Absence Of Aphasia Research Articles

The role of cognitive models in language rehabilitation

Recently, researchers have advocated the use of cognitive neuropsychological models as an infrastructure for efforts in language rehabilitation. In this approach, clinicians characterize language impairments in individual patients with respect to cognitive models of lexical and sentence processing. This approach contrasts with many earlier efforts in which evaluation and treatment focused on the presence or absence of aphasia viewed as a general language impairment, or on syndromes of aphasia. We consider the structure that cognitive neuropsychological models may provide in different portions of the rehabilitation process and find that this approach, when applied with methodological rigor, has practical implications for practice in aphasia assessment and treatment. In turn, some hope that data derived from clinical applications with this approach may support the modification of cognitive neuropsychological models.

Counselling after Stroke: An Unmet Need?

Abstract Information was gathered by means of a questionnaire survey and interviews from a group of patients (N = 17) and health professionals (N=13) working within a stroke unit, concerning the emotional needs of patients and and their relatives and how staff responded to these needs. Although most of the staff had received some training or information about counselling and felt that their interactions with patients often involved an element of counselling, there was strong support for separate specialised counselling services to deal with psychological problems suffered by both patients and their relatives. Patients rated assistance with personal and emotional worries and advice about physical problems as equally useful. A strong need for a counselling service in some form or other was expressed by patients. Neither the level of the patients' social support nor the presence or absence of aphasia, however, predicted the strength of interest expressed. It is concluded that specialised psychological help c...

Cognitive Impairments in Parkinson’s Disease

The clinical neuropsychologic profiles of patients with Parkinson's disease and patients with SDAT show both overlap and dissociation. Speech, language, and certain memory skills are examples of dissociable differences, especially in the early stages of the disease. Furthermore the presence of depression, evidence of cognitive slowing, and absence of aphasia in patients with Parkinson's disease suggest prominent subcortical involvement. It is probably premature to categorize all of the cognitive changes in patients with Parkinson's disease as subcortical, however. Some skills, such as visuospatial and executive functions, are impaired in both disorders, and although the etiologic bases for task failure may differ for each, this issue remains open-ended. Another problem is that often the evidence for or against the cortical/subcortical distinction is insufficient and in some cases based on a single measure thought to be representative of a given cognitive domain. Most importantly there are few comparative studies that provide unequivocal support for making a cortical/subcortical distinction. Failure to equate for level of cognitive impairment or functional disability between dementias and strict adherence to cross-sectional study designs further compromise efforts to characterize each syndrome precisely. Whitehouse suggested that a prospective study of several different dementias studied in parallel, examining a wide range of cognitive skills, is required before the cortical/subcortical classification scheme can be validated. A critical component is an autopsy program to confirm diagnoses and provide clinicopathologic correlation. It is possible that the diverse nature of the cognitive impairment in patients with Parkinson's disease is not a methodologic artifact but reflects multiple disease subtypes. Ross, Mahler, and Cummings proposed three dementia syndromes in patients with Parkinson's disease: one that is relatively mild and meets the criteria for subcortical dementia, a second that is more severe and shows a wider range of cognitive impairment but is still neuropathologically distinct from SDAT, and a third severe dementia with both subcortical and cortical involvement that may reflect basal ganglia and Alzheimer-type pathology.

Sporadic Olivopontocerebellar Atrophy with 'Subcortical Dementia' and Hallucinatory Paranoid State: Report of an Autopsy

An autopsied case of sporadic olivopontocerebellar atrophy with ''subcortical dementia'' and hallucinatory paranoid state is reported. A Japanese woman without a remarkable family history showed cerebellar ataxia at the age of 61 years, followed by muscle rigidity, pyramidal signs, peripheral amyotrophy and ophthalmoplegia. She had paranoid delusion and visual and auditory hallucinations. She also developed a dementia characterized by mild memory disturbance with preservation of orientation, slowing of thought processes, affective changes including apathy and depression, impaired ability to manipulate acquired knowledge and the absence of aphasia, apraxia and agnosia. These features were consistent with those seen in subcortical dementia, first proposed by Albert. Autopsy revealed pontine tegmental atrophy in addition to a marked atrophy of the inferior olivary nucleus, pontine basis and cerebellum, in contrast to a relatively well-preserved cerebrum. The peculiar psychotic features including dementia found in the patient are discussed from a clinicopathological standpoint.

