Broca’s aphasia is the classic "expressive aphasia", in distinction to the "receptive aphasia" of Wernicke; however, there are problems with this simple classification, since Broca’s aphasics may show comprehension problems with complex material, particularly in relation to syntax.
Considering each of the features suggested for the clinical classification of aphasias (see Aphasia), Broca’s aphasia is characterized by:
- Fluency: slow, labored, effortful speech (nonfluent) with phonemic paraphasias, agrammatism, and aprosody; the patient knows what s/he wants to say and usually recognizes the paraphasic errors (i.e., patients can "self-monitor").
- Comprehension: comprehension for simple material is preserved, but there may be problems with more complex syntax.
- Repetition: impaired.
- Naming: impaired (anomia, dysnomia); may be aided by phonemic or contextual cueing (cf. Wernicke’s aphasia).
- Reading: alexia with labored oral reading, especially of function words and verb inflections. Silent reading may also be impaired (deep dyslexia) as reflected by poor text comprehension.
- Writing: similarly affected.
Aphemia was the name originally given by Broca to the language disorder subsequently named "Broca’s aphasia." The syndrome may emerge during recovery from a global aphasia. Broca’s aphasia is sometimes associated with a right hemiparesis, especially affecting the arm and face; there may also be bucco-lingual-facial dyspraxia. Depression may be a concurrent feature.
Classically Broca’s aphasia is associated with a vascular lesion of the third frontal gyrus in the inferior frontal lobe (Broca’s area), but in practice such a circumscribed lesion is seldom seen. More commonly there is infarction in the perisylvian region affecting the insula and operculum (Brodmann areas 44 and 45), which may include underlying white matter and the basal ganglia (territory of the superior branch of the middle cerebral artery).
The terms "small Broca’s aphasia", "mini-Broca’s aphasia", and "Broca’s area aphasia", have been reserved for a more circumscribed clinical and neuroanatomical deficit than Broca’s aphasia, wherein the damage is restricted to Broca’s area or its subjacent white matter. There is a mild and transient aphasia or anomia which may share some of the characteristics of aphemia/phonetic disintegration (i.e., a motor disorder of speech production with preserved comprehension of spoken and written language).
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