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Journal of Neurology, Neurosurgery, and... Mar 1999Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically...
OBJECTIVES
Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically manifested by patients with global aphasia after large left perisylvian lesions. A few cases of GAWH have been reported with conflicting conclusions regarding pathogenesis, lesion localisation, and recovery. The current study was conducted to attempt to clarify these issues.
METHODS
Ten cases of GAWH were prospectively studied with language profiles and lesion analysis; five patients had multiple lesions, four patients had a single lesion, and one had a subarachnoid haemorrhage. Eight patients met criteria for cardioembolic ischaemic stroke.
RESULTS
Cluster analysis based on acute language profiles disclosed three subtypes of patients with GAWH; these clusters persisted on follow up language assessment. Each cluster evolved into a different aphasia subtype: persistent GAWH, Wernicke's aphasia, or transcortical motor aphasia (TCM). Composite lesion analysis showed that persistent GAWH was related to lesioning of the left superior temporal gyrus. Patients with acute GAWH who evolved into TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolved into Wernicke's type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but one patient.
CONCLUSIONS
Although patients with acute GAWH are similar on neurological examination, they are heterogeneous with respect to early aphasia profile, language recovery, and lesion profile.
Topics: Adult; Aged; Aphasia; Brain; Brain Mapping; Female; Hemiplegia; Humans; Language Tests; Male; Middle Aged; Prospective Studies
PubMed: 10084536
DOI: 10.1136/jnnp.66.3.365 -
Clinical Linguistics & Phonetics Feb 2010Controversy remains about the impairment of prosody in aphasia, particularly with regard to speech timing. This paper addresses this topic through an analysis of timing...
Controversy remains about the impairment of prosody in aphasia, particularly with regard to speech timing. This paper addresses this topic through an analysis of timing in four sets of a common morphological paradigm. The paradigm consisted of a basic form (stem) and two longer derived forms (e.g. zip, zipper, zippering). Normally, vowel durations are shorter in longer derived forms (e.g. zippering) than in the stem (e.g. zip), due to a process called 'initial shortening'. Twelve patients with aphasia (four each Broca, Wernicke, and Anomic), and 11 age-matched healthy adults were assessed. Structural (CT) and functional brain imaging (PET) were available for all patients. While all groups showed initial shortening between the stem and the derived forms, the patients with Broca's aphasia presented an inverse pattern between the two derived forms (longer initial vowel in 'zippering' than 'zipper'), and the patients with Wernicke's aphasia produced significantly longer vowel durations overall than the healthy participants. The results are related to radiological information regarding the location of structural and functional brain damage and relative preservation and loss of prosodic features in cerebral damage.
Topics: Adult; Aged; Anomia; Aphasia, Broca; Aphasia, Wernicke; Brain; Humans; Language Tests; Linguistics; Male; Middle Aged; Phonetics; Positron-Emission Tomography; Speech; Speech Acoustics; Speech Production Measurement; Time Factors; Tomography, X-Ray Computed
PubMed: 20100044
DOI: 10.3109/02699200903464439 -
Journal of Neurology, Neurosurgery, and... Aug 2017A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the... (Comparative Study)
Comparative Study
BACKGROUND
A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone.
METHODS
A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms. Features were rated as present or absent based on information recorded from clinical interviews and detailed neuropsychological assessment.
RESULTS
A number of behavioural and affective changes were reported more frequently in bvFTD than ALS-FTD: social disinhibition (p<0.001), inertia (p<0.001), loss of sympathy and empathy (p0.008), repetitive behaviours (p<0.001) and dietary changes (p<0.001). Warmth of affect demonstrated in the clinic setting was reported more often in ALS-FTD than bvFTD (p<0.001). Executive impairments occurred equally in both groups. Language impairments were more common in ALS-FTD than bvFTD: agrammatism (p<0.017) and impaired sentence comprehension (p<0.036). Psychotic features were relatively rare and did not distinguish the groups.
CONCLUSIONS
Our findings suggest differences between bvFTD and ALS-FTD. In particular, while changes in social behaviour are prominent in bvFTD alone, there may be a comparatively greater degree of language impairment in ALS-FTD. Prospective exploration of the pattern of differences between these groups will be essential. Identification of a distinct neuropsychological phenotype in ALS-FTD may have clinical implications for early diagnosis, disease management and care planning and theoretical implications for our understanding of the relationship between ALS and FTD.
