Brain and Language 97 (2006) 214–218
www.elsevier.com/locate/b&l

Neuropsychological evidence for “word-meaning deafness”
in a Spanish-speaking patient
Pilar Martín Plasencia ¤, Jaime Iglesias Dorado, Juan Manuel Serrano Rodríguez,
Carmen Sellán
Dpto. de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, 28049 Madrid, Spain
Accepted 18 October 2005
Available online 1 December 2005

Abstract
In this paper we present a case of “word-meaning deafness,” characterised by serious problems in the comprehension of spoken language, whilst repetition and writing words and non-words from dictation are preserved. This performance indicates the impossibility of
correctly accessing phonological representation from the semantic representation of words. Neuropsychological evidence on speciWc
alterations in word-meaning disorders is scarce, and this study contributes new Wndings with a Spanish-speaking patient. The nature of
the processes involved in understanding language and the cerebral mechanisms that might be aVected in each case were discussed, in
accordance with current neuropsychological theories.
© 2005 Elsevier Inc. All rights reserved.
Keywords: Neuropsychology of language; Cognitive neuropsychology; Word-meaning deafness; Semantic system; Phonological system; Orthographic
system

1. Introduction
Cognitive neuropsychological models of the comprehension of spoken language deWne three distinct sub-processes:
first, the sound wave is phonemically categorised through
perceptual analysis; next, this representation is identiWed as
a word by means of lexical representation; Wnally, once the
words have been recognised, their semantic representation
is accessed (see, e.g. Coltheart, 1987; Ellis & Young, 1988;
Patterson & Shewell, 1987). Such models have been based
chieXy on the study of subjects with speciWc cerebral injuries involving alterations in the diVerent sub-processes
related to the language parameters identiWed above (see, for
example Hart, Berndt, & Caramazza, 1985; Martín,
Serrano, & Iglesias, 1999; McCarthy & Warrington, 1984).
Researchers have identiWed diVerent impairments to the
initial sub-processes of spoken language comprehension,
*

Corresponding author. Fax: +3413975215.
E-mail address: pilar.martin@uam.es (P.M. Plasencia).

0093-934X/$ - see front matter © 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.bandl.2005.10.009

that is, those processes related to auditory analysis, to lexical
analysis, or to the connection between the two. Examples of
such impairments are “pure word-deafness,” which consists
in a loss of the ability to discriminate the sounds making up
the linguistic message (Vignolo, 1978), more speciWcally, an
impaired verbal comprehension sparing discrimination and
recognition of non-verbal sounds with fairly well-preserved
spontaneous speech, reading comprehension and writing
(Shivashankar, Shashikala, Nagaraja, Jayakumar, & Ratnavally,
2001). Also, “phonological agnosia,” characterised by an
inability to recognise the sounds of known words (Beauvois,
Derousne, & Bastard, 1980).
Impairments have also been identiWed, in a smaller number of cases, in the more central sub-processes of language
comprehension. These impairments would result from a
presumptive interruption of the path of information from
phonological lexical representation (input) to semantic representation. At the end of the 19th century, Branwell (1897)
presented, under the designation of “word-meaning deafness,” the case of a patient with serious diYculties for

P.M. Plasencia et al. / Brain and Language 97 (2006) 214–218

understanding spoken language, but whose ability to repeat
and write dictated words remained intact. Unlike pureword deafness, in this case the repetition of words is preserved and writing from dictation may also be maintained.
Since this pioneering description, documented cases of this
speciWc disorder have been scarce (Goldstein, 1915;
Henschen, 1919; Kleist, 1934; Liepmann, 1915; Luria, 1976,
1980; Symonds, 1953; Yamadori & Albert, 1973).
Kohn and Friedman (1986) have proposed that the
diVerential assessment of “word-meaning deafness”
requires that the phonological analysis is preserved, as evidenced by correct repetition; and, additionally, that semantic representation remains intact and is accessible by
another route (see Fig. 1). There is no general consensus on
whether writing words to dictation is essential for characterising the syndrome (Allport & Funnell, 1981; Ellis, 1984).
In this regard, Kohn and Friedman (1986) point out that
writing is not a determinant characteristic of word-meaning
deafness, but it has implications for the exact source of the
disorder. Impairments in the ability to write from dictation
reXect an interruption between phonological analysis and
phonological lexical representation (point ‘a’ in Fig. 1).
However, orthographic production is possible if interruption occurs between phonological representation and
semantic representation (point ‘b’ in Fig. 1).
In this study we describe the case of a patient who, as a
result of a cerebro-vascular accident (CVA), presented the
characteristic features of “word-meaning deafness,” that is,
a serious impairment of oral and written language comprehension and an intact ability to repeat and write words to
dictation.
Speech input

