- Last edited on June 29, 2020
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neurology:approach-aphasia [on June 29, 2020] |
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| **Aphasia** is a disturbance of language due to brain damage. This damage can affect comprehension (listening and reading) and/or expression (speaking and writing). In aphasia, the ability is name objects is always impaired to some degree. Aphasia most commonly develops after a brain injury, such as a stroke or head trauma. However, it can also develop due to neurodegenerative diseases, such as [[geri:dementia:alzheimers|Alzheimer’s disease]] or [[geri:dementia:frontotemporal|frontotemporal dementia]], leading to syndromes such as [[geri:dementia:primary-progressive-aphasia-ppa|primary progressive aphasia]]. | **Aphasia** is a disturbance of language due to brain damage. This damage can affect comprehension (listening and reading) and/or expression (speaking and writing). In aphasia, the ability is name objects is always impaired to some degree. Aphasia most commonly develops after a brain injury, such as a stroke or head trauma. However, it can also develop due to neurodegenerative diseases, such as [[geri:dementia:alzheimers|Alzheimer’s disease]] or [[geri:dementia:frontotemporal|frontotemporal dementia]], leading to syndromes such as [[geri:dementia:primary-progressive-aphasia-ppa|primary progressive aphasia]]. | ||
| + | ==== Pathophysiology ==== | ||
| + | * Aphasia may result from lesions in and around the perisylvian language area of the brain, which includes the lateral sulcus (Sylvian fissure) of the left hemisphere and includes Broca's area and Wernicke's area.[([[https://pubmed.ncbi.nlm.nih.gov/15597383/|Catani, M., Jones, D. K., & Ffytche, D. H. (2005). Perisylvian language networks of the human brain. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 57(1), 8-16.]])] | ||
| + | ==== Language vs. Speech ==== | ||
| + | <alert type="info" icon="fa fa-book fa-lg fa-fw"> | ||
| + | See also: **[[https://www.ncbi.nlm.nih.gov/books/NBK389/|Walker, H. K. (1990). Speech and Other Lateralizing Cortical Functions. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.]]** | ||
| + | </alert> | ||
| + | |||
| + | * **Language** is generated in the left hemisphere (generally), left cerebral cortex | ||
| + | * Thus, lesions/abnormalities in the cortex produce abnormalities of language, known as aphasias | ||
| + | * Thus, to test language function, one tests for fluency, naming, comprehension, and naming | ||
| + | * **Speech** is generated at the level of the brainstem, through the articulation of the mouth and its movements | ||
| + | * Thus, lesions/abnormalities in the brainstem produce abnormalities of speech, called dysarthria (i.e. - a problem of articulation) | ||
| + | * Thus, to test speech function, one tests for [[http://www.neuroexam.com/neuroexam/content25.html|motor output]] of speech | ||
| + | * [[neurology:approach-apraxia|Apraxia]] of speech is another issue involving speech and not language centres of the brain. In apraxia of speech, individuals have inconsistencies in their speech error, and there is a phenomenon called "groping," where the individual is trying to move their tongue and lips to get them into the right place to the make the sounds. There is typically a halting, effortful quality of speech, and there is typically difficulty with verb endings. | ||
| + | * It is important to note that it is possible for brain injury and neurodegeneration to cause all three speech and language problems: aphasia, dysarthria, //and// apraxia of speech (depending on which areas of the brain are affected). | ||
| + | |||
| + | <callout type="question" title="How Do I Test for Dysarthria?" icon="true"> | ||
| + | Dysarthria is predictable pattern of typical difficulty with pronunciation of a sound. To test for dysarthria, ask the patient to say a word several times repeatedly. Some common words (the NIH Stroke Scale/Score [NIHSS] Dysarthria Words) used to test for dysarthria include: | ||
| + | * ''MAMA'' | ||
| + | * ''TIP-TOP'' | ||
| + | * ''FIFTY-FIFTY'' | ||
| + | * ''THANKS'' | ||
| + | * ''HUCKLEBERRY'' | ||
| + | * ''BASEBALL PLAYER'' | ||
| + | </callout> | ||
| + | ==== Language Dominance ==== | ||
| + | * Most language functions (grammar, vocabulary and literal meaning) are usually lateralized to the left hemisphere in right-handed individuals (up to 90% of individuals). In left-handed individuals, language lateralization is either bilateral, or lateralized to the right hemisphere.[([[https://pubmed.ncbi.nlm.nih.gov/11099452/|Knecht, S., Dräger, B., Deppe, M., Bobe, L., Lohmann, H., Flöel, A., ... & Henningsen, H. (2000). Handedness and hemispheric language dominance in healthy humans. Brain, 123(12), 2512-2518.]])] | ||
| ==== Normal Speech ==== | ==== Normal Speech ==== | ||
| When we say someone has normal speech or fluency in a neurologic/psychiatric context, it means they have good phrase length, rate, and an abundance of spontaneous speech. It also means they have no paraphasic errors (inappropriately substituted words or syllables), no neologisms (nonexistent words), and no errors in grammar. Normal prosody is a term also frequently used, meaning there is normal range of rhythm, pitch, stress, intonation. | When we say someone has normal speech or fluency in a neurologic/psychiatric context, it means they have good phrase length, rate, and an abundance of spontaneous speech. It also means they have no paraphasic errors (inappropriately substituted words or syllables), no neologisms (nonexistent words), and no errors in grammar. Normal prosody is a term also frequently used, meaning there is normal range of rhythm, pitch, stress, intonation. | ||
