Contrasting cases of Italian agrammatic aphasia without comprehension disorder

Neural mechanisms of sentence production: a volumetric study of primary progressive aphasia

Studies on the neural bases of sentence production have yielded mixed results, partly due to differences in tasks and participant types. In this study, 101 individuals with primary progressive aphasia (PPA) were evaluated using a test that required spoken production following an auditory prime (Northwestern Assessment of Verbs and Sentences-Sentence Production Priming Test, NAVS-SPPT), and one that required building a sentence by ordering word cards (Northwestern Anagram Test, NAT). Voxel-Based Morphometry revealed that gray matter (GM) volume in left inferior/middle frontal gyri (L IFG/MFG) was associated with sentence production accuracy on both tasks, more so for complex sentences, whereas, GM volume in left posterior temporal regions was exclusively associated with NAVS-SPPT performance and predicted by performance on a Digit Span Forward (DSF) task. Verb retrieval deficits partly mediated the relationship between L IFG/MFG and performance on the NAVS-SPPT. These findings underscore the importance of L IFG/MFG for sentence production and suggest that this relationship is partly accounted for by verb retrieval deficits, but not phonological loop integrity. In contrast, it is possible that the posterior temporal cortex is associated with auditory short-term memory ability, to the extent that DSF performance is a valid measure of this in aphasia.

Agrammatic output in non-fluent, including Broca's, aphasia as a rational behavior

Background

Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the "economy of effort" idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge.

Aims

We here revisit the economy of effort hypothesis in light of increasing emphasis in cognitive science on rational and efficient behavior.

Main contribution

The critical idea is as follows: there is a cost per unit of linguistic output, and this cost is greater for patients with non-fluent aphasia. For a rational agent, this increase leads to shorter messages. Critically, the informative parts of the message should be preserved and the redundant ones (like the function words and inflectional markers) should be omitted. Although economy of effort is unlikely to provide a unifying account of agrammatic output in all patients-the relevant population is too heterogeneous and the empirical landscape too complex for any single-factor explanation-we argue that the idea of agrammatic output as a rational behavior was dismissed prematurely and appears to provide a plausible explanation for a large subset of the reported cases of expressive aphasia.

Conclusions

The rational account of expressive agrammatism should be evaluated more carefully and systematically. On the basic research side, pursuing this hypothesis may reveal how the human mind and brain optimize communicative efficiency in the presence of production difficulties. And on the applied side, this construal of expressive agrammatism emphasizes the strengths of some patients to flexibly adapt utterances in order to communicate in spite of grammatical difficulties; and focusing on these strengths may be more effective than trying to "fix" their grammar.

The Severity-Calibrated Aphasia Naming Test

PURPOSE

We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension.

METHOD

We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT.

RESULTS

The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead.

CONCLUSION

We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21476871.

Quantifying grammatical impairments in primary progressive aphasia: Structured language tests and narrative language production

PURPOSE

This study examined grammatical production impairments in primary progressive aphasia (PPA), as measured by structured tests and narrative samples. We aimed to quantify the strength of the relationship between grammatical measures across tasks, and identify factors that condition it. Three grammatical domains were investigated: overall sentence production, verb morphology, and verb-argument structure.

METHODS

77 participants with PPA (34 PPA-G, 16 PPA-L, 15 PPA-S and 12 other) completed a battery of grammatical tests and a narrative language sample was obtained. Accuracy scores were computed for the language tests and the narrative samples were analyzed for both accuracy of selected narrative variables as well as grammatical diversity across the three grammatical domains. Principal components analysis (PCA) and multiple regression were used to examine cross-task relationships for all measures.

RESULTS

As expected on the basis of classification criteria, accuracy scores were lower for the PPA-G group as compared to the PPA-L and PPA-S participants for overall sentence production and verb morphology, but not argument structure. Grammatical accuracy in narratives strongly predicted overall language test performance in PPA-G, whereas grammatical diversity in narratives did so in PPA-L, and no significant correspondence between narrative and language test performance was found for PPA-S. For individuals with severe grammatical impairments only, error distribution for both morphology and argument structure was strongly associated in structured tasks and narratives.

CONCLUSIONS

Grammatical production in narrative language predicts accuracy elicited with structured language tests in PPA. However, unique narrative production patterns distinguish PPA by subtype: accuracy for PPA-G, and grammatical diversity for PPA-L. The impairment in PPA-G is likely to reflect a core impairment in grammar whereas that of PPA-L may be closely tied to the word retrieval and verbal working memory deficits that characterize this variant. This underscores the theoretical distinction between PPA-L and PPA-G, as well as the importance of including grammatical diversity measures in analyses of language production, especially for patients who do not display frank agrammatism. Further, the results suggest that measures of domain-specific language deficits (i.e., verb morphology vs. argument structure) are robust across tasks only in individuals with severe grammatical impairments.

