APPLIED NEUROPSYCHOLOGY: ADULT

https://doi.org/10.1080/23279095.2017.1323753

none defined

Aphasia from the inside: The cognitive world of the aphasic patient
Alfredo Ardilaa and Silvia Rubio-Brunob
a
Department of Communication Sciences and Disorders, Florida International University, Miami, Florida, USA;
b
Fundacin Argentina de Afasia Charlotte Schwarz, Buenos Aires, Argentina

ABSTRACT KEYWORDS
The purpose of this study was to analyze the question: how do people with aphasia experience Aphasia; cognitive world;
the world? Three questions are approached: (1) how is behavior controlled in aphasia, considering language; second signal
that a normal linguistic control is no longer available; (2) what is the pattern of intellectual system; verbal abilities
abilities in aphasia; and (3) what do aphasia patients self-report regarding the experience of
living without language. In aphasia, behavior can no longer be controlled through the second
signal system and only the first signal system remains. Available information suggests that
sometimes no verbal abilities may be affected in aphasia. However, an important variability is
observed: whereas, in some patients, evident nonverbal defects are found; in other patients,
performance verbal abilities are within normal limits. Several self-reports of recovered aphasic
patients explain the experience of living without language. Considering that language represents
the major instrument of cognition, in aphasia, surrounding information is evidently interpreted in
a partially different way and cognitive strategies are reorganized, resulting in an idiosyncratic
cognitive world.

Introduction consequences of neurological deficits are not elaborated

Aphasia changes the pattern of intellectual abilities and,
ultimately, the perception and interpretation of the
surrounding world. As a result, the aphasic patient lives
in an idiosyncratic cognitive world. Cognitive world
refers to the experiential dimension of cognition, to the
worldview (Weltanschauung) resulting from the specific
pattern of an individuals intellectual abilities (Ardila &
Rosselli, 2016). Evidently, brain damage can result in
specific patterns of preserved and impaired cognitive
abilities. These patients with brain pathology live in
quite idiosyncratic cognitive worlds. The limitation
with aphasia is that, exactly, because of the lack of
language, patients cannot communicate the changes
in cognition that they have suffered. Because of that,
the reports of aphasia-recovered patients are parti-
cularly important to understand the aphasics cognitive
world.
Recently, a growing interest in understanding the
internal world of neurological patients has been
observed. For instance, Zwijsen van der Ploeg, and
Hertogh (2016) explain in their paper Understanding
the world of dementia. How do people with dementia
experience the world? that current theories on subjec-
tive experience in dementia emphasize the psychosocial
factors that influence subjective experience, but the
upon. They conclude that much more research is
required in this area. This observation is also valid for
other neurological conditions, including aphasia.
In this article three questions are approached: (1)
how is behavior controlled in aphasia, considering
that a normal linguistic control is no longer available;
(2) what is the pattern of intellectual abilities in
aphasia; and, finally, (3) what do aphasic patients
self-report regarding the experience of living without
language. At the end, some tentative conclusions are
presented.
Language as a second signal system
During the 1930s, Pavlov (1932/1960) introduced the
idea that human behavior is mediated and controlled
by two different signaling systems: the sensory infor-
mation (first signal system) and the language (second
signal system). For instance, we can present an
emotional response when we hear an explosion (first
signal system); but we can also present a similar
emotional response when we hear someone say, An
explosion has just occurred! (second signal system).
This idea about the two signal systems has been taken
and further developed by different authors (e.g., Dance,
1967; Krasnogorsky, 1954; Windholz, 1990).

CONTACT Alfredo Ardila ardilaa@fiu.edu Department of Communication Sciences and Disorders, Florida International University, 11200 SW 8th Street,
AHC3-431B, Miami, FL 33199.
2017 Taylor & Francis Group, LLC
2 A. ARDILA AND S. RUBIO-BRUNO
Pavlov assumed that language represents the funda-
mental difference in brain functioning between man
and other animals. Language emerged during human
evolution because this form of communication had
survival value to the species. Animal behavior is
controlled by the external stimuli (visual, auditory,
olfactory, information, etc.) and the resulting sensations
represent the first signal system. Humans, on the other
hand, not only react to the external stimuli, but also
have the ability to generalize using a countless amount
of language signals of the first system. Pavlov further
proposed that the second signal system is an evolution-
ary result of social activity.
