Journal of the International Neuropsychological Society (1999), 5, 213–221.

Copyright © 1999 INS. Published by Cambridge University Press. Printed in the USA.

Numerical skills and aphasia

MARGARETE DELAZER,1 LUISA GIRELLI,2 CARLO SEMENZA,3 and GIANFRANCO DENES 4

1
Universitätsklinik, Innsbruck, Austria
2
University College, London, U.K.
3
Department of Psychology, BRAIN Neuroscience Center, Trieste, Italy
4
Clinica Neurologica, Padova, Italy
(Received October 1, 1997; Revised March 16, 1998; Accepted June 15, 1998)

Abstract
The aim of this study was to investigate numerical difficulties in 50 patients with left hemispheric lesions. Aphasic
patients were grouped according to their type of aphasia diagnosed by the Aachener Aphasia Test. The overall error
rate in various transcoding and calculation tasks was clearly correlated with the severity of the language deficit,
global aphasics being the most impaired patients. Broca’s and Wernicke’s aphasics scored similarly at the
quantitative level, and amnesic aphasics were less impaired. Interestingly, qualitative analysis of the errors indicated
that each group presented with specific difficulties, partially reflecting the nature of the language problems. In
simple calculation, multiplication was found to be the most impaired operation, in particular in Broca’s aphasics.
This result supports the hypothesis that the retrieval of multiplication facts is preferentially mediated by
verbal processing. Calculation procedures were mainly impaired in Wernicke’s and global aphasics.
(JINS, 1999, 5, 213–221.)
Keywords: Calculation, Transcoding, Aphasia

