Aphasia

Clinic

• Aphasia is an inability to comprehend or formulate language with brain origin.
• For diagnosis, person's speech must be significantly impaired in one (or several) of the four communication modalities:

1. Auditory comprehension
2. Verbal expression
3. Reading and writing
4. Functional communication

Points

• Aphasia has not motor or sensory deficits
• Aphasia is a cognitive problem, therefore is not related to the mechanics of speech. (Although a person can have both problems).
• All disorders that lead to Listening / Comprehension / Speaking / Reading / Writing / Social communication performance, can be the cause of aphasia.
• Unlike aphasia, Dysarthria is a neurological movement disorder of speech organs.
• Apraxia is the loss of the ability to perform purposeful voluntary actions

Aphasia problems

Aphasia is a group of diseases that include entities such as cognitive dysfunction

• Anomia: Inability to name

• Inability to comprehend language
• Inability to pronounce, not due to muscle paralysis or weakness
• Inability to speak spontaneously
• Inability to form words
• Poor enunciation
• Excessive creation and use of personal neologisms
• Inability to repeat a phrase
• Stereotypies, Recurrent utterances/ Speech automatism: Persistent repetition of one syllable, word, or phrase
• Paraphasia: Substituting letters, syllables or words
• Agrammatism: Inability to speak in a grammatically correct fashion
• Dysprosody: Alterations in inflexion, stress, and rhythm
• Incomplete sentences
• Inability to read / write
• Limited verbal output

Anatomy

• Built on an analogy between the visual and auditory systems, the following dual stream model for language processing was suggested recently:
  • Dorsal stream is involved in mapping sound to articulation (Phonological form-to-articulation)
  • Ventral stream in mapping sound to meaning (Phonological form-to-meaning)
• Speech production is impaired primarily as a result of damage to the dorsal stream whereas speech comprehension is more likely associated with ventral stream damage. Nevertheless, many clinical tests of aphasia involve multiple processes that rely on both streams, which can result in poor performance due to damage affecting different sections of the cortical speech and language network.
• Damage to specific cortical hubs such as Broca’s area, SMG/angular gyrus, and posterior STG affects performance at least 6 months after stroke on several different aphasia tests and should be explored in future studies of prognosis in aphasia.

• Sublexical repetition of speech is subserved by a dorsal pathway, connecting the superior temporal lobe and premotor cortices in the frontal lobe via the arcuate and superior longitudinal fascicle.
• In contrast, higher-level language comprehension is mediated by a ventral pathway connecting the middle temporal lobe and the ventrolateral prefrontal cortex via the extreme capsule.

Miasms

• Aphasia: PLV, MMP, JE, BKV, LAC, TBE, VZV

Related entities

• Mouth speech difficult: PLV, MMP, CJD, HCV, HSV-1, HSV-2, VSV
• Dysarthria: CJD, FFI, GSS, NVCJD
• Word- Hunting : PLV