What is important for the current analysis is that the
aphasic patients behavior is directly mediated and
controlled only by the first signal system. The involve-
ment of the second signal system obviously depends
upon the individuals residual language abilities.
Intellectual abilities in aphasia
One of the most complex and controversial questions in
aphasia is the issue of the patients intellectual abilities.
In other words, how the pattern of cognitive skills is
when language is impaired? This is a question that has
been up for discussion for decades (e.g., Bay, 1964,
1974; Zangwill, 1964). Obviously, verbal abilities are
impaired; but what about other intellectual abilities,
such as nonverbal and conceptual abilities?
This is a question that was extensively analyzed
during the 1970s and 1980s and later virtually disap-
peared from the aphasia literature. In a recent search
in PubMed (May 5, 2016) using the terms intelligence
and aphasia in the title/abstract, a total of 135 articles
were found. However, only a few of the articles actually
analyzed the question of the intellectual abilities in
aphasia, and just four of these analyses corresponded
to articles published during the 21st century (Baldo,
Paulraj, Curran, & Dronkers, 2015; Blazkov-Ctrnct,
Kalvach, Preissov, & Mllerov, 2003; Lee & Pyun,
2014; Maeshima et al., 2002). When using the terms
aphasia and cognition, 213 articles were retrieved.
However, again, only a few of them analyzed the
question of cognition in aphasia, six of them published
during the last 16 years (Butts et al., 2015; Fedorenko &
Varley, 2016; GornoTempini et al., 2004; Helm-
Estabrooks, 2002; Kang, Jeong, Moon, Lee, & Lee,
2016; Lee & Pyun, 2014); one article was found in both
searches (Lee & Pyun, 2014). According to PubMed,
only 10 articles have been published during the last 16
years devoted to the analysis of the intellectual abilities
in aphasia, out of hundreds of articles published in the
area of aphasia (5,762 articles that include the term
aphasia in the title/abstract have been published since
the beginning of the century). There are several poten-
tial reasons for this paucity in research: (a) this is obvi-
ously a complex and polemic question and results may
impact our interpretation of aphasia; if general intellec-
tual impairments were found, it means that aphasia is
not just a language disorder but also includes a general
intellectual disturbance; and (b) research results can be
difficult to interpret; if nonverbal abilities were
decreased in aphasia, what does it mean? Several
potential explanations could be proposed; for instance:
(a) tests that are assumed to be nonverbal may also be
partially verbal tests; (b) the decrement in nonverbal
abilities may simply reflect some right hemisphere
decreased activation due to the left hemisphere pathol-
ogy; or (c) using a simpler and obvious explanation, it
could be proposed that language represents an
additional resource to solve nonverbal problems and,
hence, the aphasic patient is at a disadvantage in regard
to the normal speaking individuals. Evidently, it is not
easy to be sure what would be the correct explanation.
Several studies have used the Ravens Colored
Progressive Matrices as a measure of nonverbal abilities
(Bailey, Powell, & Clark, 1981; Basso, Capitani, &
Luzzatti, 1981; Gainotti, Derme, Villa, & Caltagirone,
1986; Kertesz & McCabe, 1975; Zaidel, Zaidel, & Sperry,
1981). In a classical study, Kertesz and McCabe selected
163 subjects, 111 aphasics, and 52 controls. The
Western Aphasia Battery (WAB) was used as a
measurement of the type of aphasia and its severity.
