Types of aphasia in neurology

Aphasia is a speech disorder due to problems with the cortical centers of speech in the brain. At the same time, there are no hearing impairments and the articulatory apparatus is completely preserved, that is, there are no other anatomical reasons for speech disorders. The most common aphasia occurs with acute disorders of cerebral circulation (stroke), with traumatic injuries brain, tumors, infectious and inflammatory lesions of brain tissue (encephalitis). Thus, aphasia is a symptom of a formidable neurological disease. Let's try to figure out what exactly aphasia manifests itself, what its types are and how it is diagnosed. This article is devoted to these issues.

The term aphasia was proposed back in 1864 by A. Trusso, comes from the Greek prefix "a" denoting negation, and the words "phasis", which means speech. Since then, a lot of time has passed, various variants of speech impairment (from total absence to insignificant, inconspicuous to the normal person's changes), but the formulation to this day remains exactly this.

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About aphasia as a symptom of a neurological disease is said when the intellect does not suffer and initially speech was not disturbed, that is, provided the speech develops normally before the illness. The underdevelopment of the ability to speak from childhood is called alalia, and this is a completely different frustration.

Content

1Varieties of aphasia
- 1.1Motor aphasia
- 1.2Sensory aphasia
- 1.3Amnestic aphasia
2Mixed and total aphasia
3How to detect aphasia?

Varieties of aphasia

There are quite a few aphasia species, all of which are indicated by not quite clear neurological terms. Here in this terminology, we'll try to figure it out.

All types of aphasia can be divided into three groups:

impaired ability to speak;
a violation of the ability to understand spoken speech;
violation of the naming of individual objects.

The first group of speech disorders consists of problems with speech reproduction, that is, when a person understands what needs to be said, but can not (the formulation is in the head, but it is not reproduced by the speech apparatus or reproduced with disturbances). In medicine, this is denoted as follows: violation of expressive speech.

The second group is a violation of the ability to understand the meaning of what has been said. This is indicated as a violation of an impressive speech.

The third group of violations is said, when both understanding and reproduction do not suffer, but the wording (matrix) of the word in the brain is lost. In this case, a person realizes, for example, what is the object before him, what they are doing, but can not call him. That is, at the sight of a spoon, he will say: "This is what they eat and stir food."

Each of the above described groups of speech disorders is divided into additional varieties. This classification is based on the anatomical principle. The fact is that there are clearly defined areas of the cerebral cortex that provide for certain types of speech. All these sites are studied, they are identical in most people. Accordingly, this or that kind of speech disturbance arises at a certain location of the pathological process in the brain. The logical chain is quite simple: such and such a violation of speech is a place of pathology in the brain. This is the basis for diagnosing the site of brain damage. It is for this that the doctor determines the type of aphasia.

In case of violation of expressive speech, there is a so-called motor aphasia, in case of violation of the impressive speech - sensory aphasia, in case of violation of the naming of certain subjects - amnestic. Let's talk about each type of aphasia in more detail.

Motor aphasia

This type of speech impairment is heterogeneous in its structure. Motor aphasia is divided into:

efferent motor aphasia;
afferent (articulatory) motor aphasia;
dynamic motor aphasia.

Efferent motor aphasia occurs when the pathology is localized in the region of the posterior part of the inferior frontal gyrus of the predominant hemisphere (left in right-handed and right-handed in left-handers). This zone is called the Broca zone, so sometimes efferent motor aphasia is called - Broca's aphasia. When the neurons of the Broca zone are affected, the person breaks syllabic and word formation, reproduces all or individual sounds. In the most severe cases, spontaneous speech is lost at all, the patient is explained only by facial expressions and gestures.

Sometimes the whole speech of the patient is verbal or syllabic remnants (for example, "ba", "for"). A particular manifestation of efferent motor aphasia can be word-embolus, that is, one single word that a patient can pronounce. For every question he says only him.

With a less pronounced defect, speech becomes poor, consists mainly of nouns, seems illiterate due to lack of coherence (there are no cases, neither births, nor prepositions). The patient is explained as a foreigner who does not know the language well. For example, "morning-doctor-bypass." At the same time the patient is fully aware of his speech defect and tries to help himself with gestures.

Efferent motor aphasia is characterized by a patient's cycling on parts of words. For example, you ask the patient to repeat the word "ax". Instead of the whole word, a person says "this and that", unable to pronounce the end of the word.

For this type of aphasia is characterized by a confusion of letters, and they are different in pronunciation. For example, instead of the word "mother" the patient is pronounced "lady", instead of "work" - "cohort" and so on.

Another feature of efferent motor aphasia is a violation of reading aloud.

Afferent motor aphasia occurs when the pathological focus is located behind the lower part of the posterior central gyrus of the predominant hemisphere (parietal lobe). In this case, a person in the brain, as it were, breaks the connection between the sound expression of individual letters and the articulatory possibilities. A distinctive feature of this kind of aphasia is the confusion of sounds that are close in pronunciation ("b" and "n", "z" and "c", "g", "k", "x"), which distorts the meaning of what has been said. For example, instead of "on paper we write", the patient says "on the cuff we drink". In addition, the patient is not able to perform simple language gestures, for example, to lay down the tongue with a tube, put the tongue between the upper teeth and the upper lip, poke the tongue. With this type of motor aphasia, reading is also impaired.

