Studies of patients with acquired cognitive deficits following brain damage and studies using contemporary neuroimaging techniques form two distinct streams of research on the neural basis of cognition. In this study, we combine high-quality structural neuroimaging analysis techniques and extensive behavioral assessment of patients with persistent acquired language deficits to study the neural basis of language. Our results reveal two major divisions within the language system – meaning vs. form and recognition vs. production – and their instantiation in the brain. Phonological form deficits are associated with lesions in peri-Sylvian regions, whereas semantic production and recognition deficits are associated with damage to the left anterior temporal lobe and white matter connectivity with frontal cortex, respectively. These findings provide a novel synthesis of traditional and contemporary views of the cognitive and neural architecture of language processing, emphasizing dual-routes for speech processing and convergence of white matter tracts for semantic control and/or integration.
Meaningful speech, as exemplified in object naming, calls on knowledge of the mappings between word meanings and phonological forms. Phonological errors in naming (e.g. GHOST named as ‘goath’) are commonly seen in persisting post-stroke aphasia and are thought to signal impairment in retrieval of phonological form information. We performed a voxel-based lesion-symptom mapping analysis of 1718 phonological naming errors collected from 106 individuals with diverse profiles of aphasia. Voxels in which lesion status correlated with phonological error rates localized to dorsal stream areas, in keeping with classical and contemporary brain-language models. Within the dorsal stream, the critical voxels were concentrated in premotor cortex, pre- and postcentral gyri and supramarginal gyrus with minimal extension into auditory-related posterior temporal and temporo-parietal cortices. This challenges the popular notion that error-free phonological retrieval requires guidance from sensory traces stored in posterior auditory regions and points instead to sensory-motor processes located further anterior in the dorsal stream. In a separate analysis, we compared the lesion maps for phonological and semantic errors and determined that there was no spatial overlap, demonstrating that the brain segregates phonological and semantic retrieval operations in word production.
aphasia; dual-stream; voxel-based lesion-symptom mapping; naming; phonological errors; semantic errors
To create two matched short forms of the Philadelphia Naming Test (PNT) that yield similar results to the PNT for measuring anomia.
Study 1: We first used archived naming data from 94 aphasic individuals to identify which PNT items should be included in the short forms, and the two constructed sets of 30 items, PNT30-A and PNT30-B, were validated using archived data from a separate group of 56 aphasic individuals. Study 2: We then evaluated the reliability of the PNT, PNT30-A, and PNT30-B across independent test administrations with a new group of 25 aphasic individuals selected to represent the full range of naming impairment.
Study 1: PNT30-A and PNT30-B were found to be internally consistent; and accuracy scores on these subsets of items were highly correlated with the full PNT. Study 2: PNT accuracy was extremely reliable over the span of one week; and independent administrations of PNT30-A and PNT30-B produced similar results to the PNT and to each other.
The short forms can be used to reliably estimate PNT performance, and the results can be compared to the provided norms. The two matched tests allow for measurement of change in naming ability.
Aphasia; Assessment; Speech production; Stroke
Many research questions in aphasia can only be answered through access to substantial numbers of patients and to their responses on individual test items. Since such data are often unavailable to individual researchers and institutions, we have developed and made available the Moss Aphasia Psycholinguistics Project Database: a large, searchable, web-based database of patient performance on psycholinguistic and neuropsychological tests. The database contains data from over 170 patients covering a wide range of aphasia subtypes and severity, some of whom were tested multiple times. The core of the archive consists of a detailed record of individual-trial performance on the Philadelphia (picture) Naming Test. The database also contains basic demographic information about the patients and patients' overall performance on neuropsychological assessments as well as tests of speech perception, semantics, short-term memory, and sentence comprehension. The database is available at http://www.mappd.org/.
aphasia; database; picture naming; language
Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production, and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques.