INTRODUCTION O’Connor, 1990; Rossor et al., 1995). Other studies empha-

In the past decade, our understanding of the cognitive pro-
cesses underlying numerical abilities has dramatically in-
creased due to numerous systematic investigations both in
normals and brain-injured patients. In particular, analysis
of impaired performance in single case studies has pro-
vided invaluable information for developing cognitive mod-
els of number processing and calculation (e.g., Cipolotti &
Butterworth, 1995; Dehaene, 1992; Dehaene & Cohen, 1995;
Hittmair-Delazer et al., 1994; McCloskey, 1992; McClos-
key et al., 1985; Noel & Seron, 1993, 1995). These studies
mostly focused on numerical processing in isolation and did
not study the relation between number processing and other
cognitive abilities, as, for example, language functions. In
one of the first investigations on calculation deficits Berger
(1926) classified calculation problems associated with apha-
sia as secondary acalculia. Similarly, Hécaen et al. (1961)
distinguished calculation problems due to alexia or agraphia
for numerals from spatial dyscalculia and pure anarithme-
tia. Some recent case reports highlight the autonomy of the
language and calculation system (e.g., Hermelin &
Reprint requests to: Margarete Delazer, Universitätsklinik für Neurol-
ogie, Anichstraße 35, 6020 Innsbruck, Austria. E-mail: margarete.delazer
@uibk.ac.at
213
size the similarities between language and number system
and stress the verbal basis of some numerical skills such as
counting, reading numbers, transcoding numbers from one
script to another (Deloche & Seron, 1982a, 1982b; Seron &
Deloche, 1983; Seron & Noel, 1992) and also simple cal-
culation (Dehaene & Cohen, 1995).
All current transcoding models postulate functionally in-
dependent mechanisms mediating numeral comprehension
and numeral production, as well as distinct pathways for
processing Arabic numerals and verbal numerals. Within
these components a further distinction is drawn between lex-
ical and syntactic mechanisms (Cipolotti & Butterworth,
1995; Deloche & Seron, 1982a, 1982b; McCloskey et al.,
1985). Lexical mechanisms are responsible for the compre-
hension and production of the single elements of a numeral
(e.g, the digits 3, 5, 8 in the numeral 358), while syntactic
mechanisms are devoted to the processing of the relations
among these elements (e.g., the relative order of the single
digits within the numerals). As reported by Deloche and Se-
ron (1982a, 1982b; Seron & Deloche, 1983), Broca’s aphas-
ics have particular difficulties in the syntactic processing,
while Wernicke’s aphasics produce lexical errors. This par-
ticular error pattern was thought to reflect more general psy-
cholinguistic difficulties, namely, difficulties in syntactic
processing and difficulties in accessing lexical–semantic
items, respectively.
214
Apart from transcoding mechanisms, models depict spe-
cific components devoted to calculation itself (McCloskey
et al., 1985). Here, the knowledge of simple arithmetic facts
(e.g., multiplication tables) is distinct from the knowledge
of arithmetical procedures (e.g., use of carrying and bor-
rowing), as well as the processing of the arithmetical signs
(i.e, identification of the specific operation required). This
basic architecture of number processing and calculation is
well supported by empirical data and widely accepted. How-
ever, current models differ in fundamental assumptions about
the nature of the mental representations underlying number
processing and calculation, as well as in the way in which
various processing components relate to each other. One is-
sue of debate is whether arithmetic facts are accessed in ver-
bal format (Dehaene, 1992; Dehaene & Cohen, 1995), in
abstract format (McCloskey et al., 1985), in an individually
preferred code (Noel & Seron, 1995, 1997) or in multiple
codes (Campbell & Clark, 1992).
Single case studies (e.g., Benson & Denckla, 1969), as
well as group studies have been devoted to the calculation
problems of aphasic patients. One attempt to differentiate
between Broca’s and Wernicke’s difficulties in calculation
tasks is the Dahmen et al.’s (1982) group study. The authors
propose that calculation problems in Broca’s and Wer-
nicke’s patients depend on different factors, linguistic for
the former and spatial for the latter.
Rosselli and Ardila (1989) investigated calculation diffi-
culties in patients with right and left sided cerebral lesions.
Since the nature of errors differed between right and left hemi-
spheric lesioned groups as well as between different aphasic
groups, it was suggested that distinct underlying deficits may
be responsible for the calculation impairments. However, this
study did not analyze the single components depicted in cur-
rent calculation models and is thus difficult to interpret. A
summary score derived from different types of calculation
(mental and written calculation), different operations (addi-
tion, subtraction, multiplication, and division) and different
levels of complexity does not allow inferences about the cal-
culation system and its relation to language functions. Thus,
further evidence based on current cognitive models is re-
quired to assess numerical difficulties in aphasia.
The present study aims to evaluate the relation between
language impairment and number processing, mental, and
written calculation. Single case studies reported associa-
tions, as well as dissociations, between verbal and numeri-
cal processing. The present group study aims to assess the
relevance of these findings.
The study investigates the single components proposed
in current cognitive models (Dehaene & Cohen, 1995; Mc-
Closkey et al., 1985) in a larger group of left hemispheric
lesioned patients. The dissociations between simple and com-
plex arithmetic on one hand, and between different types of
operations on the other, have been put forward very re-
cently thus, so far, no group studies have investigated these
issues. Thus in the present study, the functional indepen-
dence of multiple components of the calculation system and
the number processing system will be specifically assessed.
M. Delazer et al.
It is assumed that the overall error rate correlates with
the severity of the language deficit, global aphasics being
most impaired. The qualitative error pattern, however, may
vary between different types of language disorder.
In transcoding tasks one may expect syntactic errors pre-
dominantly in Broca’s aphasics and lexical substitutions pre-
dominantly in Wernicke’s aphasics.
In calculation the retrieval of arithmetic facts is of par-
ticular interest. Since multiplication tables are commonly
taught in verbal form and are rehearsed as verbal sequences