The results indicate that Global, Wernickes, and
Transcortical Sensory aphasics perform poorly on the
Ravens Colored Progressive Matrices. A common side
effect to all these forms of aphasia is poor comprehen-
sion. Brocas Transcortical Motor, Conduction, and
Anomic aphasics do as well as nonaphasic controls with
diffuse brain damage or nondominant hemisphere
lesions. Interestingly, the Ravens Colored Progressive
Matrices scores were not related directly to the severity
of aphasia. The authors concluded that nonverbal
intelligence is also impaired in aphasics to a variable
extent; however, 42% of aphasics performed as well in
Ravens Colored Progressive Matrices as the control
subjects without brain damage. Bailey et al. (1981)
selected 134 aphasia cases, on average 5 months, after
the aphasia onset (mainly CVA). Most of the cases
administered the Schuell test of aphasia, some were
given the Ravens Colored Progressive Matrices, and
some the Standard Matrices test. It was found that
non-verbal intelligence as measured by correlated in a
negative direction with severity of aphasia and positively
with recovery from aphasia. Basso et al. (1981) studied
173 left hemisphere patients subdivided according to

presence/absence, type (fluent/nonfluent) and severity
(moderate/severe) of aphasia. The Raven Progressive
Matrices and four subtests of the Wechsler-Bellevue
Performance Scale were administered. Constructive
and ideomotor apraxia scores and CT scan data of each
subject entered the statistical analysis. The factors
significant in producing a low score on Progressive
Matrices and Wechsler-Bellevue included aphasia and
constructive apraxia.
Also, by using the Ravens Colored Progressive
Matrices, Basso, De Renzi, Faglioni, Scotti, and Spinnler
(1973) found that the correlation between scores earned
by 33 subjects with left hemisphere damage on the
Ravens, and scores earned on a language test of naming
and comprehension, was practically zero. In other
words, it was impossible to predict analogic thinking
ability on the basis of language test performance. Villar-
dita (1985) selected 24 right brain-damaged patients, 24
left brain-damaged patients (10 nonaphasic and 15
aphasic) and 20 controls and administered the on the
Ravens Colored Progressive Matrices. In addition to
the total scores, the author analyzed the scores obtained
on each of the three sets, where the 36 total items in the
test could be categorized on the grounds of cognitive
abilities. The first set, which calls for the identification
of sameness, posed special problems to damaged right
brain patients. The second set, which involves the
principle of symmetry, was selectively failed by aphasic
patients. The third set, which is more demanding in
terms of analogical and conceptual thinking, was poorly
performed by left brain-damaged patients, aphasics as
well as non-aphasics.
In a more recent study, Gainotti et al. (1986)
developed a new set of Colored Matrices, devised to
minimize the influence of unilateral spatial neglect
without changing the essential features of the original
task. The test was administered to 76 normal controls,
74 right brain-damaged patients, 87 aphasics, and 61
nonaphasic left brain-damaged patients, in order to
study the effect of laterality of lesions and of language
impairment on Ravens scores. The results show that,
if the influence of unilateral spatial neglect is minimized
and Ravens scores are corrected in reference to age, edu-
cational level, and lesion size, then: (a) no significant dif-
ferences are observed between right and left brain-
damaged patients; (b) aphasics score worse than nona-
phasic left brain-damaged patients; (c) impairment is
greater in patients with Wernickes and Global aphasia
(i.e., in patients with severe language comprehension
disorders) than in patients classified as Brocas, Anomic,
or Conduction aphasia; and (d) impairment is greater in
patients with semantic-lexical discrimination errors than
in patients free from semantic-lexical comprehension.
APPLIED NEUROPSYCHOLOGY: ADULT 3
Taken together all these studies, it can be tentatively
concluded that aphasia is associated in some, but not in
all the cases, with low scores in the Ravens Colored
Progressive Matrices as a measurement of nonverbal
intelligence.
Other analyses of nonverbal abilities in aphasia have
been reviewed. Borod, Carper, and Goodglass (1982)
investigated the differences in nonverbal intelligence
between diagnostic subgroups of aphasics using the
Performance tests of the Wechsler Adult Intelligence
Scale (WAIS). Ninety-eight right-handed hospitalized
males, with unilateral left-hemisphere damage, were
selected. They had had an unambiguous clinical
diagnosis of Brocas, Anomic, Conduction, Mixed Non-
Fluent, Wernickes, or Global aphasia. Group differences
were examined using the WAIS Performance IQ (PIQ),
subscores for spatial organization (Block Design and
Object Assembly), and for verbalizability (Picture Com-
pletion and Picture Arrangement). Determined by the
impaired performance of the Global aphasics, it was
found that there were significant group differences for
each WAIS score. With covariance correction for level
of auditory comprehension, group differences were
eliminated on the verbalizable subtests, but not on the
spatial organization subtests. To further eliminate group
differences, the levels of constructional apraxia were
covaried (assessed with drawings, sticks, blocks). Using
demographic, neurological, and linguistic variables,
multiple regression analyses confirmed the covaried
analysis findings; constructional apraxia was the most
predictive variable for both spatial and verbalizability
subscores, while auditory comprehension and education
level predicted performance on the verbalizable subtests.
