title: Where language meets meaningful action: a combined behavior and lesion analysis of aphasia and apraxia.
abstract: It is debated how language and praxis are co-represented in the left hemisphere (LH). As voxel-based lesion-symptom mapping in LH stroke patients with aphasia and/or apraxia may contribute to this debate, we here investigated the relationship between language and praxis deficits at the behavioral and lesion levels in 50 sub-acute stroke patients. We hypothesized that language and (meaningful) action are linked via semantic processing in Broca's region. Behaviorally, half of the patients suffered from co-morbid aphasia and apraxia. While 24% (n = 12) of all patients exhibited aphasia without apraxia, apraxia without aphasia was rare (n = 2, 4%). Left inferior frontal, insular, inferior parietal, and superior temporal lesions were specifically associated with deficits in naming, reading, writing, or auditory comprehension. In contrast, lesions affecting the left inferior frontal gyrus, premotor cortex, and the central region as well as the inferior parietal lobe were associated with apraxic deficits (i.e., pantomime, imitation of meaningful and meaningless gestures). Thus, contrary to the predictions of the embodied cognition theory, lesions to sensorimotor and premotor areas were associated with the severity of praxis but not language deficits. Lesions of Brodmann area (BA) 44 led to combined apraxic and aphasic deficits. Data suggest that BA 44 acts as an interface between language and (meaningful) action thereby supporting parcellation schemes (based on connectivity and receptor mapping) which revealed a BA 44 sub-area involved in semantic processing.
authors.affiliation: Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425, Jülich, Germany. p.h.weiss@fz-juelich.de.|Department of Neurology, University Hospital Cologne, 50924, Cologne, Germany. p.h.weiss@fz-juelich.de.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Weiss
authors.affiliation: Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425, Jülich, Germany. simon.ubben@yahoo.de.|Department of Neurology, University Hospital Cologne, 50924, Cologne, Germany. simon.ubben@yahoo.de.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Ubben
authors.affiliation: Department of Neurology, University Hospital Cologne, 50924, Cologne, Germany. stephanie.kaesberg@uk-koeln.de.|Institute of Gerontology and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Psychological Gerontology, University of Vechta, 49377, Vechta, Germany. stephanie.kaesberg@uk-koeln.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kaesberg
authors.affiliation: Institute of Gerontology and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Psychological Gerontology, University of Vechta, 49377, Vechta, Germany. elke.kalbe@uni-vechta.de.
authors.forename: Elke
authors.initials: E
authors.lastname: Kalbe
authors.affiliation: Department of Neurology, University Hospital Cologne, 50924, Cologne, Germany. josef.kessler@uk-koeln.de.
authors.forename: Josef
authors.initials: J
authors.lastname: Kessler
authors.affiliation: Department of Neuroradiology, University Hospital Cologne, 50924, Cologne, Germany. thomas.liebig@uk-koeln.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Liebig
authors.affiliation: Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425, Jülich, Germany. g.r.fink@fz-juelich.de.|Department of Neurology, University Hospital Cologne, 50924, Cologne, Germany. g.r.fink@fz-juelich.de.
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001039:Aphasia, Broca / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology*; D001072:Apraxias / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology*; D065711:Broca Area / Q000473:pathology* / Q000503:physiopathology; D003071:Cognition; D032882:Comprehension; D005260:Female; D005868:Gestures; D006801:Humans; D007100:Imitative Behavior; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011932:Reading; D012660:Semantics; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014956:Writing
keywords: Broca’s region; Brodmann areas; Lesion mapping; Neuroanatomy; Neuropsychological assessment; Stroke