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。     

几种主要失语综合征的病灶部位和言语障碍特征

类别病灶部位自发言语言语理解口语复述能力物品(人物)命名阅读理解能力书写能力运动性失语优势额下回后部皮质或皮质下不流利、费力部分障碍差部分障碍到完全障碍朗读困难、理解好中等度障碍感觉性失语优势侧颞上回后1/3区域及其周围部分流利、言语错乱完全障碍差部分障碍到完全障碍朗读困难、理解差差,空洞传导性失语优势侧颞叶峡部岛叶皮质下的弓状束和联络纤维流利、言语错乱接近正常很差严重障碍朗读困难、理解差中等度障碍命名性失语优势侧颞、枕、顶结合区流利、空洞正常正常完全障碍稍差或正常轻度障碍经皮质运动性失语优势侧额叶内…     

皮层下失语患者的CT图象标准化及脑电地形图对比研究

选择经颅脑ＣＴ扫描证实为单侧皮层下病变患者６９例，在发病２周，１月及２月分别进行失语症检查，同时，进行ＢＥＡＭ及ＣＴ图象标准化处理。结果显示，在皮层下失语患者病灶多在基底节区偏外侧，偏前部及偏上部。病变偏外侧者及丘脑性失语者脑是地形图异常率高，且多患者多有较重的听理解障碍，而太核受损者失语中有明显的构音障碍及音的障碍。作者讨论了皮层下失语的临床特点，并认为导致失语的机制多与皮层下病变直接或间接影响     

丧动力性失语(附1例报告)

分析1例经CT证实涉及左额叶内侧面运动辅区的脑梗塞的言语障碍。病人在急性期缄默不语,而对言语的理解尚好。起病第26天,口语的表达能力突然得到相当程度的恢复。作者认为,上言语中枢损害后出现的这类言语障碍,是有别于Broca失语等的一类特殊失语,命名为丧动力性失语。     

丘脑梗塞与经皮层性失语症

<正> 丘脑损伤造成失语症文献已有报道,病因多为肿瘤、出血,这些病变因其与占位效应压迫邻近组织难以断定失语的产生是否由丘脑本身损害所致。笔者报告2例局限于丘脑的梗塞造成的经皮层性失语,并结合文献予以讨论 病例资料 例1,男性,61岁,右利。因言语障碍、右侧肢体活动不便3天入院。既往有高血压病史5年。入院查体:Bp20.0/13.3kpa,神清,失语,表现为语量少,说话费力,阅读理解障碍、命名困难,但复述能力相对正常。颈     

原发性进行性失语的临床、影像及语言特征

目的 探讨原发性进行性失语（PPA）的临床、影像及语言特征.方法 PPA患者7例,其中语义性痴呆（SD）6例,进行性非流利性失语（PNFA）1例,收集患者的人口学资料、病史,进行头MRI检查,采用汉语失语成套测验进行语言评估.结果 患者平均发病年龄56岁,均缓慢起病,以语言表达、命名障碍为首发症状.MRI示左侧颞极萎缩为主,病程长的患者左侧额叶和顶叶、右侧颞叶也明显萎缩.语言评估发现所有患者的自发语言、复述、命名、听理解、阅读和书写均不同程度损害.SD患者言语流利,复述、朗读能力下降相对较轻,命名、复杂语句的理解能力损害突出.PNFA言语顿挫吃力,患者列名能力明显下降,但命名相对保存完好.结论 PPA多为老年前期发病,语言障碍为最早、最突出的症状.MRI特征性的改变为额叶和颞极萎缩,左侧为著.其中SD表现为命名性失语和经皮质感觉性失语,PNFA表现为经皮质运动性失语的特征.     

命名性失语与命名障碍16例分析

本文对１６例首发单灶脑病变患者进行了一般命名、颜色命名和失语检查，发现失语患者１０例，另外６例无明显失语。分析结果表明：命名性失语与其它类型失语的命名障碍各有特点，两者为两种不同的概念。一般命名和颜色命名各自有其独立的脑部解剖联系和发生机制，大脑半球不同部位的损害，可产生具有相应特点的命名障碍。     

阿尔茨海默病的语言障碍特点

语言障碍是大脑高级功能障碍的敏感指标之一.阿尔茨海默病（AD）早期即可出现语言功能障碍,随着疾病的进展,在病程的不同阶段有不同的表现.现对AD语言障碍的特点及临床策略作一综述.1 AD患者语言障碍的特点由于大脑皮层及皮层下语言网络结构及其联络纤维广泛受损,导致AD患者出现语言障碍,并有其特殊的模式及演变过程,涉及口语表达、复述、理解、命名、阅读及书写等各个方面.AD的言语障碍与痴呆严重程度呈正相关.国外学者研究认为,AD患者的语言障碍经历以下四个阶段：命名性失语,经皮质感觉性失语,Wernicke失语,完全性失语.早期AD的言语障碍表现更多具备流利性失语的特征.疾病初期表现为以理解障碍为主,属于经皮层感觉性失语,晚期则出现输出障碍.AD的语言障碍临床主要表现为以下几方面：（1）初期在自发言语中,明显的找词困难是AD患者首先表现的语言障碍.关键词：阿尔茨海默病;语言障碍;评估;治疗     

