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Do subcortical structures control ‘language

selection’ in polyglots? evidence from pathological
language mixing

Jubin Abutalebi , Antonio Miozzo & Stefano F. Cappa

To cite this article: Jubin Abutalebi , Antonio Miozzo & Stefano F. Cappa (2000) Do subcortical
structures control ‘language selection’ in polyglots? evidence from pathological language mixing,
Neurocase, 6:1, 51-56, DOI: 10.1080/13554790008402757

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Published online: 17 Jan 2008.

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Neurocase (2000) Vol. 6, pp. 51-56 0 Oxford University Press 2000

Do Subcortical Structures Control ‘Language Selection’ in

Polyglots? Evidence from Pathological Language Mixing

Jubin Abutalebi‘, Antonio Miozzo’ and Stefan0 F. Cappal**

’Neuropsychology Laboratory, Clinica Neurologica, University of Brescia Medical School, Spedali Civili, Piazzale Spedali Civili 1,
25100 Brescia and *IRCCS S.Giovanni di Dio-S. Cuore Fatebenefretelli Hospital, Brescia, Italy

Abstract

In the field of multilinguism, ‘switching’ defines a mechanism operating automatically when speakers shift among
different languages. While the neural basis of this mechanism is unknown, recent studies of polyglot aphasia have
suggested a possible role of subcortical structures. We report a case of subcortical polyglot aphasia which provides
further evidence for a role of the basal ganglia in the switching mechanism. A polyglot female (Armenian-English-
Italian), after a subcortical infarction in the language dominant hemisphere, developed a non-fluent aphasia
characterized by pathological mixing among these languages in oral production tasks. This case confirms that damage
to subcortical structures may result in different types of dysfunction in the mechanisms implicated in the selection of
languages.

Introduction
Polyglottism is a frequent and worldwide condition which
provides unique information about the cerebral substrate of
language processing. One of the most important questions is
whether the polyglot’s languages are functionally indepen-
dent, or to what extent they constitute a single interdependent
functional language system. The results of both electrical
cortical stimulation (Ojemann, 1983) and functional brain
imaging (Perani et al., 1996; Kim et al., 1997) of bilingual
subjects have in general indicated differences among the
representations of different languages in the brain. Lesion
studies carried out to investigate the clinical features of
polyglot aphasia have provided a complex pattern of results.
In particular, recovery studies have clearly indicated that one
of the polyglot’s languages may recover in a different manner
from the others. It is still debated whether it is the language
learnt earlier in life, or the one spoken most frequently and
intensively before brain damage, that recovers first (Pitres’
rule). Several recovery patterns have been described (Paradis,
1977, 1998); of particular interest, from the neurolinguistic
standpoint, is the so-called blending recovery, characterized
by pathological mixing among languages. Language mixing
in polyglot aphasia may offer a direct window into the
mechanism of interaction among language systems, and
therefore provide valuable information for modelling the
neural organization of multiple language systems (Perec-
man, 1989).
Switching mechanisms might be impaired in both senses,
resulting either in a rigid fixation in one language or,
conversely, in a pathological mixing (Albert and Obler, 1978).
Aglioti and Fabbro (1993) and Aglioti et al. (1996) reported
a particular recovery pattern for a patient who was unable to
‘switch’ between languages because of a rigid fixation on
one language (so-called selective recovery; Paradis, 1977).
and suggested that damage to the left basal ganglia may
result in switching difficulties. Evidence for participation of
subcortical nuclei in cognition has been relatively well defined
for monolinguals (Cappa and Vallar, 1992). Most studies
carried out in monolinguals with damage to the dominant
subcortical nuclei have converged by proposing a crucial
role of these structures in the lexicosemantic level of language
organization, in particular for the processes involved in
lexical retrieval (Wallesch and Papagno, 1988; Crosson,
1992; Nadeau and Crosson, 1997).
Pathological language mixing may result from a lesion to
the control systems for language output and, in particular,
because of the dysfunction of a putative mechanism for
switching among languages. We report a case of subcortical
polyglot aphasia with pathological mixing which provides
complementary evidence for the role of the dominant basal
ganglia in switching mechanisms among languages.
Case report
AH is a right-handed woman born in the Armenian commun-
ity of Tripoli in Northern Lebanon in 1923, whose native

