Anomia in patients with left inferior temporal lobe lesions

Background: Damage to left inferior temporal cortex has been associated with naming deficits resulting either from impaired access to phonological word forms (pure anomia) or from degraded semantic knowledge (semantic anomia). Neuropsychological evidence indicates that pure anomia may follow damage to posterior inferior temporal cortex (BA 37), whereas semantic anomia is associated with damage to more anterior temporal lobe regions (BA 20, 21, 38). By contrast, some investigators have suggested that it is the overall severity of anomia, rather than the nature of the underlying cognitive impairment, that is affected by the anterior extent of the lesion. Aims: To examine the naming performance of patients with left inferior temporal lobe damage and determine whether anterior extension of the lesion influences the nature and/or the severity of the naming impairment. Methods & Procedures: Eight participants with focal damage to left inferior temporal cortex completed a battery of language measures that included confrontation naming, semantic processing, and single-word reading and spelling. Degree and type of anomia was examined relative to anterior lesion extension using both visual inspection and statistical analyses. Outcomes & Results: Naming performance ranged from unimpaired to severely defective, with only two participants demonstrating an additional mild impairment of semantic knowledge. The underlying mechanism of anomia seemed to be degraded access to phonological word forms in all participants, regardless of lesion configuration. The severity of the naming impairment was positively correlated with anterior extension of the lesion towards the temporal pole, although additional analyses suggested that these findings were significantly influenced by participant age. Naming was not correlated with performance on the nonverbal semantic task or any other demographic variable. Conclusions: The behavioural and neuroanatomical findings provide modest support for the hypothesis that a relationship exists between anterior lesion extension and the severity of concomitant anomia in patients with left inferior temporal lobe damage. The data suggest that such lesions may disconnect relatively preserved semantic knowledge from regions critical for access to phonological word forms. However, additional research is needed to discern to what extent age and individual variability temper these effects.