传导性失语复述障碍机制的研究进展

传导性失语以严重的复述障碍、听理解能力相对较好为特点,同时有语音错误及命名障碍。本文从传导性失语的病变部位及关于传导性失语复述障碍机制的经典理论:联系中断学说、中心性失语理论、短时记忆缺损模式及双向分布模式,阐述了传导性失语复述障碍机制的研究进展。     

命名障碍和颜色命名障碍

命名障碍是失语症最常见的关键症状,并见于许多非局灶性脑病;而命名性失语系指命名障碍是唯一或最显著表现的一组失语综合征,两者概念不能混淆.命名障碍可根据不同的表现特点分为五种类型,各种类型有其一定的皮层代表区及相应的脑机能联系.颜色命名障碍为命名障碍的一种特殊类型,其发生机制和脑部病变定位,目前多以联系中断学说来解释.     

Pattern of recovery of oral and written expression and comprehension in aphasic patients

Three hundred and eighty-eight aphasic patients (250 rehabilitated and 138 non-rehabilitated) were subjected to a study whose aim was to analyze the relationship between recovery in 4 specific language skills: oral and written expression and comprehension. By means of Cohen's K coefficient of agreement we sought to ascertain whether recovery of one out of these language skills significantly affected recovery of the remaining 3 language modalities. In rehabilitated patients recovery of oral and written comprehension and expression always turned out to be linked; in non-rehabilitated patients oral comprehension recovery was not associated with recovery of oral expression, reading and writing. Regarding the evolution of aphasia type, none of the experimental subjects changed from a fluent to a non-fluent form of aphasia.     

Modification and standardisation of Arabic version of the Comprehensive Aphasia Test

Background: The Comprehensive Aphasia Test (CAT) is a new standardised test designed to assess a wide range of language functions in participants with acquired aphasia. In its present state, the CAT is not suitable to be used with Arabic-speaking participants due to language, cultural and regional differences.

Aims: The aim of this article is to present a modified and standardised version of the CAT in order to provide a thorough assessment of aphasia among Arabic-speaking aphasic participants and to target intervention towards the disability associated with it.

Methods and Procedures: The CAT was translated into Arabic and some subtests were modified to be socio-culturally suitable to the Egyptian population. The modified CAT was tested on a sample of 100 adult participants with aphasia due to stroke or post-traumatic damage attending the out-patients clinic of the Phoniatric Unit of Ain Shams University Hospitals and the Hearing and Speech Institute. A control group of 50 normal, adult, healthy volunteers was also tested.

Outcomes and Results: Test–retest reliability checks as well as diverse validity checks were undertaken and their findings showed that the modified CAT is psychometrically well constructed and reveals a high degree of reliability and validity.

Conclusions: The modified CAT provides an overview of the linguistic abilities and impairments of an aphasic person through a quick but comprehensive and standardised profile of language performance. Analyses showed the usefulness of the modified CAT battery as a reliable and valid tool for diagnosing aphasia and for targeting therapy towards specific goals.     

Thalamic aphasia associated with mitochondrial encephalopathy,lactic acidosis,and stroke-like episodes: A case report

BackgroundMitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) with aphasia is a rare disorder, with the associated aphasia reported as either Wernicke’s or Broca’s. Herein, we report a patient with MELAS complicated by thalamic aphasia.CaseA 15-year-old right-handed girl presented with headache, nausea, right homonymous hemianopsia, and aphasia. She could repeat words said by others, but had word-finding difficulty, paraphasia, and dysgraphia. Brain MRI revealed abnormal signals from the left occipital lobe to the temporal lobe and left thalamus, but Wernicke’s area and Broca’s area were not involved. Additionally, she had short stature, lactic acidosis, bilateral sensorineural hearing loss, and a maternal family history of diabetes and mild deafness. Based on clinical findings and the presence of a mitochondrial A3243G mutation, she was diagnosed with MELAS. With treatment, the brain MRI lesions disappeared and her symptoms improved. Her aphasia was classified as amnesic aphasia because she could repeat words, despite having word-finding difficulty, paraphasia, and dysgraphia. Based on MRI findings of a left thalamic lesion, we diagnosed her with thalamic aphasia.ConclusionThalamic aphasia may be caused by MELAS. Assessment of whether repetition is preserved is important for classifying aphasia.     