Topics: Aged; Amyotrophic Lateral Sclerosis; Aphasia, Broca; Auditory Perceptual Disorders; Cohort Studies; Diagnosis, Differential; Disease Progression; Early Diagnosis; Female; Frontotemporal Dementia; Humans; Language Disorders; Male; Middle Aged; Mood Disorders; Neuropsychological Tests; Retrospective Studies; Social Behavior Disorders
PubMed: 28596248
DOI: 10.1136/jnnp-2017-315667 -
Revista de Neurologia May 2013
Review
Topics: Anticonvulsants; Aphasia, Broca; Calcinosis; Carotid Artery Thrombosis; Carotid Artery, Common; Cerebral Angiography; Confusion; Epilepsies, Partial; Humans; Intracranial Aneurysm; Male; Middle Aged; Neuroimaging; Ophthalmic Artery; Pressure
PubMed: 23629751
DOI: No ID Found -
Social Cognitive and Affective... Feb 2018Aberrant rule- and reward-based processes underpin abnormalities of socio-emotional behaviour in major dementias. However, these processes remain poorly characterized....
Aberrant rule- and reward-based processes underpin abnormalities of socio-emotional behaviour in major dementias. However, these processes remain poorly characterized. Here we used music to probe rule decoding and reward valuation in patients with frontotemporal dementia (FTD) syndromes and Alzheimer's disease (AD) relative to healthy age-matched individuals. We created short melodies that were either harmonically resolved ('finished') or unresolved ('unfinished'); the task was to classify each melody as finished or unfinished (rule processing) and rate its subjective pleasantness (reward valuation). Results were adjusted for elementary pitch and executive processing; neuroanatomical correlates were assessed using voxel-based morphometry. Relative to healthy older controls, patients with behavioural variant FTD showed impairments of both musical rule decoding and reward valuation, while patients with semantic dementia showed impaired reward valuation but intact rule decoding, patients with AD showed impaired rule decoding but intact reward valuation and patients with progressive non-fluent aphasia performed comparably to healthy controls. Grey matter associations with task performance were identified in anterior temporal, medial and lateral orbitofrontal cortices, previously implicated in computing diverse biological and non-biological rules and rewards. The processing of musical rules and reward distils cognitive and neuroanatomical mechanisms relevant to complex socio-emotional dysfunction in major dementias.
Topics: Aged; Aging; Anticipation, Psychological; Aphasia, Broca; Female; Frontotemporal Dementia; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Models, Psychological; Music; Pitch Perception; Psychomotor Performance; Reward; Socioeconomic Factors
PubMed: 29186630
DOI: 10.1093/scan/nsx140 -
Frontiers in Robotics and AI 2020In our study, we tested a combination of virtual reality (VR) and robotics in the original adjuvant method of post-stroke lower limb walk restoration in acute phase...
In our study, we tested a combination of virtual reality (VR) and robotics in the original adjuvant method of post-stroke lower limb walk restoration in acute phase using a simulation with visual and tactile biofeedback based on VR immersion and physical impact to the soles of patients. The duration of adjuvant therapy was 10 daily sessions of 15 min each. The study showed the following significant rehabilitation progress in Control ( = 27) vs. Experimental ( = 35) groups, respectively: 1.56 ± 0.29 (mean ± SD) and 2.51 ± 0.31 points by Rivermead Mobility Index ( = 0.0286); 2.15 ± 0.84 and 6.29 ± 1.20 points by Fugl-Meyer Assessment Lower Extremities scale ( = 0.0127); and 6.19 ± 1.36 and 13.49 ± 2.26 points by Berg Balance scale ( = 0.0163). -values were obtained by the Mann-Whitney test. The simple and intuitive mechanism of rehabilitation, including through the use of sensory and semantic components, allows the therapy of a patient with diaschisis and afferent and motor aphasia. Safety of use allows one to apply the proposed method of therapy at the earliest stage of a stroke. We consider the main finding of this study that the application of rehabilitation with implicit interaction with VR environment produced by the robotics action has measurable significant influence on the restoration of the affected motor function of the lower limbs compared with standard rehabilitation therapy.
PubMed: 33501248
DOI: 10.3389/frobt.2020.00081 -
Journal of Neurology, Neurosurgery, and... Aug 1993Aphemia, also called anarthria or severe apraxia of speech, is a rare disorder of speech production usually resulting from vascular lesions affecting the inferior...
Aphemia, also called anarthria or severe apraxia of speech, is a rare disorder of speech production usually resulting from vascular lesions affecting the inferior premotor cortex of the left hemisphere. A patient presenting with aphemia as the sole manifestation of primary progressive aphasia (PPA) is reported.
Topics: Aphasia, Broca; Female; Humans; Middle Aged; Neuropsychological Tests
PubMed: 8350114
DOI: 10.1136/jnnp.56.8.923 -
Frontiers in Psychology 2016In the sentence "The captain who the sailor greeted is tall," the connection between the relative pronoun and the object position of represents a long-distance...