over years, they are likely to rely more on verbal processing
than other operations (e.g., Dehaene & Cohen, 1995). Mul-
tiplication thus may present major difficulty to aphasic
patients.
METHODS
Research Participants
Fifty Italian speaking patients took part in the study. Inclu-
sion criteria were unilateral, focal, left hemispheric lesion
(documented by CT scans) and right-handedness. A further
inclusion criterion was the ability to recognize single Ara-
bic numerals by reading them aloud or by indicating their
cardinality with fingers (N 5 5). Some patients, mainly glo-
bal aphasics, had to be excluded from the study, since they
were not able to indicate the cardinality of single Arabic
numerals.
Forty-five patients had vascular lesions, 3 patients trau-
matic lesions and 2 patients a tumor. CT scans showed the
following lesion sites: 3 frontal, 6 frontotemporal, 4 fron-
toparietal, 4 parietal, 15 temporoparietal, 5 temporal, 4 oc-
cipital and 9 deep lesions. The mean time since onset was
15.3 months.
All patients underwent a language assessment using the
Aachener Aphasia Test (Italian adaptation; Luzzatti et al.,
1991). Following the outcome of the AAT, patients were clas-
sified into five different groups: (1) amnesic aphasia (AA;
N 5 10), (2) Broca’s aphasia (BA; N 5 8), (3) global apha-
sia (GA; N 5 7), (4) Wernicke’s aphasia (WA, N 5 12) and
(5) nonaphasic patients (NA, N 5 13)1 . A control group
matched for age and education included 15 normal partici-
pants (see Table 1 2 ).
Materials
The assessment of transcoding skills consisted of the fol-
lowing tasks: (1) reading aloud Arabic numerals (N 5 10;
from two-digit to five-digit numerals); (2) reading aloud
number words (N 5 5; number words corresponding to two-
1
Nonclassifiable aphasias, as well as conduction or transcortical apha-
sias were excluded due to the low frequency of these cases.
2
The ratio of female and male participants in the patient group and in
the control group are not matched. No differences were found between
male and female controls; thus we do not regard the sex distribution as a
critical factor.
Numerical skills and aphasia
Table 1. Demographical data
Sex
Age
Group N F M (range; years)
Amnesic 10 1 9 54.5
Broca 8 4 4 41.9
Global 7 3 4 57.3
Wernicke 12 1 11 63.5
Nonaphasic 13 3 10 59.8
Controls 15 9 6 57.7
Note. Number of patients, sex, age and educational level for five patient groups and controls. Etiology
is vascular (cva), traumatic (tr), and np (neoplastic).
digit to four-digit numerals); (3) writing Arabic numerals to
dictation (N 5 10; from one-digit to four-digit numerals);
(4) writing number words to dictation (N 5 8; number words
corresponding to two-digit to four-digit numerals); (5) read-
ing arithmetical signs (N 5 4; 1, 2, 3, 4); (6) writing ar-
ithmetical signs (N 5 4; 1, 2, 3, 4).
The assessment of calculation skills consisted of the fol-
lowing tasks:
1. Arithmetical Facts: Single-digit problems were pre-
sented visually and were read aloud at the same time by
the experimenter. Participants answered in the preferred
modality (verbal, written, pointing the result on a table,
or indicating the result with fingers) in order to mini-
mize errors secondary to language problems. The task
included seven addition, seven subtraction and seven
multiplication problems presented in blocked order.
2. Mental Calculation: Problems with two two-digit oper-
ands were to be solved mentally, without the use of writ-
ten procedures or strategies. Presentation and answer
modality were as in the arithmetical facts task. The task
included five addition and five subtraction problems (two
of five subtractions required borrowing, three of five ad-
ditions carrying).
3. Written Calculation: Six multi-digit problems (two ad-
ditions, two subtractions and two multiplications) were
presented in Arabic numerals to be solved in written form.
4. Number Composition Task: Patients were asked to com-
pose a given number (presented in Arabic numerals) using
tokens of different values (1, 5, 10, 20, 50, 100). The
easiest item required two tokens, the most complex re-
quiring five tokens (N 5 24).
The administration of the battery required approximately
1 hr, the testing was carried out in one or two sessions. The
Aachener Aphasia Test was performed in a different session.
RESULTS
Results were firstly analyzed quantitatively taking into ac-
count the percentage of correct responses in the different
215
Etiology
Education
(years) cva tr np
(27–70) 6.9 9 1
(22–56) 9.3 7 1
(32–76) 6.9 6 1
(41–83) 6.8 12
(40–79) 6.8 11 2
(46– 66) 7.3
subtests. In a second step a qualitative analysis of the errors
was performed. Given the distribution of the data and the
lack of homogeneity of variance in the different groups, a
nonparametric procedure was adopted in order to analyze
the results. Multiple comparisons between different groups
were carried out via Mann–Whitney U tests and a Bon-
ferroni correction was used (a conservative error rate of
alpha 5 .003 was adopted). Table 2 shows the mean per-
centage of correct answers for the single groups. Table 3
gives the percentage of patients (per group) who performed
without errors in the different tasks. Table 4 shows the pro-
portion of patients (per group) who made lexical, syntactic,
mixed, and omission errors in the different transcoding tasks,
and Table 5 gives the error distribution over groups in men-
tal and written calculation and in the number composition
task.
Transcoding Tasks — Quantitative Analysis
Reading Arabic numerals and
reading number words
Performance of the patient groups differed from the perfor-
mance of the control group in both reading tasks, with the
exception of the AA. Patients and controls differed signifi-
cantly in reading Arabic numerals (BA, p , .0001; GA,
p , .0001; WA, p , .0001; NA, p 5 .001), as well as in
reading number words (BA, p 5 .0002; GA, p , .0001; WA,
p , .0001; NA, p 5 .001). NA presented only mild difficul-
ties (above 70% correct answers in both tasks), while GA
performed at floor level in both reading tasks (0% correct).
The reading of Arabic numerals was poor in BA (only 17.5%
correct), statistically not different from the score of the GA
group. BA were the only group showing a format effect in
the reading tasks: Reading of Arabic digits was signifi-
cantly worse than reading of number words (Wilcoxon; p 5
.04). Analysis at the single-participant level showed that 6
out of 10 (reading number words) and 7 out of 10 (reading
Arabic numerals) AA performed error free, while all other
aphasic patients showed some difficulties in reading Arabic
numerals (Table 3). In reading number words, 2 out of 8 BA
and 1 out of 12 WA performed error-free.
216 M. Delazer et al.