Lack of selectivity for syntax relative to word meanings throughout the language network

To understand what you are reading now, your mind retrieves the meanings of words and constructions from a linguistic knowledge store (lexico-semantic processing) and identifies the relationships among them to construct a complex meaning (syntactic or combinatorial processing). Do these two sets of processes rely on distinct, specialized mechanisms or, rather, share a common pool of resources? Linguistic theorizing, empirical evidence from language acquisition and processing, and computational modeling have jointly painted a picture whereby lexico-semantic and syntactic processing are deeply inter-connected and perhaps not separable. In contrast, many current proposals of the neural architecture of language continue to endorse a view whereby certain brain regions selectively support syntactic/combinatorial processing, although the locus of such "syntactic hub", and its nature, vary across proposals. Here, we searched for selectivity for syntactic over lexico-semantic processing using a powerful individual-subjects fMRI approach across three sentence comprehension paradigms that have been used in prior work to argue for such selectivity: responses to lexico-semantic vs. morpho-syntactic violations (Experiment 1); recovery from neural suppression across pairs of sentences differing in only lexical items vs. only syntactic structure (Experiment 2); and same/different meaning judgments on such sentence pairs (Experiment 3). Across experiments, both lexico-semantic and syntactic conditions elicited robust responses throughout the left fronto-temporal language network. Critically, however, no regions were more strongly engaged by syntactic than lexico-semantic processing, although some regions showed the opposite pattern. Thus, contra many current proposals of the neural architecture of language, syntactic/combinatorial processing is not separable from lexico-semantic processing at the level of brain regions-or even voxel subsets-within the language network, in line with strong integration between these two processes that has been consistently observed in behavioral and computational language research. The results further suggest that the language network may be generally more strongly concerned with meaning than syntactic form, in line with the primary function of language-to share meanings across minds.

Neurocognitive Recovery of Sentence Processing in Aphasia

Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented. Conclusions Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia. Presentation Videohttps://doi.org/10.23641/asha.10257587.

Auditory-Perceptual Rating of Connected Speech in Aphasia

Purpose Auditory-perceptual assessment, in which trained listeners rate a large number of perceptual features of speech samples, is the gold standard for the differential diagnosis of motor speech disorders. The goal of this study was to investigate the feasibility of applying a similar, formalized auditory-perceptual approach to the assessment of language deficits in connected speech samples from individuals with aphasia. Method Twenty-seven common features of connected speech in aphasia were defined, each of which was rated on a 5-point scale. Three experienced researchers evaluated 24 connected speech samples from the AphasiaBank database, and 12 student clinicians evaluated subsets of 8 speech samples each. We calculated interrater reliability for each group of raters and investigated the validity of the auditory-perceptual approach by comparing feature ratings to related quantitative measures derived from transcripts and clinical measures, and by examining patterns of feature co-occurrence. Results Most features were rated with good-to-excellent interrater reliability by researchers and student clinicians. Most features demonstrated strong concurrent validity with respect to quantitative connected speech measures computed from AphasiaBank transcripts and/or clinical aphasia battery subscores. Factor analysis showed that 4 underlying factors, which we labeled Paraphasia, Logopenia, Agrammatism, and Motor Speech, accounted for 79% of the variance in connected speech profiles. Examination of individual patients' factor scores revealed striking diversity among individuals classified with a given aphasia type. Conclusion Auditory-perceptual rating of connected speech in aphasia shows potential to be a comprehensive, efficient, reliable, and valid approach for characterizing connected speech in aphasia.

Cortical and structural-connectivity damage correlated with impaired syntactic processing in aphasia

Agrammatism in aphasia is not a homogeneous syndrome, but a characterization of a nonuniform set of language behaviors in which grammatical markers and complex syntactic structures are omitted, simplified, or misinterpreted. In a sample of 71 left-hemisphere stroke survivors, syntactic processing was quantified with the Northwestern Assessment of Verbs and Sentences (NAVS). Classification analyses were used to assess the relation between NAVS performance and morphosyntactically reduced speech in picture descriptions. Voxel-based and connectivity-based lesion-symptom mapping were applied to investigate neural correlates of impaired syntactic processing. Despite a nonrandom correspondence between NAVS performance and morphosyntactic production deficits, there was variation in individual patterns of syntactic processing. Morphosyntactically reduced production was predicted by lesions to left-hemisphere inferior frontal cortex. Impaired verb argument structure production was predicted by damage to left-hemisphere posterior superior temporal and angular gyrus, as well as to a ventral pathway between temporal and frontal cortex. Damage to this pathway was also predictive of impaired sentence comprehension and production, particularly of noncanonical sentences. Although agrammatic speech production is primarily predicted by lesions to inferior frontal cortex, other aspects of syntactic processing rely rather on regional integrity in temporoparietal cortex and the ventral stream.

The role of the motor system in action naming in patients with neurodegenerative extrapyramidal syndromes

Previous studies of patients with brain damage have suggested a close relationship between aphasia and movement disorders. Neurodegenerative extrapyramidal syndromes associated with cognitive impairment provide an interesting model for studying the neural substrates of cognitive and motor symptoms. In this review, we focused on studies investigating language production abilities in patients with Parkinson's disease (PD), Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP). According to some reports, these patients exhibit a reduction in performance in both action and object naming or verb production compared to healthy individuals. Furthermore, a disproportional impairment of action naming compared to object naming was systematically observed in patients with these disorders. The study of these clinical conditions offers the unique opportunity to examine the close link between linguistic features and motor characteristics of action. This particular pattern of language impairment may contribute to the debate on embodiment theory and on the involvement of the basal ganglia in language and in integrating language and movement. From a translational perspective, we suggest that language ability assessments are useful in the clinical work-up, along with neuropsychological and motor evaluations. Specific protocols should be developed in the near future to better characterize language deficits and to permit an early cognitive diagnosis. Moreover, the link between language deficits and motor impairment opens a new issue for treatment approaches. Treatment of one of these two symptoms may ameliorate the other, and treating both may produce a greater improvement in patients' global clinical conditions.

Treatment of sentence comprehension and production in aphasia: is there cross-modal generalisation?

