PSY 448 Clinical Neuropsychology	Last revised: 10/21/2025
Language: Aphasia & Tests

Aphasia: Neurobiology and Types

Numbers below in brackets, e.g., [1] refer to the damaged areas in the diagram above on the right.
Broca's (Motor) [1]	Frontal Lobe YouTube video (3:59)	Decreased fluency May be unable to speak at all Impairment in simple sentences or, even, single words Telegraphic speech (omission of conjunctions [and, or, but] or articles [the, a, an]) Understanding language generally intact
Wenicke's (Fluent or Receptive) [2]	Temporal Lobe YouTube video (1:30)	Impaired ability to understand spoken speech Unable to repeat a sentence May produce speech which is fluent but not meaningful Not usually aware of language errors
Conduction (Associative) [3]	YouTube video (1.00)	Generally able to understand and produce language Inability to repeat words or sentences. Word finding difficulty (the right name for a person or object) Rare
Transcortical Motor [4, TCM] Sensory [5, TCS] Mixed	Left hemisphere damage outside primary language areas. The exact tracts comprising the  "conception" circuit in diagram above [C] are not yet known.	TCM: Understands & repeats language, but unable to think about or put together what to say TCS: Understands & repeats language, but unable to think about the language they have heard
Anomic (Nominal)	Left hemisphere damage which may include the left parietal lobe & the arcuate fasciculus, angular gyrus, the posterior inferior temporal lobe, and other areas	A milder form of aphasia in which a person is unable to find the right name for a person or object Person may describe rather than name target object Fluent speech otherwise
Global	More widespread and general damage to the hemisphere language areas	In some fashion, all basic language functions affected, but not necessarily completely lost
	Source: Berger & Berger, 2017;  Heath A to Z

Verbal Fluency

• Tests of fluency often ask testees to come up with as many words as they can think of beginning with certain letters, e.g, F. A. and S. Others use the letters C, F, and L while a third triad consists of P, R, and W.

• An alternative format--especially for children or those who have not learned to read--is to request that a testee name as many things associated with "things in a kitchen" or "things in a classroom"

Boston Naming Test

Developed by Edith Kaplan, Harold Goodglass, and Sandra Weitraub (1978)

• The test presents the examinee with a set of 60 pictures of objects. The examinee must name the pictured objects.
• Examinees who misperceive the item may be given a stimulus cue, e.g., if shown a tricycle and the examinee says "metal piping", the examiner might say "something little children ride on"
• If the examinee is unable to name the object in 20 seconds, they can be given a phonemic cue, i.e., the first letter of the actual name, e.g., "t" for "tricycle".

Boston Diagnostic Aphasia Examination (BDAE)

Developed by Harold Goodglass and Edith Kaplan. 1st edition published in 1972; 2nd edition published in 1983.

• This is a sophisticated, multipart (comprehensive) examination of language functioning which yields 38 separate subtest ratings or scores.

• The key components of language which this test measures involve fluency, auditory comprehension, word finding, repetition-recitation, paraphrasia, reading (oral reading & reading comprehension), writing, and visuospatial-quantitative functions (spatial & computation skills).

• "The Cookie Theft" Card: One of the most popular subtests on the BDAE involves the presentation of a card to the examinee with a picture on it. The instructions require that the examinee look over the card and write as much about what is happening in the picture as they can. Since the actual card is now readily available online, I reproduce it here:

• Note that the picture is divided into four quadrants. Neuropsychologists would look at the story created by the examinee to see not only if there is narrative coherence, but also whether information from all four quadrants is incorporated in the story.

In a fascinating study, Eyigoz and colleagues (2020) examined the responses  to multiple tests with the Cookie Theft card over several years by 270 older participants in their late 70s who are part of the famous Framingham Heart Study. Using Artificial Intelligence computing algorithms, they were able to develop a predictive model which identifies with reasonable success those who would develop Alzheimer's disease by age 85.

A normal response to the picture would be: "A young boy is reaching for the cookie jar. He is standing on a stool and is almost falling over. His sister is standing beside him and talking to him. On the other side of the kitchen their mom is wiping dishes. The water from the faucet is running over on to the floor"

An impaired response shows missing auxiliary verbs, articles and punctuation. For example: "Boy taking cookies Mother washing dishes water overflowing in sink girl getting cookie from boy stool falling over"

A more impaired response also shows misspellings and missing subjects. For example: "washing dishes getting cookies out of cookie ja stool tipping ove water running out of sink Girl reaching for cookie

Reference

Berger, W., & Berger, J. (2017) Case closed! Neuroanatomy. New York, NY: CRC Press.

Gunes, S., Aizawa, Y., Sugashi, T., Sugimoto, M., Rodrigues, P.P. (2022). Biomarkers for Alzheimer’s disease in the current state: A narrative review. International Journal of Molecular Sciences, 23, 4962. https://doi.org/10.3390/ijms23094962

Eyigoz, E., Mathur, S., Santamaria, M., Cecchi, C., & Naylor, M. (2020). Linguistic markers predict onset of Alzheimer’s disease. ECLinicalMedicine, 28, 100583. https://doi.org/10.1016/j.eclinm.2020.100583

Petti, U., Baker, S., & Korhonen, A. (2020). A systematic literature review of automatic Alzheimer’s
disease detection from speech and language. Journal of the American Medical Informatics Association, 27(1), 1784-1797. https://doi.org/10.1093/jamia/ocaa174

Rajan, K. B., Weuve, J., Barnes, L. L. et al (2021). Population estimate of people with clinical AD and mild cognitive impairment in the United States (2020-2060). Alzheimer’s & Dementia, 17(12), 1966-1975. https://doi.org/10.1002/alz.12362