case series; single-subject; cognitive neuropsychology; computational models; lexical access; semantic dementia; aphasia; semantic memory
Analysis of error types provides useful information about the stages and processes involved in normal and aphasic word production. In picture naming, semantic errors (horse for goat) generally result from something having gone awry in lexical access such that the right concept was mapped to the wrong word. This study used the new lesion analysis technique known as voxel-based lesion-symptom mapping to investigate the locus of lesions that give rise to semantic naming errors. Semantic errors were obtained from 64 individuals with post-stroke aphasia, who also underwent high-resolution structural brain scans. Whole brain voxel-based lesion-symptom mapping was carried out to determine where lesion status predicted semantic error rate. The strongest associations were found in the left anterior to mid middle temporal gyrus. This area also showed strong and significant effects in further analyses that statistically controlled for deficits in pre-lexical, conceptualization processes that might have contributed to semantic error production. This study is the first to demonstrate a specific and necessary role for the left anterior temporal lobe in mapping concepts to words in production. We hypothesize that this role consists in the conveyance of fine-grained semantic distinctions to the lexical system. Our results line up with evidence from semantic dementia, the convergence zone framework and meta-analyses of neuroimaging studies on word production. At the same time, they cast doubt on the classical linkage of semantic error production to lesions in and around Wernicke's area.
aphasia; voxel-based lesion-symptom mapping; naming; semantic; errors
Lexical access in language production, and particularly pathologies of lexical access, are often investigated by examining errors in picture naming and word repetition. In this article, we test a computational approach to lexical access, the two-step interactive model, by examining whether the model can quantitatively predict the repetition-error patterns of 65 aphasic subjects from their naming errors. The model’s characterizations of the subjects’ naming errors were taken from the companion paper to this one (Schwartz, Dell, N. Martin, Gahl & Sobel, 2006), and their repetition was predicted from the model on the assumption that naming involves two error prone steps, word and phonological retrieval, whereas repetition only creates errors in the second of these steps. A version of the model in which lexical-semantic and lexical-phonological connections could be independently lesioned was generally successful in predicting repetition for the aphasics. An analysis of the few cases in which model predictions were inaccurate revealed the role of input phonology in the repetition task.
When unimpaired participants name pictures quickly, they produce many perseverations that bear a semantic relation to the target, especially when the pictures are blocked by semantic category. These “semantic perseverations” have not shown the steep decay over lags (distance from prior occurrence) that typify the perseverations produced by people with aphasia on standard naming tasks (Cohen & Dehaene, 1998). To reconcile the discrepant findings, we studied semantic perseverations generated by participants with aphasia on a naming task that featured semantic blocking [Schnur, T. T., Schwartz, M. F., Brecher, A., & Hodgson, C. (2006). Semantic interference during blocked-cyclic naming: Evidence from aphasia. Journal of Memory and Language, 54, 199–227]. The temporal properties of these perseverations were investigated by analyzing their lag function and the influence of time (response-stimulus interval) on this function. To separate out the influence of chance on the observed lag distributions, chance data sets were created for individual participants by reshuffling whole trials (i.e., stimulus-response pairs) in a manner that preserved unique features of the blocking design. Analyses of chance-corrected lag functions revealed the expected recency bias, i.e., higher perseveration frequencies at short lags. Importantly, there was no difference between the lag functions for perseverations generated with a 5 s, compared to 1 s, response-stimulus interval. This combination of recency and insensitivity to elapsed time indicates that the perseveratory impetus in a named response does not passively decay with time but rather is diminished by interference from related trials. We offer an incremental learning account of these findings.
Perseveration; semantic blocking; aphasia; naming; priming; incremental learning
The cognitive analysis of adult language disorders continues to draw heavily on linguistic theory, but increasingly it reflects the influence of connectionist, spreading activation models of cognition. In the area of spoken word production, ‘localist’ connectionist models represent a natural evolution from the psycholingistic theories of earlier decades. By contrast, the parallel distributed processing framework forces more radical rethinking of aphasic impairments. This paper exemplifies these multiple influences in contemporary cognitive aphasiology. Topics include (i) what aphasia reveals about semantic-phonological interaction in lexical access; (ii) controversies surrounding the interpretation of semantic errors and (iii) a computational account of the relationship between naming and word repetition in aphasia. Several of these topics have been addressed using case series methods, including computational simulation of the individual, quantitative error patterns of diverse groups of patients and analysis of brain lesions that correlate with error rates and patterns. Efforts to map the lesion correlates of nonword errors in naming and repetition highlight the involvement of sensorimotor areas in the brain and suggest the need to better integrate models of word production with models of speech and action.
