Types%20of%20Aphasia

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Types of Aphasia
Ling 411 05

• Classifications are a necessary evil
• Antonio Damasio (1998)

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Wernickes Aphasia

• Impaired comprehension
• Result of failures in phonological discrimination
• Fluent verbal output
• Augmented verbal output
• Extra syllables at ends of words
• Extra words at ends of phrases
• Extra phrases at ends of sentences
• Augmentations usually nonsensical
• Syntax otherwise not too bad
• Verbal paraphasia, including neologisms

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Areas of damage in Wernickes aphasia

• Always involved
• Posterior superior temporal gyrus
• The classical core of Wernickes area
• Usually also involved
• More of superior temporal gyrus
• middle temporal gyrus
• Temporal plane
• Often also involved
• Angular gyrus
• Supramarginal gyrus
• Temporal-occipital junction area

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Definitions of Wernickes area

• Narrow definition
• Posterior superior temporal gyrus
• Best definition
• Posterior superior temporal gyrus and adjacent
  temporal plane and superior temporal sulcus
• Broad definition (used by some)
• Includes also angular gyrus and/or supramarginal
  gyrus
• A.k.a posterior language area

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Principal cortical gyri (schematic)
Review
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Subtypes of Wernicke aphasia

• Not discretely different
• Rather, spans along a scale
• Type I
• Damage is more anterior
• Phonological recognition most affected
• Word deafness
• Type II
• Damage is more posterior, incl. angular gyrus
• More word-blindness than word-deafness
• I.e., alexia
• Intermediate types also occur
• Obviously, all subtypes of Wernicke aphasia are
  variations on a continuum
• (BensonArdila144)

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Extra-Sylvian Aphasic Syndromes

• Extra-Sylvian (a.k.a. Transcortical)
• Extrasylvian motor aphasia
• Type I
• Type II
• Extrasylvian sensory aphasia
• Sometimes just called anomic aphasia
• Type I
• Type II

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Two Different Classification Schemes

• Damasio
• Wernickes aphasia
• Brocas aphasia
• Conduction aphasia
• Transcortical sensory aph.
• Transcortical motor aph.
• Global aphasia
• Anomic aphasia
• Alexia

• Benson Ardila
• Wernicke aphasia
• Broca aphasia
• Conduction aphasia
• Extrasylvian sensory aph.
• Extrasylvian motor aph.
• Global aphasia
• Anomic aphasia
• Wernicke II or Posterior extrasylvian

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Extra-Sylvian Aphasic Syndromes

• In all perisylvian syndromes, repetition is
  faulty
• In all extra-sylvian aphasic syndromes,
  repetition is intact
• (why?)
• Aphasia without repetition disturbance almost
  invariably indicates pathology outside the
  perisylvian region (BA 1996146)

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Extrasylvian motor aphasia

• Nonfluent output
• Delayed initiation
• Terse, poorly elaborated utterances
• Incomplete sentences
• Verbal paraphasia
• Good comprehension
• Good repetition

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Extrasylvian motor aphasia, Type I

• Left dorsolateral prefrontal damage
• Anterior and superior to Brocas area
• Non-fluent output, but repetition good
• Articulation is normal
• Difficulty following commands
• Understand command but do not respond
• Damage anterior and superior to Brocas area
  (Brodmann areas 45, 46, and/or part of area 9)
  (BA 1996152)

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Orientation terms (left hemisphere)
Dorsal
Rostral
Caudal
Ventral
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Extrasylvian motor aphasia, Type II

• Damage to supplementary motor area
• Occlusion of left anterior cerebral artery
• Non-fluent output, but good repetition
• Difficulty initiating speech
• Perhaps a purely motor disorder that does not
  involve basic language functions
• (in which case it isnt really a type of aphasia)

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Principal cortical gyri
Supplementary motor area
Superior parietal lobule
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Extrasylvian sensory aphasia

• Speech is fluent
• Good repetition
• Comprehension is impaired
• Naming is impaired
• Paraphasia is frequent, even verbose
• Semantic substitutions
• Neologisms
• Echolalia (patients repeat words of examiner)
• Pointing is impaired
• Two subtypes

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Extrasylvian sensory aphasia, Type I

• Damage to temporal-parietal-occipital junction
  area
• I.e., lower angular gyrus and upper area 37
• Fluent spontaneous output
• Poor comprehension
• Naming strongly impaired
• Semantic paraphasia

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Extrasylvian sensory aphasia, Type II

• Damage to upper angular gyrus
• Fluent output
• Variable ability to comprehend speech
• Naming strongly impaired
• Few semantic paraphasias
• Repetition excellent
• Many circumlocutions

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Anomic aphasia

• Perhaps part of a continuum with extrasylvian
  sensory aphasia
• Comprehension is good in many cases
• Unlike extrasylvian sensory aphasia
• Production and repetition are good
• Cannot be reliably localized
• Many different areas of damage can result in
  naming difficulty
• But different semantic categories may be impaired
  with different areas of damage
• Maybe not a true syndrome BensonArdila

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