Corresportderice to: S. F. Cappa. Clinica Neurologica dell’ Universiti di Brescia. I1 Neurologia Spedali Civili, 25125 Brescia. Italy. Tel: +39 30 399 5823;
Fax: +39 30 338 4086: e-mail: cappa@master.cci.unibs.it
52 J. Abutalebi, A. Miozzo and S. F. Cappa

language, Armenian (L1), was the only language spoken

until the age of 4 years. At this age, she moved with her
family to Khartoum, the capital of Sudan, where she learned
English (L2) at school, and where she lived until 1971. She
had 13 years of schooling in English and her environment
in Sudan was predominantly English speaking (Sudan was
then a British colony). Her native language, Armenian, was
only used in the family.
In 1943, when she met her future husband, an Italian
trader, she began to learn Italian (L3) informally. In 1971,
she settled in Italy, and Italian became the most used language.
She continued using English and Armenian with friends and
relatives. To summarize, Armenian (LI) and Italian (L3)
were never learnt at school, but only acquired in an informal
manner, whereas English (L2) was also learnt by means of
13 years of schooling. Despite this fact, her reading and
writing proficiency was also very good in Armenian and
Italian. As testified by relatives, her general pre-morbid
linguistic performance was excellent in all three languages.
In April 1997, AH had a left hemispheric stroke, resulting
in severe language disturbances. She was referred to our
laboratory in May 1997 for language evaluation. Her relatives
had noticed that AH was no longer able to hold a conversation
in only one given language, even when specifically asked to Fig. 1. CT scan of AH showing a small area of infarctiim deep within
subcortical structures of the left hemisphere. More precisely. the l e w n site I\
do so. AH spontaneously switched from one language to the located in the periventricular white niattcr surrounding the left c;ludate nucleuh.
other, so that monolingual Italian subjects found it extremely
difficult to understand her. AH was fully aware of her
impairment.
The neurological examination was normal except for the
language deficit. AH was fully oriented in time and space,
and there was no evidence of apraxia or agnosia on mental
status testing. Right-left recognition and discrimination were
intact. She could adequately remember events before and
after her stroke, and her short-term memory was normal. A
CT scan showed a hypodense lesion in the white matter,
adjacent to the left caudate nucleus (see Fig. 1).
On neurolinguistic testing, a non-fluent aphasia pattern
was established, involving all three languages to the same Fig. 2. Results of formal language testing with the Boston Diagnostic Aphasia
Examination. The language profiles essentially indicate a parallel recovsry for
extent. Language assessment was ascertained for Italian and AH’S three languages. i.e. a similar degree of language deticit for Armenian
English by formal testing with the Boston Diagnostic Aphasia (LI),English (L2) and Italian (L3).
Examination (BDAE; Goodglass and Kaplan, 1983). Armen-
ian was tested with an adaptation of the Boston Diagnostic Italian, she produced the following mixings between lan-
Aphasia Examination prepared by a native Armenian speaker. guages (Italian elements are underlined):
A typical ‘transcortical motor-subcortical’ aphasia pattern, I can not comunicare con you;
characterized by the reduction of spontaneous speech (con- I can not say il mio nome to you;
sisting essentially of hesitation to initiate conversation and I am a disastro today.
prolonged pauses when speaking), perseverations, preserva- Furthermore, when asked to describe the BDAE picture
tion of auditory comprehension and normal word repetition card in the English session, AH blended in a similar manner:
with the presence of semantic and verbal paraphasia, was I bambini steal the biscuits from the armadio;
present in all three languages (Fig. 2). The water sta cadendo per terra.
A characteristic pattern of language mixing was found to AH was fully aware of her mixed language output. and
be present in the language production tasks. In spontaneous she complained that her monolingual friends had some
speech, AH mixed elements of one language with elements difficulty in understanding her. When asked to switch volun-
of the other language. tarily from one language to another, she had no difficulties.
For instance, when invited to describe her daily life in Moreover, she was able to answer in a language different
 Control of language selection in polyglots 53

100 -
Table 1. The performance of AH in naming across her three languages. The
table includes all the responses for the subset of items for which naming was
required in all three languages
aNon-appropriate language
UAppropriate language
Item Armenian (L1) English (L2) Italian (L3)