Table 2. The groups’ mean percentage of correct answers in the different tasks

Amnesic Broca Global Wernicke Nonaphasic Controls

(N 5 10) (N 5 8) (N 5 7) (N 5 12) (N 5 13) (N 5 15)
Task M SD M SD M SD M SD M SD M SD
Reading Arabic 93 15.7 17.5 27.1 0 0 24.2 27.1 70.7 37.7 100 0
Writing Arabic 76 23.7 62.5 32.9 4.3 11.3 40.8 38 79.2 36.8 100 0
Reading NW 90 14.1 45 38.2 0 0 31.7 33.5 73.8 34 100 0
Writing NW 57.5 39.2 20.3 27.5 0 0 4.2 8.1 55.8 47 100 0
Reading signs 100 0 71.9 33.9 25 38.2 45.9 43.7 90.4 16.3 100 0
Writing signs 100 0 87.5 35.5 21.4 22.5 45.9 48.6 84.6 33.1 100 0
Facts (Total) 80 23.3 56 33.9 31.3 31.6 46.4 41.7 83.1 28.7 98.7 2.2
Addition 90 22.4 69.7 39.2 49 40.3 48.9 41.1 90.1 27.6 99 3.7
Subtraction 84.3 23.8 66.2 41.1 28.6 35 45.3 44.7 78 34.3 99 3.7
Multiplication 65.7 39.9 32.1 35.6 16.3 37.3 45.3 44.3 81.3 32.7 98.1 5
Mental calculation 60 41.9 47.5 43.8 15.7 37.3 30.8 38.5 64.6 32.7 94 7.4
Written calculation 71.6 31.5 45.8 46 9.5 19 33.3 39.6 62.8 40 91.1 15.3
Number composition 95.4 9.5 83.8 34.7 29.2 37.3 51.4 43.4 86.5 28.7 100 0

Note. Means and SDs of correct answers for the different groups in all tasks. Arithmetic facts are averaged over addition, subtraction,
and multiplication.

Writing Arabic numerals and
writing number words
All patient groups scored significantly poorer than controls
in writing tasks (writing Arabic numerals: AA, p 5 .0002;
BA, p , .0001; GA, p , .0001; WA, p , .0001; NA, p 5
.0005; writing number words: AA, p 5 .0002; BA, p , .0001;
GA, p , .0001; WA, p , .0001; NA, p 5 .0005). Omissions
of single letters or other orthographic errors were not con-
sidered as errors. Analysis at the single-participant level in-
dicated that only few individuals performed at ceiling. Even
in the NA group only 7 out of 13 patients scored error free
in writing Arabic numerals and 5 out of 13 in writing num-
ber words. In the AA group 3 out of 10 performed without
error (in both tasks). BA, GA and WA were all severely im-
paired and only 1 BA and 2 WA had no errors in writing
Arabic numerals (Table 3).
Comparison between writing and reading tasks
All patient groups presented more difficulties in writing num-
ber words than in reading number words ( p 5 .0001), with
the exception of GA who scored at the zero-level in both
tasks. This dissociation was not observed in the processing
of Arabic numerals, where writing and reading tasks re-
sulted in the same difficulty. BA even showed a signifi-
cantly poorer performance in reading than in writing Arabic
numerals ( p 5 .01).
Writing and reading arithmetical signs
The reading of arithmetical signs differed between controls
and BA ( p 5 .003), GA ( p , .0001) and WA ( p 5 .0001).
In writing arithmetical signs only GA ( p , .0001) and WA
( p , .0001) scored significantly lower than controls. For