aphasia; naming; repetition; errors; semantic; phonological
Lesion analysis is a classic approach to study brain functions. Because brain function is a result of coherent activations of a collection of functionally related voxels, lesion-symptom relations are generally contributed by multiple voxels simultaneously. Although voxel-based lesion symptom mapping (VLSM) has made substantial contributions to the understanding of brain-behavior relationships, a better understanding of the brain-behavior relationship contributed by multiple brain regions needs a multivariate lesion symptom mapping (MLSM). The purpose of this paper was to develop an MLSM using a machine learning-based multivariate regression algorithm: support vector regression (SVR). In the proposed SVR-LSM, the symptom relation to the entire lesion map as opposed to each isolated voxel is modeled using a non-linear function, so the inter-voxel correlations are intrinsically considered, resulting in a potentially more sensitive way to examine lesion-symptom relationships. To explore the relative merits of VLSM and SVR-LSM we used both approaches in the analysis of a synthetic dataset. SVR-LSM showed much higher sensitivity and specificity for detecting the synthetic lesion-behavior relations than VLSM. When applied to lesion data and language measures from patients with brain damages, SVR-LSM reproduced the essential pattern of previous findings identified by VLSM and showed higher sensitivity than VLSM for identifying the lesion-behavior relations. Our data also showed the possibility of using lesion data to predict continuous behavior scores.
Lesion-symptom mapping; support vector regression; aphasia; total lesion volume control
The dual-route interactive two-step model explains the variation in the error patterns of aphasic speakers in picture naming, and word and nonword repetition tasks. The model has three parameters that can vary across individuals: the efficiency of the connections between semantic and lexical representations (s-weight), between lexical and phonological representations (p-weight), and between representations of auditory input and phonological representations (nl-weight). We determined these parameter values in 103 participants with chronic aphasia from left hemisphere stroke whose lesion locations had been determined. Then, using voxel-based lesion-parameter mapping, we mapped the parameters onto the brain, thus determining the neural correlates of the model’s mechanisms. The maps and the behavioral findings supported the model’s central claim that word repetition is affected by both the p and nl parameters. We propose that these two parameters constitute the model’s analogue of the “dorsal stream” component of neurocognitive models of language processing.
Aphasia; Language production; Computational models; Voxel-based Lesion Parameter Mapping
To determine if the naming impairment in aphasia is influenced by error learning and if error learning is related to type of retrieval strategy.
Nine participants with aphasia and ten neurologically-intact controls named familiar proper noun concepts. When experiencing tip-of-the-tongue naming failure (TOT) in an initial TOT-elicitation phase, participants were instructed to adopt phonological or semantic self-cued retrieval strategies. In the error learning manipulation, items evoking TOT states during TOT-elicitation were randomly assigned to a short or long time condition where participants were encouraged to continue to try to retrieve the name for either 20 seconds (short interval) or 60 seconds (long). The incidence of TOT on the same items was measured on a post test after 48-hours. Error learning was defined as a higher rate of recurrent TOTs (TOT at both TOT-elicitation and post test) for items assigned to the long (versus short) time condition.
In the phonological condition, participants with aphasia showed error learning whereas controls showed a pattern opposite to error learning. There was no evidence for error learning in the semantic condition for either group.
Error learning is operative in aphasia, but dependent on the type of strategy employed during naming failure.
aphasia; naming; error learning; errorless; cueing; semantic; phonological; tip-of-the-tongue
Ventrolateral prefrontal cortex (VLPFC) has long been linked to language production, but the precise mechanisms are still being elucidated. Using neuropsychological case studies, we explored possible sub-specialization within this region for different linguistic and executive functions. Frontal patients with different lesion profiles completed two sequencing tasks, which were hypothesized to engage partially overlapping components. The multi-word priming task tested the sequencing of co-activated representations and the overriding of primed word orders. The sequence reproduction task tested the sequencing of co-activated representations, but did not employ a priming manipulation. We compared patients’ performance on the two tasks to that of healthy, age-matched controls. Results are partially consistent with an anterior-posterior gradient of cognitive control within lateral prefrontal cortex (Koechlin & Summerfield, 2007). However, we also found a stimulus-specific pattern, which suggests that sub-specialization might be contingent on type of representation as well as type of control signal. Isolating such components functionally and anatomically might lead to a better understanding of language production deficits in aphasia.