Dynamic motor aphasia develops in the lesion of the anterior and middle sections of the lower frontal gyrus of the predominant hemisphere, that is, the zone adjacent to the Broca zone. This type of motor aphasia is characterized by a decrease in spontaneous speech, as if a decrease in speech initiative. In this case, the patient is able to properly articulate the sounds, pronounce all the words. Identify such violations can be in a spontaneous narrative speech, asking the patient to tell about himself. The story will be poor, meager, as if slowed down. Additional stimulating questions are needed. In speech there are few verbs, adjectives, there are no interjections. It seems that the patient reluctantly comes into contact.

Sensory aphasia

This type of speech disorders is divided into two groups: pure sensory and semantic aphasia.

Purely sensory aphasia occurs when the posterior regions of the superior temporal gyrus of the predominant hemisphere are affected, which is called the Wernike center. With this speech disorder, the patient loses the ability to sense the meaning of sounds, syllables and words. That is, the rumor is fully preserved, but any sounds seem inarticulate. It's as if you were talking in a completely unfamiliar language.

With severe sensory aphasia, a person does not fully understand the speech addressed to him, he can not even perform simple verbal instructions (for example, "raise your hands"). With lighter forms of sensory aphasia, the understanding of certain similar sounds is disturbed. For example, a person is offered to answer the question: "Where are the crops harvested - on a tower or on a plowed land?", "Pain the fence or constipation?". If such a patient is asked to repeat a word, he can not do it correctly (for example, instead of "daughter" say "point").

Another feature of sensory aphasia is a complete lack of understanding of its defect, that is, the patient does not notice mistakes in his speech. He is sure that everything says correctly, those around him do not understand, so he often takes offense.

In addition to the violation of the understanding of reversed speech, with sensory aphasia secondary pronunciation is violated again, as the semantic control over words is lost. Often speech of such patients is verbose, inconsistent and completely meaningless. This situation is called "verbal okroshka."

In addition to the above, sensory aphasia is characterized by a violation of reading and writing. A person does not understand the essence of the proposed text, and when writing replaces some letters with others (especially dictation).

Semantic aphasia develops when the lower lobe of the prevailing hemisphere is affected. With this type of speech disorders, a person understands the spoken speech, correctly pronounces words and even performs instructions. But at the same time, the understanding of logical connections in speech instructions is violated. For example, if you ask the patient to draw a circle and a square, he will easily do it, and if you invite him to draw a circle inside the square, it will cause difficulties. That is, temporary and spatial relationships are violated (including the meaning of prepositions "under", "above", "for" and so on). Also, the patient will not be able to explain the difference in the statements of the type "mother's daughter" and "daughter's mother."

With semantic aphasia, the inability to understand the figurative meaning of what has been said develops, written between lines, proverbs and sayings lose all meaning.

Reading a patient with semantic aphasia can, but to retell in his own words - no.

Amnestic aphasia

Amnestic aphasia develops when the lower hemisphere region of the prevailing hemisphere is affected. The essence of this type of speech disturbance is forgetfulness. A person can not remember and pronounce a word denoting an object, while knowing perfectly well what the object is intended for. For example, on a match the patient will say "this is what light". If you tell the word, after naming the first syllable, the patient will say it (as if remembering), but after a minute alone can not repeat it.

Spontaneous narrative speech of such patients contains mostly verbs, is poor in nouns. But reading and writing are not violated at all.

Mixed and total aphasia

In most cases, one patient has several types of speech impairment at the same time, which is associated with the anatomical proximity of speech control zones in the brain. Then they talk about mixed aphasia.

There is still a concept of total aphasia, when all kinds of speech are violated simultaneously. Usually, this situation occurs with a large stroke, when the affected area captures almost the entire frontal-temporal region of the prevailing hemisphere.

How to detect aphasia?

Special methods have been developed to determine the type of speech impairment. There is even a specialist on speech disorders (aphasiology). In most cases, the discovery of aphasia in clinical practice is performed by a neurologist. He conducts a series of simple tests on which this or that type of speech disorders is established. What are these tests? Let's find out:

to study the patient's speech are asked to tell about themselves. A simple collection of complaints, therefore, is also a test for speech impairment;
then the patient is asked to list the days of the week or months, repeat individual sounds and syllables (similar and different: "w" and "uh", "x" and "o", "frame-lady" and so on);
give any text and offer to read aloud, and then retell the read;
the patient is shown well-known objects (a chair, a table, a door, a pen) and are asked to name them;
ask to answer a question containing words that differ in pronunciation (for example, "what does the wind drive - dust or ardor?");
suggest explaining the meaning of any known proverb;
voice the instruction for the performance of an action and ask it to perform (for example, "touch your right ear with your left hand");
ask questions on the understanding of logical and grammatical constructions ("who is the brother of the father and the father of the brother?"), the space-time relations ("what comes earlier: summer before spring or spring before summer?");
suggest drawing a triangle under a square, a circle to the left of the triangle, and so on;
ask to write their passport data (name, age) and any phrase, as well as the phrase dictated.

This group of fairly simple tests is usually enough to detect a particular type of speech disorder. As you can see, the technique is simple and does not require any additional tools or instruments, which is an indisputable plus for diagnostics.

So, aphasia is a neurological symptom of any disease of the brain. It is either a pronunciation disorder or an understanding of speech, or both. There are many types of symptoms, the occurrence of each of which is clearly associated with a specific area of the brain. To identify the disease created special techniques. However, even on an ordinary outpatient clinic with simple tests, one can find one or another kind of aphasia.

A cognitive video on the topic "Types of aphasia":

Types of aphasia