Exploring generalisation following treatment of language deficits in aphasia can provide insights into the functional relation of the cognitive processing systems involved. In the present study, we first review treatment outcomes of interventions targeting sentence processing deficits and, second report a treatment study examining the occurrence of practice effects and generalisation in sentence comprehension and production. In order to explore the potential linkage between processing systems involved in comprehending and producing sentences, we investigated whether improvements generalise within (i.e., uni-modal generalisation in comprehension or in production) and/or across modalities (i.e., cross-modal generalisation from comprehension to production or vice versa). Two individuals with aphasia displaying co-occurring deficits in sentence comprehension and production were trained on complex, non-canonical sentences in both modalities. Two evidence-based treatment protocols were applied in a crossover intervention study with sequence of treatment phases being randomly allocated. Both participants benefited significantly from treatment, leading to uni-modal generalisation in both comprehension and production. However, cross-modal generalisation did not occur. The magnitude of uni-modal generalisation in sentence production was related to participants' sentence comprehension performance prior to treatment. These findings support the assumption of modality-specific sub-systems for sentence comprehension and production, being linked uni-directionally from comprehension to production.

The dissociability of lexical retrieval and morphosyntactic processes for nouns and verbs: A functional and anatomoclinical study

Nouns and verbs can dissociate following brain damage, at both lexical retrieval and morphosyntactic processing levels. In order to document the range and the neural underpinnings of behavioral dissociations, twelve aphasics with disproportionate difficulty naming objects or actions were asked to apply phonologically identical morphosyntactic transformations to nouns and verbs. Two subjects with poor object naming and 2/10 with poor action naming made no morphosyntactic errors at all. Six of 10 subjects with poor action naming showed disproportionate or no morphosyntactic difficulties for verbs. Morphological errors on nouns and verbs correlated at the group level, but in individual cases a selective impairment of verb morphology was observed. Poor object and action naming with spared morphosyntax were associated with non-overlapping lesions (inferior occipitotemporal and fronto-temporal, respectively). Poor verb morphosyntax was observed with frontal-temporal lesions affecting white matter tracts deep to the insula, possibly disrupting the interaction of nodes in a fronto-temporal network.

A characterization of verb use in Turkish agrammatic narrative speech

This study investigates the characteristics of narrative-speech production and the use of verbs in Turkish agrammatic speakers (n = 10) compared to non-brain-damaged controls (n = 10). To elicit narrative-speech samples, personal interviews and storytelling tasks were conducted. Turkish has a large and regular verb inflection paradigm where verbs are inflected for evidentiality (i.e. direct versus indirect evidence available to the speaker). Particularly, we explored the general characteristics of the speech samples (e.g. utterance length) and the uses of lexical, finite and non-finite verbs and direct and indirect evidentials. The results show that speech rate is slow, verbs per utterance are lower than normal and the verb diversity is reduced in the agrammatic speakers. Verb inflection is relatively intact; however, a trade-off pattern between inflection for direct evidentials and verb diversity is found. The implications of the data are discussed in connection with narrative-speech production studies on other languages.

Perceptual Accent Rating and Attribution in Psychogenic FAS: Some Further Evidence Challenging Whitaker's Operational Definition

A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, and L3: English) woman with a 12-year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved toward a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based on the patient's complex medical history and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker's (1982) definition of foreign accent syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke.

Modality and morphology: what we write may not be what we say

Written language is an evolutionarily recent human invention; consequently, its neural substrates cannot be determined by the genetic code. How, then, does the brain incorporate skills of this type? One possibility is that written language is dependent on evolutionarily older skills, such as spoken language; another is that dedicated substrates develop with expertise. If written language does depend on spoken language, then acquired deficits of spoken and written language should necessarily co-occur. Alternatively, if at least some substrates are dedicated to written language, such deficits may doubly dissociate. We report on 5 individuals with aphasia, documenting a double dissociation in which the production of affixes (e.g., the -ing in jumping) is disrupted in writing but not speaking or vice versa. The findings reveal that written- and spoken-language systems are considerably independent from the standpoint of morpho-orthographic operations. Understanding this independence of the orthographic system in adults has implications for the education and rehabilitation of people with written-language deficits.

Grammatical analysis as a distributed neurobiological function

Language processing engages large-scale functional networks in both hemispheres. Although it is widely accepted that left perisylvian regions have a key role in supporting complex grammatical computations, patient data suggest that some aspects of grammatical processing could be supported bilaterally. We investigated the distribution and the nature of grammatical computations across language processing networks by comparing two types of combinatorial grammatical sequences--inflectionally complex words and minimal phrases--and contrasting them with grammatically simple words. Novel multivariate analyses revealed that they engage a coalition of separable subsystems: inflected forms triggered left-lateralized activation, dissociable into dorsal processes supporting morphophonological parsing and ventral, lexically driven morphosyntactic processes. In contrast, simple phrases activated a consistently bilateral pattern of temporal regions, overlapping with inflectional activations in L middle temporal gyrus. These data confirm the role of the left-lateralized frontotemporal network in supporting complex grammatical computations. Critically, they also point to the capacity of bilateral temporal regions to support simple, linear grammatical computations. This is consistent with a dual neurobiological framework where phylogenetically older bihemispheric systems form part of the network that supports language function in the modern human, and where significant capacities for language comprehension remain intact even following severe left hemisphere damage.