language production; sequencing; cognitive control; prefrontal cortex; aphasia
Cognitive rehabilitation research is increasingly exploring errorless learning interventions, which prioritize the avoidance of errors during treatment. The errorless learning approach was originally developed for patients with severe anterograde amnesia, who were deemed to be at particular risk for error learning. Errorless learning has since been investigated in other memory-impaired populations (e.g., Alzheimer's disease) and acquired aphasia. In typical errorless training, target information is presented to the participant for study or immediate reproduction, a method that prevents participants from attempting to retrieve target information from long-term memory (i.e., retrieval practice). However, assuring error elimination by preventing difficult (and error-permitting) retrieval practice is a potential major drawback of the errorless approach. This review begins with discussion of research in the psychology of learning and memory that demonstrates the importance of difficult (and potentially errorful) retrieval practice for robust learning and prolonged performance gains. We then review treatment research comparing errorless and errorful methods in amnesia and aphasia, where only the latter provides (difficult) retrieval practice opportunities. In each clinical domain we find the advantage of the errorless approach is limited and may be offset by the therapeutic potential of retrieval practice. Gaps in current knowledge are identified that preclude strong conclusions regarding a preference for errorless treatments over methods that prioritize difficult retrieval practice. We offer recommendations for future research aimed at a strong test of errorless learning treatments, which involves direct comparison with methods where retrieval practice effects are maximized for long-term gains.
errorless; errorful; retrieval practice; testing; spacing; aphasia; amnesia
Despite the existence of speech errors, verbal communication is successful because speakers can detect (and correct) their errors. The standard theory of speech-error detection, the perceptual-loop account, posits that the comprehension system monitors production output for errors. Such a comprehension-based monitor, however, cannot explain the double dissociation between comprehension and error-detection ability observed in the aphasic patients. We propose a new theory of speech-error detection which is instead based on the production process itself. The theory borrows from studies of forced-choice-response tasks the notion that error detection is accomplished by monitoring response conflict via a frontal brain structure, such as the anterior cingulate cortex. We adapt this idea to the two-step model of word production, and test the model-derived predictions on a sample of aphasic patients. Our results show a strong correlation between patients’ error-detection ability and the model’s characterization of their production skills, and no significant correlation between error detection and comprehension measures, thus supporting a production-based monitor, generally, and the implemented conflict-based monitor in particular. The successful application of the conflict-based theory to error-detection in linguistic, as well as non-linguistic domains points to a domain-general monitoring system.
Speech monitoring; Speech errors; Error detection; Aphasia; Computational models
We explored the neural basis of reversible sentence comprehension in a large group of aphasic patients (N=79). Voxel-based lesion-symptom mapping revealed a significant association between damage in temporoparietal cortex and impaired sentence comprehension. This association remained after we controlled for phonological working memory. We hypothesize that this region plays an important role in the thematic or what-where processing of sentences. In contrast, we detected weak or no association between reversible sentence comprehension and the ventrolateral prefrontal cortex, which includes Broca’s area, even for syntactically complex sentences. This casts doubt on theories that presuppose a critical role for this region in syntactic computations.