Table 3. Proportion of participants in each group who scored at ceiling in the different tasks

Amnesic Broca Global Wernicke Nonaphasics Controls

Task (N 5 10) (N 5 8) (N 5 7) (N 5 12) (N 5 13) (N 5 15)
Reading Arabic 70 0 0 0 46.1 100
Reading NW 60 25 0 8.3 46.1 100
Writing Arabic 30 12.5 0 16.6 53.8 100
Writing NW 30 0 0 0 38.4 100
Reading signs 100 50 14.3 25 69.2 100
Writing signs 100 87.5 0 33.3 76.9 100
Facts 30 0 0 16.6 38.4 73.3
Addition 70 25 14.3 25 76.9 93.3
Subtraction 60 37.5 14.3 25 53.8 93.3
Multiplication 40 12.5 14.3 25 61.5 86.6
Mental Calculation 30 12.5 12.5 8.3 23 53.3
Written Calculation 40 25 0 16.6 30.7 66.6
Number composition 70 62.5 0 25 61.5 100
Numerical skills and aphasia 217

Table 4. Percentage of patients who committed a particular and tens by the digits corresponding to the unit names (e.g.,
type of error in transcoding tasks twelve r 2; forty r 4; Seron & Noel, 1992) or by the in-
sertion of additional zeroes (e.g., one hundred and three
Task Amnesic Broca Global Wernicke Nonaphasics
r 1003). Additional classes consist of mixed errors (sub-
Reading Arabic stitution of elements in syntactically wrong numbers) and
Lexical 10 37.5 0 58.3 46.1 omissions. The same classification applied to reading both
Syntactic 20 50 14.3 66.6 30.8 scripts (alphabetical and Arabic) and to writing Arabic nu-
Mixed 10 62.5 14.3 75 15.4 merals. Performance in writing number words was not in-
Omission 10 62.5 100 50 15.4 cluded in the qualitative analysis, since most of the errors
Reading NW
consisted in omissions.
Lexical 30 25 0 33.3 23.1
Given that the absolute number of errors varied consid-
Syntactic 10 25 0 16.6 15.4
Mixed 0 12.5 0 16.6 15.4 erably between groups, the qualitative differences were in-
Omission 0 25 100 58.3 7.7 vestigated by comparing the percentage of patients who
Writing Arabic committed a particular type of error in the single tasks
Lexical 20 62.5 14.3 58.3 7.7 (Table 4).
Syntactic 50 62.5 0 33.3 15.4
Mixed 50 37.5 0 50 0 Reading Arabic numerals
Omission 0 50 85.7 58.3 23.1
Lexical errors appeared mainly in the WA group (58.3%)
Note. Proportion of patients who made lexical, syntactic, mixed, and omis-
sions errors in the different transcoding tasks.
and in NA (46.2%), syntactic errors in WA (66.6%) and in
BA (50%). Mixed errors were found in WA (75%) and in
BA (62.5%), while omissions were predominant in GA
(100%).
both AA and controls participants these tasks were ex-
tremely easy (100% correct).
Reading number words

Transcoding Tasks — Error Analysis
Errors were classified as lexical, syntactic, mixed or omis-
sion, as firstly proposed by Deloche and Seron (1982a,
1982b). Lexical errors consist of substitutions of single el-
ements of the numbers and belong to the same lexical class
(e.g., four r 3 or 5, or twelve r 11 or 13). These errors
have also been called position-within-class errors. Syntac-
tic errors concern the syntactic structure of the numeral; for
example, errors consist of the transcoding of verbal teens
Lexical errors appeared frequently in WA (33.3%) and AA
(30%). Interestingly, 25% of BA had syntactic errors in read-
ing number words.
Writing Arabic numerals
Lexical errors were frequent in WA (58.3%) and BA (62.5%),
while the percentage of patients with syntactic errors was
almost doubled in BA (62.5%) when compared with WA
(33.3%).

