Tomoyuki Kojima

症例は69歳男性で、外出先で体調不良を自覚、その後、急速に構音障害が進み、救急搬送された。搬送時のJapan coma scale(JCS)はI-3で、両側顔面麻痺あり、挺舌不可、軟口蓋挙上不可であった。右不全麻痺があり、頭部CT画像で両側の被殻出血を認め、緊急入院となった。2病日には両片麻痺を認めたが、立位歩行は速やかに可能となった。嚥下障害は重度で経鼻経管栄養となり、18病日に転院となった。転院時のJCSはI-1で、四肢の運動麻痺は速やかに回復し、明らかな高次脳機能障害も認めなかった。摂食嚥下機能所見から偽性球麻痺タイプの嚥下障害と判断した。罹患筋の随意運動障害による開閉口障害、口唇閉鎖不全、咀嚼・食塊形成不全と舌の送り込み不全、嚥下反射開始遅延が疑われ、喉頭挙上域や咽頭期嚥下圧の低下といった咽頭期の障害が考えられた。顔面、下顎、舌、頸部に対する他動運動から関節訓練を開始した。加えて、呼吸・発生訓練、軟口蓋挙上不良に対してブローイング訓練、咽頭期障害に対し舌骨上筋群の筋力増強訓練やアイスマッサージ、口腔構音器官の運動回復にあわせて構音訓練を開始した。画像診断より、両側の皮質延髄路が限局的に障害されたことによる脳神経(V、VII、IX〜XII)領域の核上性麻痺を呈したと考えられた。嚥下障害、構音障害の後遣は重度であったが、発症約4ヵ月後に完全経口移行となった。

A 42-year-old man suffered damage to the left supra-sylvian areas due to a stroke and presented with verbal short-term memory (STM) deficits. He occasionally could not recall even a single syllable that he had heard one second before. A study of mismatch negativity using magnetoencephalography suggested that the duration of auditory sensory (echoic) memory traces was reduced on the affected side of the brain. His maximum digit span was four with auditory presentation (equivalent to the 1st percentile for normal subjects), whereas it was up to six with visual presentation (almost within the normal range). He simply showed partial recall in the digit span task, and there was no self correction or incorrect reproduction. From these findings, reduced echoic memory was thought to have affected his verbal short-term retention. Thus, the impairment of verbal short-term memory observed in this patient was pure auditory unlike previously reported patients with deficits of the phonological short-term store (STS), which is the next higher-order memory system. We report this case to present physiological and behavioral data suggesting impaired short-term storage of verbal information, and to demonstrate the influence of deterioration of echoic memory on verbal STM.

We examined the relations between three simple intelligence tests and the WAIS-III in patients with Alzheimers disease (AD) , as well as changes in intelligence caused by the disease. The subjects were 78 AD patients (21 males and 57 females) who met the diagnostic criteria of DSM-IV and NINCDS-ADRDA. Their average age was 81.6 ± 6.0 years. We conducted three simple intelligence tests (HDS-R, MMSE, and RCPM) and the WAIS-III . Significant correlations (moderate to strong) were observed between each of the simple intelligence tests and the WAIS-III FIQ, VIQ, and PIQ, and we concluded that the concurrent validity observed with WAIS-R (the old version of WAIS) was maintained. From the correlations with the WAIS-III performance subtests, it seems that RCPM is strongly related to constructional ability and figure cognitive processes, but somewhat weakly related to analogical ability. As to the changes in intellectual function caused by AD, low scores for " similarities" and "comprehension" implied a decrease of abstract thinking and common sense, while relatively high scores for "digit span" and "matrix reasoning" suggested that intelligence fields such as short verbal memory and convergent thinking are little affected by the disease.

In conjunction with studies concerning time-course analysis of language functions in aphasics, we investigated long-term follow-up data for lesions of 270 right-handed aphasics with left lateral damage. We also studied 37 aphasics whose language functions declined in the general scores on the SLTA, examining functional change in the various factors affecting those scores. The results were as follows. Depending on the lesion site and age at onset, recovery of aphasia symptoms varies in course greatly ; however, many aphasic cases show recovery over long terms of at least six months or more. In terms of general score on the SLTA, comprehensive ability and ability of phonological retrieval from a kanji/kana word—functions of language information processing that are simpler than other functions—are easily restored. Comprehensive ability and ability of phonological retrieval from a kanji/kana word are functions that are easily maintained after speech therapy. Functions that require more complicated language processing, such as syntactic processing and writing ability, easily decline. Functional restoration of language by therapy is not stable but rather fragile. Language symptoms, in which maintenance is needed, require continuation of long-term speech therapy. Based on these results, we reconsidered the chronicity of aphasia.

