Receptive aphasia
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Template:DiseaseDisorder infobox
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WikiDoc Resources for Receptive aphasia |
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Articles |
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Most recent articles on Receptive aphasia Most cited articles on Receptive aphasia |
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Media |
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Powerpoint slides on Receptive aphasia |
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Evidence Based Medicine |
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Cochrane Collaboration on Receptive aphasia |
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Clinical Trials |
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Ongoing Trials on Receptive aphasia at Clinical Trials.gov Trial results on Receptive aphasia Clinical Trials on Receptive aphasia at Google
|
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Guidelines / Policies / Govt |
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US National Guidelines Clearinghouse on Receptive aphasia NICE Guidance on Receptive aphasia
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Books |
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News |
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Commentary |
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Definitions |
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Patient Resources / Community |
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Patient resources on Receptive aphasia Discussion groups on Receptive aphasia Patient Handouts on Receptive aphasia Directions to Hospitals Treating Receptive aphasia Risk calculators and risk factors for Receptive aphasia
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Healthcare Provider Resources |
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Causes & Risk Factors for Receptive aphasia |
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Continuing Medical Education (CME) |
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International |
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Experimental / Informatics |
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]
- 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.
- 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.
- 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.
Historical Perspective
- [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
- In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
- In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
Classification
- [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
- [group1]
- [group2]
- [group3]
- Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Clinical Features
Differentiating [disease name] from other Diseases
- [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
- [Differential dx1]
- [Differential dx2]
- [Differential dx3]
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop [disease name].
- [Disease name] is more commonly observed among patients aged [age range] years old.
- [Disease name] is more commonly observed among [elderly patients/young patients/children].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected with [disease name] than [gender 2].
- The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
Race
- There is no racial predilection for [disease name].
- [Disease name] usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop [disease name].
Risk Factors
- Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
Diagnosis
Diagnostic Criteria
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- [Disease name] is usually asymptomatic.
- Symptoms of [disease name] may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- There are no [imaging study] findings associated with [disease name].
- [Imaging study 1] is the imaging modality of choice for [disease name].
- On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
- [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
See also
References
- ↑ 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
- ↑ Kolb & Whishaw: Fundamentals of Human Neuropsychology (2003), pages 503-504. The whole paragraph on Luria's theory is written with help of this reference.
- ↑ "The neurophysiology of language: Insights from non-invasive brain stimulation in the healthy human brain". Brain and Language.