Table 5. Percentage of patients who committed a particular type of error in calculation

tasks and in number composition

Amnesic Broca Global Wernicke Nonaphasics Controls

Mental calculation
Calculation 50 50 16.6 50 61.5 46.6
Procedural 30 12.5 0 41.6 46.1 6.6
Omission 40 50 85.7 75 30.8 0
Written calculation
Calculation 40 37.5 16.6 25 53.8 40
Procedural 30 37.5 28.6 41.6 38.4 13.3
Omission 30 50 71.4 66.6 23.1 0
Number composition
Nonecon 20 25 14.3 33.3 30.8 0
Syntactic 0 0 28.6 8.3 23.1 0
Mixed 30 25 71.4 50 30.8 0
Omission 10 25 85.7 33.3 15.4 0

Note. Proportion of patients who made specific errors in the different calculation tasks. In mental and
written calculation: calculation errors, procedural errors, and omissions. In number composition: non-
economical composition, syntactic errors, mixed errors, and omissions.
218
Calculation
Arithmetic facts
All aphasic groups performed worse than controls in an-
swering arithmetic facts (AA, p 5 .006; BA, p , .0001;
GA, p 5 .0001; WA, p 5 .0003), while NA did not differ
from controls. In all patient groups addition was better pre-
served than subtraction and multiplication. Interestingly,
multiplication tables were particularly difficult for BA (as
compared to subtraction, p 5 .05). While 11 out of 15 con-
trols performed error free in arithmetic facts, only 5 out of
13 NA, 3 out of 10 AA, 2 out of 12 WA and no BA or GA
answered without errors.
Mental multidigit calculation
Only the GA and WA groups differed significantly from the
control group (both groups p , .003). The analysis at the
single-participant level showed that controls also some-
times had problems in answering mental calculation: Only
8 out of 15 performed without error. In the AA group 3 out
of 10 scored at ceiling, in all other groups the proportion
was lower (Table 3).
Written calculation
Performance in written calculation showed a similar pro-
file, with only GA and WA differing significantly from the
control group (both groups p , .003). Only 9 out of 15 con-
trols and 4 out of 10 AA performed without error. In all
other groups the proportion was lower (Table 3).
Mental multidigit calculation and written
calculation—Error analysis
Errors were analyzed in order to differentiate problems in
arithmetic procedures from failures in answering arithmetic
facts within complex calculation. Procedural errors consist
of failure to retrieve or to execute the correct algorithm; that
is, to perform the sequential steps in order to answer the
multidigit calculation. Typical errors consist of failure to use
the carry procedure in addition or the borrowing in subtrac-
tion or to select the correct factors in the multiplication pro-
cedure. Calculation errors, on the other hand, consist of
failure to answer the single problems within complex cal-
culation. Finally, omissions were counted. The same clas-
sification was adopted for mental multidigit calculation and
written calculation (since mental calculation included only
addition and subtraction, only failures of carrying or bor-
rowing were considered as procedural errors).
All groups (including controls and nonaphasic patients)
showed calculation errors in mental and written calculation
(Table 5). Paradoxically, the lowest proportion was found
in GA. This group however, had an extremely high propor-
tion of omissions. Procedural errors, as well, were found in
all patient groups and controls. Again, GA showed the low-
est proportion (zero in mental and 28.6 in written calcula-
tion), due to frequent omissions. Few controls showed
M. Delazer et al.
procedural errors, indicating that the knowledge of calcula-
tion procedures does not present major difficulties to healthy
participants. A larger proportion of WA than BA patients
had procedural errors in mental calculation.
Number Composition Task
WA and GA scored significantly more poorly than the con-
trol group (WA: p 5 .0001; GA: p , .0001), no significant
difference was found between the other patient groups and
controls. BA scored better than WA, the difference, how-
ever, was not significant ( p 5 .08). The task was for many
participants an easy one, as indicated by the analysis at the
single-participant level. All controls performed at ceiling,
as well as a good proportion of AA patients (7010), BA (508)
and NA (8013). However, only 3 out of 12 WA were error
free and none of the GA group.
Number composition task—Error analysis
Errors were classified into the following types: syntactic er-
ror (e.g., 120 is composed by a token of 1 and a token of
20), mixed error (e.g., 127 is composed by 100, 20, 20, 20,
1, 1), noneconomical composition (e.g., 55 is composed by
50, 1, 1, 1, 1, 1), and omission (also partial omissions were
included). Syntactic errors occurred only in GA, WA, and
NA. All other errors were observed, in different propor-
tions, in all groups (Table 5).
DISCUSSION
The aim of this study was to contribute to our under-
standing of the relation between language impairment and
numerical skill deficits. This issue has been previously ad-
