汉语失语症患者主语问句和宾语问句理解和表达障碍的特点

目的观察汉语失语症患者疑问句理解和表达障碍的特点，探讨其理解及表达障碍的机制，为失语症患者的诊断及康复训练方法提供依据。方法根据《汉语语法量表》选择10例失语法性失语症患者作为失语法性失语组（简称失语法组），选择14例非失语法性失语症患者作为非失语法性失语组（简称非失语法组），另外选取24例正常人作为正常对照组。用经过设计的主语问句和宾语问句（各20句）对患者进行理解能力和表达能力的测试。结果失语法组患者两种疑问句的理解正确率间差异无统计学意义（P〉0．05），失语法组患者两种疑问句的表达正确率间差异有统计学意义（P〈0．05）；失语法组患者对两种疑问句的理解能力和表达能力明显低于非失语法组患者和对照组（P〈0．05）。结论汉语失语法性失语症患者对疑问句的理解和表达障碍有其自身特点，可能为以后失语患者康复计划的制定及预后判断提供有用资料。     

传导性失误的临床与机制研究

目的：探讨传导性失语的临床特点、机制与病灶部位的对应关系。方法：应用北京医科大学第一医院神经教研室高素荣教授编制的汉语失语检查法对8例脑梗死或脑出血引起的传导性失语患者进行失语检查、评测。按照Senson分类法做失语分类。结果：本文8例患者口语为流利型或中间型,理解障碍轻而复述明显困难,伴命名、书写、阅读障碍,意向性运动性失用1例,符合传导性失语的诊断。O证明病灶部位4例病灶位于预叶及皮层下,其中累及颞叶4例。结论：传导性失语理解障碍的程度与病变是否波及颞叶（即wernicke区）有关,复述困难与听感知障碍有相关性,可因听感知缺陷引起。大多患者的病灶位于顶叶缘上回及皮质下,是传导性失语的常见部位,支持联系中断学说。     

不同失语类型的命名障碍

目的探讨不同类型失语患者的视命名问题。方法采用汉语失语检查法（ＡＢＣ法），对５０例因脑梗塞、脑出血、脑外伤引起的不同类型失语患者进行了５项视命名检查。结果动作命名成绩与少用物命名成绩比较差异有显著意义。动作命名平均成绩高于常用物命名、身体部位命名及颜色命名成绩。结论失语患者在接受５项视命名检查中，动作命名较容易，推测动作命名在大脑内的神经网络基础可能比较广泛。     

汉语语法量表及其信度和效度研究

目的 设计一套汉语语法检查量表(Chinese Agrammatism Rattery,CAB)并测试其信度和效度。方法 对46名脑部疾病患者及46例健康受试者进行了CAB测试，计算失语法指数(agrammatism quotient,AgQ)，并与汉语标准化失语检查法(aphasia battery of Chinese,ABC)对比。计算检查者问、检查者内及复测相关系数。结果 左、右大脑半球病变组及对照组CAB各亚项量表分的平均数差异极显著(F＝4．50-18．57，P＜0．05)。左大脑半球病变组各个亚项量表分平均成绩均明显低于右大脑半球病变组(q＝5．63-9．67，P＜0．05)与健康对照组(q＝7．50-9．61，P＜0．01)。量表的复测信度、检查者间信度、检查者内信度均较好(r＝0．991-0．999，P＜0．01)。CAB法的AgQ与ABC比法各指标间呈显著正相关(r＝0．928-0．979，P＜0．01)。结论 CAB具备较好的信度和效度，可以作为定量评定汉语失语症患者语法障碍的工具。     

传导性失语四例报告

本文首次报道广州话传导性失语（conduction aphasia）四例，均为右利手、其中一例交叉性传导性失语，四例表现与国内外报道基本相符，口语为流利型，有大量音素错语，有明显复述障碍及理解相对好。全部患者有复杂句理解障碍。一例双语失语者两话表达均极差，但能较好保存其互译功能，互诱出正确发音及语句，其广州话朗读理解比普通话朗读理解差。病灶部位，一例主要位于有岛叶，一例为左颞顶枕皮质区，余二例位于左顶叶。     

