types of aphasia and repetition of words

[MudPhud20XX]

Alright, so I think I've asked this before but I don't think I still get this.

So Firecracker has a nice summary of 6 diff types of aphasia. Basically it uses three parameters
1. comprehension
2. speech
3. repetition

All I am confidnet is that Broca is nonfluent and good comprehension whereas Wernicke is fluent and poor comprehension. Is there any way to make all these intuitive?

Also, what is with "repetition?" Exactly why are we asking patient to repeat words and what is the significance of it?

Many thanks in advance.

• Broca’s (motor) aphasia: nonfluent, good comprehension, poor repetition
  vs.
  Transcortical motor aphasia: nonfluent, good comprehension, good repetition
  
  
• Wernicke’s (sensory) aphasia: fluent, poor comprehension, poor repetition
  vs.
  Transcortical sensory aphasia: fluent, poor comprehension, good repetition
  
  
• Conduction aphasia: fluent, good comprehension, poor repetition
  vs.
  Global aphasia: nonfluent, poor comprehension, poor repetition
  

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[Fatalis]

for your 1st question
ask yourself where is brocas= in the motor area of the brain; so the patient will understand but then get pissed bc he or she cant repeat what you just said although they understand
wernickes is sensory: they dont understand but will just talk randomly.
youtube the conditions and you will understand the pathology more clearly.

 

[MudPhud20XX]

Thanks, so repetition is related to motor function? Then why is Wernicke also poor in repetition?

 

[Fatalis]

if you dont understand something, how can you repeat it; the sensory portion is knocked out. So if I ask the patient: what is your favourite food? They wont understand what I am saying so they will just say something randomly and therefore wont repeat what they just said. Get what I am saying?

 

[alicealicealice]

Agree with fatalis. This drawing may not help you understand but I find it helpful in answering aphasia questions:

Like fatalis said to repeat something you need to (1) understand it (Wernickes area) (2) make a motor plan to say it (broacs area) and (3) connect those two (arcuate fasiculus).
A stroke to wernickes knocks out comprehension as well as part of the arcuate fasiculus = impaired comprehension and no repetition. You can make a motor plan, but theres no real semantic content so you say full words that don't make sense.
A stroke to brocas knocks out motor and part of the arcuate fasciulus. You can't make a motor plan so you babble.
Its hard to pinpoint the anatomical locations of the transcortical aphasias, but I think of them as Brocas and Wenericke "light," with transcortical motor knocking out the anterior part of brocas but sparing the more posterior part and the arcuate fasciculus and transcortical sensory knocking out the more posterior part of Wernickes area but sparing the anterior part and arcuate fasciculus.
A mixed transcortical is caused when the "front" of brocas and the "back" of wernickes is knocked out leaving the remaining parts attached by an intact arcuate. These areas can be selectively hit sparing the space between in a low flow state because they correspond to the watershed areas of the brain.

Neurocognitive Disorders in Aging - Daniel Kempler - Google Books

 

[KZ Hasan]

I'm still a bit confused about trans cortical aphasias. What I don't understand is that why lesions around the Broca's area will produce in ability to speak. Plus I'm also not sure of the exact role of the arcuate fasciculus in speech. What I understand is that when you want to speak the Broca's area draws out the correct words from the Wernicke's area via the arcuate fasciculus and then sends the appropriate signals to the primary motor cortex to generate speech... please correct me if I'm wrong and help me out. Thanks

 

[thehundredthone]

Think of it this way:

• Broca's area is the most basic unit for speech production. Not language, just speech.
• Wernicke's area is the most basic area for comprehension of speech/the written word. Again, not language, just speech.
• The arcuate fasciculus is the connection between these two areas.

When I say just speech, what I mean is words. Broca's area contains the neural pathways to create words, phrases and sentences in a functional way (articulation) using your mouth. Wernicke's area contains neurons that associate auditory and written patterns with their respective words. Without Broca's area, creating and stringing together words (and articulation) is difficult. Without Wernicke's area, speech is just sound, and writing is just art. Without the arcuate fasciculus, the link between audition and speech output (i.e. repetition) is lost.

Conduction aphasia is fluent because the Broca's area is intact, it is entirely possible to create new speech. It has good comprehension because the Wernicke's area is intact, it is entirely possible to understand speech and writing.

