Akustiko-gnostichesky aphasia — disorder of perception and synthesis of verbally obtained speech information. Arises owing to defeat of the cortical center of the acoustic analyzer — Vernike's zone. Is followed by violation of the letter, account, reading. Akustiko-gnostichesky aphasia is diagnosed by results of neurologic, logopedic inspection, to data of MPT and KT of a brain, UZDG of cerebral vessels. Treatment provides etiopatogenetichesky therapy of causal pathology, logopedic occupations, reception of neurotyre-tread, nootropic pharmaceuticals, LFK.
Akustiko-gnostichesky aphasia is an acquired disease, arises at patients with the created speech skills. Represents speech agnosia — disorder of ability to understand and learn the turned speech. This type of violation of the speech is for the first time in detail described by the German neuropsychiatrist Karl Vernike in honor of whom carries the name Vernike's aphasia. As pathology is connected with violation of the mechanism of perception of the speech, in neurology the synonymous term "touch aphasia" is used. The most often akustiko-Gnostic form of speech disturbance is observed at ischemic strokes that causes its prevalence mainly among people 50 years are more senior. Gender distinctions in incidence are absent.
Reasons of akustiko-Gnostic aphasia
The disease develops at defeat of a zone of Vernike — the cortical structures of the acoustic analyzer located in the field of the top temporal crinkle of the left hemisphere. Etiofaktora are various, in most cases sharp violations of cerebral haemo dynamics are the reason of defeat. Major factors are subdivided into the following groups:
- Tserebrovaskulyarny diseases. ONMK with a thrombembolia, is more rare — hemorrhagic strokes in the pool of an average brain artery lead to insufficient blood supply of a zone of Vernike. The sharp hypoxia, a sdavleniye of fabrics the intracerebral hematoma which is formed at hemorrhage cause death of neurons of this area, there is Gnostic dysfunction.
- Craniocereberal injuries. Heavy concussions, brain bruises with defeat of the left temporal share make direct traumatic impact on neurons of the speech center of Vernike. Post-traumatic swelled conducts to a sdavleniye, ischemia of nervous cages. As a result akustiko-Gnostic dysfunction develops.
- Neuroinfections. Brain abscesses, encephalitis with localization of the inflammatory centers in Vernike's center provoke dysfunction or death of the neurons which are responsible for perception of the speech. Touch aphasia can be temporary, regress after subsiding of inflammatory changes.
- Brain tumors. Gliomas, astrotsitoma, glioblastoma of the corresponding localization lead to defeat of the cages surrounding them in two ways. In the first case pathology of a zone of Vernike is connected with the invasive growth of a new growth which is followed by destruction of surrounding fabrics. In the second — with a sdavleniye of neurons nearby the located tumor.
- Degenerate diseases of TsNS. The disease of Peak, a leykodistrofiya, Kreyttsfeldta-Jacob's disease, Alzheimer's disease at the initial stages can proceed with focal defeat of the center of Vernike. Speech violations are caused by the degenerate changes of neurons leading to their dysfunction and apoptosis.
The listed etiofaktor lead to dysfunction of neurons of touch speech area of Vernike. As a result in cerebral bark process of assessment and synthesis of the arriving speech information is broken. The sound perceiving, sound transferring parts of the acoustic analyzer work normally, hearing is not reduced. Phonemic perception — ability to distinguish and learn phonemes (sound units) is broken. Difficulties of a differentiation of phonemes, similar in sounding, are a consequence, in hard cases the native language is perceived sick as absolutely unfamiliar set of sounds.
Impossible is an acoustical control of own speech that causes multiple parafraziya, repetitions, agrammatisms in speech production of the patient. Reading, the letter as they are connected with internal pronunciation of words is broken. Pathology of the touch speech center seldom happens isolated, in 85% it is combined with defeat of adjacent cerebral fabrics that is clinically shown by the corresponding neurologic symptoms. Defeat of temporal shares of both hemispheres leads to total acoustic agnosia with impossibility of recognition not only speech information, but also nonverbal sounds: a paper rustle, it is ringing, the dripping water.
Symptoms of akustiko-Gnostic aphasia
At the initial stage directly after a stroke or ChMT total loss of ability to understand the turned speech is noted. Patients perceive words as unclear sound set, sometimes do not realize own speech defect. There is a psychomotor excitement, . The subsequent expressiveness of violations depends on weight of defeat. In some cases the partial akustiko-Gnostic aphasia which is shown identical perception of phonemically similar words (nail-cane-bone) and various understanding of one word comes to light (the word "flank" is recognized sometimes as "kidney", in other cases as "daughter"). Difficulties of identification of a lexico-semantic part of the word cause the complicated definition of its value. For example, having heard "hand bell", the patient understands that it is about a small subject, but does not define about what.
Touch aphasia extends to perception of own speech, control of the said offers is lost. The literal paraphasia — replacement of sounds phonemically close, but distorting the word, a verbal paraphasia — replacement of the whole words is observed. The speech of the patient loses sense, has an appearance of "speech salad" that is most characteristic of an initial stage of a disease. Similar violations last up to 1,5-2 months. Then it is noted with numerous agrammatisms, repetitions, the use of a large number of pretexts. Owing to agnosia patients do not feel defect of the speech, irritably treat misunderstanding of people around. In the recovery period inconsistency of words in the offer by the nature of, to number, the use of pronouns instead of nouns prevails.