Phonological analysis

Repetition

Phonological code

Phonological-toorthographic conversion

215

2. Case report
GGM is a 73-year-old woman, right-handed, and with
elementary education, who suVered a CVA of the left middle cerebral artery. The CT scan showed a hypodense left
temporo-parietal infarct with a slight mass eVect as the left
ventricular atrium had collapsed. There is also discrete cortico-subcortical atrophy (see Fig. 2).
3. Basic neuropsychological assessment
The neuropsychological assessment was carried out one
year after the CVA, in four sessions, each of approximately
one hour’s duration. Performance IQ assessed with the
WAIS (Wechsler, 1955), was normal to low (IP D 85); verbal
IQ was unable to be assessed due to the patient’s diYculties
in understanding language. Visual memory, assessed by
means of visual reproduction tests I and II of the revised
Wechsler clinical memory scale (Wechsler, 1945) and
Benton’s visual retention test (Benton, 1963), was found to be
normal. It was impossible to assess verbal memory. Verbal
memory could not be assessed due to the patient’s verbal
comprehension diYculties. The recognition of natural sounds
was also assessed by means of a test created specially which
consisted in a series of 20 sounds (e.g., telephone, waves, a
baby crying, plates breaking, etc.). The subject correctly identiWed 100% of the sounds presented. The praxis tests of the
Luria–Christensen Battery (Christensen, 1987) indicated correct execution in ideomotor and ideative praxis and diYculties in constructional praxis in three dimensions.
The language assessment, made using the Spanish translation of the BDAE (Goodglass & Kaplan, 1972), demonstrated Xuent spontaneous speech without articulatory
diYculties and with normal syntactic construction. Repetition of words and phrases was also relatively correct (percentiles 70 and 60, respectively), as was naming to visual
confrontation (percentile 60). In contrast, auditory comprehension was found to be highly impaired, and the patient
failed to surpass percentile 10 in any of the tests. Finally,
copying and writing to dictation presented acceptable levels
(percentile 70), but reading aloud was found to be totally
impaired (word reading and sentences reading, percentile 0).
4. Cognitive assessment of language

a

Lexical phonological
representations

Lexical orthographic
representations

In view of the fact that the patient’s language problems
were considerable with regard to auditory analysis, we proceeded to an in-depth assessment of the sub-processes and
components involved. This assessment was carried out over
four weeks, in a total of eight sessions, each of approximately one hour’s duration.

b
Lexical semantic
representations

Fig. 1. Model proposed by Kohn and Friedman (1986) to explain wordmeaning deafness.

4.1. Phonological analysis
4.1.1. Repetition
First of all, the patient was asked to repeat 20 words of
average frequency of use and of varying length (four of one

216

P.M. Plasencia et al. / Brain and Language 97 (2006) 214–218

Fig. 2. CT scan of the patient CGM showing a hypodense left parieto-occipital infarct.

syllable, four of two syllables, four of three syllables, four of
four syllables and four of Wve syllables). GGM completed this
task correctly (100% of correct answers). Secondly, she was
asked to repeat 20 non-words, also of varying length. This test
was performed with 80% of correct answers (16). The diYculties in this case did not appear to depend on the length of the
non-word, since errors were distributed as follows: two with
non-words of two syllables, one with a three-syllable nonword, and one with a Wve-syllable non-word (see Table 1, A).
The diVerence in performance between the repetition tasks
with words and non-words was statistically signiWcant,
according to the diVerence of proportions test (Z D 2.22,
p < .05). GGM performed the lexical phonological analysis
correctly, but presented slight diYculties on carrying out auditory-phonological conversion in the case of non-words. In all
probability, the auditory comprehension problems have a
residual eVect on repetition. The mistakes made were changes
in one of the phonemes, preserving the general structure of the
non-word (see Table 1). This could be due to a slight diYculty
in the autistic discrimination of some phonemes.
4.2. Auditory-graphemic analysis
4.2.1. Writing to dictation
GGM was asked to write 20 words and 20 non-words
(those that had been used in the repetition task) to dictation. The patient completed the task with 100% of correct
answers in the case of the words, and with 85% of correct
answers (17), in the case of the non-words (see Table 1, B).
This diVerence is not statistically signiWcant, according to
the diVerence of proportions test.