The most basic aspect of comprehension is to be able to hear and see. The most basic aspect of motor speech is to be able to move your muscles. Along with this, the complexity of language means that there must be some higher centers to control nuances of language, and this is where the surrounding areas come into play. Now you can understand the entity of transcortical aphasia, where the Wernicke-arcuate-Broca complex is intact but isolated from the rest of the brain.

• Transcortical sensory aphasia: Sound cannot be understood as speech. Written words cannot be processed. Reading and writing are no longer possible. The nuances of language, basically lexical semantics are affected, i.e. there is no understanding of speech as a component of language, and so the very purpose of speech, i.e. to communicate is lost. Since the Wernicke-Broca complex is intact, speech can be generated de novo, although it has no propositional meaning. Repetition is, of course, intact, even for very complex and long sentences. Echolalia is often seen. It is still possible to recite from memory.
• Transocortical motor aphasia: The frontal lobe may be affected, the link between Broca's area and the premotor cortex, basal ganglia and thalamus may be damaged and so initiation and organisation of speech is poor, but well articulated (since Broca's area itself is intact). In dialogue, the patient cannot construct complex answers to questions but can answer with one word responses. Speech and higher language processing is generally intact. Repetition is also intact.

alicealicealice's post gives a great overview of aphasias. Remember that in reality, lesions are rarely so clean and so absolute, so don't be surprised by the intact nature of some faculties in any lesion.

 

[Oh_Gee]

Think of it this way:

• Broca's area is the most basic unit for speech production. Not language, just speech.
• Wernicke's area is the most basic area for comprehension of speech/the written word. Again, not language, just speech.
• The arcuate fasciculus is the connection between these two areas.

When I say just speech, what I mean is words. Broca's area contains the neural pathways to create words, phrases and sentences in a functional way (articulation) using your mouth. Wernicke's area contains neurons that associate auditory and written patterns with their respective words. Without Broca's area, creating and stringing together words (and articulation) is difficult. Without Wernicke's area, speech is just sound, and writing is just art. Without the arcuate fasciculus, the link between audition and speech output (i.e. repetition) is lost.

Conduction aphasia is fluent because the Broca's area is intact, it is entirely possible to create new speech. It has good comprehension because the Wernicke's area is intact, it is entirely possible to understand speech and writing.

The most basic aspect of comprehension is to be able to hear and see. The most basic aspect of motor speech is to be able to move your muscles. Along with this, the complexity of language means that there must be some higher centers to control nuances of language, and this is where the surrounding areas come into play. Now you can understand the entity of transcortical aphasia, where the Wernicke-arcuate-Broca complex is intact but isolated from the rest of the brain.

• Transcortical sensory aphasia: Sound cannot be understood as speech. Written words cannot be processed. Reading and writing are no longer possible. The nuances of language, basically lexical semantics are affected, i.e. there is no understanding of speech as a component of language, and so the very purpose of speech, i.e. to communicate is lost. Since the Wernicke-Broca complex is intact, speech can be generated de novo, although it has no propositional meaning. Repetition is, of course, intact, even for very complex and long sentences. Echolalia is often seen. It is still possible to recite from memory.
• Transocortical motor aphasia: The frontal lobe may be affected, the link between Broca's area and the premotor cortex, basal ganglia and thalamus may be damaged and so initiation and organisation of speech is poor, but well articulated (since Broca's area itself is intact). In dialogue, the patient cannot construct complex answers to questions but can answer with one word responses. Speech and higher language processing is generally intact. Repetition is also intact.

alicealicealice's post gives a great overview of aphasias. Remember that in reality, lesions are rarely so clean and so absolute, so don't be surprised by the intact nature of some faculties in any lesion.

can you explain why Transcortical sensory and mixed have impaired comprehension but intact repetition?

if you dont understand something, how can you repeat it; the sensory portion is knocked out. So if I ask the patient: what is your favourite food? They wont understand what I am saying so they will just say something randomly and therefore wont repeat what they just said. Get what I am saying?

 

[oshanimalia]

can you explain why Transcortical sensory and mixed have impaired comprehension but intact repetition?

Looks like he got rekt