As the account is followed by pronunciation of the words relating to arithmetic operation, akustiko-Gnostic aphasia leads to the akalkuliya which is the most expressed in a disease debut. Patients copy figures at writing off, but solve examples as follows: "5+3=2", "4+1=15". Difficulties of reading are caused by the literal paraphasia complicated by statement of the correct accent. Additional participation of optical and kinestetichesky control in the course of reading causes moderate expressiveness of a dyslexia. Big difficulties are observed in the letter as it directly depends on phonemic hearing. The dysgraphia is shown at writing off, the letter from dictation. More careful control at writing off, connection of optical mechanisms allows to achieve exact copying of the written words over time. In acoustical dictations even during restoration it is long alphabetic paragraphias are noted.
The isolated defeat of an acoustical zone is found in 15% of cases. At other patients akustiko-Gnostic pathology is combined with other neurologic symptomatology which character is caused by an etiology and localization of pathological process. Neuroinfections are followed by temperature increase of a body, an intoksikatsionny syndrome, tumors — intra cranial hypertensia. Focal neurologic deficiency is presented mainly by a hemiparesis of the right extremities, a right-hand gemianopsiya, dysfunction of a facial nerve. Many patients have a decrease in cognitive abilities.
Existence of the expressed speech frustration interferes with verbal and general communication of the patient. The situation is aggravated with the accompanying cognitive and, perhaps, motive violations. Disorder of the highest mental functions, neurologic deficiency cause the patient's invalidization, worsen quality of life. Lack of full verbal contact adversely is reflected in an emotional condition of the patient, leads to change of his personality, behavior. Without timely logopedic, psychological support the specified changes are fixed, the patient loses hope to be a witness, becomes reserved. Development of a depression, apathy, loss of interest in treatment, desires to improve the state is possible.
It is possible to find symptomatology of touch aphasia at the patient's poll. The neurologist, the logopedist, the psychiatrist, the neuropsychologist take part in further diagnostics. Inspection of the patient is directed to specification of nature of speech violations, establishment of a morphological substratum of a disease (a stroke, a tumor, a trauma, an infection). The list of necessary researches includes:
- Neurologic survey. Seldom reveals the isolated aphasia. The right-hand spastic hemiparesis, symptoms of front paresis on the right, easy or moderate changes of cognitive functions is usually diagnosed. Glazodvigatelny frustration, decrease in a pharyngeal reflex, deviation of language and other signs of damage of craniocereberal nerves are possible.
- Inspection of the speech. The complex research of an oral and written language, slukhorechevy memory is conducted. It is carried out by the logopedist by means of special tests. Confirms disorder of phonemic hearing, a paraphasia, paragraphia, difficulty of reading.
- Brain MRT. It is necessary for visualization of morphological changes of cerebral fabrics. The magnetic and resonant tomography allows to diagnose the tumoral, inflammatory, degenerate, ischemic, hemorrhagic centers. In case of ChMT brain KT is made.
- Assessment of cerebral haemo dynamics. It is carried out by means of UZDG of vessels of a neck, transkranialny UZDG, duplex scanning. Gives the chance to analyse the level of brain blood supply, to diagnose spazmirovanny, okklyuzirovanny vascular sites.
- Research of tserebrospinalny liquid. The material received by a lyumbalny puncture is exposed to microscopic, bacteriological, cytologic studying. The analysis helps to reveal or disprove an infectious and inflammatory etiology, intrakranialny bleeding, tumoral process.
Akustiko-gnostichesky aphasia is differentiated from other forms of speech violations. The closest on manifestations is the akustiko-mnestichesky aphasia differing in more harmonious character of the speech, existence of difficulties of repetition for the doctor of several words in a row. At motor aphasia total absence or restriction of spontaneous speech production unlike a logorea at touch aphasia is observed.
Treatment of akustiko-Gnostic aphasia
Correctional therapy of speech violations is performed against the background of treatment of a causal disease: restoration of cerebral blood circulation, removal of a tumor, mitigation of consequences of ChMT, etiotropny therapy of a neuroinfection. Treatment is carried out step by step, is selected individually according to weight of violations, restoration speed. Act as the main therapeutic components:
- Logopedic occupations. Depending on weight of a condition of the patient of exercise on restoration of speech skills begin from the first days or weeks of a disease. Treatment demands patience and persistence, can take several years. A priority is restoration of phonemic hearing. Further therapy is directed to correction of all speech components: expressional speech, letter, reading.
- Medicamentous support. Promotes the fastest restoration of speech function, cognitive abilities, regress of the accompanying neurologic deficiency. It is carried out by nootropa (piracetam, a ginkgo of a bilob), the medicines improving cerebral haemo dynamics, neurometabolites (glycine, group B vitamins, gamma aminooleic acid).
Speech rehabilitation demands participation of relatives of the patient. Establishment of verbal contact is of great importance, the speech of people around for this purpose turned to the patient has to be simple, accurate, slow. Logopedic occupations have to be carried out daily, be supplemented with exercises in house conditions. Successful restoration is promoted by additional rehabilitation actions: massage, physiotherapy exercises, physical therapy, psychotherapy.
Forecast and prevention
The prospect of restoration of speech function depends on an etiology, weight of frustration, age of the patient. Timely correct treatment of infectious, traumatic, small ischemic defeats in young age leads to almost complete recovery. At heavy violations, lack of logopedic therapy at patients persistent akustiko-Gnostic aphasia remains. The most adverse forecast at the progressing degenerate and tumoral processes. Prevention is directed to reduction of probability of development of causal pathology by effective treatment of tserebrovaskulyarny diseases, preventions of injuries of the head and onkogenny influences, immunity strengthenings.