Chapter 6

Patients who are fluent are described as those whose speech is abundant.  Verbal out put may consist of 100 to 200 words per minute.  In contrast, the speech of the patients with nonfluent aphasia is often described as sparse and limited.  Aphasic patients who are fluent produce their speech with ease, good articulation, and normal prosody.  Phrase length is normal (5 to 8 words per phrase).  However, fluent speech in fluent aphasia does not imply normal language.  Fluent patients tend to omit meaningful and semantically significant words.  Their verbal expression may be full of paraphasias.

Other names for Wernicke's aphasia are receptive, acoustic-amnestic, verbal agnosia, word deafness, syntactic, posterior aphasia and central aphasia.

The combination of fluent and jargon filled speech and poor auditory comprehension characterizes Wernicke's aphasia.

It is the least controversial of the aphasias.

Located in the posterior portion of the superior temporal gyrus in the left hemisphere.

Patients appear physically normal and are often misdiagnosed.

Untreated ear infections can lead to Wernicke's aphasia.

• 1.  No paresis/paralysis. Lesions are not on the motor strip.
• 2.  May sound confused.  Jargon filled speech gives impression of confusion.
• 3.  Lack of insight to their disability.
• 4.  Lack of frustration in failed communication.  Most patients do not know that they failing in communication.
• 5.  Exhibit psychiatric symptoms.  Patient may be paranoid, homicidal, suicidal or depressed.

Because of confused and irrelevant speech, paranoia, and depression, combined with normal or near-normal neurological findings, patients with Wernicke's may be mistakenly diagnosed as psychiatric patients and treated for schizophrenic patients.

Fluent but jargon filled speech and defective auditory comprehension are the hallmarks of this syndrome.

• 1.  Normal or even abnormal speech fluency. May need signals to stop talking.
• 2.  Rapid rate of speech.
• 3.  Normal prosodic features. (normal rhythm, intonation and linguistic stress.)
• 4.  Good articulation.
• 5.  Normal phrase length. (5 to 8 words)
• 6.  Generally in tack grammatical forms. 
• 7.  Severe word finding problems.
• 8.  Empty speech. (produce much and convey little.)
• 9.  Poor auditory comprehension. 
• 10.  Impaired conversational skills. (may be due to poor auditory comprehension.)
• 11.  Impaired repetition skill.(degree of impairment corresponds with degree of auditory comprehension)
• 12.  Impaired reading comprehension.
• 13.  Impaired writing skills.

Most of the communication problems associated with Wernicke's Aphasia are explained on the basis of lack of sensory monitoring of speech and writing.  They are unable to regulate and correct their errors.