This was a multicenter retrospective study on language therapy for aphasia in Japan. We reviewed 597individuals with aphasia who were treated with language therapy and received language evaluation at least twice both pre and post treatment. Particular interest was focused on long-term therapy effect. The participants were subdivided into 15 groups according to the time course post onset. Composite scores on the Standard Language Test of Aphasia (SLTA) demonstrated significant improvements in all groups including the subacute (0-3 months) to chronic (over 2 years) groups. The results strongly suggested the effectiveness of language therapy throughout the time course observed. The degree of effectiveness of the language therapy was moderate in the first 6 months, and small but significant improvements continued to 2 years post onset. Gender, age and diffuse brain damages had significant effects on the improvements in test scores during the chronic stage. Aphasics due to cerebral hemorrhage tended to recover in the subacute stage, whereas those caused by cerebral infarction tended to show slow improvement in chronic stage.

Gogi aphasia, which was first described by Imura in 1943, is a form of transcortical sensory aphasia characterized by intact repetition, poor verbal comprehension, verbal paraphasia, and specific impairment of kanji processing. Recently, Gogi aphasia has often been discussed in the context of semantic dementia, a form of frontotemporal lobar degeneration. However, the relation between Gogi aphasia and semantic memory impairment has not been fully elucidated. We tested various semantic memory tasks in a patient with Gogi aphasia after extensive venous infarction involving the left temporal lobe. She did not exhibit any semantic memory impairment as far as we could determine. The findings suggested that Gogi aphasia is not identical with semantic dementia and that impairment of reciprocal coding between lexical items and semantic memory, or symbol and referent, can result in symptoms compatible with Gogi aphasia.

In this study we investigated the mechanism of functional reorganization underlying long-term functional recovery from acquired childhood aphasia We followed a 9-year-old boy with aphasia from 3 months to 10 years and 5 months after his stroke The patient s language ability was assessed five times by the Standard Language Test of Aphasia (SLTA) and regional cerebral blood flow (rCBF) was measured four times with 99mTc-ECD and a fully automated quantitative image analysis system The patient showed continuous improvement of language throughout this period Overall rCBF peaked at the time of the 2nd measurement (at the age of 12 years and 2 months) and then gradually decreased to the 4th measurement (at the age of 20 years and 2 months) However there were several patterns of significant relative dominance of rCBF in one cerebral hemisphere compared with the other hemisphere The Broca and supplementary motor areas showed consistent right hemisphere dominance throughout the study period but Wernicke s area showed left hemisphere dominance in the early stage (comparison between the 1st and 2nd measurements or the 2nd and 3rd measurements) followed by right hemisphere dominance in the late stage (comparison between the 3rd and 4th measurements) In the primary auditory area right hemisphere dominance was only seen in the late stage (comparison between the 3rd and 4th measurements) These findings suggest that both hemispheres are Involved in the long-term recovery of children from aphasia but the location of functional reorganization varies depending on the ROIs studied and the stage after the onset (C) 2010 Elsevier Ltd All rights reserved

Research into acquired child aphasia can provide useful evidence about the neural mechanisms involved in recovery from aphasia because the functional plasticity of the brain is greater in children than in adults. To investigate the neural correlates underlying functional recovery from acquired child aphasia, we followed a 9-year-old boy with aphasia for 2-16 months after traumatic head injury. The patient's language ability was assessed four times by the Standard Language Test of Aphasia (SLTA). Regional cerebral blood flow (rCBF) was also measured four times with 99mTc-ECD and a fully automated quantitative image analysis system. The patient showed substantial improvement of language during this period. Although overall rCBF fluctuated throughout the 1st-4th measurements, there was a significant relative dominance of rCBF in the left cerebral hemisphere compared with the right hemisphere throughout the four measurements, especially in the paracentral and temporo-parietal regions. These findings may suggest that the left cerebral hemisphere rather than the right hemisphere plays a major role in the early recovery from child aphasia. (C) 2009 Elsevier Ltd. All rights reserved.