Agrammatic aphasia verb and argument patterns in Kiswahili-English spontaneous language

Background: The spontaneous and narrative language of Kiswahili agrammatic aphasic and non-brain-damaged speakers was analysed. The bilingual participants were also tested in English to enable comparisons of verb production in the two languages. The significance of this study was to characterise bilingual Kiswahili-English spontaneous agrammatic output. This was done by describing Kiswahili-English bilingual output data with a specific focus on the production of verbs. The description involves comparison of verb and argument production in Kiswahili and English. Methods and procedures: The participants recruited for this study were drawn from two groups of participants (six non-fluent aphasic/agrammatic speakers and six non-braindamaged). From each participant, a sample of spontaneous output was tape-recorded in English and Kiswahili based on the description and narration of the Flood rescue picture’ and the ‘Cookie theft picture’. The data elicited were compared for each subject and between the participants and relevant verb parameters have been analysed. The variables that were studied included mean length of utterance (MLU), inflectional errors, verb tokens and types, copulas and auxiliaries. Further, all verbs produced were classified as per their argument structure. Results: The results from English data supported previous findings on agrammatic output. The agrammatic participants produced utterances with shorter MLU and simpler sentence structure. However, Kiswahili data surprisingly showed reversed results, with agrammatic speakers producing longer utterances than non-brain-damaged (NBD) controls. The results also revealed selective impairment in some agrammatic speakers who made inflectional errors. The verb argument structure showed contrasting results, with agrammatic speakers preferring transitive verbs whilst the NBD speakers used more intransitive verbs.Conclusions: The study attempts for the first time to characterise English-Kiswahili bilingual spontaneous and narrative output. A quantitative analysis of verb and argument production is conducted. The results of the English data are consistent with those in the literature; agrammatic speakers produce utterances with shorter MLU and simpler sentence structure. However, Kiswahili data reveals a surprisingly reversed pattern most notably with respect to MLU with agrammatics producing longer utterances than NBD controls. Argument structure analysis revealed that agrammatics used more transitive verbs than intransitives.

Training-induced improvement of noncanonical sentence production does not generalize to comprehension: evidence for modality-specific processes

The presence or absence of generalization after treatment can provide important insights into the functional relationship between cognitive processes. The aim of the present study was to investigate the relationship between the cognitive processes that underlie sentence comprehension and production in aphasia. Using data from seven participants who took part in a case-series intervention study that focused on noncanonical sentence production [Stadie et al. (2008). Unambiguous generalization effects after treatment of noncanonical sentence production in German agrammatism. Brain and Language, 104, 211-229], we identified patterns of impairments and generalization effects for the two modalities. Results showed (a) dissociations between sentence structures and modalities before treatment, (b) an absence of cross-modal generalization from production to comprehension after treatment, and (c), a co-occurrence of spared comprehension before treatment and generalization across sentence structures within production after treatment. These findings are in line with the assumption of modality-specific, but interacting, cognitive processes in sentence comprehension and production. More specifically, this interaction is assumed to be unidirectional, allowing treatment-induced improvements in production to be supported by preserved comprehension.

Aphasias and theories of linguistic representation: representing frequency, hierarchy, constructions, and sequential structure

Error and preservation patterns in aphasic speech show that the brain makes use of the frequencies of words, constructions, and collocations, as well as category membership and hierarchical structure, during language processing. Frequency effects are evident along two quasi-independent axes: syntagmatic (the sequential context, e.g., deploying correct functors, categories, and utterance-level intonation) and paradigmatic (the choice at any given linguistic level, e.g., selecting content words and modifying structures). Frequency along the syntagmatic axis is shown to play a role in errors involving idioms, constructions, and collocations that cross major phrasal boundaries. Along the paradigmatic axis, frequency affects errors involving lexical selection, competing functors and inflected forms (e.g., using plural where singular is required). An account of language representation and processing that encompasses frequency as well as categorization and structure is compatible with what we know about how the brain works: increased experience with a linguistic structure results in increased activation-and strengthening-of the neural networks involved in processing that structure. These claims are supported by the literature on experimental work in normal speakers. Parsimony, plus the unexamined assumption that mental representation is like a written record (entries either present or absent, structure displayable in two dimensions), has been a misleading guide to modeling language representation. The substantial redundancy in representations and processing that is introduced by incorporating both frequency-based and hierarchy-based information is in fact appropriate for the brain as a fast, reliable, massively parallel error-correcting network with very large storage capacity and gradient representation strength. WIREs Cogn Sci 2013, 4:651-663. doi: 10.1002/wcs.1257 CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

Training verb argument structure production in agrammatic aphasia: behavioral and neural recovery patterns

INTRODUCTION

Neuroimaging and lesion studies indicate a left hemisphere network for verb and verb argument structure processing, involving both frontal and temporoparietal brain regions. Although their verb comprehension is generally unimpaired, it is well known that individuals with agrammatic aphasia often present with verb production deficits, characterized by an argument structure complexity hierarchy, indicating faulty access to argument structure representations for production and integration into syntactic contexts. Recovery of verb processing in agrammatism, however, has received little attention and no studies have examined the neural mechanisms associated with improved verb and argument structure processing. In the present study we trained agrammatic individuals on verbs with complex argument structure in sentence contexts and examined generalization to verbs with less complex argument structure. The neural substrates of improved verb production were examined using functional magnetic resonance imaging (fMRI).

