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Types of Aphasia

Ling 411 – 05. Types of Aphasia. “Classifications are a necessary evil” Antonio Damasio (1998). Wernicke’s Aphasia. Impaired comprehension Result of failures in phonological discrimination Fluent verbal output Augmented verbal output Extra syllables at ends of words

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Types of Aphasia

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  1. Ling 411 – 05 Types of Aphasia “Classifications are a necessary evil” Antonio Damasio (1998)

  2. Wernicke’s Aphasia • Impaired comprehension • Result of failures in phonological discrimination • Fluent verbal output • Augmented verbal output • Extra syllables at ends of words • Extra words at ends of phrases • Extra phrases at ends of sentences • Augmentations usually nonsensical • Syntax otherwise not too bad • Verbal paraphasia, including neologisms

  3. Areas of damage in Wernicke’s aphasia • Always involved: • Posterior superior temporal gyrus • The classical core of Wernicke’s area • Usually also involved: • More of superior temporal gyrus • middle temporal gyrus • Temporal plane • Often also involved: • Angular gyrus • Supramarginal gyrus • Temporal-occipital junction area

  4. Definitions of Wernicke’s area • Narrow definition • Posterior superior temporal gyrus • Best definition • Posterior superior temporal gyrus and adjacent temporal plane and superior temporal sulcus • Broad definition (used by some) • Includes also angular gyrus and/or supramarginal gyrus • A.k.a ‘posterior language area’

  5. Review Principal cortical gyri (schematic)

  6. Subtypes of Wernicke aphasia • Not discretely different • Rather, spans along a scale • Type I • Damage is more anterior • Phonological recognition most affected • “Word deafness” • Type II • Damage is more posterior, incl. angular gyrus • More word-blindness than word-deafness • I.e., alexia • Intermediate types also occur • “Obviously, all subtypes of Wernicke aphasia are variations on a continuum…” • (Benson&Ardila:144)

  7. Extra-Sylvian Aphasic Syndromes • “Extra-Sylvian” (a.k.a. “Transcortical”) • Extrasylvian motor aphasia • Type I • Type II • Extrasylvian sensory aphasia • Sometimes just called ‘anomic aphasia’ • Type I • Type II

  8. Damasio Wernicke’s aphasia Broca’s aphasia Conduction aphasia Transcortical sensory aph. Transcortical motor aph. Global aphasia Anomic aphasia Alexia Benson & Ardila Wernicke aphasia Broca aphasia Conduction aphasia Extrasylvian sensory aph. Extrasylvian motor aph. Global aphasia Anomic aphasia Wernicke II or Posterior extrasylvian Two Different Classification Schemes

  9. Extra-Sylvian Aphasic Syndromes • In all perisylvian syndromes, repetition is faulty • In all extra-sylvian aphasic syndromes, repetition is intact (why?) • “Aphasia without repetition disturbance almost invariably indicates pathology outside the perisylvian region” (B&A 1996:146)

  10. Extrasylvian motor aphasia • Nonfluent output • Delayed initiation • Terse, poorly elaborated utterances • Incomplete sentences • Verbal paraphasia • Good comprehension • Good repetition

  11. Extrasylvian motor aphasia, Type I • Left dorsolateral prefrontal damage • Anterior and superior to Broca’s area • Non-fluent output, but repetition good • Articulation is normal • Difficulty following commands • Understand command but do not respond • Damage anterior and superior to Broca’s area (Brodmann areas 45, 46, and/or part of area 9) (B&A 1996:152)

  12. Orientation terms (left hemisphere) Dorsal Rostral Caudal Ventral

  13. Extrasylvian motor aphasia, Type II • Damage to supplementary motor area • Occlusion of left anterior cerebral artery • Non-fluent output, but good repetition • Difficulty initiating speech • Perhaps a purely motor disorder that does not involve basic language functions • (in which case it isn’t really a type of aphasia)

  14. Principal cortical gyri Supplementary motor area Superior parietal lobule

  15. Extrasylvian sensory aphasia • Speech is fluent • Good repetition • Comprehension is impaired • Naming is impaired • Paraphasia is frequent, even verbose • Semantic substitutions • Neologisms • Echolalia (patients repeat words of examiner) • Pointing is impaired • Two subtypes

  16. Extrasylvian sensory aphasia, Type I • Damage to temporal-parietal-occipital junction area • I.e., lower angular gyrus and upper area 37 • Fluent spontaneous output • Poor comprehension • Naming strongly impaired • Semantic paraphasia

  17. Extrasylvian sensory aphasia, Type II • Damage to upper angular gyrus • Fluent output • Variable ability to comprehend speech • Naming strongly impaired • Few semantic paraphasias • Repetition excellent • Many circumlocutions

  18. Anomic aphasia • Perhaps part of a continuum with extrasylvian sensory aphasia • Comprehension is good in many cases • Unlike extrasylvian sensory aphasia • Production and repetition are good • Cannot be reliably localized • Many different areas of damage can result in naming difficulty • But different semantic categories may be impaired with different areas of damage • Maybe not a true syndrome: Benson&Ardila

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