A study on statistical classification of aphasia by multivariate analysis methods was attempted. The author applied the SLTA (Standard Language Test for Aphasia) to several groups of aphasic patients who had been clinically diagnosed as Wernicke's aphasia (23 cases), Broca's aphasia (39), amnestic aphasia (17), conduction aphasia (4) and global aphasia (36). The SLTA scores were analyzed by means of discriminant, multiple discriminant and cluster analysis. The results were as follows : (1) The correct identification rate (CIR) between statistical classification and clinical classification averaged 88.7% (range 66.7% to 100%). (2) The CIR was lower in analysis between Wernicke's and Broca's aphasia and Broca's and amnestic aphasia. (3) Global aphasia was well discriminated from other types. (4) In multiple discriminant analysis, cases of Wernicke's aphasia and Broca's aphasia overlapped. (5) In cluster analysis, cases of Wernicke's aphasia and Broca's aphasia were not well separated. The results suggested that it was to some extent possible to classify aphasia types using only the SLTA score, but discrimination between Wernicke's and Broca's aphasia is not always clear. A possible major cause for this is that items for evaluating fluency, prosody and phonetic construction are not contained in SLTA.
This study aimed to reexamine S. L. T. A. measurements. 313 aphasics were tested and principal component analysis and biquartimin rotation were administered. Three factors were derived which reflected writing, speech expression and comprehension. In order to compare with clinical evaluations, i. e., expressive, receptive, amnestic and expressive-receptive types, as well as severity of communication disabilities, we calculated factor scores. The factor scores of the expressive and receptive types showed similar distributions. Factor scores spread widely for every factor. The amnesic type showed good results on every factor. The expressive-receptive type showed poor on first and second factors, and spread widely on the third factor. Severe cases showed poor on all factors. Moderate cases showed good results on second or third factor scores. Mild cases did well also on the first factor. In other words, writing and speech expressive abilities are based on comprehensive ability. S. L. T. A. scores mainly show severity of aphasia, which reflects multidimensional factors .
Factor and scalogram analyses were carried out on data obtained from 313 aphasic patients whose clinical state was evaluated by the Standard Language Test of Aphasia (SLTA). This report describes the results of scalogram analysis following up the previous report which dealt with the results of factor analysis, and proposes a rating scale which determines over all severity of aphasic patients. Guttman's scalogram analysis was performed in various ways on the SLTA items in order to construct a simple and practical scale. The 26 items were classified into three item-groups based on the results of the factor analysis which was reported in the previous report : group A consisting of items with high factor loadings on the 1 st factor (writing), group B consisting of items related to the 2 nd factor (speech) and group C related to the 3 rd factor (comprehension). Four compound items were constructed in group A and three each in groups B and C, and these compound items were analyzed separately. The analysis reveals that they are sufficiently unidimensional for scale construction. A rating scale with total scores of A, B and C was proposed for overall assessment of aphasia.
Based on analysis of test scores obtained by presently employed scoring methods, a new scoring scale for the Token Test was devised in an attempt to achieve the test results which would more adequately reflect the clinical impression. The Tokon Test was given to 120 aphasics. Their performance was first scored by the Weighted-Score and the Pass-Fail-Score methods and the results were analyzed as to the correlation with their aphasic types, severity, auditory pointing span and their performance on the Standard Language Test of Aphasia (S. L. T. A. ). The interrelationships among each part (A~F) of the test were also analyzed. Scale analysis and Hayashi's quantification analysis III revealed uni dimensionality among test parts according to difficulty. Relative to the value each part showed on the first axis in Hayashi's quantification analysis III which had the most eiqenvalue, the New-Weighted-Score was then devised, giving each item 1 point in part A, 3 points in part B, 4 points in part C, 6 points in part D, and 7 points in parts E and F. The New-Weighted-Score thus enabled us to take into account the difficulty of each part more adequately, and therefore the auditory comprehension of the subjects was more accurately reflected in the total test score than with other scoring methods presently employed.
Recently, several cases of pure agraphia caused by left parietal lobe lesion have been reported. Most of the reported cases were caused by space-occupying lesions, but clinical descriptions and anatomical correlations were not sufficiently detailed. The present authors investigated two cases of pure agraphia caused by left posterior parietal infarction. Detailed analyses of symptoms, CT scans and 13NH3 PET (Positron Emission Tomography) were performed. The characteristics of the symptoms in both cases were : 1) Agraphia was present with both hands. 2) Copying was not greatly disturbed as compared with spontaneous writing or dictation. 3) Agraphia was characterized mainly by paragraphia, non-reaction, omissions and wrong writing order of letters. 4) One patient who had much knowledge of English was examined as to his writing and oral spelling in English. The main lesions in the CT scan were found in the left supramarginal gyrus and the upper parietal lobe. The functional lesions seen in 13NH3 PET were much wider than those in CT scan but not extending to the frontal lobe. These observations suggest that pure agraphia may also be caused by left parietal lobe lesion.