卒中后失语患者非语言认知功能损害特点的临床研究

目的 探讨卒中后失语患者非语言认知功能损害的特点，并分析卒中后失语患者语言障碍与非语言 性认知功能损害之间的关系。 方法 选择2017年5月-2018年6月就诊的卒中患者共32例，经西方失语症成套测验（western aphasia battery，WAB）评估语言功能，分为失语组和无失语组，其中失语组15例，无失语组17例。洛文斯顿成 套测验中文版（Loewenstein occupational therapy cognitive assessment，LOTCA）第2版评估患者非语言认 知功能。对失语组与非失语组的LOTCA各分项分值及总分分别进行非参数检验；对WAB中各分项得 分及失语商与LOTCA各认知分项得分及总分进行偏相关分析，并行多元逐步回归分析。 结果 失语组的LOTCA总分低于无失语组，差异有统计学意义[85.0（69.0～92.0）分 vs 99.0 （86.0～102.5）分，P <0.05]；失语患者LOTCA总分与WAB各分项及失语商呈正相关（r =0.587～0.883， 均P <0.05），WAB分项中的各分项与LOTCA中各分项之间呈正相关（r =0.521～0.843，均P <0.05）；多 元逐步回归分析显示，影响患者失语商的主要因素为LOTCA总分（β=0.707，P =0.003）。 结论 卒中后失语患者存在非语言认知功能障碍，失语程度越重其非语言认知功能受损程度越重。     

卒中后失语症类型及其影响因素分析

目的 通过探讨性别、年龄、病变部位及卒中病因等与失语症类型之间的关系，探索影响卒中后失
语类型的因素。
方法 回顾性分析2004年1月-2018年12月于首都医科大学附属北京天坛医院就诊、因语言障碍进行
西部失语成套测验（western aphasia battery，WAB）的卒中后失语症患者临床资料。分析失语症类型与
性别、年龄、卒中类型、卒中病因及发病机制之间的关系。
结果 共纳入失语症患者681例，按照失语症类型分为完全性失语（global aphasia，GA）（n =185）、
运动性失语（broca’s aphasia，BA）（n =148）、经皮质混合性失语（mixed transcortical aphasia，MTCA）
（n =30）、经皮质运动性失语（transcortical motor aphasia，TCMA）（n =67）、感觉性失语（werni cke’s
aphasia，WA）（n =69）、经皮质感觉性失语（transcortical sensor aphasia，TCSA）（n =21）、传导性失
语（conduction aphasia，CA）（n =32）和命名性失语（anomic aphasia，NA）（n =129）。将患者分为青年组
（18～44岁）、中年组（45～59岁）、老年组（≥60岁），校正其他因素影响后，三组人群间失语症类型
无统计学差异。男性和女性患者的失语症类型也无统计学差异。各类型失语症患者的病变部位具有
异质性，除合并经典语言区损伤外，还可合并左侧基底节及丘脑损伤。在脑出血所致的各类型失语
症患者中，最常见的病因均为高血压（77.8%～100.0%）。脑梗死后GA患者中，最常见的卒中发病机制
是混合型（42.4%）和动脉-动脉栓塞（27.3%），而BA、WA及CA患者以动脉-动脉栓塞（分别占51.5%，
71.4%和40.0%）最常见，TCMA、TCSA及NA以低灌注/栓子清除能力下降（分别占65.9%，58.3%和
38.4%）最常见。
结论 年龄及性别对失语症类型均无明显影响。男性和女性患者均以GA、BA和NA最为常见。病变
部位对失语症类型具有重要影响，卒中病因及发病机制对失语症类型的影响可能与特定血管及血管
供血区损伤有关。     