METHODS

Eight individuals with chronic agrammatic aphasia participated in the study (four experimental and four control participants). Production of three-argument verbs in active sentences was trained using a sentence generation task emphasizing the verb's argument structure and the thematic roles of sentential noun phrases. Before and after training, production of trained and untrained verbs was tested in naming and sentence production and fMRI scans were obtained, using an action naming task.

RESULTS

Significant pre- to post-training improvement in trained and untrained (one- and two-argument) verbs was found for treated, but not control, participants, with between-group differences found for verb naming, production of verbs in sentences, and production of argument structure. fMRI activation derived from post-treatment compared to pre-treatment scans revealed upregulation in cortical regions implicated for verb and argument structure processing in healthy controls.

CONCLUSIONS

Training verb deficits emphasizing argument structure and thematic role mapping is effective for improving verb and sentence production and results in recruitment of neural networks engaged for verb and argument structure processing in healthy individuals.

Why reference to the past is difficult for agrammatic speakers

Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to the past is selectively impaired in agrammatic aphasia. That is, verb inflections for past tense and perfect aspect are hard to produce. Furthermore, verb clusters that refer to the past will be affected as well, even if the auxiliary is in present tense, as in he has been writing a letter. It will be argued that all these verb forms referring to the past require discourse linking [Zagona, K. (2003). Tense and anaphora: Is there a tense-specific theory of coreference. In A. Barrs (Ed.), Anaphora: A reference guide (pp. 140-171). Oxford: Blackwell Publishing] and discourse linking is affected in agrammatic aphasia [Avrutin, S. (2006). Weak syntax. In K. Amunts, & Y. Grodzinsky (Eds.), Broca's region (pp. 49-62). New York: Oxford Press]. This hypothesis has been coined the PAst DIscourse LInking Hypothesis (PADILIH) [Bastiaanse, R., Bamyaci, E., Hsu, C.-J., Lee, J., Yarbay Duman, T., & Thompson, C.K. (2011). Time reference in agrammatic aphasia: A cross-linguistic study. Journal of Neurolinguistics, 24, 652-673]. The PADILIH has been tested in several languages and populations that have hardly been studied before in aphasiology: languages such as Turkish, Swahili and Indonesian were included, as well as monolingual and bilingual populations. In all these populations, the same test has been used: the Test for Assessing Reference of Time [Bastiaanse, R., Jonkers, R., & Thompson, C.K. (2008). Test for assessing reference of time (TART). Groningen: University of Groningen] to enable reliable comparisons between the languages. The results show that the PADILIH predicts the performance of agrammatic speakers very well: discourse-linked grammatical morphemes expressing time reference to the past are hard to produce for agrammatic speakers, whereas non-discourse-linked verb inflections (for present and future) are relatively spared. In languages that use aspectual adverbs (free-standing and optional time reference markers), such as Chinese and Indonesian, time reference to all time frames is impaired, since all aspectual adverbs, regardless of the time frame they refer to, require discourse linking. Remarkably, the problems are not restricted to grammatical morphemes: the production of temporal lexical adverbs is impaired as well.

Grammar disruption in a patient with Neuro-Sweet syndrome

This paper for the first time reports detailed neurolinguistic findings in a patient with Neuro-Sweet syndrome. In this patient the presenting symptoms of central nervous system (CNS) involvement primarily consisted of a selective grammar deficit restricted to spontaneous speech. On MRI a left prefrontal ischemic stroke (superior part BA 6) and two small subcortical left parietal infarctions were found. Neurolinguistic analyses, however, did not reveal a profile consistent with any observations of agrammatism caused by structural damage to the language areas critically involved in grammatical processing. It is hypothesized that selectively distorted grammar might reflect disruption of the frontosubcortical network involved in language processing. Prefrontal neurobehavioral abnormalities associated with functional disruption of the inferior medial frontal regions as demonstrated by SPECT, additionally suggest that agrammatic symptoms may be linked to a higher-level cognitive disorder following encephalopathic CNS involvement.

The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders

OBJECTIVE

Patients with Lewy body spectrum disorders (LBSD) such as Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies exhibit deficits in both narrative comprehension and narrative expression. The present research examines the hypothesis that these impairments are due to a material-neutral deficit in organizational executive resources rather than to impairments of language per se. We predicted that comprehension and expression of narrative would be similarly affected and that deficits in both expression and comprehension of narrative would be related to the same anatomic distribution of prefrontal disease.

METHOD

We examined 29 LBSD patients and 26 healthy seniors on their comprehension and expression of narrative discourse. For comprehension, we measured accuracy and latency in judging events with high and low associativity from familiar scripts such as "going fishing." The expression task involved maintaining the connectedness of events while narrating a story from a wordless picture book.

RESULTS

LBSD patients were impaired on measures of narrative organization during both comprehension and expression relative to healthy seniors. Measures of organization during narrative expression and comprehension were significantly correlated with each other. These measures both correlated with executive measures but not with neuropsychological measures of lexical semantics or grammar. Voxel-based morphometry revealed overlapping regressions relating frontal atrophy to narrative comprehension, narrative expression, and measures of executive control.

CONCLUSIONS

Difficulty with narrative discourse in LBSD stems in part from a deficit of organization common to comprehension and expression. This deficit is related to prefrontal cortical atrophy in LBSD.

Active perception: sensorimotor circuits as a cortical basis for language

Action and perception are functionally linked in the brain, but a hotly debated question is whether perception and comprehension of stimuli depend on motor circuits. Brain language mechanisms are ideal for addressing this question. Neuroimaging investigations have found specific motor activations when subjects understand speech sounds, word meanings and sentence structures. Moreover, studies involving transcranial magnetic stimulation and patients with lesions affecting inferior frontal regions of the brain have shown contributions of motor circuits to the comprehension of phonemes, semantic categories and grammar. These data show that language comprehension benefits from frontocentral action systems, indicating that action and perception circuits are interdependent.

