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Language is one of the most celebrated hallmarks of human cognition. With the continuous improvement of medical technology, functional MRI (fMRI) has been used in aphasia. Although many related studies have been carried out, most studies have not extensively focused on brain regions with reduced activation in aphasic patients. The aim of this study was to identify brain regions normally activated in healthy controls but with reduced activation in aphasic patients during fMRI language tasks.
Methods:
We collected all previous task-state fMRI studies of secondary aphasia. The brain regions showed normal activation in healthy controls and reduced activation in aphasic patients were conducted activation likelihood estimation (ALE) meta-analysis to obtain the brain regions with consistently reduced activation in aphasic patients.
Results:
The ALE meta-analysis revealed that the left inferior frontal gyrus, left middle temporal gyrus, left superior temporal gyrus, left fusiform gyrus, left lentiform nucleus and the culmen of the cerebellum were the brain regions with reduced activation in aphasic patients.
Discussion:
These findings from the ALE meta-analysis have significant implications for understanding the language network and the potential for recovery of language functions in individuals with aphasia.
The chapter presents and discusses empirical data on the neuropsychology of gesture production. The focus of this chapter is on the specific contributions of the right and left hemispheres to the generation of gestures. Since the respective neuroscientific method has a substantial impact on the study results and different methodologies can even entail apparently opposing results concerning gesture production, different neuropsychological methods, their paradigms, and limitations are presented in detail. Spontaneous gesture production studies evidence a substantial contribution of the right hemisphere to gesture production, while gesture production on command studies show a relevant role of the left hemisphere. Gestures that are generated in association with right hemispheric functions such as spatial cognition, nonverbal emotional expression, global and metaphorical thinking appear to be generated in the right hemisphere, while gestures that are linked to tool use praxis are generated in the left hemisphere. The findings further provide a neuropsychological basis for understanding the complementarity but also the dissociation between gestural and verbal message.
Over the last 10 years or so, I have noticed increasing trouble understanding what people are saying to me, especially if there are several people speaking at the same time, such as at a family dinner, or worse, at a big party. It may be the main reason I find social occasions increasingly difficult and intimidating. When Lois speaks to me, I often have to ask her to repeat what she said. She has learned to say things twice if she wants me to get it. I know that is irritating for her. Often, I just nod or grunt, pretending I understand what she is saying. I have attributed this increasing problem to my Alzheimer’s disease interfering with my ability to understand language, particularly if I don’t hear every word clearly. Aphasias affecting language production (poor word finding) or reception (impaired understanding) are common in the mid-to-late stages of Alzheimer’s, but trouble finding the right word or name is often one of the earliest symptoms of Alzheimer’s.
Language, a hallmark of human cognition, is a complex and universal tool for conveying thoughts and ideas. This chapter navigates the intricate landscape of language development, spanning its various dimensions. We begin by dissecting language into its components, be it spoken or signed, and explore its dual nature – both specific and universal. The chapter illuminates the brains remarkable capacity to derive meaning from linguistic input, pinpointing the neural structures underpinning language comprehension and production. Distinguishing between language quantity and quality, we delve into the role of contingent learning and experiential adaptation in molding linguistic abilities. Additionally, we ponder the evolutionary origins of language, contemplating its exclusive human attribute. Drawing from a diverse pool of research, including neuroimaging, behavioral assessments, and developmental studies, this chapter offers a comprehensive view of language development. It underscores the profound influence of gene–environment interactions in enabling infants to acquire language organically, without explicit instruction.
Disorders of thought include disorders of intelligence, disorders of the stream of thought, disorders of thought possession and obsessions, and disorders of the content and form of thinking. This chapter outlines disorders of intelligence, disorders of thinking, disorders of thought tempo, disorders of the continuity of thinking and disorders of the content of thinking. It presents descriptions of obsessions and primary and secondary delusions, as well as detailed examinations of specific delusions of persecution, infidelity, love, grandiosity, ill-health, guilt, nihilism and poverty. Speech disorders are also explored, along with aphasias. The chapter concludes with suggested questions for eliciting specific symptoms in clinical practice, in addition to standard history-taking and mental state examination. Disorders of thought and speech are central to the manifestation and diagnosis of many psychiatric disorders, including schizophrenia, and this chapter provides both descriptions and explanations of key signs and symptoms in this field.
To explore the utility of neuropsychological testing for patients with Primary Progressive Aphasia and compare testing data for a Logopenic and Semantic PPA variants within the medically complex Veteran population.
