1 language chris rorden aphasia: broca’s, wernicke’s, etc. alexia anomia dyslexia agraphia split...
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Language
• Chris Rorden• Aphasia: Broca’s, Wernicke’s, etc.• Alexia• Anomia• Dyslexia• Agraphia• Split brain patients• Disconnection syndromes
www.mricro.com
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Background (from c82bio)
Localization– Certain regions devoted to
specific tasks.– Broca, Gall– Based on (almost) no evidence
Equipotentiality– Whole brain involved with tasks– Flourens (1840s), Head, Lashley
Both correct/wrong.
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Language
Distinctly human?
Superior to other animals
Is there a single anatomical basis?
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Language Production
Broca’s Area (1861)Difficulty in speech productionLoss of ability to repeat speechComprehension intactFoot of 3rd frontal convolution
(BA 44)Left hemisphere (1865)
– Except left handers
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Language Comprehension
Wernicke’s Area (1874) Normal production (speech sounds and
fluent nonsense) Sounds okay if you do not know the
patient’s language (e.g. Chinese Wernicke’s aphasic would sound fine to me)
Unaware of deficit Impaired comprehension Left hemisphere Superior temporal gyrus
(BA 42, 22)
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Wernicke’s prediction
Predicted two language centers:– Broca’s Area: speech articulation.– Wernicke’s Area: language comprehension.
Predicted 3rd Syndrome:– Disconnection syndrome– ‘Conduction aphasia’– Damage to
arcuate fasciculus
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Conduction aphasia
Can comprehend speech Articulation is intact Difficulty in repeating speech Lesions in Temporal Parietal Junction that
knock out underlying white matter Patients with damage ONLY to the arcuate
fasciculus can still generate speech.– Why? Other pathways
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Wernicke-Lichtheim (1885) Schema
From auditory input (a) to motoric articulation of speech (m)
Broca’s Aphasia Wernicke’s
Aphasia
Concepts(Distributed)
Conduction aphasia
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4: Transcortical Motor Aphasia
Disconnection of Broca’s from concepts
Speech is slow, terse Can comprehend speech Found after damage to the
frontal lobes Unlike Broca’s Aphasics,
can repeat phrases when spoken to– direct Wernicke’s to Broca’s
pathway intact
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6: Transcortical Sensory Aphasia
Disconnection of Wernicke’s from concepts
Can repeat words Speech is articulate
nonsense Unable to comprehend
speech Found after damage to the
posterior language area
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7 Pure Word Deafness
Loss of ability to understand spoken speech.
Normal speech, reading, writing
Behaviour and anatomy dissociate from Wernicke’s aphasia
Written comprehension intact, intact written/verbal production.
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Specifically language
Aphasics unable to use speech to convey information.
However, aphasics can often cite memorized texts– Songs– Prayers, verses– Cliché
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Exceptions to the rule
Dronkers et al [2000] note exceptions to anatomy Traditional Theory:
– JC will have Broca’s and MC will have Wernicke’s Aphasia– JH and OB will not have aphasia
Reality: – Neither JC or MC has Aphasia– JH has Broca’s and OB has Wernicke’s Aphasia.
Broca’s Wernicke’s
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Exceptions to the rule
Patients with similar lesions can show very different behaviour.
What are the implications?
Are these exceptions to rule worth worrying about?– Perhaps we can not see functional extent of OB/JHs lesion
But JC/MC clearly have damage in areas associated with language deficits.
– Different brains develop differently– Group studies required
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Brain areas vary between people
Broca’s Area = Brodmann’s 44/45 BA44/45 vary between people Perhaps Broca was right, but JC and JH have slightly
unusual locations for these regions. Group studies required to resolve this question.
Textbook Location of Broca’s Area
Actual location of BA44/45 based on histology for two people. Very different size/location
(Amunts et al., 2004 NeuroImage 22, 42-).