De Renzi, Faglioni, Savoiardo, and Vignolo (1966)
analyzed the influence of aphasia as well as the hemi-
spheric side of the cerebral lesion on abstract thinking.
A modified version of the Weigl Sorting Test allowing 5
criteria of classification was administered to 40 control
patients, 40 right brain-damaged patients, 22 left non-
aphasic brain-damaged patients, and 45 aphasics. Right
and left nonaphasic brain-damaged patients performed
no differently from control patients on the Weigl test,
while the mean score of the aphasic group turned out
to be about one half of that of the control group. In
addition, the t-score obtained by aphasics on the Weigl
test was found to highly correlate with an auditory
verbal comprehension score, while no significant
connection was found between the Weigl score and
either a visual naming or an ideomotor apraxia score.
It was concluded that the Weigl test is not sensitive to
the presence of cerebral damage per se, while it is highly
sensitive to the presence of left (dominant) hemisphere
lesions associated with aphasia. The authors suggest that
4 A. ARDILA AND S. RUBIO-BRUNO
the evidence pointing to a specific defect of abstract
thinking in aphasics may be interpreted as the
consequence of a disruption of inner language in these
patients; however, an alternative view may be advanced,
namely, that the same areas subserving linguistic
activities in the left hemisphere are also specialized in
carrying out intellectual tasks of a symbolic nature.
Haas, Vogt, Schiemann, and Patzold (1982) analyzed
non-verbal intelligence in brain tumor patients. The
Aachen Aphasia Test and subtests of the Wechsler
Adult Intelligence Scale (WAIS) were used. The statisti-
cal evaluation of the data from 43 patients indicated
that: (a) Aphasia was an amnestic aphasia, independent
of the localization of the tumor within the dominant
hemisphere; (b) aphasics have no more intellectual
impairment than nonaphasics with similar brain lesions;
(c) the severity of the aphasic syndrome does not
correlate with the WAIS; and (d) with right-sided
tumors, there was correlation between the speech
reception subtest and the WAIS scores.
Moving to the articles published during the 21st
century, Helm-Estabrooks (2002) selected 13 right-
handed, left hemisphere stroke patients (five females
and eight males); four linguistic and four nonlinguistic
tasks were administered in one session. No significant
relationship was found between linguistic and nonlin-
guistic skills, and between nonlinguistic skills and age,
education, or time post onset. Instead, individual profiles
of strengths and weaknesses were found. The author
concluded that sometimes nonlinguistic tasks are affec-
ted in aphasia, but a significant variability is observed.
Some authors (Butts et al., 2015; GornoTempini
et al., 2004) have analyzed different types of primary
progressive aphasia and concluded that cognitive,
genetic, and anatomical features indicate that different
progressive aphasia clinical variants may correspond
to different underlying pathological processes. In cases
of progressive aphasia, there are variations in the
specific profile of cognitive disturbances, depending
upon the particular subtype of progressive aphasia.
Blazkov-Ctrnct et al. (2003) selected 41 persons
hospitalized after a brain stroke and tested them to cor-
relate the level of aphasia with intelligence scores. As an
aphasia test, the Western Aphasia Battery (WAB) was
used; to determine the general mental performance as
an equivalent of the IQ test, the nonverbal Ravens
and verbal Euro-ADAS tests were used. Correlation
between both types of measures was positive and stat-
istically significant, suggesting that aphasia is associated
with an intellectual disturbance.
Baldo et al. (2015) observed that the degree of lan-
guage impairment is strongly associated with the degree
of impairment on complex reasoning tasks, such as the
Wisconsin Card Sorting Task (WCST) and Ravens
Matrices. Similarly, Kang et al. (2016) have suggested
that patients with more severe aphasia show greater
impairments to cognitive functions. Lee and Pyun
(2014) reported that cognitive tests for working memory
and sustained attention are significantly impaired in the
aphasic patients.