Non-Fluent Speech in Frontotemporal Lobar Degeneration

We investigated the cognitive and neural bases of impaired speech fluency, a central feature of primary progressive aphasia. Speech fluency was assessed in 35 patients with frontotemporal lobar degeneration (FTLD) who presented with progressive non-fluent aphasia (PNFA, n=11), semantic dementia (SemD, n=12), or a social and executive disorder without aphasia (SOC/EXEC, n=12). Fluency was quantified as the number of words per minute in an extended, semi-structured speech sample. This was related to language characteristics of the speech sample and to neuropsychological measures. PNFA patients were significantly less fluent than controls and other FTLD patients. Fluency correlated with grammatical expression but not with speech errors or executive difficulty. SemD and SOC/EXEC patients were also less fluent than controls. In SemD, fluency was associated with semantically limited content. In SOC/EXEC, fluency was associated with executive limitations. Voxel-based morphometry analyses of high-resolution MRI related fluency to gray matter volume in left inferior frontal, insula, and superior temporal regions for the entire cohort of FTLD patients. This region overlapped partially distinct atrophic areas in each FTLD subgroup. It thus appears to play a crucial role in speech fluency, which can be interrupted in different ways in different FTLD subgroups.

A psychometric analysis of functional category production in English agrammatic narratives

Hierarchical models of agrammatism propose that sentence production deficits can be accounted for in terms of clausal syntactic structure [Friedmann, N., & Grodzinsky, Y. (1997). Tense and agreement in agrammatic production: Pruning the syntactic tree. Brain and Language, 56, 397-425; Hagiwara, H. (1995). The breakdown of functional categories and the economy of derivation. Brain and Language, 50, 92-116]. Such theories predict that morpho-syntactic elements associated with higher nodes in the syntactic tree (complementizers and verb inflections) will be more impaired than elements associated with lower structural positions (negation markers and aspectual verb forms). While this hypothesis has been supported by the results of several studies [Benedet, M. J., Christiansen, J. A., & Goodglass, H. (1998). A cross-linguistic study of grammatical morphology in Spanish- and English-speaking agrammatic patients. Cortex, 34, 309-336; Friedmann, N. (2001). Agrammatism and the psychological reality of the syntactic tree. Journal of Psycholinguistic Research, 30, 71-88; Friedmann, N. (2002). Question production in agrammatism: The tree pruning hypothesis. Brain and Language, 80, 160-187], it has also been challenged on several grounds [Burchert, F., Swoboda-Moll, M., & De Bleser, R. (2005a). Tense and agreement dissociations in German agrammatic speakers: Underspecification vs. hierarchy. Brain and Language, 94, 188-199; Lee, M. (2003). Dissociations among functional categories in Korean agrammatism. Brain and Language, 84, 170-188; Lee, J., Milman, L. H., & Thompson, C. K. (2005). Functional category production in agrammatic speech. Brain and Language, 95, 123-124]. In this paper the question of hierarchical structure was re-examined within the framework of Item Response Theory [IRT, Rasch, G. (1980). Probabilistic models for some intelligence and attainment tests (Expanded ed.). Chicago: University of Chicago Press]. IRT is a probabilistic model widely used in the field of psychometrics to model behavioral constructs as numeric variables. In this study we examined production of functional categories (complementizers, verb inflections, negation markers, and aspectual verb forms) in narrative samples elicited from 18 individuals diagnosed with nonfluent aphasia and 18 matched controls. Data from the aphasic participants were entered into an IRT analysis to test (1) whether production of clausal functional categories can be represented as a variable on a numeric scale; and (2) whether production patterns were consistent with hierarchical syntactic structure. Pearson r correlation coefficients were also computed to determine whether there was a relation between functional category production and other indices of language performance. Results indicate that functional category production can be modeled as a numeric variable using IRT. Furthermore, although variability was observed across individuals, consistent patterns were evident when the data were interpreted within a probabilistic framework. Although functional category production was moderately correlated with a second measure of clausal structure (clause length), it was not correlated with more distant language constructs (noun/verb ratio and WAB A.Q.). These results suggest that functional category production is related to some, but not all, measures of agrammatic language performance.

Speech and language functions that require a functioning Broca's area

A number of previous studies have indicated that Broca's area has an important role in understanding and producing syntactically complex sentences and other language functions. If Broca's area is critical for these functions, then either infarction of Broca's area or temporary hypoperfusion within this region should cause impairment of these functions, at least while the neural tissue is dysfunctional. The opportunity to identify the language functions that depend on Broca's area in a particular individual was provided by a patient with hyperacute stroke who showed selective hypoperfusion, with minimal infarct, in Broca's area, and acutely impaired production of grammatical sentences, comprehension of semantically reversible (but not non-reversible) sentences, spelling, and motor planning of speech articulation. When blood flow was restored to Broca's area, as demonstrated by repeat perfusion weighted imaging, he showed immediate recovery of these language functions. The identification of language functions that were impaired when Broca's area was dysfunctional (due to low blood flow) and recovered when Broca's area was functional again, provides evidence for the critical role of Broca's area in these language functions, at least in this individual.