Participants and Methods:
Both participants were referred by their psychiatrist due to memory concerns. The case studies testing data will be compared to look at the differences on testing between different PPA presentations within the Veteran population. Patient A is a 77 year old, right handed, African American, divorced man with approximately 14 years of formal education. Patient B is a 76 year old, right handed, Caucasian, widowed man with approximately 16 years of formal education.
Results:
Patient A displayed problems with single-word retrieval, repetition of nonsense words and sentences, comprehension, reading, spelling, and naming. He also displayed impairments in aspects of working memory, along with learning and memory. His cognitive profile raises concern for a logopenic variant of primary progressive aphasia, which often has Alzheimer's disease pathology. Patient B displayed empty speech, impairments in fluency and reduced semantic knowledge that raises concern for a semantic variant of primary progressive aphasia. However, aspects of his presentation are not consistent with this diagnosis, specifically intact confrontation visual naming. Patient has a history of significant alcohol abuse, although he has mostly remained sober since moving to Texas. This evaluation cannot rule out the contribution of sustained alcohol use on his cognitive functioning; however, this is likely not the primary etiology given his significant language issues.
Conclusions:
Patients with medically complex histories and unclear timelines of symptom progressive make it difficult for diagnostic clarity. Diagnoses can be additionally difficult to determine at times when the clinical presentation is not as clearly defined in textbooks. This case study comparison displays the importance of integrating all data to determine the proper diagnosis to optimize patient care and provide recommendations tailored to that individual.
Despite the prevalence of aphasia in Morocco, standardized quick assessment tools are not available for use with patients in acute stroke care. The present study set out to (1) describe the processes of linguistic adaptation of a Moroccan Arabic (MA) version of the Bedside Western Aphasia Battery-Revised (WAB-R), (2) examine the test’s sensitivity to the detection of aphasia in an acute clinical setting, and (3) measure the instrument’s ability to detect improvement in language ability in the acute period.
Participants and Methods:
To achieve the first objective, the English Bedside WAB-R was adapted to Moroccan Arabic by a group of linguists. The instrument’s psychometric properties were established by (1) ascertaining the test’s sensitivity to the presence of aphasia, and (2) verifying the tool’s validity and reliability. Participants included a group of age- and education-matched non-brain-damaged individuals (N = 106), a group of right hemisphere brain-lesioned patients (N = 20), and a group of left hemisphere aphasic patients (N = 52). To accomplish the second and third objectives, the Bedside MA-WAB-R was administered to a group of aphasic participants in the acute period (less than three months post-stroke), and a group of age- and education-matched participants (N = 20). Aphasic patients in the acute stage were tested twice on a seven-day interval (3 days and 10 days post-onset). All data were collected from the Neurology department at the University Medical Hospital Hassan II, and the study received approval from the ethics committee of the Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah.
Results:
Regarding the first objective, the results indicated that the MA-WAB-R is sensitive to the presence of aphasia, as revealed by the significantly worse performance of the aphasic group on all subtests relative to matched normal and right-hemisphere participants (p = .000). Analyses revealed excellent content and construct validity (correlations between subtests and AQ ranging from .5 to .8) as well as high inter-rater reliability, intra-rater reliability and test-retest reliability (ICC (2,1) > .9). For the second and third objectives, the results supported the test’s sensitivity to the detection of aphasia in the acute phase, as confirmed by the significantly worse performance of aphasic patients relative to matched normal controls (p = .000). The instrument also proved as a reliable measure of language improvement in the acute period, as supported by better scores on the second testing point relative to the first across all subtests.
Conclusions:
The MA-WAB-R is the first standardized assessment tool that can be used for a quick but reliable screening of aphasia in both chronic and acute clinical settings. The test can inform the initial diagnosis of aphasia, and guide a more comprehensive assessment of patients’ spared and impaired linguistic abilities within a context receiving little attention in the aphasia literature.
BAbSANT (Bilingual Abstract Semantic Associative Network Training) is a novel, theoretically motivated approach to anomia therapy for bilingual persons with aphasia (BPWA). We report on a Russian-dominant, Russian–English BPWA, who was trained on abstract English and Russian words. We hypothesized both within- and cross-language generalization when the non-dominant language was trained, and only within-language generalization when the dominant language was trained. We also hypothesized that cross-language generalization is modulated by nonverbal cognitive control. Results revealed that when English abstract words were trained, within-language generalization to concrete words and cross-language generalization to Russian abstract words was observed, confirming our first hypothesis. However, our second hypothesis was not confirmed. When Russian was trained, direct effects of treatment and within- or cross-language generalization effects were not observed. Our third hypothesis was confirmed. Results from cognitive control tasks from this individual suggest a role of nonverbal cognitive control on cross-language treatment outcomes.