Finally, Fedorenko and Varley (2016) observed that
individuals with global aphasia, despite their near-total
loss of language, are nonetheless able to add and sub-
tract, solve logic problems, think about another persons
thoughts, appreciate music, and successfully navigate
their environments. The author concluded that many
aspects of thought engage distinct brain regions from,
and do not depend on, language.
Taken together all these studies suggest that no verbal
abilities may be affected in aphasia; however, an impor-
tant variability is observed: whereas in some patients,
evident nonverbal defects are found, in other patients,
performance is found to be within normal limits.
Aphasics personal reports
Up to this date, there are several books and articles of
aphasic patients who have recovered language and
explained how their experience was of living without
language (e.g., Bay, 1969; Green, 2012; Hale, 2007; Hall,
1961; McGuire, 2012; Mills, 2004; Moss, 1972; Riese,
1954; Rolnick & Hoops, 1969; Schultz, 2010; Segre,
1983; Sies & Butler, 1963; Taylor, 2008; Weinstein,
2008; Wulf, 1979). These reports represent an extraordi-
narily important source of information to understand
the experience of living without language, that is, the
cognitive world in aphasia. Although these books are
mostly centered on reports of the clinical events and
the process of language recovery, sometimes they
mention the patients internal world. Several in-depth
case studies of aphasic patients are also available
(Crepet, 1925; Dieguez & Bogousslavsky, 2007; Lebrun,
Hasquin-Deleval, Brohaye, & Flament, 1971; Luria,
1972; Parr, Byng, & Gilpin, 1997; Saloz, 1919).
However, to report on ones internal world requires
unusual introspective abilities and special communi-
cation skills. Because of this, it is not easy to find an
overt report of a patients internal conditions. The
following passage is the personal report of an aphasia-
recovered patient, expressing in a poem how the world
was perceived without language. It is noteworthy that
previous to the aphasia, the patient was a professional
writer. This report has been selected to illustrate the
internal world in aphasia because it directly and clearly
refers to the internal experiences, that is, how the
patients interpretation of the world changed because

of the aphasia (the original Spanish version is presented
in the Appendix A of this article).
When Words were Lost
And suddenly words disappeared Only shapes and things
remained
but I forgot the way to name them.
A flash of lightning erased from my memory
the language inherited from other centuries
that I everyday discovered.
I had to re-invent the world around me
because that universe was only in the words.
I just understood that the silence is just a pause
separating what is and what is not.
Because it was no longer important to discover the beauty
as long as it could not be expressed in words.
I just understood that without the words the contemplation
is a useless call to the senses
that without words become regressive
blocking the deepest intelligence.
And also, the feeling, the clearest one
the highest one, has to be expressed with words
(Ricardo Gaspari, recovered aphasic,
Centro Integral del Rehabilitacin del Afsico
CIRA- Buenos Aires, Argentina)
In the poem, several important clues to understand
the internal cognitive world of the aphasic patient are
evident: (a) a particular dimension of the world is lost
(language) and only the visuo-perceptual information
remained (And suddenly words disappeared; Only
shapes and things remained); (b) the world is basically
understood through language (I had to re-invent the
world around me, because that universe was only in
the words); (3) the emotional interpretation of the
surrounding world is also mediated through language
(Because it was no longer important to discover the
beauty, as long as it could not be expressed in words);
(4) sensory information (first signaling system)
acquires a particular importance (without the words
the contemplation is an useless call to the senses); and
(5) (verbal) intelligence is impaired in aphasia ( that
without words become regressive blocking the deepest
intelligence). Simply speaking, this patient is expressing
that his internal cognitive world had significantly
changed due to the lack of language.
What could be concluded about human
cognition?
First of all, an aphasic individual is not a person without
language, but a person, who had language, developed and
organized cognition through language, and later in life
APPLIED NEUROPSYCHOLOGY: ADULT 5
lost some language abilities, which means that except in
the case of global aphasia, the person still maintains some
residual linguistic abilities. In this regard, the analysis of
cognition in deaf individuals without sign or oral
language, or the study of feral children, can represent
better models to study cognition without language.
