Functions

19.4 Language Disorders

Aphasia may refer to a language disorder apparent in speech,

Thus, disturbances of language due

to severe intellectual impairment, to loss of sensory input (especially vision and
hearing), or to paralysis or incoordination of the musculature of
the mouth (called anarthria) or hand (for writing) are not con-
sidered aphasic disturbances. These disorders may accompany
aphasia, however, and they complicate its study.
Howard Goodglass and Edith Kaplan (1972) divide language
disturbances into 10 basic types that we group into disorders
of comprehension and disorders of production in Table 19.2.
Most were described in Part III chapter discussions of parietal-,
temporal-, and frontal-lobe functions. The one exception is
paraphasia, the production of unintended syllables, words, or
phrases during speech. Paraphasia differs from difficulties in ar-
ticulation in that sounds are correctly articulated, but they are
the wrong sounds: people with paraphasia either distort the in-
tended word (for example, “pike” instead of “pipe”) or produce a

completely unintended word (for example, “my mother” instead

of “my wife”).

Despite disagreement among experts concerning the number

of types of aphasias, certain classification systems are widely used (for example,
see Mazzocchi and Vignolo, 1979). The system we present in Table 19.3, based
on correlations of lesion locations among stroke patients, groups aphasias into
three broadly defined categories:
1. Fluent aphasias: fluent speech but difficulties either in auditory verbal
comprehension or in the repetition of words, phrases, or sentences spoken
by others.

2. Nonfluent aphasias: difficulties in articulating but relatively good audi-

tory verbal comprehension.

3. Pure aphasias: selective impairments in reading, writing, or recognizing

words in the absence of other language disorders.
Within each category, Table 19.3 lists subtypes, including Wernicke’s aphasia,
transcortical aphasia, conduction aphasia, anomic aphasia, and Broca’s aphasia.
Table 19.2 Summary of symptoms of language disorders
Disorders of Comprehension
1. Poor auditory comprehension
2. Poor visual comprehension
Disorders of Production
1. Poor articulation
2. Word-finding deficit (anomia)
3. Unintended words or phrases (paraphasia)
4. Loss of grammar and syntax
5. Inability to repeat aurally presented material
6. Low verbal fluency
7. Inability to write (agraphia)
8. Loss of tone in voice (aprosidia)

Chapter 19 Language §19.4 537

Fluent Aphasias
Fluent aphasias are impairments related mostly to language input or reception.
The impression of a listener who did not speak the language of a fluent aphasic
would be that the subject was speaking easily and correctly.
Wernicke’s aphasia, or sensory aphasia, is the inability to comprehend
words or to arrange sounds into coherent speech even though word production
remains intact. Alexander Luria proposed that sensory aphasia has three char-
acteristic deficits—in classifying sounds, producing speech, and writing (Luria
and Hutton, 1977).
The first, hearing and making sense of speech sounds, demands the ability
to qualify sounds—that is, to recognize the different sounds in the system of
phonemes that are the basic speech units in a given language. For example, in
the Japanese language, the sounds “l” and “r” are not distinguished; a Japanese-
speaking person hearing English cannot distinguish these sounds because the
necessary template was never laid down in the brain. Thus, although this dis-
tinction is perfectly clear to English-speaking persons, it is not clear to native
Japanese. This problem is precisely what a person with Wernicke’s aphasia has
in his or her own language: the inability to isolate the significant phonemic
characteristics and to classify sounds into known phonemic systems. Thus, we
see in Wernicke’s aphasia a deficit in sound categorization.
The second characteristic of Wernicke’s aphasia is a speech defect. The af-
fected person can speak, and may speak a great deal, but he or she confuses
phonetic characteristics, producing what is often called word salad, intelligible
words that appear to be strung together randomly. The third characteristic is a
writing impairment. A person who cannot discern phonemic characteristics can-
not be expected to write because he or she does not know the graphemes (pic-
torial or written representations of a phoneme) that combine to form a word.
Table 19.3 Classification of aphasic syndromes
Syndrome Type of Speech Production Type of Language Errors
Fluent Aphasias Fluent speech without Neologism or anomias, or
- Wernicke (sensory) articulatory disorders paraphasias, poor
comprehension; poor
repetition