Asyntactic thematic role assignment by Mandarin aphasics: a test of the Trace-Deletion Hypothesis and the Double Dependency Hypothesis

This study examines the comprehension patterns of various sentence types by Mandarin-speaking aphasic patients and evaluates the validity of the predictions from the Trace-Deletion Hypothesis (TDH) and the Double Dependency Hypothesis (DDH). Like English, the canonical word order in Mandarin is SVO, but the two languages differ in that the head noun precedes the relative clause in English, but it follows the relative clause in Chinese. According to the Default Principle as stated in the TDH, the word order discrepancy will make subject relative clauses more difficult to comprehend for Mandarin agrammatics than object relative clauses, but the DDH predicts that agrammatic patients from the two languages have the same pattern of selective deficits. The results of this study support the prediction of the TDH.

Clause structure and verb movement in a Greek-English speaking bilingual patient with Broca's aphasia: evidence from adverb placement

In this paper, we investigate the performance of a Greek-English bilingual patient with Broca's aphasia and mild agrammatism on the placement of CP, MoodP, AspectP, and NegP-related adverbs, labeled specifier-type adverbs, and VP-related adverbs, labeled complement-type adverbs, by means of a constituent ordering task and a grammaticality judgment task. Based on the results derived by means of these two different tasks in both Greek and English, we argue that (i) the CP layer causes great difficulties to aphasic performance in both languages but it is not missing from aphasic grammar, whereas the VP layer remains intact in both languages; (ii) the MoodP, AspectP, and NegP-related adverbs cause more difficulties in English that in Greek. We attribute this to the independent differences between English and Greek that relate to properties of verbal morphology and syntactic head movement.

Anatomical functional and cognitive determinants of semantic memory disorders

Contemporary debates on the 'semantic memory' construct revolve around three main topics: (1) the functional and anatomical relationships between episodic and semantic memory; (2) the format of semantic representations and their relationships with the underlying sensory-motor processes; (3) the categorical organization of semantic memory. The aim of the present review is to demonstrate that there is a common thread linking these different aspects of semantic memory. This thread is represented by the interdependence of mechanisms involved in the construction of semantic memory and the content of semantic representations. In particular, I suggest there is a continuity between: (a) the mechanisms of acquisition of episodic and semantic memory; (b) semantic representations and sensory-motor processes preliminary to the acquisition of these representations. This continuity has important implications for the format of semantic representations and the brain structures subserving the organisation of various categories of knowledge.

Comprehension of sentences with stylistic inversion by French aphasic patients

Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and the Conduction aphasics performed at chance. The results are discussed in relationship to existing models of aphasic impairments in assigning syntactic structures and using them to determine thematic roles in sentences. We conclude that the results for the agrammatic patients demonstrate the importance of compensatory mechanisms underlying aphasic comprehension and the results in the Conduction aphasics indicate the importance of working memory deficits in determining such deficits. The results are also relevant to models of normal syntactic structure.

Language processing: functional organization and neuroanatomical basis

Earlier formulations of the relation of language and the brain provided oversimplified accounts of the nature of language disorders, classifying patients into syndromes characterized by the disruption of sensory or motor word representations or by the disruption of syntax or semantics. More recent neuropsychological findings, drawn mainly from case studies, provide evidence regarding the various levels of representations and processes involved in single-word and sentence processing. Lesion data and neuroimaging findings are converging to some extent in providing localization of these components of language processing, particularly at the single-word level. Much work remains to be done in developing precise theoretical accounts of sentence processing that can accommodate the observed patterns of breakdown. Such theoretical developments may provide a means of accommodating the seemingly contradictory findings regarding the neural organization of sentence processing.

Does morphology make the difference? Agrammatic sentence comprehension in German

This study examines the syntactic comprehension of seven German agrammatic speakers. The German language allows the study of the interaction of syntactic principles and morphological devices in the comprehension process. In addition, due to its relatively free word order, German allows the study of strictly minimal pairs of canonical and non-canonical sentences in addition to the rather controversial active-passive contrast. A central research question was whether the pattern of agrammatic comprehension predicted by the trace deletion hypothesis (TDH, Grodzinsky, 1990, 1995), relatively normal comprehension performance of canonical sentences and chance performance on non-canonical sentences, can be found in a language with richer morphology than English. The generalisability of the TDH-pattern to morphologically rich languages is not obvious, given that case morphology in particular can provide explicit cues to the detection of the agent and patient roles in a sentence. The results of this study indicate that morphology does not make a difference. Furthermore, the group results are in line with the TDH-predictions only for number marked sentences but not for case marked sentences. However, single case analysis reveals different patterns of syntactic comprehension in agrammatic patients, a spectrum that encompasses near-normal comprehension of canonical and non-canonical sentences, overall chance performance, and TDH-like profiles.

Dissociations among functional categories in Korean agrammatism

This study investigated the hypothesis that the syntactic trees formed by individuals with agrammatic aphasia cannot be constructed any higher than an impaired node as suggested by the tree-pruning hypothesis (Friedman, 1994; Friedmann & Grodzinsky, 1997) and hypothesis. It also examined their following implication that the members of a certain functional category are subject to the same degree of impairment. Two experiments were conducted to investigate a Korean agrammatic patient's use and understanding of three functional categories--Mood, Tense, and Complementizer. The results showed a dissociation among functional categories that preserves the higher node while leaving the lower node impaired both in production and comprehension. Another dissociation was found among members of the same category depending on their linear position in the clause. These results contrast with the predictions of the tree-pruning hypothesis, suggesting that the nearer to the end of the clause a functional element is located, the better it is preserved in Korean agrammatism.

