非流利型失语症患者命名障碍与语言恢复之间的关系

目的通过对比非流利型失语症患者口语命名障碍与语言功能恢复的关系,探讨非流利型失语症语言功能损伤的环节。为预测失语症的语言功能恢复和失语症的亚分类提供有益的方法。方法选出16例口语图形命名得分相近的非流利型失语症患者,分别进行图形写名、听觉词／图匹配、视觉词／图匹配、听觉图／词核证、视觉图／词核证各项任务检测。2月后根据语言自然恢复程度的不同分为无明显好转组和好转组,比较无明显好转组及好转组上述各项语言命名任务间正确得分有无差异,分析影响语言恢复的机制。所有数据用SPSS13．0软件包处理,检验两项任务间的得分差异用Wilcoxon分析方法,患者间及多项任务间得分差异比较应用KruskabWaUis分析方法。结果语言功能恢复较差的11名患者是源于中心语义系统受损严重,另外4名语言功能恢复较好的患者源于语音输出系统受,两组在听觉词／图匹配、视觉词／图匹配、听觉图／词核证、视觉图／词核证各项任务上得分差异性具有明显统计学意义（P〈0．05）。结论语言损伤环节可能不同：中心语义系统受损者比语音输出系统受损者,语言功能恢复要差,因为语义层高于语音层。     

不同型失语症患者的复述障碍

目的 探讨不同型失语症患者的复述障碍特点。方法 设计8组近音单字词及词的图画,对不同型失语症患者做复述检查。结果 3例传导性失语症患者复述障碍最重,复述错误主要为音位性错语,但大多配画正确;3例经皮质感觉性失语症患者的复述错误中,9个音位性错语及2个词义性错语,大多错语配画正确,但16个复述正确的词配错画;7例经皮质运动性失语症患者中,5例复述和配画全对,另1例口语表达表现为语音障碍,1例在复述中有持续现象。结论 本文三型失语症患者复述障碍的特点不同,揭示其复述障碍各有不同的病理生理机制。     

脑卒中失语症和阿尔茨海默病的语义记忆损害的研究

目的分析脑卒中失语症和阿尔茨海默病的字词理解障碍的特点,探索语言在脑内的加工过程的神经机制和指导言语康复锻炼。方法采用词画匹配的方法,比较脑卒中失语症患者和阿尔茨海默病患者在呈现时间、语义相关性、字词频率、反应一致性4种条件下的字词理解的成绩。结果呈现时间作用、语义相关性作用影响失语症患者的理解成绩。字词频率是决定阿尔茨海默病患者成绩的一个主要因素。反应不一致性是失语症患者的特点,而在阿尔茨海默病患者中没有观察到反应不一致性。结论脑卒中失语症患者的字词理解障碍,是由于对已存贮的语义表象的再现受损;阿尔茨海默病患者的字词理解障碍,系由于已存贮的语义表象本身缺陷。     

语义范畴特异性损伤原因探索：物体可操作性的作用

目的 探讨物体可操作性在语义范畴特异性损伤中的作用。方法 考察1例脑外伤患者在真假物体判断、图片命名、词图匹配、根据定义命名、属性判断、词语关联匹配等任务上生物范畴与非生物范畴分离的模式,并利用逻辑回归考察可操作性指标在范畴分离中的作用。结果 该例患者表现为生物范畴特异性损伤,即在图片命名、词图匹配、根据定义命名和属性判断等任务上非生物范畴项目成绩显著好于生物范畴项目。逻辑回归发现范畴这一变量可预测命名成绩,但加入可操作性指标后,可操作性指标取代范畴成为预测该例患者命名成绩的显著因素。结论 该例患者表现出的非生物范畴成绩好于生物范畴,可能是由于其操作知识的保留在语义水平上支持着非生物范畴概念的表征所导致的。     

脑卒中后基底节性失语的特点

目的探讨脑卒中后基底核性失语的特点。方法选择急性期单侧皮层下脑卒中后基底核性失语患者29例,行失语症检查,分析其语言学特征。结果基底节性失语有较重的听理解障碍及书写能力的受损,其中理解中度障碍18例(62%);重度障碍11例(38%);书写障碍以描写障碍突出,重度障碍25例(86%);复述相对较好,轻中度障碍24例(83%)。23例(79%)出现语音障碍,包括音韵及音律障碍。8例患者出现言语失用。基底神经节性失语多为轻至中度语言表达障碍,表现为语言减少,口语流畅性差,说话缓慢、费力,启动难,词与词之间缺乏连惯性,词汇单调,理解障碍相对较轻,可有找词困难(说不出恰当词),偶有错语,但复述正常或相对正常。结论基底节性失语在脑卒中后较为常见,其类型复杂,几乎包括所有失语类型,表现为较重的听理解障碍及书写能力的受损,书写障碍以描写障碍突出;复述相对较好;多数患者出现语音障碍,口语流畅性差;言语失用常见;命名障碍较常见。     

