Review Old and recent approaches to the problem of non- verbal conceptual disorders in aphasic patients Guido Gainotti a,b, * a Center for Neuropsychological Research and Institute of Neurology of the Catholic University of Rome, Italy b IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy article info Article history: Received 17 September 2013 Reviewed 11 November 2013 Revised 19 November 2013 Accepted 16 January 2014 Action editor Marjorie Lorch Published online 28 January 2014 Keywords: Aphasic non-verbal cognitive disorders Preverbal conceptual disturbances Defective semantic activation control Verbal mediation hypothesis abstract From the first research on aphasia, it has been shown that, in addition to verbal communi- cation disorders, aphasic patients often have difficulty on non-verbal cognitive tasks, which can actually be solved without the use of language. In this survey, I will discuss in a historical perspective the different interpretations provided by classical and contemporary authors to explain this puzzling observation. First, I will take into account the different positions of classical authorities on this topic, starting from the first debates (mainly based on anatomo- clinical observations) on the organisation of language in the brain. Then, I will attempt to summarize the work of authors who have tackled this complex issue more recently, in systematic investigations using methods drawn from experimental psychology, to clarify the meaning of non-verbal cognitive disorders in aphasia. Finally, in the last part of the survey, I will discuss the interpretation of proponents of the ‘semantic hub’ hypothesis who have tried to analyse and explain the differences between the non-verbal semantic defects of patients with semantic dementia and aphasic stroke patients. The hypothesis which as- sumes that most non-verbal cognitive disorders observed in aphasic patients are due to a preverbal conceptual disorder, which cannot be attributed to a loss of semantic represen- tations but rather to a defect in their controlled retrieval, seems substantially confirmed. Nevertheless, two main issues must still be clarified. The first is that some of the non-verbal cognitive defects of aphasic patients seem due to the negative influence of language dis- turbances on abstract non-verbal cognitive activities, rather than to a preverbal conceptual disorder. The second issue concerns the exact nature and the neuroanatomical correlates of the defective controlled retrieval of unimpaired conceptual representations, which should subsume most of the non-verbal cognitive disorders of aphasic patients. ª 2014 Elsevier Ltd. All rights reserved. 1. Introduction Since the earliest investigations of aphasia, it has been stressed that aphasic patients not only exhibit different types of verbal communication disorders but often have great dif- ficulty on non-verbal cognitive tasks that apparently can be solved without the use of language. Different interpretations have been advanced to explain these unexpected findings. Some authors assumed that disruption of preverbal symbolic * Center for Neuropsychological Research, Institute of Neurology, Policlinico Gemelli, Catholic University of Rome, Largo A. Gemelli, 8, 00168 Roma, Italy. E-mail addresses: [email protected], [email protected]. Available online at www.sciencedirect.com ScienceDirect Journal homepage: www.elsevier.com/locate/cortex cortex 53 (2014) 78 e89 0010-9452/$ e see front matter ª 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.cortex.2014.01.009
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c o r t e x 5 3 ( 2 0 1 4 ) 7 8e8 9
Available online at
ScienceDirect
Journal homepage: www.elsevier.com/locate/cortex
Review
Old and recent approaches to the problem of non-verbal conceptual disorders in aphasic patients
Guido Gainotti a,b,*aCenter for Neuropsychological Research and Institute of Neurology of the Catholic University of Rome, Italyb IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
a r t i c l e i n f o
Article history:
Received 17 September 2013
Reviewed 11 November 2013
Revised 19 November 2013
Accepted 16 January 2014
Action editor Marjorie Lorch
Published online 28 January 2014
Keywords:
Aphasic non-verbal
cognitive disorders
Preverbal conceptual disturbances
Defective semantic
activation control
Verbal mediation hypothesis
* Center for Neuropsychological Research,00168 Roma, Italy.
E-mail addresses: [email protected],0010-9452/$ e see front matter ª 2014 Elsevhttp://dx.doi.org/10.1016/j.cortex.2014.01.009
a b s t r a c t
From the first research on aphasia, it has been shown that, in addition to verbal communi-
cation disorders, aphasic patients often have difficulty on non-verbal cognitive tasks, which
can actually be solvedwithout the use of language. In this survey, I will discuss in a historical
perspective the different interpretations provided by classical and contemporary authors to
explain this puzzling observation. First, I will take into account the different positions of
classical authorities on this topic, starting from the first debates (mainly based on anatomo-
clinical observations) on the organisation of language in the brain. Then, I will attempt to
summarize the work of authors who have tackled this complex issue more recently, in
systematic investigations using methods drawn from experimental psychology, to clarify
the meaning of non-verbal cognitive disorders in aphasia. Finally, in the last part of the
survey, I will discuss the interpretation of proponents of the ‘semantic hub’ hypothesis who
have tried to analyse andexplain thedifferences between thenon-verbal semantic defects of
patients with semantic dementia and aphasic stroke patients. The hypothesis which as-
sumes that most non-verbal cognitive disorders observed in aphasic patients are due to a
preverbal conceptual disorder, which cannot be attributed to a loss of semantic represen-
tations but rather to a defect in their controlled retrieval, seems substantially confirmed.
Nevertheless, twomain issuesmust still be clarified. The first is that some of the non-verbal
cognitive defects of aphasic patients seem due to the negative influence of language dis-
turbances on abstract non-verbal cognitive activities, rather than to a preverbal conceptual
disorder. The second issue concerns the exact nature and the neuroanatomical correlates of
the defective controlled retrieval of unimpaired conceptual representations, which should
subsume most of the non-verbal cognitive disorders of aphasic patients.
ª 2014 Elsevier Ltd. All rights reserved.
1. Introduction
Since the earliest investigations of aphasia, it has been
stressed that aphasic patients not only exhibit different types
Lemmo, 1976). As to the second point, I have already noted
in Section 3.9 that Butterworth et al. (1984) found no consis-
tency between pictures that elicited semantic errors in
comprehension and naming tasks. Furthermore, Silveri,
Carlomagno, Nocentini, Chieffi, and Gainotti (1989) studied
the semantic field integrity of anomic patients with and
without semantic comprehension disorders and found that
the mean number of errors obtained on the various associa-
tive categories did not vary as a function of the capacity to
name the corresponding item. On the other hand, Hillis, Rapp,
Romani, and Caramazza (1990) described a patient with a left
fronto-parietal lesion who showed an item-specific selective
semantic-lexical impairment across tasks of oral and written
picture naming, oral reading, writing-to-dictation and tactile
naming. Furthermore, a very similar pattern of item consis-
tency in the verbal modality was reported by Miceli, Capasso,
and Caramazza (1994) in a patient with a left temporal lesion.
Recognizing that most non-verbal cognitive defects observed
in aphasic patients are probably due to a multimodal control
deficit that is not ascribable to loss of semantic representa-
tions, leaves open a number of questions, tackled in the pre-
vious section of the present review. These questions concern:
(a) the extent to which some of the non-verbal cognitive dis-
orders of aphasic patients are not due to amultimodal control
deficit, but to the negative influence of a severe language
disorder on non-verbal cognitive activities; (b) the exact na-
ture of the disturbances affecting the selection and activation
of the structurally unimpaired conceptual representations
and the neuroanatomical correlates of these disorders.. In
spite of these open questions, it must be acknowledged that
the work of Jefferies and Lambon Ralph (2006) has led to a
remarkable breakthrough in explaining the old and contro-
versial issue of the non-verbal cognitive disorders of aphasic
patients.
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