Verb and auxiliary movement in agrammatic Broca's aphasia

Verb production in agrammatic Broca's aphasia has repeatedly been shown to be impaired by a number of investigators. Not only is the number of verbs produced often significantly reduced, but verb inflections and auxiliaries are often omitted as well (e.g., Bastiaanse, Jonkers, & Moltmaker-Osinga, 1996; Saffran, Berndt, & Schwartz, 1989; Thompson, Shapiro, Li, &Schendel, 1994, 1997). It has been suggested that these problems are, in part, caused by the fact that finite verbs need to be moved from their base-generated position to inflectional nodes in the syntactic tree (e.g., Bastiaanse & Van Zonneveld, 1998). Others have suggested that production deficits in agrammatism can be predicted based on the position that certain structures take in the syntactic tree (Friedmann & Grodzinsky, 1997; Hagiwara, 1995). If the former theory is correct, several predictions can be made. First of all, the discrepancy between production of finite verbs in the matrix and embedded clause that has been found for Dutch (Bastiaanse & Van Zonneveld, 1998) should not be observed in English, since the word order of the matrix and embedded clause are the same in the latter language. Second, if verb movement (including movement of auxiliaries) is problematic for speakers with agrammatic aphasia, then a hierarchy in the production of auxiliaries in yes/no questions, auxiliaries, and finite verbs in declarative sentences in English would be expected, since the former has been moved and the two latter are in base-generated position. In the present paper, these hypotheses were tested in a cross-linguistic study of Dutch and English. Results showed the position in the syntactic tree does not predict deficit patterns; rather the critical factor appears to relate to whether or not verb or auxiliary movement is required.

Selective impairment of morphosyntactic production in a neurological patient

In this paper we describe the impaired morphosyntactic production of a neurological patient (R.B.). The patient's production of almost all freestanding morphological material (e.g. subjects, verbs, and function words) is unimpaired, while production of bound inflectional morphology is impaired. We show that this impairment involves featural information on both verbs and nouns and discuss it in the context of the Distributed Morphology model of morphosyntactic processing. We conclude that her error pattern is consistent with impaired ability to convert featural information to morphological material after sentence formation is complete.

Verbs: some properties and their consequences for agrammatic Broca's aphasia

It has repeatedly been shown that agrammatic Broca's aphasics have serious problems with the retrieval of verbs on action naming tests (Miceli, Silveri, Villa & Caramazza, 1984; Kohn, Lorch & Pearson, 1989; Basso, Razzano, Faglioni & Zanobio, 1990; Jonkers, 1998; Kim & Thompson, 2000). Less attention has been paid to the production of verbs at the sentence level (but see Miceli, Mazzuchi, Menn & Goodglass, 1983; Thompson, Shapiro, Li & Schendel, 1995; Thompson, Lange, Schneider & Shapiro, 1997; Bastiaanse & Van Zonneveld, 1998; Bastiaanse, Rispens & Van Zonneveld, 2000; Friedmann, 2000), although it has been mentioned that in agrammatic spontaneous speech verbs are lacking (Saffran, Berndt & Schwartz, 1989; Thompson et al., 1995, but see Bastiaanse & Jonkers, 1998).In this paper, three cross-linguistic studies are discussed to show that these problems with verbs have consequences for other grammatical morphemes and structures that have been mentioned to be impaired in agrammatic speech and that these consequences are different per language, depending on linguistic characteristics. The first study focuses on finiteness and compares the production of finite verbs in matrix and embedded clauses in Dutch and English, showing that a linguistic rule in Dutch (Verb Second), which does not exist in English, can explain the different performance of Dutch and English agrammatic Broca's aphasics. The second study focuses on determiners and (finite) verbs in German and shows that poor determiner production is directly related to poor verb production. The last study demonstrates that the ability to construct negative sentences is dependent on the language specific relation between verb movement and negation: Dutch and Norwegian agrammatics perform equally well on affirmative and negative sentences, whereas English and Spanish agrammatics are more impaired on negative sentences.Overall, these studies show that the problems agrammatics encounter with verbs and their properties have a spin-off on the production of other word-classes and that the characterization 'problems with grammatical morphemes' is too general for telegraphic speech.

The lateralized linguistic cerebellum: a review and a new hypothesis

During the past 2 decades the collaboration across disciplines and the methodologic and conceptual advances of contemporary neuroscience have brought about a substantial modification of the traditional view of the cerebellum as a mere coordinator of autonomic and somatic motor functions. Growing insights in the neuroanatomy of the cerebellum and its interconnections, evidence from functional neuroimaging and neurophysiological research, and advancements in clinical and experimental neuropsychology have established the view that the cerebellum participates in a much wider range of functions than conventionally accepted. This increase of insight has brought to the fore that the cerebellum modulates cognitive functioning of at least those parts of the brain to which it is reciprocally connected. This article reviews the recently acknowledged role of the cerebellum in cognition and addresses in more detail experimental and clinical data disclosing the modulatory role of the cerebellum in various non-motor language processes such as lexical retrieval, syntax, and language dynamics. In agreement with the findings indicating a topographical organization of the cerebellar structures involved in language pathology we advance the concept of a "lateralized linguistic cerebellum." In our view crossed cerebral diaschisis processes, reflecting a functional depression of supratentorial language areas due to reduced input via cerebellocortical pathways, might represent the relevant pathomechanism for linguistic deficits associated with cerebellar pathology.