失语（Aphasia）

一、概述：失语是大脑语言特区病损造成的语言理解和陈述表达的紊乱，其实质是语言和思维二者双向转译机制的崩溃和中断。失语不是知觉疾患，如耳聋；也不是运动疾患，如发音器有失调造成的发音障碍和语音的扭曲，这种增况称之为构语障碍或呐吃（dysarthria）·不应误称为失语；失语更不是思维基本过程的紊乱，如精神分裂患者其语言机制保持完全，能十分有效表达其扭曲的思维过程．失语不只影响以听觉信号为基础的说听语言，也影响以视觉一运动符号为基础的符号语言（signlanpog6s）。失语故可见及解释文字书写密码。此外，失用还可累及语言…     

传导性失语四例报告

本文首次报道广州话传导性失语（ｃｏｎｄｕｃｔｉｏｎａｐｈａｓｉａ）四例。均为右利手、其中一例为交叉性传导性失语。四例表现与国内外报道基本相符。口语为流利型，有大量音素错语、有明显复述障碍及理解相对好。全部患者有复杂句理解障碍。一例双语失语者两话表达均极差，但能较好保存其互译功能，互诱出正确发音及语句。其广州话朗读理解比普通话朗读理解差。病灶部位：一例主要位于右岛叶，一例为左颞顶枕皮质区，余二例位于左顶叶。     

卒中后失语症类型及其影响因素分析

目的 通过探讨性别、年龄、病变部位及卒中病因等与失语症类型之间的关系,探索影响卒中后失 语类型的因素。 方法 回顾性分析2004年1月-2018年12月于首都医科大学附属北京天坛医院就诊、因语言障碍进行 西部失语成套测验（western aphasia battery,WAB）的卒中后失语症患者临床资料。分析失语症类型与 性别、年龄、卒中类型、卒中病因及发病机制之间的关系。 结果 共纳入失语症患者681例,按照失语症类型分为完全性失语（global aphasia,GA）（n =185）、 运动性失语（broca’s aphasia,BA）（n =148）、经皮质混合性失语（mixed transcortical aphasia,MTCA） （n =30）、经皮质运动性失语（transcortical motor aphasia,TCMA）（n =67）、感觉性失语（werni cke’s aphasia,WA）（n =69）、经皮质感觉性失语（transcortical sensor aphasia,TCSA）（n =21）、传导性失 语（conduction aphasia,CA）（n =32）和命名性失语（anomic aphasia,NA）（n =129）。将患者分为青年组 （18～44岁）、中年组（45～59岁）、老年组（≥60岁）,校正其他因素影响后,三组人群间失语症类型 无统计学差异。男性和女性患者的失语症类型也无统计学差异。各类型失语症患者的病变部位具有 异质性,除合并经典语言区损伤外,还可合并左侧基底节及丘脑损伤。在脑出血所致的各类型失语 症患者中,最常见的病因均为高血压（77.8%～100.0%）。脑梗死后GA患者中,最常见的卒中发病机制 是混合型（42.4%）和动脉-动脉栓塞（27.3%）,而BA、WA及CA患者以动脉-动脉栓塞（分别占51.5%, 71.4%和40.0%）最常见,TCMA、TCSA及NA以低灌注/栓子清除能力下降（分别占65.9%,58.3%和 38.4%）最常见。 结论 年龄及性别对失语症类型均无明显影响。男性和女性患者均以GA、BA和NA最为常见。病变 部位对失语症类型具有重要影响,卒中病因及发病机制对失语症类型的影响可能与特定血管及血管 供血区损伤有关。     