| + | |||
| + | <callout type="info" title="Foreign Accent Syndrome" icon="true"> | ||
| + | Acquired Neurogenic Foreign Accent Syndrome (ANFAS) is a motor speech disorder in which, after brain damage such as a traumatic brain injury or stroke, patients start speaking with a new accent, which sounds like a foreign accent to listeners. This typically occurs after damage to the language-dominant, left hemisphere (affecting the primary motor cortex, the premotor cortex, the internal capsule, the corona radiata, or the basal ganglia nuclei).[([[https://pubmed.ncbi.nlm.nih.gov/32688273/|Priftis, K., Algeri, L., Barachetti, L., Magnani, S., Gobbo, M., & De Pellegrin, S. (2020). Acquired neurogenic foreign accent syndrome after right-hemisphere lesion with left cerebellar diaschisis: a longitudinal study. Cortex, 130, 220-230.]])] Although impaired expression of emotion through pitch, loudness, rate, and rhythm of speech can occur after right-hemisphere (RH) strokes, these rarely result in FAS.[([[https://pubmed.ncbi.nlm.nih.gov/29681885/|Patel, S., Oishi, K., Wright, A., Sutherland-Foggio, H., Saxena, S., Sheppard, S. M., & Hillis, A. E. (2018). Right hemisphere regions critical for expression of emotion through prosody. Frontiers in neurology, 9, 224.]])] | ||
| + | </callout> | ||
| ==== Aphasic Speech ==== | ==== Aphasic Speech ==== | ||
| Line 12: | Line 43: | ||
| When speech is impaired and not normal, it is called aphasic speech. Aphasias are first categorized as either fluent or non-fluent. They can then be further sub-characterized by whether there are deficits in repetition, comprehension, and naming. | When speech is impaired and not normal, it is called aphasic speech. Aphasias are first categorized as either fluent or non-fluent. They can then be further sub-characterized by whether there are deficits in repetition, comprehension, and naming. | ||
| * **Fluency** | * **Fluency** | ||
| - | * **Fluent**: Patient is able to produce connected speech. Sentence structure is relatively intact but lacks meaning. | + | * **Fluent Aphasia**: Patient is able to produce connected speech. Sentence structure is relatively intact but lacks meaning. |
| - | * **Non-fluent**: Speech production is halting and effortful. Grammar is impaired; content words may be preserved. | + | * **Non-fluent Aphasia**: Speech production is halting and effortful. Grammar is impaired; content words may be preserved. |
| * **Repetition**: Patient is able to repeat words over and over again | * **Repetition**: Patient is able to repeat words over and over again | ||
| * **Language Comprehension**: Patient is able to understand the context and meaning behind sentences and words | * **Language Comprehension**: Patient is able to understand the context and meaning behind sentences and words | ||
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| * Neologisms: a completely new word (e.g. - "bobfrest" instead "tree") | * Neologisms: a completely new word (e.g. - "bobfrest" instead "tree") | ||
| * Perseveration: returning to a same topic or word, over and over again | * Perseveration: returning to a same topic or word, over and over again | ||
| - | * Anomia | + | * **Anomia** |
| * Anomia is a symptom of all forms of aphasia, but patients whose primary deficit is word //retrieval// are diagnosed with anomic aphasia. Some level of anomia is seen in all of the aphasias. | * Anomia is a symptom of all forms of aphasia, but patients whose primary deficit is word //retrieval// are diagnosed with anomic aphasia. Some level of anomia is seen in all of the aphasias. | ||
| + | * **Fluency Tasks** | ||
| + | * Semantic fluency (also known as category fluency): is a task that involve producing words belonging to a predetermined semantic category (e.g. - animals, fruits and vegetables) | ||
| + | * Phonemic fluency (also known as lexical or letter fluency): is a task that involves producing words beginning with a given letter (e.g. - F, A and S being the most commonly) | ||
| </WRAP> | </WRAP> | ||
| <WRAP half column> | <WRAP half column> | ||
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| ==== Comparison Table ==== | ==== Comparison Table ==== | ||
| + | * **Fluency**: the smoothness or flow in which sounds, syllables, words, and phrases are joined when speaking quickly | ||
| + | * **Repetition**: (e.g. - "No ifs ands or buts" in the MMSE") | ||
| + | * **Comprehension**: assesses understanding (e.g. - the 3-step command in MMSE) | ||
| + | * **Naming**: (e.g. - naming watch, pen) | ||
| + | |||
| <panel type="info" title="Aphasia Syndromes" subtitle="N = Normal or relatively spared, Imp = Impaired, * = with paraphasia, † = with echolalia" no-body="true"> | <panel type="info" title="Aphasia Syndromes" subtitle="N = Normal or relatively spared, Imp = Impaired, * = with paraphasia, † = with echolalia" no-body="true"> | ||
| ^ Aphasia ^ Fluency ^ Repetition ^ Comprehension ^ Naming ^ | ^ Aphasia ^ Fluency ^ Repetition ^ Comprehension ^ Naming ^ | ||
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| ^ Wernicke's (Receptive) | **N*** | //Imp// | //Imp// | //Imp// | | ^ Wernicke's (Receptive) | **N*** | //Imp// | //Imp// | //Imp// | | ||
| ^ Transcortical Sensory | **N**† | **N** | //Imp// | //Imp// | | ^ Transcortical Sensory | **N**† | **N** | //Imp// | //Imp// | | ||
| - | ^ Conduction | **N*** | //Imp// | **N** | //Imp// | | + | ^ Conduction (Arcuate) | **N*** | //Imp// | **N** | //Imp// | |
| ^ Anomic | **N** | **N** | **N** | //Imp// | | ^ Anomic | **N** | **N** | **N** | //Imp// | | ||
| </panel> | </panel> | ||