# 21 - 7. Language

# 7. Language

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7. Language 
 Aphasia refers to a higher-level language defect despite intact hearing, sound production, 
articulation mechanisms. 
 Aphasia is almost always organic. Naming defects (anomia) accompanies any aphasia in various 
degrees. 
 To understand aphasia, consider the following facts 
 
Sound received by ears is transmitted to Wernicke’s area and auditory association cortex that 
processes the language component. 
 
Arcuate fasciculus connects Wernicke’s area to Broca’s area. (NOTE: this is different from the 
uncinate fasciculus that interconnects the anterior temporal and inferior frontal gyrus) 
 
Broca’s area is the higher motor area of language production. Signals from Broca’s area are 
relied on onto the motor area to coordinate the delivery of language via the tongue, lips and 
vocal cords. 
 Three important components of language are 
 
Fluency depends on intact Broca’s area and its forward connections. 
 
Comprehension depends on intact Wernicke’s area and its connection with association cortex 
and sensory input 
 
Repetition requires no high-level processing. Repetition can occur if Broca’s, Wernicke’s and 
arcuate fasciculus are intact. Repetition does not need relay of signals from either Broca’s or 
Wernicke’s areas to higher association areas. 
Adapted from Harrison’s 
Textbook of internal 
medicine; 15 e 
 
 
 
 In Broca's aphasia the speech is nonfluent; it often appears laboured with any interruptions and 
pauses. Function words (propositions, conjunctions) are most affected though the good degree of 
meaning-appropriate nouns and verbs are still produced. Abnormal word order and a 
characteristic agrammatism are noted. Speech is telegraphic. Harrison’s Textbook of Medicine 
quotes the following example: "I see...the dotor, dotor sent me...Bosson. Go to hospital. Dotor...kept 
me beside. Two, tee days, doctor send me home”. 
 In Wernicke's aphasia, the comprehension is impaired for both spoken and written language. 
Language output is fluent but is highly paraphasic, sometimes with string of neologisms and 
circumlocutions. Hence, it is also termed as "jargon aphasia." The speech contains large numbers 
of function words (e.g., prepositions, conjunctions) but few substantive nouns or verbs that refer to 
specific actions. The output is, therefore, voluminous but uninformative, mimicking schizophrenic 
speech disturbance at times. 
Type of aphasia 
Fluency 
Repetition 
Comprehension 
Naming 
Wernicke’s sensory aphasia 
Intact 
Lost 
Lost 
Lost 
Broca’s motor aphasia 
Lost 
Lost 
Intact 
Lost 
Conduction aphasia 
Intact 
Lost 
Intact 
Lost 
Transcortical sensory aphasia 
Intact 
Intact 
Lost 
Lost 
Transcortical motor aphasia 
Lost 
Intact 
Intact 
Lost

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 Pure word deafness: Patient can speak read & write fluently, but comprehension is impaired only 
for spoken language. Bilateral (or left sided with disrupted connections to non-dominant circuit) 
damage to the superior temporal pole is suspected. 
 Pure word blindness (alexia no agraphia): Here the patient can speak normally and comprehend 
what is spoken; he can also write spontaneously and to dictation, but reading comprehension is 
impaired. It almost always involves an infarct to the left posterior cerebral artery affecting 
splenium of the corpus callosum and left visual cortex. So the affected person, who is still able to 
see with the right visual cortex, cannot undertake lexical word processing making him unable to 
read. 
 Pure word dumbness: Spoken language cannot be produced clearly, but the patient can 
comprehend language well, can read and write. 
 Pure agraphia: This is an isolated inability to write while other faculties of language are preserved.