非流利型失语患者汉语反身代词指称理解障碍浅析

目的通过对比人称代词和反身代词在句子中指称理解受损表现的差异,分析汉语非流利型失语症患者反身代词指称理解障碍的特点,用以指导康复治疗。方法采用北京医科大学汉语失语症标准化检查法,将诊断为非流利型失语症的患者作为测试对象。设计相应（ABCDE型）句子,A型句和C型句含人称代词,B型句和D型句将人称代词替换汉语反身代词。通过听句子-配正确图和听句子-配错误图进行上述句子测试,把被试者测试的分数进行统计分析。结果10例失语症患者听句子-配图理解得分数明显低于对照组;失语症患者在听句子-配正确图理解所得分数中B型句组低于A型句组（P〈0.05）;D型句组低于C型句组（P〈0.05）。结论汉语失语症患者的反身代词的指称受损伤程度相对于人称代词的指称受损伤程度较重,含反身代词的句子理解和加工过程具有独特性。     

阿尔兹海默病患者语义记忆障碍特征性研究

目的 探讨阿尔兹海默病(Alzheimer's disease, AD)患者语义记忆障碍的特点,揭示语义知识在大脑中组织的性质。方法 对43例AD患者及28例正常对照者进行一般认知功能测评和语义记忆评估。语义记忆评估选用常见的有生命类及无生命类物体,进行口头图片命名、口头声音命名、图片关联匹配、词语关联匹配测试。统计每一例被试对物体名称和物体语义关联匹配的正确比例,对数据进行群组分析和个体分析。结果 与正常对照组相比,AD组对有生命物体和无生命物体的名称及语义关联匹配均有损伤。10例患者在有生命物体的语义任务上的成绩显著差于在无生命物体的语义任务上的成绩,而另外6例患者在无生命物体的语义任务上的成绩显著差于在有生命物体的语义任务上的成绩。结论 AD患者存在语义记忆障碍,部分AD患者可出现语义范畴特异性损伤,且可出现语义障碍的范畴双分离现象。这表明有生命物体和无生命物体范畴在大脑内相对独立表征,与大脑中语义知识的分布式表征理论一致。     

非流利型失语患者对汉语句子理解的句法和语义加工研究

目的利用汉语非流利型失语患者对汉语句子理解中句法和语义加工机制进行研究,来进一步探讨句子理解的理论,并为患者的语言康复治疗提供指导。方法选取2组被试为研究对象,即20例汉语非流利型失语患者(病例组)以及20例正常受试者(对照组),分别进行探测词是否为施事任务、"把"字句判断任务、语义可逆的句图匹配任务及短时记忆检测,比较2组受试者各项得分情况,分析两组被试表现上的差异。结果探测词是否为施事任务中病例组和对照组可逆osv词序、可逆svo词序之间有明显统计学差异(P0.05),而病例组和对照组不可逆osv词序、不可逆svo词序之间无明显统计学差异(P0.05)。失语患者在完成句子判断任务时句法违反和语义违反两种错误的判断的错误率无明显统计学差异(P0.05)。在句图匹配任务中失语患者对svo词序和"把"字句完成得较好,而对"被"字句和osv词序完成得较差,svo词序和"把"字句完成的错误率两者之间无明显统计学差异(P0.05),osv词序和"被"字句两者之间无明显统计学差异(P0.05);在短时记忆检测中病例组与对照组有明显统计学差异(P0.05)。结论 (1)非流利型失语患者出现了句法加工和语义加工的分离,实验支持句法自主理论;(2)支持句子的理解是一个可分离的阶段的理论。非流利型失语患者的句子理解障碍不能简单地归因于功能词加工障碍,句子理解障碍的原因可能是句法整合的障碍即句子理解的阶段三出现了障碍。     

纯词哑临床分析——附2例报告

报道2例纯词哑，临床表现以口语表达障碍为主要特点。起病时甚至听不清患者说的内容。但复述和命名时的发音比自发谈话好。听理解、阅读和书写正常。CT示厅侧侧脑室旁小梗塞灶。一年后复查，口语表达障碍是遗留的唯一临床症状，并对其临床与解剖关系加以详细讨论。     