Anyhow, language impairment in aphasia may some-
times be associated with the deterioration of diverse
cognitive abilities, such as spatial and conceptual abilities,
resulting in an idiosyncratic cognitive world. The deterio-
ration of those cognitive abilities beyond language
suggests that they are developed and are normally
mediated through language. Numerous authors have
expressed the idea that language represents the major
instrument of human cognition (e.g., Luria, 1976;
Vygotsky, 1934/2012). However, it is also important to
bear in mind that there is a crucial dispersion in cognitive
abilitiesincluding languagenot only in brain-
damaged patients but also in normal people (Ardila,
Galeano, & Rosselli, 1998). By the same token, there is
an important variability in the associated cognitive
impairments in case of aphasia (e.g., Bailey et al., 1981;
Basso et al., 1981; Gainotti et al., 1986; Helm-Estabrooks,
2002; Kertesz & McCabe, 1975; Zaidel et al., 1981).
In summary,
1. Because of language impairment, aphasia patients
live in an idiosyncratic cognitive world. It has been
proposed that the surrounding world is known using
two different strategies (signal systems); in aphasia,
only the first one (external stimuli) is available.
2. Nonverbal abilities sometimesbut not alwaysare
affected in aphasia; however, an important variability
has been reported.
3. Quite frequently, people without brain pathology inter-
pret the world through language; and language usually
represents the major instrument of cognition. In
aphasia the cognitive strategies have to be re-organized.
Acknowledgment
Our sincere gratitude to Adriana Ardila for her editorial
support.
Declaration of interest
The authors declare that there is no conflict of interest
regarding the publication of this article.
References
Ardila, A., Galeano, L. M., & Rosselli, M. (1998). Toward a
model of neuropsychological activity. Neuropsychology
Review, 8, 171190.
6 A. ARDILA AND S. RUBIO-BRUNO
Ardila, A., & Rosselli, M. (2016). Cognitive world: Neuro-
psychology of individual differences. Applied Neuropsycho-
logy, advance online publication, 19. doi:10.1080/
23279095.2016.1232264
Bailey, S., Powell, G. E., & Clark, E. (1981). A note on intelligence
and recovery from aphasia: The relationship between Ravens
matrices scores and change on the Schuell Aphasia Test.
International Journal of Language & Communication
Disorders, 16(3), 193203. doi:10.3109/13682828109011400
Baldo, J. V., Paulraj, S. R., Curran, B. C., & Dronkers, N. F. (2015).
Impaired reasoning and problem-solving in individuals
with language impairment due to aphasia or language delay.
Frontiers in Psychology, 6, 1523. doi:10.3389/fpsyg.2015.01523
Basso, A., Capitani, E., & Luzzatti, C. (1981). Intelligence and
the left hemisphere. Brain, 104, 721734.
Basso, A., De Renzi, E., Faglioni, P., Scotti, G., & Spinnler, H.
(1973). Neuropsychological evidence for the existence of
cerebral areas critical to the performance of intelligence
tasks. Brain, 96(4), 715728. doi:10.1093/brain/96.4.715
Bay, E. (1964). Aphasia and intelligence. International Journal
of Neurology, 4(3), 251.
Bay, E. (1969). The Lordat case and its import on the theory of
aphasia. Cortex, 5(3), 302308. doi:10.1016/s0010-9452(69)
80038-9
Bay, E. (1974). Intelligence and aphasia. Neurolinguistics:
Intelligence in aphasia. Amsterdam, The Netherland: Swets
& Zetlinger.
Blazkov-Ctrnct, D., Kalvach, P., Preissov, I., & Mllerov, Performance of aphasics on Ravens coloured progressive
B. (2003). Loss of intelligence in aphasic disorders. Casopis
Lekaru Ceskych, 143(3), 164168.
Borod, J. C., Carper, M., & Goodglass, H. (1982). WAIS
performance IQ in aphasia as a function of auditory
comprehension and constructional apraxia. Cortex, 18(2),
199210. doi:10.1016/s0010-9452(82)80003-8
Butts, A. M., Machulda, M. M., Duffy, J. R., Strand, E. A.,
Whitwell, J. L., & Josephs, K. A. (2015). Neuropsychological
profiles differ among the three variants of primary
progressive aphasia. Journal of the International Neuro-
psychological Society, 21(06), 429435. doi:10.1017/
s1355617715000399
Crepet, E. (1925). Les derniers jours de Charles Baudelaire
[The last days of Charles Baudelaire]. Bulletin du Bibliophile,
4, 7484.