We examined Alzheimer's disease (AD) patients using a Japanese version of the Wechsler Adult Intelligence Scale, 3rd Edition (JWAIS-III) to clarify i) the significance of expansion of the indicated age range, ii) the characteristics of cognitive impairment in AD patients and iii) the efficacy of th neuropsychological assessment for the early detection of AD using the Digit Symbol subtest, which involves attention and episodic memory, and the Pairing supplementary test, which relates to digit symbol-incidental learning. The JWAIS-III was given to 43 AD patients (12 males and 31. females; mean age, 80.9 +/- 6.3 years, who fulfilled the diagnostic criteria for AD on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Severity of dementia of the patients was classified according to Functional Assessment Staging (F) as follows: 9 patients in F3 (borderline), 15 in F4 (mild AD), 12 in F5 (moderate AD), 7 in F6 (somewhat severe AD) and none in F7 (severe AD). i) Mean intelligence quotients (IQs) were: Full Scale IQ 84.3 +/- 14.0, Verbal IQ 84.6 +/- 12.5 and Performance IQ 86.9 +/- 15.5. Comparison of IQs and subtest scores of the patients aged 75 years or older assessed by standard scores for 70 to 74 years of age, which is the upper limit of the indicated age range on the WAIS-R (the previous version of the WAIS-III), with those assessed by the standard scores for the appropriate age revealed that the former were significantly lower in IQ and all subtest scores. ii) Significant differences were noted among the severities of dementia in the scores of 7 subtests for Similarities, Comprehension, Arithmetic, Digit Span, Letter-Number Sequencing, Digit Symbol and Symbol Search. iii) When both the Digit Symbol subtest scores of 7 points or more and the Digit Sumbol-Pairing supplementary test scores exceeding 10% of the cumulative percentile were regarded as normal, 11 of 15 (73.3%) patients in F4 (mild AD) could be detected. These findings suggest that i) expansion of the indicated age range in the WAIS-III allows a more valid assessment of cognitive function in AD patients, ii) a marked decline in abstract thinking and verbal problem-solving ability and relative preservation of Perceptual organization are characteristics of cognitive impairment in AD patients and iii) a combination of the Digit Symbol subtest with the Pairing supplementary test is useful for the early detection of AD.

We understand from experience that musical contexts are formed when chords are combined according to the rules of harmony. In this study, the N1 component of the auditory-evoked potential was measured using comparable three-chord sequences; these sequences were constructed as a consecutive task (cf. C-C-C vs. Cm-Cm-Cm; control) and a cadence task (cf. C-G-C vs. C-G-Cm). In the cadence task, compared with cadences ending with a major chord (anticipated chord), those ending with a minor chord (unanticipated chord) showed a significantly larger amplitude of N1 waves. These components of auditory-evoked potentials reflect the effect of chord progression in musical perception and suggest that the musical context is recognized at least 100 ms after a chord is played. NeuroReport 20:251-256 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

This is a report on a man with Gogi aphasia who found it difficult to read English at the age of 50, to recall words at 52, and to recognize words thereafter, finally developing surface dyslexia and surface dys graphia. Although he has already retired from his job because of his aphasia, he has no problems in his daily life. He shows no difficulty in using tools, but has mild difficulty in recognizing people. He reveals difficulty in visual semantic memory tasks for living things and processed food, but has almost no difficulty in using or buying those things in his daily life. He shows no semantic memory loss for nonliving things. T1-weighted contrast MRI demonstrated atrophy in the left temporal pole extending to the inferior temporal lobe. <br>  The relationship between Gogi aphasia and semantic dementia is not fully understood. Difficulty of encoding and decoding in our case can be classified into aphasia for nonliving things, because semantic memory for nonliving things is retained at present. On the other hand, semantic memory for living things is slightly disrupted. Although many studies suggest that the mechanism of Gogi aphasia lies in storage disorder of words, we think that the mechanism in our case lies in a mutual access disorder between words and semantic memory.