Bilingualism and the severity of poststroke aphasia

Background: Bilingualism has been associated with cognitive benefits in healthy people as well as in patients with cognitive impairment due to stroke and dementia. However, the relationship between bilingualism and aphasia is more complex. While bilinguals are as likely as monolinguals to develop aphasia after stroke, studies of relationship between bilingualism and severity of poststroke language recovery are few and have produced conflicting results, with much evidence derived from immigrant populations or small case series.

Aims: Against this background of limited number of studies, we set out to explore the relationship between bilingualism and severity of language impairment in stroke aphasia. We explored the hypothesis that enhanced cognitive abilities related to bilingualism may have a positive impact on recovery from aphasia.

Methods & Procedures: We investigated 38 bilingual and 27 monolingual patients who participated in a longitudinal hospital-based stroke registry and were evaluated at least 3 months after stroke (mean 11.5 months). Patient performance on language and other cognitive functions was evaluated with Addenbrooke’s Cognitive Examination – Revised (ACE-R) validated for use in aphasia in local languages and for varying educational levels. The results of monolinguals and bilinguals were compared after accounting for confounding variables, including age, gender, education, occupation, medical, and stroke characteristics.

Outcomes & Results: Aphasia severity as measured by the language domain sub-scores (total of language and fluency scores) of ACE-R was significantly higher in monolinguals compared with bilinguals (7.0 vs. 14.4, maximum score 40; p = 0.008, effect size = ?0.691). Bilinguals performed significantly better than their monolingual counterparts in attention, memory, and visuospatial domains of ACE-R. A univariate general linear model analysis showed that bilingualism was significantly associated with higher language domain scores of ACE-R after adjusting for other confounding variables.

Conclusions: The results suggest that although bilingual speakers are at equal risk of developing aphasia after stroke as monolingual ones, their aphasia is likely to be less severe.     

交叉性失语

右利手者右大脑半球病变所致的失语称为交叉性失语。交叉性失语少见。我科八年来共诊断八例（占我组失语症患者２５０例的２．８％），均为男性右利手者，头颅ＣＴ扫描均证实右大脑半球单发病灶，其中脑梗塞７例，脑出血１例。均于发病三个月内作失语检查。其中交叉性Ｂｒｏｃａ失语一例，交叉性传导性失语一例，交叉性Ｗｅｒｎｉｃｋｅ失语一例，交叉性经皮质运动性失语一例，交叉性经皮质感觉性失语三例，交叉性丘脑性失语一例。此８例各型交叉性失语之临床表现与右利手左大脑半球病变产生的各相应类型失语无根本不同。产生交叉性失语是患者的大脑半球语言中枢的逆转所致（不在左侧而在右侧大脑半球的对称部位），它与遗传有关。失语症类型与患者年龄和性别的关系有待进一步研究。     

Thalamic aphasia

Summary Four patients with aphasia due to small circumscribed thalamic lesions are presented. A review of the literature on thalamic aphasia revealed 16 similar cases. While the general consensus that only left-sided thalamic lesions are associated with aphasia is confirmed, analysis of the sites of the thalamic infarctions and the dysphasia elements did not reveal an unequivocal correlation. The explanation of this finding is that (a) disruption of any circuit, whether taking place in the connections or in the nuclei, leads to dysfunction and (b) thalamofrontal connections are not topographically arranged according to the thalamic nuclei, but show a frontal rostrocaudal/thalamic mediolateral interrelationship irrespective of thalamic nuclear masses.     

“Do you have mowing the lawn?” – improvements in word retrieval and grammar following constraint-induced language therapy in primary progressive aphasia

Background: Much recent progress has been made in developing speech–language therapy in primary progressive aphasia (PPA). Several treatment approaches that have shown significant effects with people with aphasia have been adapted and re-evaluated for PPA. Constraint-induced aphasia therapy (CIAT) is a well-evaluated method that has yielded significant language improvements in people with post-stroke aphasia but has not yet been evaluated with people with PPA. Nevertheless, the combination of CIAT features like massed practice and a motivating communicative setting seem likely to make it a suitable tool for improving the speech and language performance of individuals with PPA as well.

Aims: This study investigates the effectiveness of a modified CIAT protocol on word retrieval, grammatical structure and connected speech in two individuals with non-fluent variant PPA (nfvPPA).