A case of semantic aphasia (Luria) with difficulty in understanding logico-grammatical relations was reported. The patient, 28-year-old left-handed woman, was injured in a traffic accident in the right parieto-occipital area. After fifteen months of recuperation, she was noticed to suffer from mild word-finding difficulty, agraphia, acalculia, minimum right-left discrimination deficit and disturbance of logico-grammatical operations, in the context of excellent verbal I. Q. on the WAIS Test and almost normal performance on the Token Test and other syntax tests. Spatial organization and representation ability showed some decline. Difficulty of understanding logico-grammatical relations became apparent mostly in the case of double comparative constructions or triple constructions which required the subject, for instance, to draw a circle to the right of a triangle and to the left of a square. To decipher these logico-grammatical constructions according to grammatical rules, it seemed neccessary for the subject to consider the elements of the sentence simultaneously in order to know which is the main element acting as the basic point of judgment, to represent mentally the relation of elements as a spatial constellation, and to reverse mentally the word order in the sentence. It was difficult for the patient to meet these requirements.
A 33-year-old, right-handed man was admitted to our hospital with one episode of generalized convulsion. His general condition and laboratory data were normal. Plain skull films were normal. EEG showed a sharp focus over the left temporal area. CT scan displayed a low-density area in the left temporal lobe which was enhanced with contrast medium. Angiogram showed an arteriovenous malformation in the left temporal lobe. It was fed by branches of middle cerebral artery and drained through the middle cerebral, Labbé, Trolard and Rolandic veins. Preoperative speech and intelligence tests were normal (SLTA and WAIS). Amytal test indicated the left cerebral hemisphere to be dominant. AVM was removed from the left posterior superior temporal gyrus. No neurological deficits followed operation, and WAIS and SLTA were normal. Two years and five months after surgery, EEG-topography was performed under such psychological tasks as animal naming, mental calculation, etc., which showed the left hemisphere to be dominant. These data suggest that the patient's speech center was dominant in the left cerebral hemisphere but had shifted to some other area than the posterior superior temporal gyrus (Wernicke's center).
Palilalia refers to the paroxymal repetition of a word or sentence. The subject was a 61-year-old female. When she was 57 years old, she suffered a general convulsion and was medically examined. The convulsion soon disappeared when she was treated with an anticonvulsive drug. Four years later, at 61 years old, the subject suffered a sudden attack of palilalia. It lasted for a duration of less than one minute, but thereafter occurred several times a day paroxymally. She was admitted to Tohoku University Hospital and was again examined. CT examination revealed a low-density area on the surface of the left frontal lobe. EEG showed an abnormal wave at the fronto-parietal area, and this was diagnosed as a kind of epilepsy. A biopsy showed that it was a chronic inflammatory disease, and not a brain tumor. Palilalia occurred very often during the 2 months after the first episode. However, with therapy using antico vulsives and antibiotics, the condition began to improve after 4 months and disappeared completely after 6 months. Now 6 months have passed since she left the hospital, and her palilalia has never recurred. It is assumed that the inflammatory change which occurred at the left frontal lobe stimulated the supplementary motor area paroxymally, and subsequently palilalia occurred as a kind of epilepsy.
1. Some characteristics observed in the development of written and spoken language of an 11-year-old boy (examined initially at age 6) complaining of dyslexia and dysgraph ia were studied. 2. In the written language, he had difficulty associating configurations of letters directly with their sound referents in hiragana, kanji and numbers. He learned to establish associations between them by intervention of semantic meaning. 3. In the spoken language, a limited vocabulary and paraphasia and difficulty in picture naming tasks were observed. 4. Specific features in acquiring letters and error analysis of his acquired reading and writing suggested that he had a functional impairment of the association between visual information conveyed through the visual modality and auditory-verbal information transmitted through the auditory-verbal modality. 5. Careful observations of his naming difficulties indicated that he made fewer errors in naming tasks when only a single (i. e., auditory-verbal) modality was involved than when two (i. e., visual and auditory-verbal) modalities participated in the tasks. 6. Some of the characteristics of his written and spoken language to a certain extent resembled the symptoms of alexia with agraphia in adults and of language disorder syndrome, a type of developmental dyslexia.