Broca’s area; Prefrontal; Temporoparietal; Thematic Roles; Syntax
Semantic errors in aphasia (e.g., naming a horse as “dog”) frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were found in the left anterior temporal lobe (L-ATL), in the mid- to anterior MTG region. The absence of findings in Wernicke’s area was surprising, as were indications that ATL voxels made an essential contribution to the post-semantic stage of lexical access. In this follow-up study, we sought to validate these results by re-defining semantic errors in a manner that was less theory dependent and more consistent with prior lesion studies. As this change also increased the robustness of the dependent variable, it made it possible to perform additional statistical analyses that further refined the interpretation. The results strengthen the evidence for a causal relationship between ATL damage and lexically-based semantic errors in naming and lend confidence to the conclusion that chronic lesions in Wernicke’s area are not causally implicated in semantic error production.
aphasia; voxel-based lesion-symptom mapping; naming; semantic; errors
This paper investigates the cognitive processes underlying picture naming and auditory word repetition. In the 2-step model of lexical access, both the semantic and phonological steps are involved in naming, but the former has no role in repetition. Assuming recognition of the to-be-repeated word, repetition could consist of retrieving the word’s output phonemes from the lexicon (the lexical-route model), retrieving the output phonology directly from input phonology (the nonlexical-route model) or employing both routes together (the summation dual-route model). We tested these accounts by comparing the size of the word frequency effect (an index of lexical retrieval) in naming and repetition data from 59 aphasic patients with simulations of naming and repetition models. The magnitude of the frequency effect (and the influence of other lexical variables) was found to be comparable in naming and repetition, and equally large for both the lexical and summation dual-route models. However, only the dual-route model was fully consistent with data from patients, suggesting that nonlexical input is added on top of a fully-utilized lexical route.
Lexical access; Aphasia; Repetition; Picture naming; Computational models; Case-series; Word frequency
We investigated the influence of phonological neighborhood density (PND) on the performance of aphasic speakers whose naming impairments differentially implicate phonological or semantic stages of lexical access. A word comes from a dense phonological neighborhood if many words sound like it. Limited evidence suggests that higher density facilitates naming in aphasic speakers, as it does in healthy speakers. Using well controlled stimuli, Experiment 1 confirmed the influence of PND on accuracy and phonological error rates in two aphasic speakers with phonological processing deficits. In Experiments 2 and 3, we extended the investigation to an aphasic speaker who is prone to semantic errors, indicating a semantic deficit and/or a deficit in the mapping from semantics to words. This individual had higher accuracy, and fewer semantic errors, in naming targets from high versus low density neighborhoods. It is argued that the results provide strong support for interactive approaches to lexical access, where reverberatory feedback between word- and phoneme-level lexical representations not only facilitates phonological level processes but also privileges the selection of a target word over its semantic competitors.
phonology; neighborhood density; aphasia; interactivity; lexical access
Patients with damage involving left ventrolateral prefrontal cortex (left VLPFC) often show syntactic deficits. They also show exaggerated interference effects during a variety of non-syntactic tasks, including picture naming and working memory. Conceivably, both deficits could arise from inadequate biasing of competitive interactions during language production. To test this hypothesis, we manipulated “positional” interference during multiword naming by priming one of the nouns in the same or different position. Experimental case studies of four left VLPFC patients revealed that two of the patients showed exaggerated positional interference, greater number of errors, including omissions during multiword production, increased production difficulty when the order of nouns did not match the predominant English pattern as well as impaired comprehension of non-canonical reversible sentences. These results suggest that these two patients had an impairment in “selection for position”. Different from the other two, their lesions included a subregion of frontal cortex (BA 44/6) that has been shown in neuroimaging studies to pay a role in sequencing.
aphasia; language; production; syntax; sequencing; interference; prefrontal
Semantic short-term memory (STM) deficits have been traditionally defined as an inability to maintain semantic representations over a delay (R. Martin, Shelton & Yaffee, 1994). Yet some patients with semantic STM deficits make numerous intrusions of items from previously presented lists, thus presenting an interesting paradox: Why should an inability to maintain semantic representations produce an increase in intrusions from earlier lists? In this study, we investigated the relationship between maintenance deficits and susceptibility to interference in a group of 20 aphasic patients characterized with weak semantic or weak phonological STM. Patients and matched control participants performed a modified item-recognition task designed to elicit semantic or phonological interference from list items located one, two, or three trials back (Hamilton & R. Martin, 2007). Controls demonstrated significant effects of interference in both versions of the task. Interference in patients was predicted by the type and severity of their STM deficit; that is, shorter semantic spans were associated with greater semantic interference and shorter phonological spans were associated with greater phonological interference. We interpret these results through a new perspective, the reactivation hypothesis, and we discuss their importance for accounts emphasizing the contribution of maintenance mechanisms for STM impairments in aphasia as well as susceptibility to interference.