dressed in single case studies and occasionally in group
studies indicating its theoretical importance. In the present
study, however, the selection of the numerical tasks as well
as the interpretation of the results have been driven by re-
cent theoretical models of number processing and calcula-
tion. Thus, our results may provide evidence for theoretical
issues currently discussed.
Our results suggest that patients with left hemisphere le-
sions, and in particular aphasic patients, are likely to present
difficulties of various kinds in all numerical abilities. The
results thus confirm previous studies that document the in-
volvement of the left hemisphere in calculation (Grafman
et al, 1982; Jackson & Warrington, 1986; Rosselli & Ardila,
1989).
The overall error rate clearly correlates with the severity
of the language deficit, global aphasics being the most im-
paired patients. BA and WA scored similarly at the quanti-
tative level, AA showed only mild difficulties. Further to
these quantitative results, error analysis revealed qualita-
tive differences between the patient groups, partially reflect-
ing the nature of the specific language problems. BA scored
very poorly in reading of Arabic numerals. Moreover, they
showed a format effect and scored significantly lower in read-
Numerical skills and aphasia
ing Arabic numerals than in reading number words (none of
the other groups presented with this effect). This result in-
dicates that Broca’s difficulties in reading Arabic numerals
cannot be simply explained by speech output problems, but
more likely by specific difficulties in assembling the syn-
tactic structure of complex numerals. Further support for
this hypothesis comes from the high incidence of syntactic
errors observed in this group (87.5% of BA made syntactic
errors in transcoding tasks). This finding is in line with pre-
viously reported data (Deloche & Seron, 1982a, 1982b; Se-
ron & Deloche, 1983). Syntactic errors have been interpreted
as the result of morphological difficulties in constructing
complex numerals and were thought to reflect a more gen-
eral impairment of syntactic skills in BA.
Note that syntactic errors in reading Arabic numerals aloud
can arise from at least two different processing stages: ei-
ther the syntactic comprehension of the Arabic numeral is
incorrect (Noel & Seron, 1993), or the generation of the
verbal syntactic frame is defective. Since BA patients had
few problems in the number composition task (where Ara-
bic numerals have to be analyzed), difficulties are likely to
arise from the assembling of the syntactic frame rather than
from the comprehension of Arabic numerals.
The reading of number words and the reading of Arabic
numerals may dissociate as a consequence of a disorder for
number syntax: Such disorder would disproportionately af-
fect reading of Arabic numerals where the reader has to con-
struct the syntactic structure of the verbal numeral (e.g., the
Arabic numeral 406 has to be transformed into four hun-
dred six). In written number words, on the other hand, the
verbal syntax is fully specified.
WA were likely to make lexical errors (substitutions of
single elements) in transcoding tasks. They correctly ac-
cessed the respective number class (e.g., teens), but failed
to retrieve the appropriate item within the class [e.g., 14 r
quindici (fifteen)]. These lexical errors were thought to par-
allel WA’s semantic errors in linguistic tasks (Seron & De-
loche, 1983). It should be noted, however, that WA produced
syntactic and mixed errors as well. This fact may be par-
tially explained by the error classification adopted. Misor-
derings of single elements, which were subsumed under
syntactic errors, were frequently found in WA (e.g., 23 r
trentadue (thirty-two). This particular type of error might
also be favored by difficulties in lexical access.
Lexical and syntactic errors were also observed in the per-
formance of nonaphasic patients, suggesting that transcod-
ing problems are not bound to language impairments, but
may reflect specific difficulties in number processing. In fact,
intact processing of alphabetical script with impaired pro-
cessing of Arabic script has been reported (Cipolotti & But-
terworth, 1995) and the reverse dissociation (intact reading
of Arabic numerals, impaired alphabetical reading) is a well
known finding in neuropsychology (e.g. Anderson et al.,
1990; Dejerine, 1892; Hécaen et al., 1961).
In arithmetic facts retrieval, all aphasic groups showed
problems and differed significantly from controls. These def-
icits can neither be explained by encoding difficulties (pa-
219
tients could recognize Arabic numerals and most of the time
arithmetical signs),3 nor by speech output problems (differ-
ent answer modalities were allowed).4
Simple addition was the better mastered operation, while
subtraction and multiplication were more compromised. In
particular, BA patients performed significantly lower in
multiplication as compared to subtraction. This result is con-