We report on a case of aphasia that developed owing to injury to the left hemisphere. The aphasia improved slowly, but worsened mainly in using phonemes and kana after injury to the right hemisphere due to recurrence one year later. There appeared untranscribable jargon and logoclonia. Improvement is hardly in evidence even after a lapse of two years. The clinical course from the onset of the disease indicates that the homologue area in the contralateral hemisphere might be concerned with recovery of aphasia after the acute phase. <br>  This case and past cases in the literature show a possibility that functional recovery of aphasia is achieved by the homologue area in the contralateral hemisphere. We studied untranscribable jargon and logoclonia appearing after new injury of the right hemisphere from the viewpoint of disturbed action control of speech.

We evaluated the validity of the conventional theory proposing that constructional function is localized separately in the right and left hemispheres of each individual. In patients with brain damage, constructional ability was evaluated using control factors such as criteria, etiology, and the location and extension of the lesion. The subjects consisted of 33 patients with cerebral infarction (23 with left brain damage and 10 with right brain damage). The subjects copied Rey's complex figure, and their drawings were assessed using the Rey-Osterrieth unit scoring system. The following results were obtained. 1) Comparison between the groups with right or left brain damage showed good constructional ability in the group with left brain damage but decreased ability in the group with right brain damage. 2) For both groups, patients with an exceptional score were suspected to have anomalous lateralization. These results suggested that: (1) constructional function is not localized separately in each hemisphere in each individual, but is generally localized contralateral to the localization of language function (mostly the right hemisphere) and (2) language and constructional functions are localized in the same hemisphere only in exceptional cases.

Aim: To determine the prognostic value of brain perfusion single-photon emission computed tomography (SPECT) in patients with aphasia after a stroke. Methods: Brain perfusion SPECTwith Tc-99m-ethyl cysteinate dimer (Tc-99m-ECD) was used in 16 right-handed patients with aphasia after a left-sided cerebrovascular accident (CVA) in the early chronic period after the onset of CVA. The region of interest (ROI) method was used to calculate the relative regional cerebral blood flow (rCBF) in each cerebral lobe, the thalamus, the putamen and the cerebellum as ratios to the count in the left cerebellar hemisphere. The Standard Language Test of Aphasia (SLTA) was performed twice, once at the same time as SPECT, a mean of 2.3 months after CVA onset (early SLTA), and again a mean of 17.0 months after CVA onset (late SLTA). In addition to the overall language function score, scores for taking dictation (Dictation), oral reading (Speaking) and comprehension (Comprehension) were calculated, and the correlations with each of the rCBF values were evaluated. Results: Left temporal CBF correlated with the late Dictation score; bilateral frontal, bilateral temporal and right parietal CBF correlated with the late Speaking score; and right frontal, left temporal and left occipital CBF correlated with the late Comprehension score. Conclusion: Brain perfusion SPECT in the early chronic stage was shown to be useful for predicting recovery from aphasia, recovery of oral reading, ability to take dictation and comprehension.

In this paper, several issues concerning terminology, symptomatology, and intervention strategies relating to "apraxia of speech" were pointed out. First, in order to inspect the validity of including this symptom under apraxia, a study was made of inconstancy in speech errors and voluntary/involuntary dissociation in speech fluency in cases with this symptom, which Darley et al. regard as evidence that this symptom is a type of apraxia. The findings suggested, however, that it is not valid to interpret this symptom as a subtype of apraxia. Second, the validity of using the term "substitution", which also is used in reference to a type of speech error shown by cases with phonological retrieval disorders, as a type of speech error shown by cases with this symptom was discussed. Finally, concepts concerning intervention strategies for this symptom were demonstrated, referring to the dichotomy by Square et al. i.e., namingly, microstructural and macrostructural approaches.

Objective: Event-related potentials (ERPs) and response latencies were recorded from aphasic subjects with auditory language processing impairments and age-matched normal controls, while performing a lexical-semantic evaluation task, aiming at clarifying whether ERPs could be a reliable measure for indicating language impairments in aphasic patients. Methods: The stimuli were 50 pairs of spoken words (prime word-target word): 25 pairs, which were semantically and/or associatively related to each other, and 25 pairs which were not. The subjects pressed a switch in response to the presentation of target words semantically related to the prime words. The ERP component analyzed in this study was N400. Results: With the performances, the response latencies were longer in the aphasic subjects than in the normal controls. With the ERPs, onset latencies of N400 were shifted behind in the aphasic patients compared to the normal controls. For the aphasic patients, there were correlations between the size of N400 and performances in auditory comprehension evaluated in the aphasia test. Conclusion: The conclusions drawn from the results are that not only response latencies in the lexical-semantic judgement task, but also N400 effects, may be a reliable clinical measure of the severity of even mild lexical-semantic impairments in aphasic patients. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

