Acquired Neurogenic Language Disorders

Acquired Neurogenic Language/Cognitive Disorders

• Four categories exist: aphasia, right hemisphere damage, traumatic brain injury, and dementia
• Aphasia: An impairment in expressing, understanding, reading, or writing oral and written language. 
• Right Hemisphere Damage: Memory problems, impaired attention, impulsivity issues, and visual disturbances.
• Traumatic Brain Injury: Cognitive-communication impairment linked to brain damage.
• Dementia: Loss of linguistic and cognitive ability due to a progressive brain disease.

Additional Considerations

• Acquired, not developmental, following neurological injury.
• Language-based, not motor-based, although the two can coexist.
• People with aphasia usually have intact psychosocial skills (but not always).
• Language deficits should not be mistaken for psychological issues.

Defining Aphasia

• Aphasia is an impairment of the ability to comprehend and formulate language, due to acquired or recent central nervous system damage. (Rosenbek et al, 1989)
• "Without language".
• Language disturbance in adults who have previously learned language.
• Results from neurological damage in the language-dominant hemisphere of the brain.
• Includes receptive and/or expressive disturbances for both oral and written language.

Causes of Aphasia

• CVA (Cerebral Vascular Accidents): Including ischemic, hemorrhagic, cerebral aneurysm, and arteriovenous malformation. 
• Neoplasms (tumors) in the brain.
• Traumatic Brain Injury (TBI)
• Medications

Classifying Aphasia

• Classifying methods are not always agreed upon.
• Dichotomous classification based on motor/sensory, receptive/expressive, anterior/posterior, and fluent/non-fluent.
• Characteristics of the language impairment (like the Boston System).

Boston System

• Characteristics are fluency, auditory comprehension, naming abilities, repetition, reading, and writing.

Boston System Types

• Broca's, Wernicke's, Conduction, Global, Transcortical Motor Aphasia, Transcortical Sensory Aphasia, Anomic, and Subcortical.

Fluency

• Fluent aphasia involves smooth, uninterrupted speech flow and rate. Characterized by spontaneous speech flow and adequate phrase length. Usually results from damage to posterior regions (temporal/parietal).
• Non-fluent aphasia results in decreased phrase length, hesitations, slowed/labored speech production, grammatical impairments, and impaired pitch/stress variation. Typically found with damage to anterior regions (frontal lobe).

Auditory Comprehension

• The complex process of understanding spoken language, involving segmenting sounds into meaningful phonemes, understanding the sentence's message, and retaining it to formulate a response. Factors influencing comprehension include: amount of information, frequency of words, personal relevance, and part of speech.

Repetition

• The ability to precisely reproduce verbal stimuli. Processes include receiving, processing the stimulus, conveying it to brain regions for speech formulation, and articulating the stimuli. Requires efficient pathways connecting Wernicke’s and Broca's areas. Wernicke’s area processes auditory information and Broca’s area programs speech movements.

Naming

• Ability to retrieve and produce a target word. It's a complex process involving recognizing the object, retrieving the semantic label for the object, developing the phonological form, and programming the needed speech movements. 
• Naming difficulties are a common pervasive and persistent deficit (anomia). Subtypes of naming difficulties include phonemic and semantic paraphasias.

Reading and Writing

• Written language disturbances are often similar and parallel spoken language impairments.  Individuals with auditory comprehension difficulties will also have comprehension issues with written information.

Review of Neuroanatomy (Chapter 1)

•  (Abstract - this section is a single line; it contains no data, facts, or figures.)

Specific Aphasia Types (Review)

• (a list of aphasia types. Some information from earlier section.)

Characteristics of Each Type of Aphasia

• General Characteristics
  • Location of damage (e.g., location of brain damage that causes the disruption.)
  • Fluency (e.g., smooth or labored spontaneous speech.)
  • Comprehension, Auditory comprehension, and Naming
• Specific Example - Broca's Aphasia: Location is frontal lobe typically Broca's area. Characteristics include non-fluent speech characterized by Agrammatism (telegraphic speech), Naming deficits (mild to severe), paraphasias (articulation errors and circumlocutions), impaired and slow labored reading, writing effortful with errors, and difficulty repeating.
• Specific Example - Transcortical Motor Aphasia: Location is frontal lobe, typically superior and anterior portions. Characteristics include agrammatism, naming deficits, articulation errors, Relatively intact repetition, and poor conversational speech / trouble initiating speech and writing.
• Specific Example - Global Aphasia: Location is a large region of the brain; multiple sites of injury may be affected. Characteristics include non-fluent, severe problems communicating, severe spontaneous speech deficits, severe comprehension deficits, and typically non-verbal with limited gestures., and severe deficits in reading and writing.
• Specific Example - Wernicke's Aphasia: Location is temporal lobe and possibly parietal lobe, specifically Wernicke's area. Characteristics include fluent speech prosody, possible logorrhea, limited meaningful content, auditory comprehension deficits, Naming deficits (paraphasias and neologisms or jargon), poor repetition, fluent writing but limited meaning, Reading comprehension deficits.
• Specific Example - Transcortical Sensory Aphasia: Location: border of temporal and occipital lobes or parietal lobe (superior region). Characteristics: Fluent speech with normal prosody, Possible logorrhea, limited meaningful content, Auditory comprehension deficits, severe Naming deficits, Paraphasias, neologisms, jargon, intact repetition, fluent/limited meaning writing and deficient reading comprehension abilities.
• Specific Example - Conduction Aphasia: Location: temporal-parietal region; typically the connector pathway - arcuate fasciculus. Characteristics: Fluent, mild spontaneous speech deficits, mild auditory comprehension deficits, naming deficits (paraphasias), deficient repetition, inability to read aloud.
• Specific Example - Anomic Aphasia: Location: no specific area, Angular Gyrus is most common. Characteristics: Fluent (meaningful), mild deficits in spontaneous speech (speech fluency affected by word retrieval deficits), possible auditory comprehension deficits, Naming deficits, and relatively intact repetition.

Explore the intricacies of acquired neurogenic language and cognitive disorders, focusing on categories such as aphasia, right hemisphere damage, traumatic brain injury, and dementia. This quiz will test your understanding of these conditions, their symptoms, and how they affect language and cognition. Perfect for students of psychology or speech-language pathology.