Methods and procedures: Two participants with nfvPPA took part in a 9-day intensive CIAT-based group therapy with additional computer-based home training. Stimuli were 120 photos of people performing daily life activities, which could be described using a simple (e.g., “The man is mowing the lawn”) or reduced (e.g., “mowing the lawn”) sentence structure. During the treatment phase, the participants were required to request picture cards from other group members using spoken language only. The task difficulty was increased hierarchically (shaped) in accordance to each participant’s performance level.

Outcomes and results: Directly after therapy, both participants achieved significant improvements in their noun and verb naming accuracy and their grammatical structure for trained items. Training effects were maintained 2 months after therapy. Moreover, generalisation to different pictures of the same item was found for both participants and one participant also showed improved grammatical structure when describing untrained pictures. No significant generalisation to untrained connected speech samples was observed for either participant.

Conclusion: This study illustrates that CIAT can be effective in people with PPA. However, further modifications of CIAT should be considered to facilitate generalisation and in order to determine which aspects of the treatment are most important.     

Primary progressive aphasia in a bilingual speaker: a single-case study

We report on the case of an elderly bilingual woman presenting with a diagnosis of primary progressive aphasia. The participant's native language was Friulian (L1), a predominantly oral Romance language, and her second language was Italian (L2), formally learned at primary school in oral and written forms. We investigated her linguistic abilities by means of the Bilingual Aphasia Test ( . The assessment of bilingual aphasia. Hillsdale, NJ: Lawrence Erlbaum Associates), which is specifically devised for studying language levels and skills in bilingual/polyglot individuals with aphasia. Specifically, we focused on different tasks extracted from the Bilingual Aphasia Test, targeting phonology, morphology, syntax and lexical semantics. Results show that both languages were affected to a clinically significant degree, but with different profiles in terms of linguistic levels, suggesting the presence of greater phonological, morphological, grammatical and syntactic impairments in L2. Results are discussed in terms of possible dissociations both within the language system of each language and between languages, within the Procedural/Declarative theoretical framework of language acquisition in bilinguals.     

Time reference decoupled from tense in agrammatic and fluent aphasia

Background: Reference to an event’s time frame can be accomplished through verb inflection. In agrammatic aphasia, a deficit in past time reference has been identified by Bastiaanse and colleagues (2011). In fluent aphasia, specific problems with this time frame (expressed by the past tense) have been found as well (Dragoy & Bastiaanse, 2013; Jonkers & de Bruin, 2009). However, time reference does not always coincide with tense; in languages such as Dutch and English, reference to the past can be established by using past tense (e.g., “he wrote a letter”) or a present tense auxiliary in combination with a participle, i.e., the present perfect (e.g., “he has written a letter”).

Aims: The goal of this study is twofold. First, it aims to untangle tense problems from problems with past time reference through verb morphology in people with aphasia. Second, this study aims to compare the production of time reference inflection by people with agrammatic and fluent aphasia.

Methods & Procedures: A sentence completion task was used to elicit reference to the non-past and past in Dutch. Reference to the past was tested through (1) a simple verb in past tense and (2) a verb complex with an auxiliary in present tense + participle (the present perfect). Reference to the non-past was tested through a simple verb in present tense. Fourteen agrammatic aphasic speakers, sixteen fluent aphasic speakers, and twenty non-brain-damaged speakers (NBDs) took part in this study. Data were analysed quantitatively and qualitatively.

Outcomes & Results: NBDs scored at ceiling and significantly higher than the aphasic participants. Agrammatic speakers performed worse than fluent speakers, but the pattern of performance in both aphasic groups was similar. Reference to the past through past tense and [present tense auxiliary + participle] was more impaired than reference to the non-past. An error analysis revealed differences between the two groups.

Conclusions: People with agrammatic and fluent aphasia experience problems with expressing reference to the past through verb inflection. This past time reference deficit is irrespective of the tense employed. The error patterns between the two groups reveal different underlying problems.     

Patterns of decline in naming and semantic knowledge in primary progressive aphasia

Background: Individuals with primary progressive aphasia (PPA) and their caregivers want to know what to expect so that they can plan support appropriately. The ability to predict decline in naming and semantic knowledge, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically.

Aims: The aims of this study were to investigate patterns of decline in naming and semantic knowledge in each of the clinical variants of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline.

Methods and Procedures: A total of 94 participants with PPA underwent language testing, including 36 participants with lvPPA, 31 participants with nfaPPA, and 27 participants with svPPA. All participant groups were similar in age and education. We focused on decline on three tests: the short form of the Boston Naming Test (BNT), the Hopkins Assessment of Naming Actions (HANA), and the short form of the Pyramids and Palm Trees Test (PPTT).

Outcome and Results: Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA, followed by svPPA, then lvPPA. Female sex, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline.

Conclusions: PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. Further study of prognostically-relevant variables in PPA is indicated in this population.