失语患者听理解中的特殊范畴语义障碍

目的：探讨失语患者听理解中特殊范畴语义障碍的特点。方法：（1）用汉语失语检查法（ABC）检查42例卒中后失语患者，其中，Broca失语（BA）8例，Wernicke失语9WA）5例，传导性失语（CA）11例，经皮质运动性失语（TCM）8例，经皮质感觉性失语（TCS）7例，命名性失语（AA）3例；（2）分别统计各型失语患者ABC中听辨认9项的得分，并用SPSS软件处理数据。结果：（1）BA、TCM和AA患者听辨认9项间差异无显著性意义（P＞0．05）。（2）WA、CA、TCS患者对9个项目的听辨认存在不同程度困难；物品和动作听理解障碍的程度较轻，而颜色和（或）身体部位的听理解障碍较重。差异有显著意义的（P＜0．05）是：WA患者在物品（M＝4分）、物品图（M＝6分）、动作图（M＝4分）与颜色（M＝0）分、家具（M＝0分）及身体部位（高、低频和左／右）（M＝2，0，0分）间，几何图（M＝2分）与物品图及身体部位（低频）间；CA患者在物品（M＝10分）、物品图（M＝10分）、动作图（M＝10分）与身体部位（高、低频和左／右）（M＝9，8，4分）间，几何图（M＝9分）与物品图间，颜色（M＝10分）、家具（M＝10分）与身体部位（低频）间；TCS患者在物品（M＝10分）与家具（M＝5分）和身体部位（低频）（M＝6分）间，动作图（M＝10分）、家具和身体部位（低频）间。结论：（1）失语患者听理解中特殊范畴语义障碍主要见于有明显听理解障碍者，（2）不同型失语患者的听辨认中有相似的特殊范畴语义障碍。     

When a rose is a rose in speech but a tulip in writing.

We report the pattern of performance on language tasks by a neurologically impaired patient, RCM, who makes semantic errors in writing to dictation and in written naming, but makes very few errors at all (and no semantic errors) in spoken naming, oral reading, or spontaneous speech. RCM also shows a significant effect of concreteness on spelling accuracy and other features of so-called "deep dysgraphia." However, it is shown that, unlike previously reported patients described as deep dysgraphic, RCM has intact semantic processing but impairment in accessing lexical-orthographic representations, at least for the items tested. These results demonstrate that the collection of features labelled as "deep dysgraphia" can arise from damage to different cognitive processes. Detailed analyses of RCM's performance across lexical tasks, at two different time periods of recovery, provide evidence that lexical orthographic representations can be either directly activated by lexical semantic representations, or activated by the interaction of lexical semantic and sublexical information from phonology-to-orthography conversion mechanisms.     

Where do semantic errors come from?

We report the performance of two brain-damaged subjects (RGB and HW) whose frequent errors in spoken production are nearly always semantically related to the target word. Both subjects show similar, high rates of these "semantic" errors in oral naming and oral reading; yet neither subject makes semantic errors in comparable written tasks. Further, results of a variety of lexical tasks with the same stimuli demonstrate unimpaired comprehension of printed or spoken words, including those that are orally produced as semantic errors. These patterns of performance are interpreted as resulting from damage to the phonological output lexicon. The postulated deficit is contrasted to the hypothesis of impairment to the lexical-semantic component, required to explain performance by brain-damaged subjects described elsewhere who make seemingly identical types of oral production errors to those of RGB and HW, but, in addition, make comparable errors in writing and comprehension tasks.     

Modality-specific deterioration in naming verbs in nonfluent primary progressive aphasia

A longitudinal study of oral and written naming and comprehension of nouns and verbs in an individual (M. M. L.) with nonfluent primary progressive aphasia (PPA) is reported. M. M. L. showed progressive deterioration of oral naming of verbs well before deterioration of written naming of verbs and before deterioration of oral or written naming of nouns. Her comprehension of both nouns and verbs remained intact, at least relative to oral naming of verbs. Her performance is compared to that of two other individuals with nonfluent PPA, who were tested at two time points. These patients showed similar patterns with respect to grammatical word class (verbs more impaired than nouns) and modality (spoken production more impaired than written production), but somewhat different courses of deterioration. The modality-specific nature of the observed verb production deficits rules out a semantic locus for the grammatical class effects. The results provide a new source of evidence for the hypothesis that there are distinct neural mechanisms for accessing lexical representations of nouns and verbs in language production.     

