Aphasia Classification (Types, Features, Lesion Sites)
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Overview
Aphasia is an acquired language disorder from brain damage, most often a left-hemisphere stroke, affecting speaking, comprehension, reading and writing in varying combinations. Board-style items generally follow the Boston classification (also used by the WAB-R): fluency, auditory comprehension and repetition sort a profile into one of eight types. Real lesions vary; the types are a shorthand, not a map of every patient. Primary progressive aphasia is covered in Dementia & Right Hemisphere Disorders; treatment choice in Language Intervention.
| Judgement | Good / fluent | Poor / nonfluent |
|---|---|---|
| Fluency | Phrases of about five or more words, normal rate and prosody, little effort | Short, effortful phrases with reduced grammar |
| Comprehension | Follows conversation and simple commands; reliable yes/no | Misses single words and simple commands |
| Repetition | Repeats phrases and sentences accurately | Fails on phrases or sentences, worse as length grows |
Classification by Fluency, Comprehension, and Repetition
| Type | Fluency | Comprehension | Repetition | Naming | Lesion Site |
|---|---|---|---|---|---|
| Broca's | Non-fluent | Relatively preserved | Impaired | Impaired | Left posterior inferior frontal (Broca's area, BA 44/45) |
| Wernicke's | Fluent | Severely impaired | Impaired | Impaired | Left posterior superior temporal (Wernicke's area, BA 22) |
| Global | Non-fluent | Severely impaired | Impaired | Impaired | Large left perisylvian (MCA territory) |
| Conduction | Fluent | Relatively preserved | Severely impaired | Impaired (conduite d'approche) | Left posterior temporal-parietal cortex (supramarginal gyrus, area Spt), with or without the arcuate fasciculus; the classic model names the arcuate |
| Transcortical Motor | Non-fluent | Relatively preserved | Preserved | Impaired | Anterior/superior to Broca's area (frontal watershed) |
| Transcortical Sensory | Fluent | Severely impaired | Preserved | Impaired | Posterior/inferior to Wernicke's (parietal-temporal watershed) |
| Mixed Transcortical | Non-fluent | Severely impaired | Preserved | Impaired | Anterior + posterior watershed areas |
| Anomic | Fluent | Relatively preserved | Relatively preserved | Severely impaired | Variable; angular gyrus, temporal lobe |
What Each Type Sounds Like
Invented samples for teaching. Judge the speech, then check comprehension and repetition; no single sample settles the type.
| Type | Sample and what gives it away |
|---|---|
| Broca's | Asked about the weekend: "Son... car... uh... lake. Fish... big." Slow, effortful content words with little grammar; aware of the errors and frustrated |
| Wernicke's | "Oh sure, I went down with the farl and they had the whole dinner sitting on the window, you know, the one that tells it." Effortless, normal melody, little meaning; neologisms and paraphasias; keeps going without noticing the listener is lost |
| Global | Answers every question with the same phrase, "on the way, on the way," changing only the intonation; gestures to fill in. Comprehension and repetition both fail |
| Conduction | "I put it in the... the frinch... the fritch... fridge." Fluent and grammatical, with sound errors the speaker hears and keeps correcting (conduite d'approche); repetition is the worst task and fails as sentences get longer |
| Anomic | "I need to call the man who fixes, you know, the pipes, the water... the plumber." Fluent and grammatical, follows conversation; pauses and talks around the missing word (circumlocution) |
| Transcortical motor | Asked about breakfast: a long pause, then "Toast." Yet repeats "The bus stopped at the corner by the bakery" word for word. Sparse, effortful self-started speech with repetition preserved; may echo the examiner |
| Transcortical sensory | Examiner: "Where do you live?" Patient: "Where do you live. Yes, over by the garage, where I keep the spoons for writing." Fluent and empty, with semantic paraphasias (garage for kitchen, spoons for pens) and echolalia; misses the question but repeats sentences accurately |
| Mixed transcortical | Examiner: "How are you feeling?" Patient: "How are you feeling." Almost no speech of the patient's own; echoes the examiner and finishes an automatic phrase once started ("Ready, set..." "Go") without understanding it; repetition preserved |
High-Yield: Preserved repetition narrows the field to the three transcortical aphasias and anomic aphasia (some subcortical aphasias also repeat well). Then use fluency and comprehension: nonfluent with good comprehension = transcortical motor; nonfluent with poor comprehension = mixed transcortical; fluent with poor comprehension = transcortical sensory; fluent with good comprehension = anomic. Conduction aphasia's hallmark is severely impaired repetition with conduite d'approche (successive self-correction attempts).
Conduction is the mirror image of the transcortical pattern: fluent output and good comprehension, but repetition impaired out of proportion to everything else.
The rest of this outline 10
- Key Features by Type
- Vascular Correlates
- Subcortical, Crossed, and Related Syndromes
- Paraphasia Types
- Aphasia vs. AOS vs. Dysarthria
- Assessment Tools
- Prognosis and Evolution
- Treatment Approaches
- Common Traps
- Sources to Know
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