Clock + L3 L2
Scissors L3 + +
Lighter L3 Semantic error (L3) L2
L1 L2 L3
Chair + + L2
Fig. 3. AH‘s performance in naming. The figure shows the percentage of Key L2 + L2
correct responses in the naming tasks performed during language evaluation. Glove + L3 +
The subcolumn of the ‘non-appropriate language’ responses represents the Feather + Anomia +
percentage of responses which are semantically correct. but not performed in Hammock L3 + +
the required language (i.e. the language used in the evaluation session by Guitar + + L2
the examiner). Square L3 + L2
Triangle Neologism L3 +
Running + + +
from the one used by the examiner. The two latter conditions Sleeping L2 + +
did not affect remarkably her spontaneous mixing rate. Drinking + + +
Smoking + + L2
A noticeable characteristic of her impairment was the Falling + L3 +
fact that, despite code mixing, noun phrases were always Dripping + Semantic error Perseveration
completed in the same language; furthermore, morphological Ear L3 + L2
Nose + L3 +
markers were always used appropriately across languages. Shoulder Anomia + +
For example, in the sentences reported above, the English Ankle L3 L3 +
Wrist L2 L3 L2
verb was in correct number agreement with the Italian noun Thumb + + +
(I bambini-plural form-steal...), and vice versa (The water Elbow + L3 +
sta-3rd person singular...). Her impairment thus appeared Eyebrow Perseveration + Perseveration
to involve a stage of lexical retrieval occurring after the Cheek + Semantic error Anomia
Knee L2 + Semantic error
specification of semantic and syntactic information (see the (L2)
discussion below).
+. the target item was named correctly in the required language; L2iL3, the
target item was named correctly, but using a different language (L2 or L3)
Multilingual naming from the one of the evaluation session; perseveration refers to the item
preceding the target item.
In order to assess language mixing more formally, we
developed a three-language picture naming task, which languages. It is noteworthy that several identical target items
included a subset of 27 ‘common’ items to be named in L1, were named using a language not required; however, when
L2 and L3. invited to name the same items using the non-required
AH’s naming deficit was mild in all three languages, but language, she sometimes named them using the previously
her naming performance was impaired by her inability to unavailable language. For example, when presented with the
respond consistently in the required language. This language picture of a clock, AH responded in the L2 session with
mixing was multidirectional, as it was present to the same ‘orologio’ (instead of clock), whereas she responded to the
degree in all three languages (see Fig. 3). In the L1 session, same stimulus presented in the L3 session using ‘clock’
she named correctly (from the semantic point of view) 24 of instead of ‘orologio’. The picture of a lighter was named in
27 stimuli (89%);however, 10 of the correct responses (42%) the L1 session using L3; in the L2 session, she again used
were not given in L1, but rather in L2/L3, even when she L3, but making a semantic error (‘sigaretta’l‘cigarette’instead
was invited to use L1. The same phenomenon was observed of ‘lighter’/‘accendino’), and finally, in the L3 session, she
in the L2 and L3 sessions. In the L2 session, naming was named the stimulus using L2.
correct for 45 of 55 items (82%). using L3 14 times (31%), Considering the whole corpus of naming stimuli, AH also
whereas in the L3 session she named 44 of the 52 items made other aphasic errors, consisting mostly of anomias
(85%) using L2 14 times (32%). The prevalence of the use (n = 7; 1 for L1, 3 for L2 and 3 for L3), semantic errors
of a different language while naming was therefore similar (n = 6; 4 for L2 and 2 for L3). perseverations (n = 5; 1 for
L1, 2 for L2 and 2 for L3) and neologisms (n = 4; 1 for L1,
among the three languages (x2 = 0.88; P = 0.64, not
1 for L2 and 1 for L3). It is noteworthy that none of the 27
significant). She mixed English with Italian, Italian with
‘common’ items gave rise to aphasic errors in all three
English, Armenian with Italian or with English. Characterist-
languages.
ically, Italian or English were never observed to be mixed
with Armenian, probably due to the fact that Armenian was
the less frequently used language.
Discussion
Table 1 shows the item-specific performance for the 27 Lexical access requires the selection of the meaning of words
items for which naming was required in each of the three (semantic representation), as well as access to morpho-
54 J . Abutalebi, A. Miozzo and S. F. Cappa
syntactic information (word class, number, etc.) and the
corresponding phonological features (phonemic and syllabic
structure). While psycholinguistic models of lexical pro-
cessing differ considerably (Dell, 1986; Levelt, 1989; Caram-
azza, 1997), they all include a stage in which the phonological
form of a word must be retrieved: this is the process which
appears to be involved in this patient, since her responses
were always semantically and syntactically appropriate.
The deficit observed in AH could be considered to arise
because of language-specific word-finding difficulties, which
were consciously avoided by selecting the correct item in a
different language. However, in our opinion, this is unlikely
to be the exclusive explanation of our patient’s unusual
behaviour. At the observational level, AH’S code mixing did
not appear to be under voluntary control, as the language
shifts were not regularly preceded by hesitations, as can be
expected in the case of word-finding difficulties. She also
denied the use of this strategy to circumvent naming difficul-
ties, and appeared to be genuinely puzzled by the phenom-
enon. The unpredictable direction of the mixing, which did
not show any advantage of the most used language, also
appears to militate against a ‘strategic’ interpretation.
The dysfunction of a ‘control mechanism’, subserving the
lexical selection across languages, which should deactivate
one language while speaking in a different language, seems
to be a more plausible mechanism. This hypothesis does not
exclude the possibility that the same ‘device’ also intervenes
in the complex mechanism of word finding.
The neurological mechanisms responsible for lexical selec-
tion in monolinguals are incompletely known. In the model
proposed by Wallesch and co-workers (so-called ‘Lexical
Decision-Making Model’; Wallesch, 1985; Wallesch and
Papagno, 1988), a crucial role is assigned to the subcortical
structures of the dominant hemisphere. The basic assumption
is that multiple lexical alternatives (e.g. the response alternat-
ives in a naming task) are formulated and released in the
posterior perisylvian cortex, then carried to the anterior
perisylvian cortex and the striatum in parallel modules. The
role of the striatum is to monitor the lexical alternatives and
to select the most appropriate one, and therefore control the
correct language output. The main reason for postulating a
control function for the dominant basal ganglia (and the
striatum, in particular) lies in their key position within the
system, due essentially to their multiple afferents from the
cortex, including limbic cortex. The striatum is thus consid-
ered to be responsible for the integration of various situational,
emotional and motivational inputs in order to drive the
selection of the most fitting lexical item among multiple
alternatives. Aphasia reports in monolinguals with damage
confined within the left basal ganglia are in agreement
with the hypothesis of an involvement of these subcortical
structures in the process of coordination and selection of
language items that precede verbal production (Crosson,
1992). In the specific case of bilinguals and polyglots, not
only has the most appropriate alternative to be chosen
correctly, but the selection of linguistic elements belonging
to one language represents a further crucial step towards the
correct production of meaningful language. Fabbro and
Paradis (1995) proposed that the basal ganglia are an essential
structure for the link between the mere automatic functions
of language and the propositional, emotional and switching
aspects, which would be subserved by the so-called ‘frontal
lobe system’. One widely accepted model of basal ganglia-
thalamo-cortical circuits (Alexander and Crutcher, 1990)
identifies four separate circuits (motor, oculomotor, limbic
and ‘prefrontal’). It is the latter one, which projects to the
dorsolateral and lateral orbitofrontal cortex, that has been
associated with cognitive processes. Considering the tight
relationship between left basal ganglia and left frontal cortex,
such a neural network represents an ideal candidate for a
system responsible for the control of correct language output.
In the specific topic of polyglottism, a model dealing with
speech control in multilinguals was proposed by Green
( 1986). This model presupposes the existence of reciprocally
interdependent language subsystems for the polyglot’s lan-
guages. Language output is therefore regulated by a device
(so-called ‘specifier’) that prevents code mixing. This stage
is followed by the operation of a resource generator which,
following the specification of the language, activates the
appropriate output system. Briefly, if the polyglot intends to
speak in LI, the ‘language specifier’ selects the intended
language. Then, the resource generator activates the subsys-
tems for word output in L1 and at the same time suppresses
the word output subsystem for L2, and vice versa, in order
to avoid code mixing. A lesion within this framework 01‘
control and activation may result in a variety of language
deficits, essentially represented at one extreme by pathological
code mixing and at the other by a difficulty i n switching
among languages, as in pathological fixation on a language.
The latter entity constitutes the main clinical feature observed
in the phenomenon of selective recovery in polyglot aphasia
(Aglioti and Fabbro, 1993; Aglioti et d., 1996). Conversely,
the language deficit observed in AH is compatible with the
opposite mechanism of dysfunction, i.e. an inability of the
control mechanism to deactivate the subsystems of one
language while speaking in a different language.
The anatomical correlation of damage to the switching
mechanism is not known. Some findings have suggested that
the neural basis for language switching may be located in
the prefrontal and frontal cortices (Stengel and Zelmanowicz,
1933; Zatorre, 1989). Considering the close links between
these areas and the basal ganglia, this hypothesis is not in
contradiction with evidence from this case, as well as the
patient reported by Aglioti and Fabbro ( I 993) and Aglioti
e? al. (1996), indicating a role for the basal ganglia region.
It is noteworthy that lesions in the basal ganglia region
appear to be associated with both pathological tixation
(Aglioti and Fabbro, 1993; Aglioti rt uf., 1996). and code
mixing (our patient). It may be speculated that a strategically
located lesion (e.g. the caudate nucleus lesion in AH and the
capsulo-putaminal lesion in the patient reported by Aglioti
et al.) within this network of interconnected structures, which

