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Impairments of procedures for implementing complex language are due to disruption of frontal attention processes

Published online by Cambridge University Press:  22 March 2006

MICHAEL P. ALEXANDER
MICHAEL P. ALEXANDER
Affiliation:
Harvard Medical School, Behavioral Neurology Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract

Production of complex discourse—lengthy, open-ended utterances and narratives—requires intact basic language operations, but it also requires a series of learned procedures for construction of complex, goal-directed communications. The progression of clinical disorders from transcortical motor aphasia to dynamic aphasia to discourse impairments represents a progression of procedural deficits from basic morpho-syntax to complex grammatical structures to narrative and a progression of lesions from posterior frontal to polar and/or lateral frontal to medial frontal. Two cases of impaired utilization of language exemplify the range of impairments from clearly aphasic agrammatic, nonfluency to less and less “aphasic” and more and more executive impairments from transcortical motor aphasia to dynamic aphasia to narrative discourse disorder. The clinical phenomenology of these disorders gradually comes to be more accurately defined in the terminology of executive deficits than that of aphasia. The executive deficits are, in turn, based on impairments in various components of attention. Specific impairments in energizing attention and setting response criteria associated, respectively, with lesions in superior medial and left ventrolateral frontal regions may cause defective recruitment of the procedures of complex language assembly. (JINS, 2006, 12, 236–247.)

Keywords

DiscourseExecutive functionAttentionAphasiaCerebellumCaudate
Type
SYMPOSIUM
Information
Journal of the International Neuropsychological Society , Volume 12 , Issue 2 , March 2006 , pp. 236 - 247
Copyright
© 2006 The International Neuropsychological Society

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