Non-Fluent & Fluent Aphasias Pt.2: CSD 641 - Language Disorders in Adults

What are the 4 types of fluent aphasias?

1. Wernicke's Aphasia

2. Transcortical Sensory Aphasia (TSA)

3. Conduction Aphasia

4. Anomic Aphasia

What are the other three names fluent aphasia may be referred to as?

1. Receptive Aphasia

2. Posterior Aphasia

3. Jargon Aphasia

Diagnostic characterisitics fluent aphasia ?

1. auditory comprehension deficits

2. paraphasic speech with poor self-monitoring

- (not monitoring)

3. effortless and melodic speech

4. good speech articulation

4. ability to initiate verbal expression

5. decreased use of real words, i.e., neologisms (jargon)

6. "empty speech", i.e., verbal output devoid of semantic content

7. paragrammatism, e.g., morphological disturbances

What are common erros in fluent aphasias?

Speech content is low

- a decrease in the use of real words

What are the four different types of verbal output errors noted?

1. Semantic (verbal paraphasia)

2. Phonemic (literal paraphasia)

3. Jargon or neologisms

4. Circumlocutions

Example of Semantic (verbal paraphasia)

"My uncle is having a pregnant"

- The word uncle is substitiued for the desired word aunt and pregnant is substituted for baby

example of Phonemic (literal paraphasia)

"I smoke a pike"

- The word pike is substituted for the desired word pipe

Example of Jargon or neologisms

"It's a sega segment in a pegment"

- These words meet the phonological rules for the language but have no meaning

Neologism are

made up words

Jargon is stringing the _______ together in a sentnence or phrase?

neologism

What is Circumlocutions?

Descriptions are used to describe a more appropriate word

example of Circumlocutions

" I want a match to light the white stick with smoke"

- The phrase white stick with smoke is substituted for the desired word cigarette

Wernicke's Aphasia - Receptive Language

Auditory Modality (2)

1. Poor auditory comprehension

2. Possible auditory agnosia

Wernicke's Aphasia - Receptive Language

Visual Modality (4)

1. Oral reading impairment

2. Reading comprehension

3. Poor Letter and word recognition

4. Spelling difficulties

Wernicke's Aphasia - Expressive Language

Verbal Modality (3)

1. Empty speechwith paragrammatism

2. Neologistic output

2. Logorrhea (pree for speech)

Wernicke's Aphasia - Expressive Language

Graphic Modality

Similar to verbal modality

(e.g., paragraphic error)

W's A notes

- clear fluent speech

- uses real words but string together words does not make sense

- push for speech(urgently) -> no real turn-taking

- Long sentences but not making sense

Transcortical Sensory Aphasia (TSA) is thought of as less severe form of what?

Wernicke's aphasia

What is TSA sometime mistaken for?

Alzheimer's Dementia

What does TSA generally results from?

Vascular insufficency (MCA) at the watershed areas of blood supply.

In TSA, what areas remain intact but the surrounding tissues have damage?

Wernicke's area, Borca's area, arcuate fascisulus

Where does necrosis occur?

at the places farthest from arterial blood supply, at border zone between middle and posterior cerebral arteries

What are the clinical characterisitics of TSA?

1. Fluent, well-articulated speech

2. auditory comprehension deficits may be severe

- there is difficulty applying meaning to what is heard

3. Discourse tends to be empty and circumlocutionary

More clinical characterisitics of TSA (4)

1. There are neologism and verbal paraphasias

2. Pt can usually repeat what is said

3. Word finding (lexcial retrieval) problems are common

4. Many ready made expressions (stereotypical speech) and echolalia are used

What is syndrome may also be present with TSA?

Gerstmann's Syndrome

what is Gerstmann's Syndrome?

A rare genetic brain disorder with destruction to areas of the inferior parietal lobe of the dominant hemisphere with symptoms that can diminish over time

What a neurological disorder related to left parietal lobe damage resulting in cognitive impairment and aphasia?

Gerstmann's Syndrome

4 primary symptoms of Gerstmann's Syndrome

1. Agraphia

- impaired writing/spelling

2. Acalculia

- impaired math/calculating

3. Inability to distinguish right from left

4. Inability to identifty individual fingers when touch out of view

Conduction aphasia has better rehab outcomes compared to

W's A

What is conduction aphasia also known as

associative aphasia

conduction aphasia affects approximately

5%-10% of adults annually

(less common after stroke)

What aphasia type has lesion localization that is controversial?

conduction aphasia

conduction aphasia can result from a lesion to the __________ connecting B's to W's areas. (the primary areas remain intact)

cortical region

A more posterior lesion means the patient will have more

fluent speech

More anterior and inferior lesions tend to result in speech that is more

non-fluent with phonemic paraphasias

4 clinical characteristics of Conduction aphasia

1. Good intonation

2. Good auditory comprehension

3. Difficulty with word finding

4. Paraphasic errors (more phonemic/literal type)

4 More clinical characterisitics of Conduction aphasia

1. Hesitations in speech but generally fluent

2. Good recognition of errors with attempts to self-correct

3. USe of comples syntactic structures in spontaneous speech

4. Marked difficulty with repetition

- (especially with multisyllabic words and longer sentences)

Prognosis of conduction is

favorable spontaneous recovery patterns

Some people with conduction aphasia return to

near-normal levels BUT other remain signifcantly impaired and frustarted

Conduction aphasia may evolved from what was a more severe

W's A

Anomic Aphasia is less common then

B's A

Where is the lesion in Anomic Aphasia

The angular gyrus and second temporal gyrus tend to be implicated BUT it is NOT easily localized

Anomic Aphasia:

Tend to find ->

1. Left frontal lobe lesions

2. Left temporal lesions

Left frontal lobe lesions =

More difficulty with verbs

Left temporal lesions =

more difficulty with nouns

What is the major impairment is seen in Anomic Aphasia?

Lexical Retrieval

Confrontation naming (Naming when a visual image is present) is often more difficult than

finding words in spontaneous communication

What are the 7 lexical retriveal error types?

1. Delayed Response

2. Self-Correction

3. Circumlocuations

4. Neologisms

5. PAraphasias

6. Perseveration

7. No response

Patients with anomic aphasia tend to have greater success naming words that are

(5 things)

1. nouns

2. More frequently used in the language and conversation

3. Shorter in length

4. Personally meaningful

5. Part of a sentence completion tasks