In the sentence "The captain who the sailor greeted is tall," the connection between the relative pronoun and the object position of represents a long-distance dependency (LDD), necessary for the interpretation of "the captain" as the individual being greeted. Whereas the lesion-based record shows preferential involvement of only the left inferior frontal (LIF) cortex, associated with Broca's aphasia, during real-time comprehension of LDDs, the neuroimaging record shows involvement of the left posterior superior temporal (LPST) and lower parietal cortices, which are associated with Wernicke's aphasia. We test the hypothesis that this localization incongruence emerges from an interaction of memory and linguistic constraints involved in the real-time implementation of these dependencies and which had not been previously isolated. Capitalizing on a long-standing psycholinguistic understanding of LDDs as the workings of an active filler, we distinguish two linguistically defined mechanisms: , triggered by the retrieval of the relative pronoun, and , triggered by the retrieval of the embedded verb. Each mechanism is hypothesized to have distinct memory demands and given their distinct linguistic import, potentially distinct brain correlates. Using fMRI, we isolate the two mechanisms by analyzing their relevant sentential segments as separate events. We manipulate LDD-presence/absence and type (direct/indirect) reflecting the absence/presence of intervening islands. Results show a -LIF cortex correlation that crucially excludes the LPST cortex. Notably, recruitment is confined to supplementary-motor and lower-parietal cortex indicating that presence alone is not enough to engage predictive functions in the LIF cortex. Finally, shows recruitment implicating including: the supplementary motor cortex, left supramarginal cortex, precuneus, and anterior/dorsal cingulate. Altogether, the results are consistent with previous findings connecting , as we define it, to the LIF cortex. They are not consistent with an involvement of the LPST cortex in any of the two mechanisms, and therefore support the view that the LPST cortex is not crucial to LDD implementation. Finally, results support neurocognitive architectures that involve the dorsal pathway in LDD resolution and that distinguish the memory commitments of the LIF cortex as sensitive to specific language-dependent constraints beyond phrase-structure building considerations.
PubMed: 27746748
DOI: 10.3389/fpsyg.2016.01434 -
Cureus Sep 2021Acute flare of multiple sclerosis usually presents with sensorimotor deficits in limbs or one side of the face, optic neuritis, internuclear ophthalmoplegia, and/or...
Acute flare of multiple sclerosis usually presents with sensorimotor deficits in limbs or one side of the face, optic neuritis, internuclear ophthalmoplegia, and/or cerebellar signs and symptoms. Isolated aphasia is observed only in a handful of cases. Herein, we present a case of a patient who presented with isolated transcortical motor aphasia. Initial thought was that the patient was having a cerebrovascular accident as he had a history of uncontrolled hypertension. It was only later found on magnetic resonance imaging (MRI) of the brain that the patient had demyelinating lesions compatible with his new symptoms. He exhibited an excellent response to intravenous methylprednisolone therapy and was discharged with outpatient evaluation for immunotherapy.
PubMed: 34722056
DOI: 10.7759/cureus.18278 -
Journal of Speech, Language, and... Oct 2016This study evaluates how proposition density can differentiate between persons with aphasia (PWA) and individuals in a control group, as well as among subtypes of...
PURPOSE
This study evaluates how proposition density can differentiate between persons with aphasia (PWA) and individuals in a control group, as well as among subtypes of aphasia, on the basis of procedural discourse and personal narratives collected from large samples of participants.
METHOD
Participants were 195 PWA and 168 individuals in a control group from the AphasiaBank database. PWA represented 6 aphasia types on the basis of the Western Aphasia Battery-Revised (Kertesz, 2006). Narrative samples were stroke stories for PWA and illness or injury stories for individuals in the control group. Procedural samples were from the peanut-butter-and-jelly-sandwich task. Language samples were transcribed using Codes for the Human Analysis of Transcripts (MacWhinney, 2000) and analyzed using Computerized Language Analysis (MacWhinney, 2000), which automatically computes proposition density (PD) using rules developed for automatic PD measurement by the Computerized Propositional Idea Density Rater program (Brown, Snodgrass, & Covington, 2007; Covington, 2007).
RESULTS
Participants in the control group scored significantly higher than PWA on both tasks. PD scores were significantly different among the aphasia types for both tasks. Pairwise comparisons for both discourse tasks revealed that PD scores for the Broca's group were significantly lower than those for all groups except Transcortical Motor. No significant quadratic or linear association between PD and severity was found.
CONCLUSION
Proposition density is differentially sensitive to aphasia type and most clearly differentiates individuals with Broca's aphasia from the other groups.
Topics: Aged; Aphasia; Diagnosis, Computer-Assisted; Female; Humans; Language Tests; Male; Middle Aged; Multivariate Analysis; Narration; Pattern Recognition, Automated; Speech
PubMed: 27657850
DOI: 10.1044/2016_JSLHR-L-15-0401