Receptive aphasia

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Receptive aphasia
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Broca's area and Wernicke's area
ICD-10 F80.2
ICD-9 315.32
MeSH D001041

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Receptive aphasia, or Wernicke’s aphasia, fluent aphasia, or sensory aphasia is a type of aphasia often (but not always) caused by neurological damage to Wernicke’s area in the brain (Broddman area 22, in the posterior part of the superior temporal gyrus of the dominant hemisphere). This is not to be confused with Wernicke’s encephalopathy or Wernicke-Korsakoff syndrome. The aphasia was first described by Carl Wernicke and its understanding substantially advanced by Norman Geschwind.

Presentation

Damage to the Wernicke's area in the non-dominant hemisphere results in sensory dysprosody, in which the ability to perceive the pitch, rhythm, and emotional tone of speech is lost.

Speech is preserved, but language content is incorrect. This can range from the inclusion of a few inappropriate or nonexistent words to a torrent of jargon. Grammar, intonation, stress, syntax and rate are normal. Substitutions of one word for another (paraphasias, e.g. “telephone” for “television”) are common. In severe cases, this can be confused with the psychiatric signs of “pressure of speech” and “word salad.” Comprehension may be poor and repetition is also inadequate.

Example:

I called my mother on the television and did not understand the door. It was too breakfast, but they came from far to near. My mother is not too old for me to be young.


Regarding speech and comprehension, people with Wernicke’s aphasia may:

  • sequence words together to make illogical sentences
  • form new words which may be senseless
  • be oblivious of spoken mistakes
  • be able to deliver words in a normal melodic line
  • articulate words
  • face hardship or add words while repeating phrases
  • interrupt others and speak too fast

Aphasia is different from a disease like Alzheimer’s, in which many of the brain’s functions diminish over time. Those with Wernicke’s aphasia may:

  • have impaired reading and writing capacity
  • understand visual materials better than written or spoken words
  • preserve cognitive abilities different than those related with language

Patients who recover from Wernicke’s aphasia describe that they experienced others speech to be incomprehensible and, despite knowing they were speaking, did not recognize their own words or were able to stop themselves from speaking. The ability to understand and repeat songs is generally unaffected, as these are processed by the opposite hemisphere. "Melodic intonation therapy" had been attempted with aphasic patients as therapy to help them speak normally, but in 2003 this was found to be ineffective.[1]

Interestingly, patients were able to recite from memory, a key difference from Alzheimer Dementia. The patient is still able to express obscenity, however typically they have no control or knowledge of their spoken obscenities.

Patients are usually physically independent in the absence of other focal neurological deficits.

Luria's theory on Wernicke's aphasia

Luria proposed that this type of aphasia has three characteristics.[2]

1) A deficit in the categorization of sounds. In order to understand what is said, one must be able to perceive subtle sounds of spoken language. For example, differentiating between bad and bed is simple for native English speakers. The Dutch language however, makes no difference between these vowels, and therefore the Dutch experience trouble with these sounds. This is exactly what patients with Wernicke’s aphasia experience even in their own dialect: they can't isolate notable sound characteristics and organize them into known arrangements.

2) A defect in speech. A patient with Wernicke's aphasia can and may be able to speak a great deal, though confusing sound characteristics, producing “word salad”: separately comprehensible words that make no sense together.

3) An impairment in writing. Those who cannot differentiate sounds cannot be predicted to write.

Treatment

Treatment is mainly comprised of speech and language therapy, which is most effective when started as soon as possible post injury. The aim of treatment is to enable the patient to make best use of their remaining language function, improve language skill, and learn how to communicate in other possible ways so their wants and needs can be articulated and addressed.[3] It often involves group therapy.

However, treatment is particularly challenging due to the fact that patients with aphasia suffer from impaired comprehension, which limits their perception of their degree of impairment.

When the cause of aphasia is a stroke, recovery of language function peaks within two to six months, after which further progress is limited. However, efforts should still be made, as an improvement in aphasia has been recorded long after a stroke.

Family support and social support are crucial to a positive outcome. Treatment of post-stroke depression and post-stroke cognitive issues, as well as of other neurological disorders such as neglect, agnosia, and hemiparesis, should be worked on during rehabilitation to further improve patient outcome.


See also

References

  1. Hébert, S. & Racette, A., Gagnon, L. & Peretz, I. (2003). Revisiting the dissociation between speaking and singing in aphasia. Brain, 126, 1838-1850. http://brain.oxfordjournals.org/cgi/reprint/126/8/1838
  2. Kolb & Whishaw: Fundamentals of Human Neuropsychology (2003), pages 503-504. The whole paragraph on Luria's theory is written with help of this reference.
  3. "The neurophysiology of language: Insights from non-invasive brain stimulation in the healthy human brain". Brain and Language.

de:Wernicke-Aphasie




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