairly good but I think it's going somewhere and as I say it's down again . . . let's see what else has gone the this is just I don't know how she how they did this but it must have been fairly hard when they did it and I think there isn't very much there I think."

Defining aphasia

Rao 1994

Defining language
Speech? Communication? Thought? A separate system of knowledge?

Double dissociations

Double dissociations
Cognitive systems dissociate from one another One can be impaired while another is (relatively) spared This is taken as evidence that cognitive systems are likely distinct from one another the brain/mind is MODULAR in its organization Language is not a monolith Dissociations require caution: - maybe one function is just more vulnerable to certain kinds of damage than another - one task might be more difficult than another - Apparent dissociations might arise from non-modular systems

Single word reading by two alexic patients: Warrington 1981, Patterson 1979, Plaut & Shallice 1993

Localization of function
Phrenology

Gall, Spurzheim, early

1800s Different cognitive functions can be localized to different parts of the brain Level of development of a particular function is reflected in skull formation

The sad tale of Phineas Gage Dissociation of language from other cognitive faculties

Localization of language
Paul Broca (1861): patient Carl Wernicke: patients Tan with posterior lesions in Slow, effortful, nonfluent the left hemisphere speech with many omissions; comprehension is but good comprehension impaired but speech is on parle avec lhemisphere fluent gauche

From the Whole Brain Atlas at Harvard Medical School : http://www.med.harvard.edu./AANLIB/home.html

Wernickes prediction
Predicted two language centers:
Brocas area: speech articulation Wernickes area: speech comprehension

Predicted a third disconnection syndrome damage to the arcuate fasciculus Conduction aphasia
Chris Rorden, University of Nottingham http://www.psychology.nottingham.ac.uk/staff/cr1/c83lnp/c83lnp2.pdf

Wernicke-Lichtheim model
Concepts (distributed)

Brocas aphasia Brocas area arcuate fasciculus conduction aphasia

Wernickes aphasia Wernickes area

Conduction aphasia: can produce and understand meaningful speech, but cannot repeat words they hear

Wernicke-Lichtheim model
1. Brocas aphasia 2. Wernickes aphasia 3. Conduction aphasia 4. Transcortical motor aphasia 5. Dyspraxia 6. Transcortical sensory aphasia 7. Pure word deafness

Classifying the aphasias

Advantages of classifying patients into syndromes
increases interscientist communication groups homogeneous patients for research and for therapy describes a set of behaviors for diagnostic purposes can help in determining a prognosis contribute data toward localization of lesion - advancing our understanding of the relations between brain and mind

Disadvantages of syndrome approaches

limits thought exceptions may be more interesting and more fruitful for research may force a label onto a patient who does not really fall into a particular syndrome category presumes too much about premorbid functioning localization issues may be vexed by individual differences

Behavioral studies of aphasia

Investigations of aphasic deficits have permitted insight into the organization and function of various aspects of the undamaged language system For example, anomic aphasics can show differential breakdown of different word classes, suggesting that the mental lexicon may be organized according to syntactic and/or semantic categories (not just by frequency of use) Agrammatic aphasic patients have problems interpreting non-canonical sentences, suggesting that mapping between syntax and semantics, and/or syntactic movement may be processes which can break down in aphasia

Understanding agrammatism: a central syntactic deficit?

Caramazza and Zurif 1976: agrammatics do have a comprehension deficit, and it parallels their production disabilities The test case: Semantically reversible sentences Theta-roles: assignment of interpretive roles to syntactic objects
subject verb object

Grammatical roles Theta roles

John

kissed

Mary

Agent

Patient

Non-canonical word order

object verb

reliance on grammatical structure

subject

John

was kissed by Mary

Patient??

Agent??

central disruption of the syntactic parsing component of the language system Berndt & Caramazza 1980

Understanding agrammatism: a mapping deficit?

Problems with the central syntactic deficit account:
agrammatics do have some ability to interpret complex utterances - in particular, they are quite good at grammaticality judgment Some agrammatics are modality-specifically impaired note assumptions of central deficit hypothesis Some fluent aphasics show comprehension deficits similar to those found in Brocas aphasics

Perhaps the deficit is not central to syntax, but involves the transfer from syntactic structure to semantic structure of a sentence: a mapping deficit (Saffran et al 1980)

Understanding agrammatism: the trace deletion hypothesis

We have seen that things move around in sentences And we have seen that interpreting sentences does not just mean knowing where the subject and the object are it means knowing what theta roles to assign, too In the normal language system, movement leaves traces behind Theta roles can be assigned to traces, and then transmitted to the moved item Grodzinsky (1990) asked: what if traces get deleted from the syntactic representation? Maybe this is what happens in agrammatism The trace deletion hypothesis

Trace Deletion Hypothesis

Assigning a theta role to the girl should be no problem no trace involved in that P by assigns a theta role of Agent so the girl = Agent But, if traces are deleted, then the boy has no theta role So follow your instincts USUALLY, the first noun in a sentence is the Agent So the boy is probably an Agent Now, the agrammatic thinks:
the boy = Agent AND the girl = Agent

What to do? Guess at the right interpretation of this sentence

Neuroimaging and aphasia

Price & Crinion 2005

Right hemisphere compensation after aphasia

Semantic processing of visually presented words: Gold & Kertesz 2000 Patient GP with a large left hemisphere lesion, and profound global aphasia, including extreme impairment of auditory-verbal comprehension, speech and writing GP demonstrated considerable ability for semantic processing of visual words identified superordinate and subordinate visual words accurately could distinguish proper written names from frequent nouns matched for initial letter and length could distinguish printed words representing living things from nonliving things performed well on the Pyramids and Palm Trees Test (Howard & Patterson,1992)

Right hemisphere compensation after aphasia

Tasks: Shoe Sock Hat Semantic - Which of the lower words is more closely related to the top one? (Response: L/R) Orthographic are all these words spelt correctly? (Response: Y/N) Equally good behavioral results on all items, for both participants fMRI Subtraction: Semantic - Orthographic

Changes in compensatory activations post-stroke

Fernandez et al 2004: PL, aged 44, postgraduate education, righthanded male Suffered left sylvian stroke involving Wernickes area, the posterior part of the insula, and the inferior part of the supramarginal gyrus (SMG) mild conduction aphasia with preserved semantic access difficulties of word-form retrieval reading and writing from dictation were most impaired, with many phonological errors moderate improvement on follow-up testing Token test showed length effect 10 age and education-matched controls

Changes in compensatory activations post-stroke

Studies of different aphasia types

Jodzio et al 2003: SPECT study of 50 aphasic patients, looking for correlations between lesion location and behavioral presentation (used BDAE diagnosis) Findings included a degree of hypoperfusion throughout the left hemisphere, common to all aphasic patients; different perfusion profiles correlated with different aphasic presentations:
Brocas: perfusion deficits in frontal and temporal lobes and striatum; only group to show subcortical perfusion deficits Wernickes: temporo-parietal perfusion deficits Conduction: Left-to-right temporoparietal perfusion asymmetry Global: hypoperfusion throughout perisylvian regions

Thalamic involvement was very common, and was related to: comprehension deficits, word-finding problems, alexia and agraphia Concluded that our understanding of the neuroanatomical correlates of the classical aphasias should be re-evaluated, especially with a view to clarifying the role of subcortical structures in language

Studies of different aphasia types

Jodzio et al 2003 Above: Brocas aphasic Below: Wernickes aphasic

Dronkers et al, 1992, 1994

Thank you!
kfroud@tc.columbia.edu http://www.tc.edu/neurocog