As a part of the research about psychological mechanisms underlying P300, in this paper, we studied latencies and amplitudes for the P300s elicited by more than one target stimuli and/or more than one standard rtimuli. We administered to 10 healthy adults four blocks of oddball paradigm using verbal sounds i.e., 1) single-single condition constituted of single target stimulus and single standard stimulus (condition 1), 2) single-multi condition constituted of single target stimulus and five standard stimuli (condition 2), 3) multi-single condition constituted of five target stimuli and single standard stimulus (condition 3), 4) multi-multi condition constituted of five target stimuli and five standard stimuli (condition 4). The results were as follows; 1) P300 latency was shortest in condition 1, and delayed in condition 3, then in condition 2, and the last was condition 4. 2) P300 amplitude was largest in condition 1, and decreased in condition 3, and then in condition 2, and the last was condition 4. These results showed that weakness of the contrast between figure (target) and ground (standard) in working memory caused by multi target stimuli and/or multi standard stimuli influence the P300 latency and amplitude, i.e., latency is delayed and amplitude is decreased. And besides, in order to elicit P300, the ground made by single standard stimulus is thought to be more important rather than the figure made by single target stimulus to make up contrast between the figure and the ground in working memory.

In this study, we reported the efficacy of a training method for articulation of a velar plosive in apraxia of speech. The case was a 53-year-old male who suffered from mixed type aphasia with severe apraxia of speech after cerebral infarction in April 1999. MRI showed an extensive lesion in the left middle cerebral artery region. We administered a training method for articulation of the velar plosive /k/, one of the most difficult sounds for the subject to articulate, in which icing stimulation was applied to the point of articulation, i.e. the soft palate and back of tongue. We then compared performances before and after stimulation. Results showed that the icing stimulation had significant effects on the patient's articulation of /k/. The findings suggest that tactile stimuli applied to the point of articulation facilitate the appropriate movements necessary to articulate. This method was thought to be clinically useful for training of sounds in apraxia of speech which are difficult to instruct by imitation of visual stimuli. © 2002, The Japan Society of Logopedics and Phoniatrics. All rights reserved.

We evaluated the influence of aphasia on performance intelligence tests. The subjects were 22 patients with fluent aphasia not accompanied by motor disturbance such as paralysis or ataxia (19 with Wernicke's aphasia, 2 with conduction aphasia, and 1 with amnesic aphasia). As intelligence tests, the Standard Language Test of Aphasia (SLTA), performance test of the Wechsler Adult Intelligence Scale-Revised (WAIS-R), and Raven's Colored Progressive Matrices (RCPM) were used. The WAIS-R performance test could be classified into subtests : those readily affected and those negligibly affected by aphasia. The subtests that tended to be affected by aphasia were "Picture Arrangement" and "Digit Symbol." The decrease in scores on the "Picture Arrangement" test appeared to be associated with language expression ability at the speaking level, while that in the scores on the "Digit Symbol" test was thought to be associated with impaired phoneme processing of written language. In the RCPM, items that require inference/thinking ability tended to be affected by speech function and also by the degree of aphasia. Consideration should be given to these subtests and items when the results of WAIS-R and RCPM performance tests are interpreted.

In this paper, aphasia in adults was overviewed from two standpoints, i.e., intra-individual plasticity and inter-individual plasticity, on the basis of the author's clinical data. In reference to intra-individual plasticity, the relationships between brain lesions and disturbed subcomponents of language information processing and extent of recovery in right-handed aphasic patients with lesion in the left hemisphere were discussed. For inter-individual plasticity, variations in the lateralization of higher brain functions between individuals were discussed. In this section, we reported not only on crossed aphasia and/or crossed non-aphasia in which whole language function shows anomalous lateralization, but also on phenomena in which specific language subcomponents could be lateralized independently in either hemisphere, and the relationships between these phenomena and handedness were discussed. Finally, we stressed that for patients with anomalous language lateralization, research into lateralization of other higher brain functions, i.e., praxis, directional attention, spacial cognition and construction are essential. © 2002, The Japan Society of Logopedics and Phoniatrics. All rights reserved.