Dance, F. E. (1967). Speech communication theory and
Pavlovs second signal system. Journal of Communication,
17(1), 1324. doi:10.1111/j.1460-2466.1967.tb01159.x
De Renzi, E., Faglioni, P., Savoiardo, M., & Vignolo, L. A.
(1966). The influence of aphasia and of the hemispheric
side of the cerebral lesion on abstract thinking. Cortex,
2(4), 399420. doi:10.1016/s0010-9452(66)80017-5
Dieguez, S., & Bogousslavsky, J. (2007). Baudelaires aphasia:
From poetry to cursing. Frontiers of Neurology and
Neuroscience, 22, 121149. doi:10.1159/000102876
Fedorenko, E., & Varley, R. (2016). Language and thought are
not the same thing: Evidence from neuroimaging and
neurological patients. Annals of the New York Academy of
Sciences, 1369, 132153. doi:10.1111/nyas.13046
Gainotti, G., Derme, P., Villa, G., & Caltagirone, C. (1986).
Focal brain lesions and intelligence: A study with a
new version of Ravens colored matrices. Journal of
Clinical and Experimental Neuropsychology, 8(1), 3750.
doi:10.1080/01688638608401295
GornoTempini, M. L., Dronkers, N. F., Rankin, K. P., Ogar, J.
M., Phengrasamy, L., Rosen, H. J., & Miller, B. L. (2004).
Cognition and anatomy in three variants of primary
progressive aphasia. Annals of Neurology, 55(3), 335346.
doi:10.1002/ana.10825
Green, J. S. (2012). Headlights: How I turned the lights back on
after my stroke and aphasia. [E-version] Retrieved from
https://9nqsaym.files.wordpress.com/2017/05/headlights-
turned-lights-stroke-aphasia-pdf-a56e21405.pdf.
Haas, J., Vogt, G., Schiemann, M., & Patzold, U. (1982).
Aphasia and non-verbal intelligence in brain tumour
patients. Journal of Neurology, 227(4), 209218. doi:10.1007/
bf00313388
Hale, S. (2007). The man who lost his language: A case of
aphasia. Philadelphia, PA: Jessica Kingsley Publishers.
Hall, W. A. (1961). Return from silence A personal
experience. Journal of Speech and Hearing Disorders,
26(2), 174177. doi:10.1044/jshd.2602.174
Helm-Estabrooks, N. (2002). Cognition and aphasia: A dis-
cussion and a study. Journal of Communication Disorders,
35(2), 171186. doi:10.1016/s0021-9924(02)00063-1
Kang, E. K., Jeong, H. S., Moon, E. R., Lee, J. Y., & Lee, K. J.
(2016). Cognitive and language function in aphasic patients
assessed with the Korean version of mini-mental status
examination. Annals of Rehabilitation Medicine, 40(1),
152161. doi:10.5535/arm.2016.40.1.152
Kertesz, A., & McCabe, P. (1975). Intelligence and aphasia:
matrices (RCPM). Brain and Language, 2, 387395.
doi:10.1016/s0093-934x(75)80079-4
Krasnogorsky, N. I. (1954). Writings on studies of higher
nervous activity in man and animals (Vol. 1). Moscow,
Russia: Medgiz. (in Russian).
Lebrun, Y., Hasquin-Deleval, J., Brohaye, J., & Flament, J.
(1971). L aphasie de Charles Baudelaire [The aphasia of
Charles Baudelaire]. Revue Neurologique, 125, 310316.
Lee, B., & Pyun, S. B. (2014). Characteristics of cognitive
impairment in patients with post-stroke aphasia. Annals
of Rehabilitation Medicine, 38(6), 759765. doi:10.5535/
arm.2014.38.6.759
Luria, A. R. (1972). The man with a shattered world:
The history of a brain wound. Cambridge, MA: Harvard
University Press.
Luria, A. R. (1976). Basic problems of neurolinguistics. Berlin:
Walter de Gruyter.
Maeshima, S., Ueyoshi, A., Matsumoto, T., Boh-Oka, S. I.,
Yoshida, M., & Itakura, T. (2002). Quantitative assessment
of impairment in constructional ability by cube copying in
patients with aphasia. Brain Injury, 16(2), 161167.
doi:10.1080/02699050110102095
McGuire, D. (2012). The aphasia caf. San Francisco, CA:
IFSF.