Chapter 7 shows that abstract concepts are inner/cognitive tools. Inner speech is potent in enhancing our cognition, imagination, and motivation. In this chapter, I propose that we use inner speech more extensively with more abstract concepts, during both their acquisition and use, while monitoring our knowledge during their processing and referring to others to complement and enrich it. I review several studies with children and adults showing that the mouth motor system is more engaged during abstract concept acquisition and elaboration. This mouth activation suggests that language is implicitly activated during abstract language processing. Also, while low numbers engage the hand effector more, the processing of larger numbers might involve language, hence the mouth, more extensively. I overview research on the neural underpinning of abstract concepts, which confirms the importance of linguistic and social neural networks for their representation. Finally, I illustrate studies on abstractness in conditions characterized by impairments in social interaction and inner and overt speech abilities, such as autism, schizophrenia, and aphasia. Overall, the studies reviewed support the idea of a determinant role of language as an inner tool supporting the acquisition and use of abstract concepts.
Aphasia, apraxia, and agnosia are terms we use to describe clinical abnormalities. Each term is applied to a variety of neurologic disorders. In a given case more than one of the terms could be appropriate to describe the deficit. The phenomena to which these words are applied have no uniform patho-anatomic basis.
In this chapter, we focus on language development in individuals suffering from language and cognitive disorders. One of the major concerns of families and caregivers of individuals with these disorders is that exposure to more than one language may cause further difficulties, slow down, or hinder linguistic and cognitive development. Scientific research, however, shows that this is an unmotivated prejudice, and that bilingualism does not provide negative effects, but rather, can offer benefits. We explore the interaction between bilingualism and language disorders, discussing in particular developmental language disorders, developmental dyslexia, autism spectrum disorders, hearing loss, Down syndrome, and aphasia.
The past twenty years have brought a revolution in the understanding of how the human brain accomplishes language comprehension, as more sophisticated models have been proposed in response to the discovery of brain regions in the left hemisphere other than Broca’s and Wernicke’s areas involved in syntactic and semantic processing. Nevertheless, some old mysteries remain unsolved. One of these is the surprising finding that some split-brain patients have some linguistic abilities in their isolated right hemisphere, including, for a few, the ability to make grammaticality judgements. If the neural machinery for syntactic processing is found exclusively in the left hemisphere, this should not be possible. This paper proposes an account of this unexpected phenomenon using the grammatical tools of Role and Reference Grammar, and the solution has implications for the theory itself as well as for another old mystery, namely the ability of some aphasics, who cannot correctly interpret reversible passives, to nevertheless judge the grammaticality of sentences.
Most cognate research suggests facilitation effects in picture naming, but how these effects manifest in bilinguals after brain damage remains unclear. Additionally, whether this effect is captured in clinical measures is largely unknown. Using data from the Boston Naming Test, we examined the naming of cognates and noncognates, the extent of cognate facilitation produced, and the individual differences in bilingual language experience associated with naming outcomes in forty Spanish–English bilingual persons with aphasia (BPWA) relative to thirty-one Spanish–English healthy bilinguals (HB). Results suggest that naming performance in L1 and L2 in both groups is modulated by lexical frequency, bilingual language experience, and by language impairment in BPWA. Although the two groups showed similarities, they deviated in benefit drawn from the extent of phoneme/grapheme overlap in cognate items. HB showed an association between cognate facilitation and bilingual language experience, while cognate facilitation in BPWA was only associated with L2 language impairment.
In this chapter, the author, from the double perspective of ethology and neuropsychiatry, gives an interdisciplinary account of language through the lens of the neurosciences, interweaving diverse scientific discourses. Using phylogenetic and ontogenetic accounts, he describes the transition from sensory perception to symbolic representation in animals and humans, and the way neural circuitry of language coalesces through relating. He thus maps the processes and trajectories of the ‘word-making machine’, corroborated by studies of sensory or institutional deprivation or of illness, abuse, or accidents. Studies carried out on plurilingual speakers recovering from aphasia reveal that the Mother tongue, the most deeply imprinted language, is the one that comes back first. Experiments with newborn babies confirm the origin of the Mother tongue in tactile interuterine stimuli, which are later recognised by the newborn in the lower frequencies of the mother’s voice, creating ‘a reassuring bond of familiarity’. This interdisciplinary approach sheds light on the embedding of language in the body and on the enduring imprint of early language formation in the brain.