are associated with complex patterns of reciprocal excitation
and inhibition (Graybiel, 1995), may result in opposite effects,
on the basis of the final output of the system.
Conclusion
The case presented in this paper suggests, from a physio-
logical viewpoint, an essential role for subcortical networks
in the switching mechanism among languages in polyglots.
Our findings have shown that damage to the dominant basal
ganglia may not only produce an inhibition of an ability to
switch across languages, but also an exaggeration of this
language property may occur. It is noteworthy that on the
basis of this evidence, it may be hypothesized that the
polyglot’s lexical representations are accessible and control-
lable through neural routes which pertain to a cortical-
subcortical loop, and in particular to a left basal ganglia-left
frontal cortex loop. More insight might be gained by exploring
this topic with the use of modern technology, like cognitive
brain activation investigations, which could solidify our
knowledge about the neural basis of language switching.
Acknowledgements
We wish to thank Dr G. H. Mardighian for his invaluable
help in the Armenian assessment; we are also grateful to
Dr M. A. Lambon Ralph and two anonymous referees for
their thoughtful comments on an earlier version of this
manuscript.
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Received 011 30 October; 1998; resubmitted on 19 April, 1999;
accepted on 29 April, 1999
56 J . Abutalebi. A. Miozzo and S. F. Cappa

