Akustiko-mnestichesky aphasia — the speech disturbance caused by inferiority of slukhorechevy memory. It is characterized by the complicated repetition of a verbal chain, difficulties of selection of the necessary word in the course of the conversation. Diagnostics is made by results of logopedic inspection, assessment of the neurologic status, carrying out cerebral MRT, a research of brain haemo dynamics, tserebrospinalny liquid. Correction of aphasia is carried out against the background of treatment of the main causal pathology, includes logopedic occupations, medicamentous support, the general rehabilitation (massage, LFK).
The term "akustiko-mnestichesky aphasia" was entered and was widely used by the founder of a domestic neuropsychology professor A. R. Luriya. Certain authors apply the name "touch aphasia". Pathology belongs to back forms of afatichesky violations of the speech. According to experts in the field of neurology and logopedics, the isolated aphasia form practically does not meet, usually speech frustration have the mixed character with simultaneous dysfunction of 2-3 mechanisms. The most often akustiko-mnestichesky aphasia is observed in the sharp period of ONMK. Speech defect is expressed not roughly, sometimes remains unnoticed against the background of other neurologic symptomatology, in some cases mistakenly is accepted to cognitive decrease, disorder of neurodynamics.
Reasons of akustiko-mnestichesky aphasia
Pathology develops owing to defeat of bark of average-back departments of an average temporal crinkle of a prepotent hemisphere — the 21 and 37 cytovery tectonic fields of Brodman. Changes of cerebral fabrics can carry ischemic, inflammatory, destructive, compression character. Are the possible reasons of defeat:
- Strokes. The most frequent reason of speech violations. According to various data, aphasia is observed at 30-60% of patients with ONMK. At an ischemic stroke the mnestichesky form of aphasia arises owing to a lack of blood supply and a hypoxia of the respective area of brain bark, at a hemorrhagic stroke — as a result of a sdavleniye of fabrics the streamed blood.
- Craniocereberal injuries. The bruise, a razmozzheniye of cerebral fabrics, formation of an intracerebral hematoma lead to damage and death of the neurons responsible for slukhorechevy memory. The zone of damage extends at the expense of post-traumatic hypostasis and an inflammation.
- Intracerebral tumors. Primary and metastatic new growths in temporal departments of a brain cause speech violations in two ways. Invasively growing a neoplasia people around of fabrics cause destruction. The delimited tumors in process of growth begin to squeeze cerebral structures and vessels feeding them.
- Infectious and inflammatory diseases. Encephalitis, meningoentsefalita, cerebral abscesses with an arrangement of the centers of an inflammation in the area 21, 37 of the field lead to dysfunction of neurons, responsible for the speech. Inflammatory swelled, the compression, a dismetabolizm in a zone of defeat become the reason of apoptosis of nervous cages, violations of mezhneyronalny communications.
- The progressing degenerate processes. Initial stages of Alzheimer's disease, disease of Peak, Shilder's leykoentsefalit can proceed with a focal degeneration, demiyelinizatsiy area of an average temporal crinkle. There is a progressing akustiko-mnestichesky dysfunction over time passing into the mixed sensomotorny aphasia.
The speech articulation, phonemic hearing is normal. A pathogenetic basis of this speech frustration is violation of slukhorechevy memory. According to assumptions, at patients the tormozimost of slukhorechevy traces is raised. Clinically it is expressed by a zabyvaniye of the previous heard words at perception of new. Limitation of volume of slukhorechevy memory is considered other pathogenetic aspect of this pathology. Defect negatively affects ability to the letter, the account, reading.
In most cases defeat of zadnevisochny areas (field 37) is followed by violation of their communication with nearby optiko-Gnostic structures of an occipital share. Difficulties in the ratio result from verbal designation of a subject and its vision, the semantic aspect of the speech suffers. Clinically observed difficulties of the perception told and difficulties of selection of necessary words in the expressional speech are a consequence.
Symptoms of akustiko-mnestichesky aphasia
Dissociation between the broken ability to repeat several words turned to the patient and normal reproduction of separately told word is typical. Due to the restriction of slukhorechevy memory of the patient it is capable to repeat the first and last or only one word from a verbal chain. The patient explains it with a problem with storing. The situation repeats at repeated listening. The understanding of long statements, simultaneous communication with several interlocutors is complicated. Having listened to the instruction from 5-7 words, the patient captures its essense, but can execute with mistakes (for example, to make the specified action by other subject).
The expressional speech is followed by difficulties of selection of the proper word that is connected with dysfunction of an optiko-Gnostic component. Arising "blurring" of word meaning causes a large number of verbal paraphasias — not always the verbal replacements suitable on sense. Agrammatisms are presented mainly by discrepancy of verbs, nouns, pronouns in number and a sort. The patient experiences difficulties at expression of own thoughts, the description of pictures, drawing up the story by separate parts.