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。     

Transcortical sensory aphasia: Dissociation between naming and comprehension

Abstract

Although anomia in transcortical sensory aphasia (TSA) is usually described as a semantically based deficit (naming and recognition are equally affected), dissociations in naming performance have occasionally been reported. We report a two-part study: in Study 1 the pattern of preserved and impaired language abilities was examined in five patients with TSA and intact object naming; in Study 2 the neural mechanism(s) underlying preserved visual confrontation naming in TSA was examined. Demographic factors, severity of language deficits, lesion volume and location, and cerebral asymmetries of patients with TSA and intact naming (TSA-intact) (n = 6) were compared with those of patients with TSA and impaired naming (TSA-impaired) (n = 6), anomic aphasia (Anomia) (n = 6), and left hemisphere damage without aphasia (Control). The results of Study 1 revealed that all five patients had a relative preservation of oral production (spontaneous speech, repetition, naming and reading aloud), but impaired auditory and written (sentence-level) comprehension. Object/picture naming was significantly better than auditory comprehension of the same targets, and naming was also preserved in tactile and auditory (verbal definitions and non-verbal sounds) modalites, but written naming was impaired. In four patients oral reading showed a pattern of phonological dyslexia. The results of Study 2 failed to demonstrate significant differences between the groups with preserved naming (TSA-intact and control) and those with impaired naming (TSA-impaired and anomia) in non-language variables that might explain the selective preservation or impairment of naming. These results are discussed in terms of the functional and anatomical independence of the neural systems responsible for object naming and comprehension.     

Transcortical sensory aphasia due to extensive infarction of left cerebral hemisphere]

We report a case of transcortical sensory aphasia occurred after extensive infarction of left cerebral hemisphere. A 68-year-old, right-handed man with atrial fibrillation suddenly developed cerebral embolism of left middle cerebral artery. He was treated conservatively, and the right hemiplegia, aphasia, apraxia in a slight degree and right hemispatial neglect in a slight degree consequently existed. MRI showed a large cortical and subcortical infarct lesion including the left Broca's area, central region, perisylvian area with Wernicke's area and temporal lobe. In contrast, neuropsychological evaluation using the Western Aphasia Battery (WAB) demonstrated transcortical sensory aphasia, e.g., fluency 8, auditory comprehension 1. repetition 10 and object naming 2.4. In addition to preserved repetition, both linguistic prosody and affective prosody were well preserved. Most cases with transcortical sensory aphasia are known to occur with the lesion including temporo-parieto-occipital junction of dominant hemisphere. Our patient and a few other reported cases of transcortical sensory aphasia had a lesion in perisylvian area including Wernicke's area. Therefore, it is possible that their minor hemisphere worked selectively for repetition. Furthermore, we suggest that this patient presented dissociative aphasia that all the process of repetition and the function of linguistic and emotional prosody were represented in the right hemisphere and the other functions including comprehension of word meanings were existed in the left hemisphere. We believe that our case of transcortical sensory aphasia with dissociative aphasia gives a suggestion about the mechanism and localization of repetition and prosody in the whole system of language.     

Gesture recognition in aphasia

abstract

to study the relationship between verbal and nonverbal behaviour in aphasia, a Gesture Recognition Test (GRT) was given to 111 aphasic patients and to 48 normal controls (NC). Forty-eight aphasics were impaired on the GRT. Global, Wernicke's and Transcortical aphasìcs performed worse than Broca's, Conduction and Anomic aphasics, whose scores did not differ from those of NC. Although a moderate to strong correlation was found between GRT and auditory comprehension performances, type of aphasia had an effect on gesture recognition that was independent of the severity of auditory comprehension impairment. This may reflect the major role played by posterior left-hemispheric areas in the identification of gestures. GRT impairment was associated with reading defects only in patients with central alexia. A strong correlation was found with constructional apraxia, suggesting that these two nonverbal tasks share common neural mechanisms. The weak association between gesture recognition impairment and ideomotor apraxia supports an independence between “receptive” and “expressive” aspects of gestural communication.     

"Transcortical" features of aphasia following left thalamic hemorrhage.

In a series of 14 thalamic hemorrhage documented by Computerized Axial Tomography (CT) scans, aphasia was present in seven out of eight patients with left lesions while it was absent in the six patients with right lesions. In three cases where detailed language testing was performed, aphasia was characterized by reduction of spontaneous speech with semantic paraphasias, preserved repetition and partially defective auditory verbal comprehension. The language disturbance was persistent in two patients, while it recovered spontaneously within four weeks in one patient. The clinical picture in these patients is similar to the classical "transcortical" aphasias, which are usually due to damage of the marginal language areas. It is suggested that the left thalamus contributes to the semantic level of verbal behavior, which is possibly subserved by these areas.     