Transcortical Fluent speech without Verbal paraphasias and

(isolation syndrome) articulatory disorders; anomias; poor
good repetition comprehension

Conduction Fluent, sometimes halting Phonemic paraphasias

speech, but and neologisms; phonemic
without articulatory grouping; poor
disorders repetition; fairly good
comprehension

Anomic Fluent speech without Anomia and occasional

articulatory disorders paraphasias

Nonfluent Aphasias Speechlessness with

Broca (expressive), severe Laborious articulation recurring utterances or
syndrome of phonetic
disintegration; poor
repetition

Broca (expressive), mild Slight but obvious Phonemic paraphasias

articulatory disorders with anomia;
agrammatism; dysprosody
Transcortical motor Marked tendency to Uncompleted sentences
reduction and inertia; and anomias; naming
without articulatory better than
disorders; good repetition spontaneous speech

Global Laborious articulation Speechlessness with

recurring utterances; poor
comprehension;
poor repetition

Transcortical aphasia, sometimes called isolation syndrome, is curious in that

people can repeat and understand words and name objects but cannot speak spon-
taneously, or they cannot comprehend words although they can repeat them.
Comprehension could be poor because words fail to arouse associations. Produc-
tion of meaningful speech could be poor because, even though word production
is at normal, words are not associated with other cognitive activities in the brain.

Conduction aphasia is paradoxical: people with this disorder can speak eas-
ily, name objects, and understand speech, but they cannot repeat words. The
simplest explanation for this problem is a disconnection between the “percep-
tual word image” and the motor systems producing the words.
People with anomic aphasia (sometimes called amnesic aphasia) comprehend
speech, produce meaningful speech, and can repeat speech, but they have great
difficulty finding the names of objects. For example, we saw a patient who, when
shown a picture of a ship anchor, simply could not think of the name and finally
said, “I know what it does. . . . You use it to anchor a ship.” Although he had ac-
tually used the word as a verb, he was unable to access it as a noun. Difficulties
in finding nouns appear to result from damage throughout the temporal cortex
(see Figure 19.12D). In contrast, verb-finding deficits are more likely to come
from left frontal injuries (see Figure 19.12A).

Although the extent to which the brain differentiates between nouns and
verbs may seem surprising, we can see that they have very different functions.
Nouns are categorizers. Verbs are action words that form the core of syntactical
structure. It makes sense, therefore, to find that they are separated in such a way

that nouns are a property of brain areas controlling recognition and classifica-
tion, and verbs are a property of brain areas controlling movement.

Nonfluent Aphasias
In nonfluent aphasia (Broca’s aphasia, or expressive aphasia), a person con-
tinues to understand speech but has to labor to produce it: the person speaks in
short phrases interspersed with pauses, makes sound errors, makes repetitious
errors in grammar, and frequently omits function words. Only the key words
necessary for communication are used. Nevertheless, the deficit is not one of
making sounds but rather of switching from one sound to another.
Nonfluent aphasia can be mild or severe. In one form, transcortical motor
aphasia, repetition is good, but spontaneous production of speech is labored. In
global aphasias, speech is labored and comprehension is poor.

Pure Aphasias
The pure aphasias include alexia, an inability to read; agraphia, an inability to
write; and word deafness, in which a person cannot hear or repeat words. These
disorders may be quite selective. For example, a person is able to read but not
write or is able to write but not read.

19.5 Localization of Lesions in Aphasia

Beginning students of language are intrigued by the simplicity of the Wernicke–

Geschwind model, where Wernicke’s area is associated with speech compre-

hension, Broca’s area is associated with speech production, and the fibers
connecting them translate meaning into sound (see Figure 19.7). As earlier
sections explain, however, the neural organization of language is more complex
and requires consideration of the brain’s many pathways and anatomical regions
related to language.
Four variables to keep in mind summarize why studying the neural basis of
language is itself so complex:
1. Most of the brain takes part in language in one way or another.
It makes sense that a behavior as comprehensive and complex as lan-
guage would not be the product of some small, circumscribed region of
the brain.
2. Most of the patients who contribute information to studies of
language have had strokes, usually of the middle cerebral artery
(MCA). Figure 19.15A illustrates the location of this artery and its tribu-
taries. Because stroke results from arterial blockage or bleeding, all core
language areas may be damaged or only smaller regions may be damaged,
depending on where stroke occurs. Individual differences in the tributary
pattern of the MCA add to the variation seen in stroke symptoms and out-
comes. The artery supplies subcortical areas as well, including the basal
ganglia, a region that includes the caudate nucleus and is important in lan-
guage (Figure 19.15B).