Mills, H. (2004). A mind of my own. Memoir of recovery from
aphasia. Bloomington, IN: AuthorHouse.
Moss, C. S. (1972). Recovery with aphasia: The aftermath of
my stroke. Urbana, IL: University of Illinois Press.
Parr, S., Byng, S., & Gilpin, S. (1997). Talking about aphasia:
Living with loss of language after stroke. New York, NY:
McGraw-Hill Education.
Pavlov, I. P. (1932/1960). Conditioned reflexes: An investi-
gation of the physiological activity of the cerebral cortex.
New York, NY: Dover.

Riese, W. (1954). Auto-observation of aphasia. Bulletin of the
History of Medicine, 28, 237.
Rolnick, M., & Hoops, H. R. (1969). Aphasia as seen by the
aphasic. Journal of Speech and Hearing Disorders, 34(1),
4853. doi:10.1044/jshd.3401.48
Saloz, J. (1919). Mmoires dun mdecin aphasique (auto-
observation et notes psychologiques) [Memories of an
aphasic physician (self-observations and psychological
notes)]. Archives de Psychologie, 17, 138.
Schultz, C. C. (2010). Crossing the void: My aphasic journey.
Bellingham, WA: Chuckanut Enterprises.
Segre, R. (1983). Mi propia rehabilitacin como afsico [My
own rehabilitation as aphasic]. Buenos Aires, Argentina:
Publicaciones Mdicas Argentinas.
Sies, L. F., & Butler, R. (1963). A personal account of
dysphasia. Journal of Speech and Hearing Disorders, 28(3),
261266. doi:10.1044/jshd.2803.261
Taylor, J. B. (2008). My stroke of insight: A brain scientists
personal journey. London: Penguin.
Villardita, C. (1985). Ravens colored progressive matrices and
intellectual impairment in patients with focal brain damage.
Cortex, 21(4), 627635. doi:10.1016/s0010-9452(58)80010-6
Vygotsky, L. S. (1934/2012). Thought and language.
Cambridge, MA: MIT Press.
Weinstein, D. F. (2008). My stroke: 450 days from severe apha-
sia to speaking, reading and writing. Long Island, NY:
Donald F. Weisntein.
Windholz, G. (1990). The second signal system as conceived
by Pavlov and his disciples. The Pavlovian Journal of
Biological Science, 25(4), 163173.
Wulf, H. H. (1979). Aphasia, my world alone. Detroit, IL:
Wayne State University Press.
Zaidel, E., Zaidel, D. W., & Sperry, R. W. (1981). Left and
right intelligence: Case studies of Ravens progressive
matrices following brain bisection and hemidecortication.
Cortex, 17(2), 167185. doi:10.1016/s0010-9452(81)80039-1
APPLIED NEUROPSYCHOLOGY: ADULT 7
Zangwill, O. L. (1964). Intelligence in aphasia. In A. V. S. de
Rueck & M. OConnor (Eds.), Disorders of language
(pp. 261284). London: Churchill.
Zwijsen, S. A., van der Ploeg, E., & Hertogh, C. M. (2016).
Understanding the world of dementia. How do people with
dementia experience the world? International Psychogeria-
trics/IPA, 28, 10671077. doi:10.1017/s1041610216000351
Appendix A. When Words were Lost by
Ricardo Gaspari (Spanish version)
Cuando se perdieron las palabras
Y de pronto se perdieron las palabras
slo las cosas y las formas perduraban
pero haba olvidado el modo de llamarlas.
Un relmpago haba borrado de mi memoria
el lenguaje heredado de otros siglos
y el que descubra cotidianamente.
Tena que reinventar el mundo que me circundaba
porque ese universo solo estaba en la palabra.
Y recin supe que el silencio es mera pausa
la que separa el ser del no ser de la existencia.
Porque ya no importaba descubrir la belleza
mientras no pudiera decirlo con palabras.
Y recin supe que sin palabras, la contemplacin
es un sordo e intil llamado a los sentidos
que sin palabras se torna regresivo
se bloquea la inteligencia mas profunda.
Y tambin el sentimiento, el ms puro, el ms noble
necesita expresarse con palabras