Word comprehension in temporal cortex and Wernicke area: A PPA perspective

M. Marsel Mesulam*, Benjamin M. Rader, Jaiashre Sridhar, Matthew J. Nelson, Jungmoon Hyun, Alfred Rademaker, Changiz Geula, Eileen H. Bigio, Cynthia K. Thompson, Tamar D. Gefen, Sandra Weintraub, Emily J. Rogalski

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

ObjectiveTo explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = -0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.

Original languageEnglish (US)
Pages (from-to)E224-E233
JournalNeurology
Volume92
Issue number3
DOIs
StatePublished - Jan 15 2019

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Primary Progressive Aphasia
Temporal Lobe
Wernicke Area
Patient Rights
Neurodegenerative Diseases
Atrophy
Autopsy
Language

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

@article{5ba63441a00d4a98a33877b184938268,
title = "Word comprehension in temporal cortex and Wernicke area: A PPA perspective",
abstract = "ObjectiveTo explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = -0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50{\%} loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.",
author = "Mesulam, {M. Marsel} and Rader, {Benjamin M.} and Jaiashre Sridhar and Nelson, {Matthew J.} and Jungmoon Hyun and Alfred Rademaker and Changiz Geula and Bigio, {Eileen H.} and Thompson, {Cynthia K.} and Gefen, {Tamar D.} and Sandra Weintraub and Rogalski, {Emily J.}",
year = "2019",
month = "1",
day = "15",
doi = "10.1212/WNL.0000000000006788",
language = "English (US)",
volume = "92",
pages = "E224--E233",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Word comprehension in temporal cortex and Wernicke area : A PPA perspective. / Mesulam, M. Marsel; Rader, Benjamin M.; Sridhar, Jaiashre; Nelson, Matthew J.; Hyun, Jungmoon; Rademaker, Alfred; Geula, Changiz; Bigio, Eileen H.; Thompson, Cynthia K.; Gefen, Tamar D.; Weintraub, Sandra; Rogalski, Emily J.

In: Neurology, Vol. 92, No. 3, 15.01.2019, p. E224-E233.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Word comprehension in temporal cortex and Wernicke area

T2 - A PPA perspective

AU - Mesulam, M. Marsel

AU - Rader, Benjamin M.

AU - Sridhar, Jaiashre

AU - Nelson, Matthew J.

AU - Hyun, Jungmoon

AU - Rademaker, Alfred

AU - Geula, Changiz

AU - Bigio, Eileen H.

AU - Thompson, Cynthia K.

AU - Gefen, Tamar D.

AU - Weintraub, Sandra

AU - Rogalski, Emily J.

PY - 2019/1/15

Y1 - 2019/1/15

N2 - ObjectiveTo explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = -0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.

AB - ObjectiveTo explore atrophy-deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = -0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.

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DO - 10.1212/WNL.0000000000006788

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