Case Study Impairment to phonological processes in a Cantonese‐speaking brain‐damaged patient

Background: Previous studies have shown that brain‐damaged patients with selective deficits to phonological processes produced frequent phonological errors and similar error patterns in all spoken tasks, exhibited the effects of word frequency, grammatical class, and imageability, and were unable to make rhyming judgements, due to impaired lexical retrieval and/or phonological representations. Aims: This paper describes a Cantonese‐speaking brain‐damaged patient, LKK, whose performance patterns in spoken tasks indicate impairment to both the lexically mediated non‐semantic and semantic pathways of oral production, as well as the phonological output buffer. Methods & Procedures: A range of tasks was conducted including repetition, reading aloud, oral naming, written/spoken word–picture matching, non‐verbal semantic tests, written lexical decision, and homophone judgements. Outcomes & Results: LKK performed normally on written lexical decision, word–picture matching, and non‐verbal semantic tests, but he was unable to make homophone judgements and showed impaired production in all oral tasks. He was better able to read aloud names of objects than to name them. He also made more semantic errors in naming than reading. His accuracy in reading single words was affected by word frequency and form class. Further observations of his oral production included better (but nevertheless impaired) performance on repetition than reading and naming, a consistent effect of word length across tasks, and a tendency for phonological errors to occur on the coda compared with the onset. Conclusions: There was sufficient evidence for deficits of the phonological lexicon and/or the access to it along the non‐semantic route and the semantic pathway at the post‐semantic level in LKK. The effect of word length and comparable patterns of error distribution across spoken tasks suggested additional impairment to the phonological output buffer. The different levels of accuracy in repetition, reading, and naming, as well as the differential rates of semantic errors in these tasks were consistent with predictions of the summation hypothesis.     

The Relationship Between Type of Naming Error and Semantic-Lexical Discrimination in aphasic Patients

When submitted to confrontation naming tasks, aphasic patients show different types of naming errors: phonetic, phonemic and verbal-semantic paraphasias, neologisms and anomia, but it is generally difficult to decide whether these errors are mainly due to a breakdown of the semantic systems or to post-lexical phonological disorders. In order to clarify this issue, 118 aphasic patients were given 3 tests of confrontation naming and 3 tests of semantic-lexical discrimination. Naming errors on confrontation were used to classify aphasic patients in various subgroups (according to the prevalence of a given type of naming error), whereas performances obtained on tests of semantic-lexical discrimination were taken as an index of disorganization of the semantic systems. The performances on semantic discrimination tests of patients showing a prevalence of phonetic, phonemic and verbalsemantic paraphasias, neologisms and anomia on confrontation naming tasks were compared. a very small number of semantic discrimination errors was obtained by patients showing a prevalence of phonetic or phonemic transformations on confrontation, whereas a much larger number of semantic discrimination errors was obtained by patients showing a prevalence of verbal-semantic paraphasias, neologisms and anomia.     

No right to speak? The relationship between object naming and semantic impairment: neuropsychological evidence and a computational model

The processes required for object naming were addressed in a study of patients with semantic dementia (a selective decline of semantic memory resulting from progressive temporal lobe atrophy) and in a computational model of single-word production. Although all patients with semantic dementia are impaired in both single-word production and comprehension, previous reports had indicated two different patterns: (a) a parallel decline in accuracy of naming and comprehension, with frequent semantic naming errors, suggesting a purely semantic basis for the anomia and (b) a dramatic progressive anomia without commensurate decline in comprehension, which might suggest a mainly postsemantic source of the anomia. Longitudinal data for 16 patients with semantic dementia reflected these two profiles, but with the following additional important specifications: (1) despite a few relatively extreme versions of one or other profile, the full set of cases formed a continuum in the extent of anomia for a given degree of degraded comprehension; (2) the degree of disparity between these two abilities was associated with relative asymmetry in laterality of atrophy: a parallel decline in the two measures characterized patients with greater right- than left-temporal atrophy, while disproportionate anomia occurred with a predominance of atrophy in the left-temporal lobe. In an implemented computational model of naming, semantic representations were distributed across simulated left- and right-temporal regions, but the semantic units on the left were more strongly connected to left-lateralized phonological representations. Asymmetric damage to semantic units reproduced the longitudinal patient profiles of naming relative to comprehension, plus additional characteristics of the patients' naming performance. On the basis of both the neuropsychological and computational evidence, we propose that semantic impairment alone can account for the full range of word production deficits described here.     