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Broca’s Aphasia
Broca’s Aphasia is a syndrome: association of deficits. – ‘Telegraphic’ speech: Produce content words with few
grammatical markers, pauses between words– Apraxia of Speech: distortion of speech sounds
(‘yawyer’ instead of lawyer), poor prosody, stress on wrong syllable without motor problems for non-speech movements.
– Dysarthria: poor control of muscles used in articulation– Word finding– Repetition– Comprehension: problems with complex grammar.
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Problems with traditional model
Does this cluster of symptoms reflect one functional module, or separate anatomical neighbours?
Comprehension: Broca’s not simply problem in speech production– Intact: ‘the boy kissed the girl’– Problems: ‘the girl was kissed by the boy’
Is comprehension specific to speech, or due to attentional/working memory problems?
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Fractionation of Broca’s Aphasia
Dronkers et al (1994) examined > 100 aphasics Comprehension deficits associated with Broca’s Aphasia
appear to correlate with Temporal Lobe damage. Suggests association due to neighbouring centers, not
shared function. Finding confirmed in neuroimaging studies (Bavelier et al.
1997).
Broca’s Area (BA44/45)
Region identified by Dronkers
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Reflections
Dronkers suggests grammatical problems not due to Broca’s Area
Used low quality structural scans – See Hillis et al. for critique. Brain (2004),
127, 1479-1487
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Apraxia of Speech
Dronker’s [1996, Nature, 384, 159-161] AoS: disorder of shaping the vocal tract for a particular
speech sound. Studied 25 apraxic and 19 control patients.
– Tested 1 year after lesion: deficits are stable.– All AoS had damage to portion of insula.– This region was spared in all controls.– Region near motor strip [M1] for mouth.
Apraxics Controls
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Apraxia of Speech
Dronkers (1996) suggest that insular damage causes AoS.
– Supported by Shuren,, 1993; Donnan et al., 1997; Bates et al., 2003).
Hillis et al. (2004; Brain 127 1479-1487) disagree: argue Broca’s Area critical for AoS.
– Dronker’s examined chronic patients with structural scans.
– Hillis examined acute patients and found that patients with AoS had perfusion deficits in Broca’s Area, even if these were not seen in structural scans.
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Wernicke-Lichtheim (1885) Schema
From auditory input (a) to motoric articulation of speech (m)
Broca’s Aphasia Wernicke’s
Aphasia
Concepts(Distributed)
Conduction aphasia
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Aphasia Notes [lcbr.ss.uci.edu]
Type of Aphasia
Site of Brain Damage
Comprehension Speech Repetition Paraphasias
Broca's Broca's area Good Non-fluent, effortful, usually agram m atic
Poor Yes (phonem ic, sem antic)
Wernicke's Pos terior STG Poor Fluent, (para)gram m atical,
som etim es jargon-like
Poor Yes (phonem ic, sem antic, neologis tic)
Conduction Supram arginal Gyrus or auditory
cortex
Good Fluent, gram m atical, self-corrective
Poor Yes (phonem ic)
Global All of Perisylvian Cortex
Poor Very little Poor n/a
Transcortical Motor
Frontal lobe Good Terse, echolalic Good Yes (phonem ic, sem antic)
Transcortical Sensory
Tem poral-occipital-parietal
junction
Poor Fluent, gram m atical, som etim es jargon-like
Good Yes (m os tly sem antic)
Anom ic Varied, but inf. tem poral lobe often involved
Good Fluent, Gram m atical Good No
Aphem ia Lower m otor cortex
Good Dysarthric Good No
Pure Word Deafness
Usually auditory cortex bilaterally
Very Poor Fluent Very Poor In theory, no, but m os t have paraphas ias
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Aphasia notes
Anomic: problem naming objects Paraphasia: use of related but inappropriate words
– Semantic: ‘fork’ when ‘knife’ is meant– Phonemic: ‘fork’ when ‘stork’ is meant
Neologism: literally “new word,” using word that bears no obvious relation to a recognizable word. e.g., “glester”
Paragrammatic: incorrect use of grammatical function words. e.g., “he is always brillianting”
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Recovery from aphasia
Many aphasics get better– Is this due to intact tissue on damaged left?– Or does right hemisphere take over?