Do subcortical structures control

'language selection' in polyglots?
Evidence from pathological language
mixing

J. Abutalebi, A. Miozzo and S. F. Cappa

Abstract
I n the lield of multilinguism, 'switching' detines a mechanism operating
~iutoinaticallywhen speakers shift among different languages. While the neural
hnsis of this mechanism is unknown. recent studies of polyglot aphasia have
wggested a possible role of subcortical structures. We report a case of
\ubcortical polyglot aphasia which provides further evidence for a role of the
basal ganglia in the switching mechanibm. A polyglot female (Armenian-
English-Italian). after a subcortical infarction in the language dominant
hemisphere. developed a non-fluent aphasia characterized by pathological
mixing aiiiong these languages in oral production tasks. This case confirms
that damage to subcortical structures may result i n different types of dysfunction
in the mechanisms iniplicated in the selection of languages.

Journal
Neurocase I O W ; 6 : 5 1-6

Neurocase Reference Number:

0183

Primary diagnosis of interest

Polyglot aphasia

Author's designation of case

A I~I

Key theoretical issue

8 A n eahential role for subcortical networks in the language selection
mechanism among the polyglot's languages
Kcv I I ' o d S : language switching: polyglot aph ; basal ganglia lesion;
language output control

Scan, EEG and related measures

CT scanning

Standardized assessment
Bo\ton Diagnostic Aphasia Examination (BDAE)

Lesion location
0 Periventricular white matter surrounding the caudate nucleus of the left
hemisphere

Lesion type
Infiirction

Language
English