The semantic deficit in aphasia: the relationship between semantic errors in auditory comprehension and picture naming

Thirty aphasic subjects were asked to point to pictures on auditory command both when the distractors came from the same semantic category as the target and when the distractors were unrelated to the target picture. The aphasics made significantly more semantic errors than non-aphasic brain-damaged controls; the incidence of semantic comprehension errors was unrelated to aphasic diagnostic groups but was related to the overall severity of aphasia. The subjects were subsequently asked to name the pictures from the comprehension task; pictures that had elicited semantic errors in comprehension were no less likely to be named than those that had not, but the incidence of semantic errors in comprehension correlated significantly with their incidence in naming. The implications of a semantic deficit common to both auditory comprehension and naming that is not specific to particular lexical items is discussed in relation to a number of information processing models of the lexicon.     

Anomic alexia of kanji in a patient with anomic aphasia

The ability to read aloud kanji (logogram) words and to comprehend their meaning was systematically examined to clarify the underlying mechanism of kanji alexia in a patient with anomic aphasia. Confrontation naming, reading aloud and reading comprehension tasks were performed using 110 words from 11 semantic categories written in kanji or kana. Performance in oral reading of kanji words was significantly worse than oral reading of the same words transcribed into kana words. In addition, for kanji words reading aloud was much worse than reading comprehension. Oral reading of kanji words had a significant correlation with naming pictures corresponding to the words, but no correlation with comprehension of kanji words. Qualitative analyses demonstrated that errors in oral reading and naming tasks had many features in common. Our results indicated that some common mechanisms underlie both naming and oral reading of kanji words. We propose calling this type of alexia "anomic alexia of kanji", which should be distinguished from kanji alexia with difficulty in both reading aloud and comprehension. Lesions in our patient were located in the middle part of the left middle temporal gyrus and its subcortical area, which could be important for access to the phonological lexicon from semantics.     

Repetition priming of picture naming in semantic aphasia: The impact of intervening items

Background: We present an experiment that explores the nature of repetition priming of picture naming in a group of semantic stroke aphasic patients. The study was designed to extend previous investigations of repetition priming effects among other stroke aphasic patients and patients with semantic dementia. This work builds on previous work with semantic aphasic patients that shows enhanced picture-naming performance due to correct phonemic cues.

Aims: To assess the extent to which semantic control deficits observed during semantic aphasic patients' picture naming are resolved by prior exposure to an identical stimulus, and to determine the optimal lag between prime and target to maximise naming success.

Methods & Procedures: The procedure was carried out with five stroke patients who had all failed verbal and picture versions of tests of semantic association, revealing difficulties with manipulation of semantic information, and their performance was compared to five age- and education-matched controls. A total of 180 pictures to be named were presented individually on a computer screen in two sessions at least a week apart, with half preceded by an identical item in session one and the other half preceded by an identical item in session two. Three lags (0, 1, and 7 items intervening) were embedded in the pseudo-random structure such that it was unpredictable whether the next trial would be a repeat or not.

Outcomes & Results: Considerable repetition priming was observed in this semantic aphasic patient group, bringing their performance up to control level at lag 0. Priming with a very short lag between prime and target (0–1 item) significantly reduced latency. Accuracy was significantly increased and semantic errors decreased with up to seven intervening items. Controls also benefited from repetition priming, but showed little variation in latency, accuracy or errors over this range of short lags.

Conclusions: For patients with problems manipulating semantic information, repetition priming was an effective way to boost naming performance, although increasing the number of intervening items had a progressively detrimental effect. The observed repetition priming effects are interpreted within a connectionist model of speech production.     

Where (in the brain) do semantic errors come from?

Background

Semantic errors result from the disruption of access either to semantics or to lexical representations. One way to determine the origins of these errors is to evaluate comprehension of words that elicit semantic errors in naming. We hypothesized that in acute stroke there are different brain regions where dysfunction results in semantic errors in both naming and comprehension versus those with semantic errors in oral naming alone.

Methods

A consecutive series of 196 patients with acute left hemispheric stroke who met inclusion criteria were evaluated with oral naming and spoken word/picture verification tasks and magnetic resonance imaging within 48 h of stroke onset. We evaluated the relationship between tissue dysfunction in 10 pre-specified Brodmann's areas (BA) and the production of coordinate semantic errors resulting from (1) semantic deficits or (2) lexical access deficits.

Results

Semantic errors arising from semantic deficits were most associated with tissue dysfunction/infarct of left BA 22. Semantic errors resulting from lexical access deficits were associated with hypoperfusion/infarct of left BA 37.

Conclusion

Our study shows that semantic errors arising from damage to distinct cognitive processes reflect dysfunction of different brain regions.