Warburton et al. (1999) examined recovered aphasics.– Many controls show left-only activity [far left]– Others show bilateral activity, but predominantly left [2nd
from left]– Patients show different patterns of activity: for some,
intact regions on damaged side have become active.
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Musical Syntax
Musical syntax is processed in Broca's area.
Non-musicians listen to 5 chords harmonically inappropriate chords
generate early right-anterior negativity (ERAN), measured with MEG.
Inferior BA44 source of ERAN (Broca’s source and right homologue).
Maess et al. (2001) Nature Neuroscience 4, 540 – 545.
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Reading and writing
Wernicke’s aphasics: language comprehension– Regardless whether spoken or written
Broca’s aphasics: speech production– Primarily spoken (except grammar)
Are there specific reading centres?
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Alexia with agraphia
Déjerine, 1891: Damage to the angular gyrus (BA 39) leads to– ‘Alexia with agraphia’ reading & writing
deficits– Intact speech comprehension
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Alexia without agraphia
Disconnection of angular gyrus from visual inputs– Language outputs intact– Patients cannot read– Writing preserved
Rare: left and right pathways to angular gyrus
Requires damage to 1. posterior callosum2. left occipital lobe
Without damage to left angular gyrus
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Reading Vision vs Braille
Fusiform gyrus also involved with reading
Büchel et al. (1998) Nature, 394, 274-277.– 3 Groups:
Sighted Early Blind Congenitally Blind
– Reading activates fusiform gyrus (relative to speech).
– Fusiform not simply visual area.
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Language and laterality
Language mainly LEFT hemisphere task– Broca’s/Wernicke’s patients left
hemisphere– Wada Test [Intracarotid amobarbital
procedure] temporarily disables one hemisphere
Virtually all right handers have language in left Left Handers:
– 70% like right handers– 15% language on right (reversed)– 15% distributed language (bilateral)
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Brain asymmetries (Toga & Thompson, 2003)
Right frontal and left occipital protrude relative to counterpart
Skull imprints called ‘petalia’ Cortical structures (sulci)
shifted as well (‘Yakovlevian torque’)
Cortical Assymetries Left occipital: wider, protrudes posteriorly Right frontal: wider, protrudes anteriorly
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Brain asymmetries
Sylvian fissure (SF) and superior temporal sulcus (STS) also differ between left and right.
Left SF/STS more posterior Planum temporale (posterior-ventral face of
STS) larger on left. See Martin’s Human Neuropsychology for more asymmetries.
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Corpus callosum
Fiber tract between left and right side of the brain.– 200 million axons– Primarily homotopic: connects corresponding region
(Lparietal-Rparietal, Lfrontal-Rfrontal)– Also Heterotopic: connecting different regions (Lfrontal-
Rparietal).
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Split brain patients
Complete or partial commissurotomy – 1950s operation for intractable epileptics – Unseen objects
Identified when presented to right hand Verbally unidentified when presented to left hand, though
hand can select matching object
– Visual stimuli (briefly flashed) Verbally describe items presented to right field Unable to name items in left field, though can choose
correct item with left hand
– Spatial tasks: suggest right hemisphere better (Nebes, 1978).
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Alien Hand Syndrome
Alien hand syndrome [Brion and Jedynak; 1972]– Split brain patients do not recognize their unseen left
hand when touched by right hand.– ‘intramanual conflict’: e.g. one hand buttons up shirt,
other unbuttons.– Left hand spontaneously engages in actions that the
patient says they are not intending: acts foreign, alien or uncooperative.
– Seen in other patients: Goldberg et al (1981) report similar effects in patients with mesial-frontal/callosal lesions
– AKA ‘wayward hand’, ‘anarchic hand’