sistent with the neuropsychological literature, which indi-
cates a high incidence of multiplication deficits in patients
with language impairment (Hittmair-Delazer et al., 1994;
Kashiwagi et al., 1987; McCloskey et al., 1985). Given that
multiplication tables are learned in verbal rhymes, while
the other operations are studied less systematically, it has
been suggested that multiplication facts are stored at a
prephonological level (Dehaene, 1992; Dehaene & Cohen,
1995). Thus one may speculate that different operations are
supported by distinct cognitive mechanisms, varying from
computational strategies (requiring attentional resources,
planning, monitoring) for subtraction and division to more
automated fact retrieval in multiplication and some addi-
tion facts.
While all aphasic groups differed from controls in simple
fact retrieval, only GA and WA (but not BA and AA) scored
significantly lower than controls in mental multidigit cal-
culation and written calculation. Evidently these tasks pre-
sented some difficulties to all groups, nonaphasic patients
and controls included. Further to fact retrieval errors within
complex calculation, errors in the application of arithmetic
procedures were observed. These errors may arise either from
a defective knowledge of the underlying algorithm (Girelli
& Delazer, 1996) or from a specific difficulty in monitoring
the execution of the complex procedure (Semenza et al.,
1997). The qualitative error pattern (erroneous subpro-
cedures, omissions of single steps, confusions of factors,
etc.) indicates that WA and GA had difficulties in both steps,
retrieving the correct algorithm and monitoring the appli-
cation of the procedure.
In the number composition task, again, WA and GA scored
significantly lower than the other groups. Similarly to the
written calculation task, number composition requires the
execution of sequential steps. First, complex numerals have
to be analyzed in their multiplicative and additive structure
(Power & Dal Martello, 1990), e.g. the numeral 17 has to
be decomposed into 1 times 10 plus 7 and 7 has to be de-
composed into 5 plus 1 plus 1. Secondly, the appropriate
tokens may be selected and finally the sum has to be assem-
bled. Thus, the task is multicomponential and several sources
of errors have to be considered. Further to problems in
encoding and understanding the complex structure of
numerals, errors may arise in selecting, memorizing, and
3
Moreover, operations were presented in blocked order reducing cross-
operation confusion.
4
Participants were allowed to point their answers from a number table
including all Arabic numerals from 1 to 100. This answer modality, by-
passing verbal production, eliminates the critical factor of number size (re-
sults in multiplication being greater than addition and subtraction).
220
assembling the appropriate tokens. Interestingly, BA showed
only slight difficulties in this task and no syntactic errors
were observed. Syntactic difficulties of BA were thus lim-
ited to transcoding tasks, where number forms have to be
produced on-line either in Arabic or verbal notation.
Though our findings suggest associations between im-
pairments in language processing and impairments in the
numerical tasks, we are cautious to draw conclusions on the
verbal basis of numerical skills in general. Firstly, many of
the observed problems in numerical processing may also
arise from other, nonlinguistic impairments frequently found
in left hemispheric patients, such as attentional deficits, short
term memory problems, or difficulties in monitoring com-
plex sequences. Second, double dissociations between cal-
culation and language abilities have been observed. The first
side of the dissociation, intact language functions and im-
paired calculation, has been repeatedly described (e.g., War-
rington, 1982). The second side of the dissociation, good
calculation abilities despite severe language problems, was
clearly demonstrated by a recent case study of Rossor et al.
(1995). Their patient answered correctly simple additions,
subtractions, and multiplications and performed multidigit
operations without problems. Seemingly, this patient did not
rely on verbal forms in any of the operations or compen-
sated impaired verbal skills by nonverbal ones. Despite the
fact that this evidence supports the functional indepen-
dence of language and some numerical skills, we neverthe-
less assume that other numerical abilities are mediated (e.g.,
counting, writing number words) or preferentially sup-
ported (e.g., multiplication tables) by linguistic functions.
In this respect, the systematic association of linguistic and
numerical deficits may be informative and may contribute
to our understanding of numerical difficulties in different
clinical populations.
ACKNOWLEDGMENTS
Part of this study has been presented as a poster at the INS
Conference, Bergen, 1997, and at the Academy of Aphasia, Phil-
adelphia, 1997.
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