Wernicke’s aphasia, also known as receptive aphasia, is a type of aphasia characterized by impaired auditory and reading comprehension, fluent speech production, and poor repetition. Comprehensive assessment is important for diagnosis and guiding treatment. Assessment involves evaluating language comprehension, speech production, repetition, naming, reading, writing, and cognition.
What is Wernicke’s aphasia?
Wernicke’s aphasia occurs due to damage to Wernicke’s area in the left posterior superior temporal gyrus of the brain. This area is important for processing language comprehension. People with Wernicke’s aphasia have difficulty understanding spoken and written language but can often speak fluently with normal grammar, syntax, rate, and intonation. Their speech may contain incorrect words or nonsensical phrases, a condition known as paraphasia. They also have difficulty repeating words and sentences. Wernicke’s aphasia differs from Broca’s aphasia, which causes non-fluent speech production but relatively preserved comprehension.
Goals of assessment
Thorough assessment of Wernicke’s aphasia is important for:
- Confirming the diagnosis
- Identifying the severity of impairment
- Determining strengths and weaknesses in different language domains
- Establishing a baseline to monitor progress
- Guiding treatment planning
Comprehensive assessment includes:
Language comprehension
Language comprehension is severely impaired in Wernicke’s aphasia. Formal tests can help quantify deficits:
- Token Test – identify and manipulate tokens based on verbal instructions
- Boston Diagnostic Aphasia Examination (BDAE) – follow commands of increasing complexity
- Cognitive Linguistic Quick Test (CLQT) – follow instructions
Informal assessment examines the ability to:
- Understand yes/no questions
- Identify objects, pictures, and body parts
- Comprehend single words versus sentences
- Follow simple commands and conversations
Speech production
Speech in Wernicke’s aphasia is fluent with normal rate, prosody, and grammar. Assessment identifies paraphasia:
- Phonemic paraphasia – substitutions of phonemes e.g. “cat” said as “mat”
- Verbal paraphasia – substitutions of words e.g. “dog” instead of “cat”
- Neologistic paraphasia – made-up nonwords e.g. “daskin” instead of “basket”
- Jargon – fluent nonsensical words
Repetition
Repetition is severely impaired. Formal tests include:
- Repeating words, phrases, sentences
- Reciting days of the week, months, nursery rhymes
- Naming items from verbal description
Naming
Naming is assessed by:
- Picture naming tests e.g. Boston Naming Test
- Confrontation naming of objects, pictures, and body parts
- Verbal fluency e.g. generating words from a category
Phonemic and semantic paraphasias are common.
Reading
Reading comprehension is impaired. Assessment examines:
- Single word reading
- Reading sentences and paragraphs aloud
- Answering questions about written passages
- Identifying errors in sentences
Writing
Writing ability is variable but often poor. Testing includes:
- Writing name
- Copying words and sentences
- Taking dictation
- Picture description
- Confrontation writing – writing names of objects/pictures
Cognition
Cognitive deficits are common in Wernicke’s aphasia. Assessment includes:
- Attention
- Memory
- Executive function e.g. problem-solving
- Visuospatial abilities
Testing cognition aids in developing appropriate treatment strategies.
Informal assessment
Informal assessment throughout interactions provides valuable information about the person’s language deficits:
- Conversation
- Reporting an event
- Answering open-ended questions
- Following instructions during activities
Assessing severity
Determining severity of impairment guides prognosis and treatment planning. Mild Wernicke’s aphasia features occasional paraphasias with relatively preserved comprehension. Severe Wernicke’s aphasia involves severe paraphasia, jargon, and impaired comprehension.
Tools for determining severity include:
- Aphasia quotient from formal testing e.g. WAB
- Aphasia severity rating scales
Progress monitoring allows tracking of improvements or decline over time.
Multidisciplinary assessment
Comprehensive evaluation involves a multidisciplinary team including:
- Speech-language pathologist – communication
- Neurologist – neurological status
- Neuropsychologist – cognition
- Occupational therapist – activities of daily living
- Physical therapist – mobility
- Psychologist – mood and behavior
- Social worker – psychosocial support
Information from all team members guides diagnosis and patient-centered treatment planning.
Conclusion
Assessing individuals with Wernicke’s aphasia involves testing comprehension, speech production, repetition, reading, writing, naming, and cognition using formal and informal measures. Determining severity level helps monitor progress over time and guide prognosis. Comprehensive assessment by a collaborative team ensures appropriate diagnosis and treatment planning to maximize language recovery and communication.