The dysgraphia is more expressed when writing from dictation, is characterized big, than in oral speech, by quantity of agrammatisms. Patients badly remember the dictated phrases, often ask to repeat their fragments, are capable to keep in memory no more than three words at the same time. The dyslexia is observed when reading texts with offers of considerable length. Disorder of slukhorechevy memory causes inability to hold the readable text in the head that leads to misunderstanding of read. Akalkuliya is expressed in difficulty of arithmetic actions with multidigit numbers as the patient cannot remember the numbers transferred from one category to another.
Aphasia interferes with normal communication of the patient with people around, deprives of a possibility of full reading, the letter, performance of arithmetic actions. The specified changes adversely affect quality of life, level of social adaptation. Patients are irritated by inability to precisely inform of the thoughts people around. Experiences concerning the accompanying neurologic violations in the motive sphere, disability join. On this soil development of neurotic frustration (morbid depression, a depression), accentuation of negative traits of character is possible. The situation is aggravated if akustiko-mnestichesky aphasia is accepted by doctors and relatives to cognitive frustration. Lack of specialized treatment leads to permanent fixing of speech dysfunction.
The Akustiko-mnestichesky form is unevident, its identification at primary consultation of the patient requires a comprehensive investigation of speech function. Diagnostics is performed by joint efforts of a number of experts: neurologist, afaziolog, neuropsychologist, psychiatrist, logopedist. As the diagnosis "aphasia" is sindromologichesky, specification of an etiology of process is required. Comprehensive examination of the patient includes:
- Neurologic research. In the neurologic status the accompanying focal neurologic deficiency is found: spastic hemiparesis, pathology of cranial nerves. Assessment of cognitive abilities is of great importance. At deviations in the mental status consultation of the psychiatrist is required.
- Diagnostic inspection of the speech. It is carried out by the logopedist, afaziology in a complex. The verbal paraphasia, agrammatisms, decrease in slukhorechevy memory, a dyslexia, a dysgraphia comes to light. Optiko-gnostichesky dysfunction is diagnosed on lack of distinctive details of a subject in drawings of the patient: handles at a cup, a nose at a teapot.
- Brain MRT. Allows to define a morphological substratum of a disease. Visualizes tumoral processes, inflammatory focuses, degenerate changes, ischemia zones, intra cranial hematomas, traumatic damages.
- Vascular researches. UZDG, duplex scanning, the MR-angiography are appointed at suspicion of tserebrovaskulyarny pathology. Help to confirm changes of a cerebral blood-groove, vessel occlusion, to estimate a condition of collateral blood circulation.
- Lyumbalny puncture. It is made in the presence of clinical data for a neuroinfection for the purpose of receiving and a research of tserebrospinalny liquid. When carrying out laboratory analyses inflammatory changes, the concrete activator, tumor cells, symptoms of hemorrhage are defined.
Akustiko-mnestichesky aphasia is differentiated from other speech frustration. The active expressional speech allows to exclude motor aphasia at which speech production is sharply limited. Unlike akustiko-Gnostic aphasia the mnestichesky form is characterized by more finished statements, lack of a literal paraphasia, "speech salad". The careful research of the speech gives the chance to distinguish aphasia from violations of the cognitive sphere.
Treatment of akustiko-mnestichesky aphasia
Correction of speech defect is carried out against the background of obligatory therapy of the main pathology. Depending on a type of a stroke thrombolytic or haemo static therapy is performed. At a tumor, a hematoma together with neurosurgeons the possibility of radical removal, radiotheraphy is considered. The patient with a neuroinfection appoints etiotropny antibacterial or antiviral treatment. Therapy of actually speech violations includes two components:
- Logopedic occupations. A problem of logopedic correction is expansion of volume of random access slukhorechevy memory. Whenever possible occupations begin from the first days of a disease and are carried out step by step with gradual building and complication. In the beginning tasks are performed with a support on visual perception, then short acoustical dictations are carried out. Learning and a recall of speech ranks, verses, songs is recommended. Difficulties of selection of words in the speech are overcome by specification of their sense, systematization, comparison of synonyms and antonyms.
- Pharmacotherapy. It is necessary for stimulation of exchange processes in a brain, restoration of the lost neural communications and functions. It is produced vascular (), nootropic (piracetam), by neurometabolic (gamma aminooleic acid) medicines. In treatment of aphasias well proved medicine .
During rehabilitation the patient needs the help of relatives. Productive communication is possible on condition of decrease in tempo of speech, an exception of long difficult statements. Maintenance of verbal contact from the family, the help in performance of logopedic exercises promote the fastest restoration of speech function at home. Carrying out logopedic rehabilitation against the background of the all-strengthening recovery occupations of LFK, massage, psychotherapy is effective.
Forecast and prevention
The outcome of akustiko-mnestichesky aphasia in many respects depends on an etiology of a causal disease, timeliness of the begun logopedic treatment. Persistent stage-by-stage therapy often allows to restore speech function after the had stroke, ChMT, encephalitis. The aphasia which is not distinguished, left without correction can undergo insignificant regress, but speech violations turn into resistant residual defect. Aphasia of tumoral and degenerate genesis has the most adverse forecast. Preventive actions mean timely therapy of tserebrovaskulyarny diseases, an exception of onkogenny influences, injury prevention, strengthening of immune system