3. Immediately following stroke, symptoms are generally severe but

improve considerably as time passes. Thus, the symptoms cannot be
easily ascribed to damage in a particular brain region.
4. Aphasia syndromes described as nonfluent (Broca’s) or fluent
(Wernicke’s) consist of numerous varied symptoms, each of which
may have a different neural basis.
Cortical Language Components
In studying a series of stroke patients with language disorders, Nina Dronkers
and her coworkers (1999) correlate different symptoms of nonfluent and fluent
aphasia with specific cortical regions. Their analysis suggests that nonfluent
aphasia consists of at least five kinds of symptoms: apraxia of speech (difficulty
in producing sequences of speech sounds), impairment in sentence comprehen-
sion, recurring utterances, impairment in articulation of sounds, and impair-
ment in working memory for sentences.
Their analysis suggests that the core deficit, apraxia of speech, comes from
damage to the insula. Impairments in sentence comprehension seem to be as-
sociated with damage to the dorsal bank of the superior temporal gyrus and the
middle temporal gyrus; recurring utterances seem to stem from damage to the
arcuate fasciculus; and impairments in working memory and articulation seem
to be associated with damage to ventral frontal cortex.
Concerning fluent aphasia, Dronkers and her colleagues propose that most
of the core difficulties, especially the lack of speech comprehension, come
from damage to the medial temporal lobe and underlying white matter. Dam-
age in this area not only destroys local language regions but also cuts off most
of the occipital, temporal, and parietal regions from the core language region.
The researchers also propose that damage to the temporal cortex contributes to
(A)–
(Plane of
section in part B

Basal
ganglia
Broca’s
area

Wernicke’s area

Insula

Figure 19.15 m
Middle Cerebral Artery
The amount of damage to the
cortex by blockage or bleeding of
the middle cerebral artery (red)
can vary widely in the neocortex
(A) and the basal ganglia (B),
depending on the location of the
blockage or bleeding.

540 Part IV Higher Functions

deficits in holding sentences in memory until they can be repeated. Thus, these
patients appear to have impairment in the “iconic” memory for sounds but are
not impaired in comprehension.
REPORT

-APHASIA- Language Disorder

It usually happens after stroke or a head injury
It can affect any aspect of language which means your speech output what you
understand other people is saying and reading and writing. It all has to do with
language.
This is interesting because even people who use visual language like sign language if
they get APHASIA they will no longer be able to sign. This is because you have centers
in your brain that are language centers.
Im gonna talk about three types of Aphasia that we commonly see. Broca’s Aphasia,
Wernicke’s Aphasia and Global Aphasia.

1. Broca’s Aphasia is considered as nonfluent.

They usually have few words that they say, some people is very severe like they only
say one word for everything like- do, some people get more sounds but its struggled.
Most of what they hear you say were understood. Their comprehension is pretty good.

2. Wernicke’s Aphasia- is kinda opposite its call fluent aphasia

They consistently say several words. Now the interesting thing is it doesn’t mean that its
a speech that you understand. So a lot of the time in Wernicke’s Aphasia. They speak in
jargon or fake words or strings of real words that don’t make any sense.
So they’ll say oh, down the way, I remember, the woman in red, coffee is good.
You won’t know what they actually saying. Some people don’t understand anything that
they hear. There’s a big deficit in comprehension

In
global aphasias, speech is labored and comprehension is poor.Global Aphasia is the most
severe form of aphasia and is applied to patients who can produce few recognizable words and
understand little or no spoken language. 

A person with global aphasia

may only be able to produce
and understand a handful of
words. Often, they can't read
or write.