Auditory vocabulary of the right hemisphere following brain bisection or hemidecortication.

Unilateral scores of two commissurotomy and three (one left and two right) hemispherectomy patients were obtained on standardized auditory language comprehension tests which use pointing responses to a pictorial array. Unilateral performance by the commissurotomy patients was achieved by restricting the pictorial array to one visual half field, using a novel contact lens system which permits ocular scanning of the lateralized stimulus and self-monitoring of task performance. Using the Peabody and Ammons Picture Vocabulary Tests, the auditory vocabulary in the disconnected or isolated right hemispheres was found to be equivalent to that of normal subjects of ages 8:1 to 16:3 with a mean of 11:7 (eleven years and 7 months old). At the same time, standardized aphasia tests showed that the picture vocabulary in the right hemispheres is similar to that of a heterogeneous population of aphasics, even though the right hemispheres did not behave quite like any classical aphasic diagnostic group. No significant differences were found between right hemisphere comprehension of object vs. action names. Results indicated that vocabulary as a function of word frequency followed the same pattern in the right and left hemisphere although the right hemisphere was consistently lower. This parallel between the two hemispheres was conjectured to reflect some similar or even shared lexical structures in the two hemispheres. Together with other data on the performance of the right hemisphere on the Token Test (Zaidel, 1976), the results suggest a complex model of the development of language laterality in the brain, in which some, but not all, auditory language functions continue to develop in the right hemisphere past what is generally regarded as the critical period for language acquistion. In general, auditory language comprehension is better characterized as that of an "average aphasic" than that of a child of a specific age.     

Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study

AIM: To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke. METHODS: 270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1 year after stroke. RESULTS: The frequencies of the different types of aphasia in acute first-ever stroke were: global 32%, Broca's 12%, isolation 2%, transcortical motor 2%, Wernicke's 16%, transcortical sensory 7%, conduction 5% and anomic 25%. These figures are not substantially different from what has been found in previous studies of more or less selected populations. The type of aphasia always changed to a less severe form during the first year. Nonfluent aphasia could evolve into fluent aphasia (e.g., global to Wernicke's and Broca's to anomic), whereas a fluent aphasia never evolved into a nonfluent aphasia. One year after stroke, the following frequencies were found: global 7%, Broca's 13%, isolation 0%, transcortical motor 1%, Wernicke's 5%, transcortical sensory 0%, conduction 6% and anomic 29%. The distribution of aphasia types in acute and chronic aphasia is, thus, quite different. The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasia. Thus, a scoring of general stroke severity helps to improve the accuracy of the prognosis for the language function. One year after stroke, fluent aphasics were older than nonfluent aphasics, whereas such a difference was not found in the acute phase.     

Facets of Analytical Processing in Aphasia: A Picture Ordering Task

Aphasics, especially those diagnosed as Broca's, have more difficulties than patients will right hemisphere lesions when required to order six pictures on the basis of a single feature delineated by the extremes of the rank-order. Additional analyses indicate that they tend also to perform worse than patients with diffuse injuries and than patients with left hemisphere lesions without aphasia. Differences are more. pronounced when the critical features have to be inferred from the depicted objects (e.g. age of persons) than when they can be seen directly in the drawings (e.g. girth of persons). The performance of the aphasics correlated significantly with word comprehension scores but negligible with the Token Test. Results are discussed with respect to analytical functions differentially impaired in aphasia.     

Auditory Language Comprehension in Aphasia: A Factor-Analytic Study

A battery of nine auditory comprehension test. taken by seventy aphasics, was subjected to a factor analysis. Two factors, interpretable respectively as a lexical semantic and a syntactic comprehension factor, were obtained. Comprehension described in terms of these factors was found to be related to criterion variables of importance, namely the Token Test and a rating of comprehension in daily life. Broca's aphasics were found to be more impaired in syntactic than in lexical semantic comprehension; Wernicke patients tended to have low scores on both factors. The results of this study support the view of independent lexically based and syntactic processing in auditory comprehension which can be differentially disrupted by brain damage.