WORKING-MEMORY; RECENT-NEGATIVES; INHIBITION; SEMANTIC; PHONOLOGICAL
Naming a picture of a dog primes the subsequent naming of a picture of a dog (repetition priming) and interferes with the subsequent naming of a picture of a cat (semantic interference). Behavioral studies suggest that these effects derive from persistent changes in the way that words are activated and selected for production, and some have claimed that the findings are only understandable by positing a competitive mechanism for lexical selection. We present a simple model of lexical retrieval in speech production that applies error-driven learning to its lexical activation network. This model naturally produces repetition priming and semantic interference effects. It predicts the major findings from several published experiments, demonstrating that these effects may arise from incremental learning. Furthermore, analysis of the model suggests that competition during lexical selection is not necessary for semantic interference if the learning process is itself competitive.
Some theories of lexical access in production locate the effect of lexical frequency at the retrieval of a word’s phonological characteristics, as opposed to the prior retrieval of a holistic representation of the word from its meaning. Yet there is evidence from both normal and aphasic individuals that frequency may influence both of these retrieval processes. This inconsistency is especially relevant in light of recent attempts to determine the representation of another lexical property, age of acquisition or AoA, whose effect is similar to that of frequency. To further explore the representations of these lexical variables in the word retrieval system, we performed hierarchical, multinomial logistic regression analyses of 50 aphasic patients’ picture-naming responses. While both log frequency and AoA had a significant influence on patient accuracy and led to fewer phonologically related errors and omissions, only log frequency had an effect on semantically related errors. These results provide evidence for a lexical access process sensitive to frequency at all stages, but with AoA having a more limited effect.
SentenceShaper® (SSR) is a computer program that is for speech what a word-processing program is for written text; it allows the user to record words and phrases, play them back, and manipulate them on-screen to build sentences and narratives. A recent study demonstrated that when listeners rated the informativeness of functional narratives produced by chronic aphasic speakers with and without the program they gave higher informativeness ratings to the language produced with the aid of the program (Bartlett, Fink, Schwartz, & Linebarger, 2007). Bartlett et al. (2007) also compared unaided (spontaneous) narratives produced before and after the aided version of the narrative was obtained. In a subset of comparisons, the sample created after was judged to be more informative; they called this “topic-specific carryover”.
(1) To determine whether differences in informativeness that Bartlett et al.’s listeners perceived are also revealed by Correct Information Unit (CIU) analysis (Nicholas & Brookshire, 1993)—a well studied, objective method for measuring informativeness—and (2) to demonstrate the usefulness of CIU analysis for samples of this type.
Methods & Procedures
A modified version of the CIU analysis was applied to the speech samples obtained by Bartlett et al. (2007). They had asked five individuals with chronic aphasia to create functional narratives on two topics, under three conditions: Unaided (“U”), Aided (“SSR”), & Post-SSR Unaided (“Post-U”). Here, these samples were analysed for differences in % CIUs across conditions. Linear associations between listener judgements and CIU measures were evaluated with bivariate correlations and multiple regression analysis.
Outcomes & Results
(1) The aided effect was confirmed: samples produced with SentenceShaper had higher % CIUs, in most cases exceeding 90%. (2) There was little
That the percentage of CIUs was higher in SSR-aided samples than in unaided samples confirms the central finding in Bartlett et al. (2007), based on subjective judgements, and thus extends the evidence that aided effects from SentenceShaper are demonstrable across a range of measures, stimuli and participants (cf. Linebarger, Schwartz, Romania, Kohn, & Stephens, 2000). The data also attest to the effectiveness of the CIU analysis for quantifying differences in the informativeness of aphasic speech with and without SentenceShaper; and they support prior studies that have shown that CIU measures correlate with the informativeness ratings of unfamiliar listeners.
Aphasia; Sentenceshaper; AAC; Informativeness; functional communication