Are you a doctor? … Are you a doctor? I’m not a doctor! A reappraisal of mitigated echolalia in aphasia with evaluation of neural correlates and treatment approaches

Language Learning Variability within the Dorsal and Ventral Streams as a Cue for Compensatory Mechanisms in Aphasia Recovery

“…The compensatory effects between the phonological and semantic systems reported in healthy subjects are consistent with what has recently been observed in aphasia (Berthier et al, 2017b ; López-Barroso et al, 2017 ). A clear example of a compensatory process of the ventral stream after dorsal pathway damage is a characteristic behavioral symptom of conduction aphasia (fluent aphasia with preserved comprehension and impaired repetition; Kohn, 1992 ), conduite d’approche (CdA) .…”

“…Echolalia is defined as the repetition of words and/or utterances spoken by another person (Berthier et al, 2017a ), and ME is a mild form of echolalia characterized by the introduction of changes (intonation or verbal content) as an echoed emission, in general for communicative purposes (Pick, 1924 ; Berthier et al, 2017a , b ; López-Barroso et al, 2017 ). ME usually occurs in fluent aphasia due to lesions of the ventral stream, which typically disrupt auditory comprehension at the word and sentence levels (Berthier et al, 2017b ) but can also be observed in nonfluent aphasias (e.g., Broca’s aphasia; Hadano et al, 1998 ; López-Barroso et al, 2017 ). The main compensatory function of ME is to resolve impaired access to the semantic system due to ventral damage (Berthier et al, 2017b ).…”

Thinking on Treating Echolalia in Aphasia: Recommendations and Caveats for Future Research Directions

“…Modifications in wording or intonation on the echoed emissions may have different purposes such as recapitulate meaning, regain attention, take time to plan a response, reinforcement of an idea, contradict, complement the just received message, or empathize with the interlocutor. However, despite the general consensus that the production of echoes of words and phrase fragments is aimed to resolve impaired access to word meaning during auditory comprehension, deficits in auditory-verbal short-term memory and incompetent inhibitory control have also been described (Berthier et al, 2017b). Thus, it seems that mitigated echolalia is not always in the service of improving auditory comprehension.…”

“…The picture is not as clear for the less severe types (mitigated and effortful). Even when, in many cases, echolalia may be functional and, for example, facilitate comprehension, the incessant repetition of auditory stimuli may interfere with functional communication and make evaluations excessively long (Berthier et al, 2017b). In a recent single case study of a patient with residual Wernicke's aphasia, mitigated echolalia was significantly reduced using CIAT (supplemented with verbal instructions made by the therapist to attenuate imitative tendencies) and a cognitive-enhancing drug (memantine; Berthier et al, 2017b).…”

“… 4 Mitigated echolalia refers to any language change in the echoed emission for communicative purposes (Pick, 1924), but recent data suggest that this is not always the case (Berthier et al, 2017b). …”