Aphasia

There are two pathways in the brain that processes speech and language in the brain

1. Dorsal (upwards) Broca’s Area: left temporoparietal & frontal peri-sylvian structures
= articulatory-phonological processing

● Broca’s aphasia: area damaged is the inferior frontal lobes (Brodmann area
44&45)
● Dysphasia vs Dysarthria

a. Dysphasia = difficulty understanding or producing language (words, sentences

conversations ) which may include reading and writing

b. Dysarthria= difficulty producing clear speech (slurred speech) due to muscle

weakness, intact fluency & comprehension

Others have attributed Broca’s aphasia to fundamental disruptions of lexical retrieval, grammar
& sentence comprehension (Thompson et al., 2013)

2. Ventral (downwards) Wernicke’s Area: left middle & inferior temporal lobes
=lexical-semantic processing (impaired comprehension, speech is normal rate, rhythm &
grammar)

● Wernicke’s Aphasia: area damaged is the superior temporal gyrus (Brodmann

22)
● Attribute to severe impairments of both word & sentence comprehension
TYPES OF APHASIA (FCR)

1. Global aphasia: severe form of nonfluent aphasia caused by damage to the

left side of the brain that affects receptive & expressive language skills as
well as auditory & visual comprehension
2. Mixed cortical aphasia: repetition is the primary language ability of the
person
3. Broca’s aphasia (Expressive aphasia): partial loss of the ability to produce
language (spoken/manual/written) although comprehension is generally
intact
4. Transcortical motor aphasia: similar to Broca’s aphasia. It is due to
stroke/ brain injury that impacts but does not directly effect Broca’s area
5. Wenicke’s aphasia: the loss in ability to comprehend and understand
language, but the ease of producing speech (nonsense) is intact
6. Transcortical sensory aphasia: damage to specific area of the temporal
lobe of the brain , resulting in poor auditory comprehension, relatively
intact repetition, fluent speech & semantic paraphasia present
7. Conduction aphasia: Intact auditory comprehension, fluent (yet
paraphasic) speech production but poor speech repetition
 8. Anomic aphasia: mild fluent type of aphasia where individuals have word
retrieval failures & cannot express the words

Primary Progressive Aphasia

● Can be a variant of FTD, Can be caused by stroke, Can also be caused by

neurodegenerative diseases such as Alzheimer's Disease
● Aetiology: Language capabilities becomes slowly & progressively impaired (at least
years). Speech and language capabilities deteriorate over time
● Is diagnosed when;
1. There is a gradual impairment in language (not just speech)
2. The language problem is initially the only impairment
3. The underlying cause is a neurodegenerative disease
● Is usually classified in terms of fluent vs non-fluent
● There are three variants to PPA
1. Non-fluent agrammatic type : can caused mutism. People with this type of aphasia find it
difficult to speak (not usually due to a motor disorder/ difficulty with general cognitive
planning/organization). T (GRAMMATICAL SENTENCE) have intact semantic
knowledge about the meanings of individual words. The main problem with these
individuals is that they develop complications in using grammatical rules to construct
sentences
● Diagnosis : Sympatology & some core features that must be present;-
1. Verbal/written production characteristics with a tendency to form sentences without
correct grammatical structure
2. Telegraphic/halting speech
3. Impaired comprehension of syntactically complex sentences
4. Spared object knowledge
5. Spared single-word comprehension
6. Brain imaging structure (MRI) shows frontoinsular atrophy (Therefore lower scores on
cognitive flexibility and processing speed task in participants with agPPA= Consistent
with left frontal lobe compromise

Speech/language Task Behavioural measure

function

Grammar Picture description Grammatical structure; mean length of utterance,

task, story retelling speech rate, accuracy of content, melody, specific
error types in word selection; articulation
Motor Speech Multiple repetitions of Effortfulness, hesitations, presence of apraxia of
multisyllabic words, speech, sounds errors, factors that affect
spontaneous speech articulation (word length in syallables)

2. Semantic variant type (MEANING): Degradation of semantic knowledge (similar to

Wernicke’s aphasia)
● Diagnosis; Sympatology & some core features that must be present;-
1. Impaired confrontational naming evident from the Boston Naming Task
2. Impaired single word comprehension
3. Impaired knowledge of familiar items
4. Spared repetition, few phonological error
5. Spared speech production
6. Loss of single word meaning disproportionate to overall aphasia severity
7. Brain imaging structure (MRI) ; anterior & inferior temporal lobes

Speech/language Task Behavioural measure

function

Confrontation Single word retrieval Error rate, delay in naming, factors that affect
Naming in response to pictures, accuracy (unfamiliar vs familiar) items, error
sounds, foods & types (phonemic errors & semantic errors)
odours

Single word Word to picture Factors that affect comprehension (e.g: familarity,
comprehension matching frequency, grammatical word class)

Object/people Picture-picture Factors that affect object knowledge (e.g;

knowledge matching; odd one out familarity, semantic category)

3. Logopenic variant: aka phonological variant of PPA . Deficits on tasks that requires short
term phonological storage. Phonological paraphasis in connected speech
● Diagnosis; Sympatology & some core features that must be present;-
1. Impaired repetition of sentences & phrases
2. Impaired single word retrieval in spontaneous speech & naming
 3. Spared motor speech
4. Phonological errors in spantaneous speech & naming
5. Spared single-word comprehension & object knowledge
6. Absence of agrammaticism (grammatical errors in sentence)
7. Brain imaging structure (MRI); temporoparietal (IvPPA can show
impairments on measures of immediate & delayed memory as well as
visuospatial reasoning= consistent with disruption in tempoparietal
circuity
8. Can also show deficits such as deficits in speeded mental flexibility &
impaired working memory = compromised frontal lobe region

Speech/language Task Behavioural measure

function

Reading/ Lists including regular Factors that affect reading/spelling accuracy (e.g:
Spelling & irregular word lists regularity, frequency, word class), error
from various word types(phonologically plausible errors, articulatory
classes distortions)

Repetition Oral repetition of Factors that affect repetition accuracy (e.g:

words, pseudowords predictability of the phrase, sentence length,
phrases & sentences grammatical complexity) error types