Mild Dementia Associated with Joseph Disease in a Japanese Family

We clinically studied 4 patients with Joseph disease in a Japanese family, who developed mild dementia, and neuropathologically examined one autopsied case among them. Neurological findings included cerebellar ataxia, progressive external ophthalmoplegia, peripheral amyotrophy, and pyramidal signs. Mental state examination revealed mild impairment of intelligence. The dementia was characterized by mild memory disturbance with preservation of orientation, slowing of thought processes, affective changes including apathy and depression, impaired ability to manipulate acquired knowledge, and the absence of aphasia, apraxia and agnosia. CT demonstrated severe atrophy of the brain stem and severe dilatation of the fourth ventricle with mild atrophy of the cerebral and cerebellar hemispheres. EEG showed slowing of background activity. The autopsied case showed atrophy of the tegmentum of the brain stem in addition to the common pathological findings of Joseph disease. The features of dementia in the 4 patients were similar to those seen in ‘subcortical dementia’, suggesting that its pathological basis may be involvement of the tegmentum of the brain stem.

Progression of Cognitive Impairment in Alzheimer's Disease

Change in cognitive function was assessed over 12 months in 110 patients over the age of 65 satisfying National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria for "probable" Alzheimer's Disease. A highly significant deterioration in cognitive function was observed. Decline in cognitive scores was relatively normally distributed. Patients who died during the follow-up had more apraxia at entry to the study than survivors. A greater rate of decline was seen in patients whose parents suffered from dementia (but not in those where a sibling or other relative was affected), in subjects who had moderate dementia, and those who had been ill for less than 24 months. Age, age of onset, and the presence or absence of aphasia or apraxia had no influence on rate of progression. A cluster analysis revealed three patterns of decline.

Decision strategies in neuropsychology III: The relationship among lateralized dysfunction, etiology and depression

The present study examines depression as a function of lateralized dysfunction and etiology. The proposed hypothesis is: patients with left hemisphere lesions would be depressed, whereas patients with right hemisphere lesions would not. A total of 61 patients (26 right hemisphere, 35 left hemisphere) having either a stroke, tumor, or penetrating head wound, completed the MMPI and were given a neuropsychological evaluation. Lesion localization was based on electroencephalography and neuroradiological procedures. A regression formula derived from the MMPI assessed depression. Two analyses were performed between: (i) right and left lesioned groups of mixed etiology and a control group, and (ii) right and left cerebrovascular lesioned groups and a control group. Potentially confounding factors, such as, diagnosis, demographic factors, degree of neuropsychological impairment, presence or absence of aphasia, and lesion localization were examined. Regardless of etiology, left and right lesioned patients did not significantly differ in their depression score, nor was either group considered depressed based on the criteria used in this study to measure depression.

Dementia in Parkinson's disease: the problem of clinicopathological correlation

Four cases of Parkinson's disease with advanced dementia are described. Postmortem examination revealed cell loss in the substantia nigra, with Lewy bodies present, and loss of cells in the basal nucleus of Meynert. A few tangles were observed in the hippocampus, but no senile plaques or neurofibrillary tangles were found in the neocortex. The authors note that a dramatic dementia syndrome may occur with Parkinson's disease alone, without the associated cytoskeletal markers of Alzheimer's disease. Cases were characterized by disorientation, episodic confusion and hallucinations persisting off medication, disturbed behavior, and the absence of aphasia.

Absence of aphasia in a dextral with a left hemisphere lesion: A case report

Abstract Right-handed patients with aphasia due to a right hemisphere lesion, or sinistral aphasics with a left hemisphere lesion, are referred to as crossed aphasics (Bramwell 1899). Since left damaged sinistrals with aphasia are the rule (Brown and Hecaen 1976), it is the dextral with a right hemisphere lesion that has received most of the attention. When we reviewed the topic of crossed aphasia in dextrals some years ago in relation to a case report (Brown and Wilson 1973). only seven other cases could be found that satisfied the minimal criteria of a clearcut aphasia dextrality and a negative family history ofleft handedness, but since this paper there have been many additional observations (e.g. Assal, Perentes and Dervaz 1981, Donoso, Santander and Pavez 1984, Pillon, Desi and Lhermitte 1979, Wechsler 1976; see Joanette, Puel, Nespoulos, Rascol and Lecours [1982] and Castro-Caldas and Confraria [1984] for review).

Aphasia Does Not Always Follow Left Thalamic Hemorrhage: A Study of Five Negative Cases

Five right-handed patients suffering from a recent CT-assessed left posterior thalamic hemorrhage are reported. In all patients a standard language examination performed -within one month after stroke onset did not reveal aphasic disturbances. While the present series argues for the role of mtrathalamic lesion localization, a review of the literature suggests that lesion site per se does not always account for the presence or absence of aphasia in the individual case. The importance of reduced blood flow and metabolism in cortical areas which appear undamaged on CT scan is briefly discussed.

The concept of subcortical and cortical dementia: another look.