Worldwide, we are an aging population, with dementia affecting people in increasing numbers. Here we focus on two types of dementia: Alzheimer's disease because it is the most prevalent form of dementia and the primary progressive aphasia of frontotemporal dementia because of its capacity to enhance creativity in music and visual art. For individuals with progressive dementia, the creative trance is an oasis, a world apart from the daily world of their growing difficulties. Instead, they face the solvable problems of creativity. Iris Murdoch wrote her final novel, Jackson's Dilemma, during the early stages of Alzheimer’s disease, and Willem de Kooning focused on painting as his dementia advanced. Sometimes, dementia can influence work for the better, even if only for a brief time. Frontotemporal dementia gave power to Maurice Ravel’s best-known work, Bolero, and Anne Theresa Adams, who also had frontotemporal dementia, resonated with the music, and transcribed it into visual art.
Traditional naming tests are unsuitable to assess naming impairment in diverse populations, given the influence of culture, language, and education on naming performance. Our goal was therefore to develop and validate a new test to assess naming impairment in diverse populations: the Naming Assessment in Multicultural Europe (NAME).
Method:
We carried out a multistage pilot study. First, we generated a list of 149 potentially suitable items – e.g. from published cross-linguistic word lists and other naming tests – and selected those with a homogeneous age of acquisition and word frequency across languages. We selected three to four colored photographs for each of the 73 remaining items; 194 controls selected the most suitable photographs. Thirteen items were removed after a pilot study in 15 diverse healthy controls. The final 60-item test was validated in 39 controls and 137 diverse memory clinic patients with subjective cognitive impairment, neurological/neurodegenerative disease or psychiatric disorders in the Netherlands and Turkey (mean age: 67, SD: 11). Patients were from 15 different countries; the majority completed primary education or less (53%).
Results:
The NAME showed excellent reliability (Spearman–Brown coefficient: 0.95; Kuder–Richardson coefficient: 0.94) and robust correlations with other language tests (ρ = .35–.73). Patients with AD/mixed dementia obtained lower scores on most (48/60) NAME items, with an area under the curve of 0.88. NAME scores were correlated with age and education, but not with acculturation or sex.
Conclusions:
The NAME is a promising tool to assess naming impairment in culturally, educationally, and linguistically diverse individuals.
This chapter investigates whether sentence comprehension difficulty in aphasia can be explained in terms of retrieval processes. By modelling individuals with aphasia (IWAs) separately, we show that different IWAs show impairments along different dimensions: slowed processing, intermittent deficiency, and resource reduction. The parameters in the cue-based retrieval model have a theoretical interpretation that allows these three theories to be implemented within the architecture. In a further investigation, we compare the relative predictive accuracy of the cue-based model with that of the direct-access model. The benchmark data here are from Caplan et al. (2015); k-fold cross-validation is used as in the preceding chapter. The cue-based retrieval model is shown to have a better predictive performance.
Chapter 8 describes the fundamental research questions, empirical approaches and findings of neurolinguistics. It is a highly interdisciplinary linguistic subfield focusing on the relationship between brain and language behaviour. Concentrating on experimental research, methodological issues include considerations on research participants, data types, and techniques of data acquisition and analysis. The chapter ends with recommendations for further reading and a list of short exercises and ideas for small research projects.
In this chapter we consider more closely what we mean by a word. We begin by contrasting the differences between the mental lexicon and dictionaries. We then introduce students to the methods and techniques that psycholinguists use for studying the mental lexicon. We look at reaction time experiments, brain imaging, and the ways in which we can study individuals with aphasia and genetic disorders that affect lexical knowledge. Students are introduced to how children acquire morphology. We then look at English past tense morphology in the context of the ‘storage versus rules’ debate, considering what experimentation, brain imaging, and the study of aphasia and genetic disorders tell us about this controversy. The chapter ends with a brief history of dictionaries.
Much research has been dedicated to the effects of bilingualism on executive control (EC). For bilinguals with aphasia, the interplay with EC is complex. In this systematic review, we synthesize research on this topic and provide an overview of the current state of the field. First, we examine the evidence for EC deficits in bilingual persons with aphasia (bPWA). We then discuss the domain generality of bilingual language control impairments. Finally, we evaluate the bilingual advantage hypothesis in bPWA. We conclude that (1) EC impairments in bPWA are frequently observed, (2) experimental results on the relationship between linguistic and domain-general control are mixed, (3) bPWA with language control problems in everyday communication have domain-general EC problems, and (4) there are indications for EC advantages in bPWA. We end with directions for experimental work that could provide better insight into the intricate relationship between EC and bilingual aphasia.