The subcortical dementias such as progressive supranuclear palsy, Huntington's disease, and Parkinson's disease are said to be characterized by the presence of slowed mentation, apathy, and the absence of aphasia, agnosia, and apraxia, symptoms that are claimed to be more common in cortical dementias such as Alzheimer's disease. Conceptual problems (such as vagueness of terms and difficulties with symptom definition) and methodological problems (such as improper matching of comparison groups and inadequate assessment techniques) found in currently available studies require a reappraisal of this classification of dementias into cortical and subcortical forms. A review of recent clinical, neuropathological, and neurochemical studies offers little support for this classification system, although adequate systematic studies have not been performed.

Musical Perception and Cerebral Function: A Critical Review

A critical review is provided of the literature on musical performance following intracarotid sodium Amytal injection and on studies of musical perception in groups of unilaterally brain-damaged persons. The sodium Amytal data suggest that both hemispheres are active in singing familiar songs, since injection into either hemisphere produces disruption of singing. Studies with brain-damaged populations generally find deficits after right-sided damage in tasks demanding processing of patterns of pitches (e. g., unfamiliar melodic sequences) as well as with differences in timbre. Damage to the right temporal lobe causes the most consistent deficits in these tasks. Damage to the left side does not impair performance on such tasks, but does cause problems when familiar tunes are involved, especially if naming or identification is required, regardless of the presence or absence of aphasia. Damage to the right hemisphere also affects performance in such cases, but not usually to the extent that left-hemisphere lesions do.

Analytic and Global Strategies in Copying Designs by Unilaterally Brain-Damaged Patients

Different strategies in copying designs were investigated in unilaterally brain-damaged patients. Site of lesions (right or left) and presence or absence of aphasia, seen as a planning disorder, were taken in consideration. Aphasic patients proved to be more inclined to use an analytic strategy rather than a global one, differing from both other brain-damaged patients and normals. A comparison between patients with right and left brain lesion failed to yield a significant difference.

The social behavior of elderly aphasic versus nonaphasic long-term patients.

A study was made of the social consequences of communicative disorders among 51 elderly hospitalized long-term patients. Independent variables used to account for variations in social behavior were: 1) the presence or absence of aphasia, an impairment resulting in varying degrees of loss of verbal recognition, comprehension and language production; 2) sex; and 3) the level of nursing-care needs as an indicator of overall physical independence. A rating scale for measuring "Social Involvement" was constructed. It involved four analytically-derived factors - Interpersonal Behavior, Familial and Social Contacts, Group Participation, and Extent of Social Contacts. Since a comparison of the 15 aphasic and 36 nonaphasic subjects on the basis of these four factors revealed no substantial main effect, it would seem that social isolation was not attributable to aphasia per se. Rather, a number of significant interactions indicated that differences in the levels of social involvement were attributable to the combined influences of sex, presence or absence of aphasia, and varying levels of physical independence. The relationship between social involvement and social isolation has implications for the overall management and rehibilitation of long-term patients.

Impairment of Color Sorting Behavior After Hemispheric Damage: An Experimental Study with the Holmgren Skein Test

This study aimed at assessing whether the Holmgren skein sorting test, a test repeatedly used in cases of impaired color behavior, predominantly involves hue discrimination, as claimed by some authors, or abstract thinking, as maintained by Gelb and Goldstein. Eighty control patients and 165 brain-damaged patients were examined. The brain-damaged sample was classified according to the hemispheric side of the lesion and to presence or absence of visual field defect (VFD). Left hemisphere patients were also subdivided as to presence or absence of aphasia. Three brain-damaged groups were found impaired with respect to controls: right hemisphere patients with VFD and the two aphasic groups, with and without VFD. To evaluate the relationship between Holmgren performance and proficiency in hue discrimination and in abstract thinking, the scores obtained by patients on the Farnsworth test and on the Weigl test were introduced as covariates in the analysis of the Holmgren means. By computing the regression coefficients, it was found that the Farnsworth scores significantly adjusted the Holmgren scores, while the Weigl scores did not. The Holmgren scores were not significantly correlated in aphasics with the scores of an oral comprehension test, the Token test. It is concluded that right hemisphere patients with VFD fail on the Holmgren test, because they are impaired in hue discrimination. The reason for aphasics’ poor performance is, on the other hand, not clear. Results are inconsistent with the hypothesis that their failure reflects a disorder of language or of conceptual thinking.

Aphasia and literacy.

We had been struck over the past few years in this area by the startling lack of aphasia in patients with large dominant hemisphere infarcts who were often illiterate. The question arose as to whether this was due to the illiteracy or possibly to the patient's race since our state contains a large number of elderly uneducated black citizens. Therefore this study is to determine the presence or absence of aphasia in stroke patients in relation to sex, race, age, and the degree of literacy.