Table 1
List of words and non-words used in repetition and dictation tasks, and
erroneous answers observed
Words

Non-words

Erroneous
answers in
repetition (A)

Mano (hand)
Azul (blue)
Gato (cat)
Bata (coat)
Libro (book)
Puma (puma)
Domino (domino)
Próximo (next)
Sereno (calm)
Camino (road)
Garage (garage)
Natillas (custard)
Bolígrafo (pen)
Cuaderno (notebook)
Anillo (ring)
Cajón (drawer)
Papeleria (stationer’s)
Tulipan (tulip)
Lapicero (pencil)
Canario (canary)

Deji
Mopu
Sute
Cali
Tour
Proen
Pituvo
Calire
Consuto
Aboli
Tricose
Ambite
Pelete
Ostuvi
Osley
Cutipo
Pulade
Coluro
Melusa
Tulisa

Diji
Macu

Erroneous
answer in
dictation (B)

Calemi

Calide

Otube

Ortube

Conudo

5. Analysis of access to the semantic system (semantic
representation)
5.1. Comprehension of oral language
Auditory comprehension was tested by means of probe
questions referring to personal matters or common objects

P.M. Plasencia et al. / Brain and Language 97 (2006) 214–218

and with picture–word pairing tests. All of them were
designed speciWcally for this case.
(1) Response to personal matters questions. First, 10 questions
referring to personal matters were prepared for oral presentation: “Where do you live?,” “How old are you?,” etc.
The patient responded correctly to all of them.
(2) Response to common object question. Next, 80 questions referring to objects were presented. Yes or no
answers were required (e.g., Is a harmonica a musical
instrument?, Is a lion a domestic animal?). The patient
responded incorrectly to all of the questions, either
repeating the question or indicating that she did not
understand it.
(3) Picture–word pairing. This task consisted of indicating, from three semantically-related pictures (e.g., a
reel of cotton, a needle, and a thimble), which one corresponded to the word spoken by the examiner. Total
number of items in this test was 52. The patient completed the test with 70% correct answers (36), a result
that falls below that attained by a control group made
up of 20 subjects of similar age (M D 64.5; SD D 9.5;
range 50–77) and educational characteristics as the
patient (100% correct answers). Nevertheless, the
patient’s performance was better than expected, given
the auditory language comprehension deWciency she
presented. This result appears to indicate, then, that
the presence of the picture aided recognition of the
word and permitted an acceptable level of performance. This would imply that the cognitive system of
semantic analysis was intact, or at least not severely
impaired.
5.2. Semantic tasks with non-linguistic material
Given that the patient presented serious diYculties in
understanding oral language, the semantic tasks were given
using pictorial material.
(1) Categorisation of pictures. GGM was asked to categorise 125 cards, each with a picture, without clues as to
the categorisation criteria. Given the comprehension
impairments, instructions were given by means of
examples devised by the examiner using pictures from
several categories. The pictures were taken from the
Snodgrass and Vanderwart (1980) naming test. GGM
formed correctly the following groups: food, clothing,
vases, furniture, kitchen utensils, means of transport,
animals, personal use objects, and household appliances.
(2) Sub-categorisation of pictures. The patient was asked
to make the following distinctions: (a) wild animals vs
tame animals, (b) kitchen utensils for use on the
cooker vs kitchen utensils that cannot be used on the
cooker, and (c) items of clothing that can be washed
vs items of clothing that cannot be washed. GGM
performed this task without any diYculty.

217

(3) Pyramid and Palm Test (Howard & Orchard-Lisle,
1984). This test uses 52 sheets, plus 4 more as examples. Each sheet contains a target picture and two
more pictures, only one of which is semantically
related to the target, and which the subject must identify. GGM carried out the task with 83% of correct
answers (43), a result similar to that obtained by the
control group (80–85% of correct answers).
6. Discussion
GGM’s neuropsychological assessment shows severe
alterations in auditory comprehension of language which
does not occur in comprehension activities in which the
material is presented visually. The maintenance of the
capacity to recognise non-verbal sounds and to repeat
words might suggest that the origin of the observed deWciencies were not due to agnosia. On the other hand,
although the patient shows a severe reading deWciency, the
execution does not Wt entirely with a diagnosis of alexia
without agraphia. The total inability to read was accompanied by clear diYculties in writing which was limited to isolated words.
The cognitive assessment revealed that GGM was
capable of processing phonological information and recognising words, as demonstrated by the correct execution
of the repetition and writing to dictation tasks. With
regard to understanding oral language, an alteration was
found in response to common object questions. The relative improvement observed in the personal matter question task may be due to the subject being involved in a
rehabilitation program which precisely dealt with these
type of questions.
The subject’s semantic system appears to function correctly, as shown by the results of the diVerent categorisation
tasks carried out. The major problems appeared in the
tasks involving the use of the linguistic auditory channel, as
demonstrated by the subject’s performance in oral comprehension and picture–spoken word pairing. This suggests
that GGM may present impairment of lexico-semantic connections, and also that the semantic system is isolated from
phonological linguistic representation.
Regarding the ability to write from dictation, in accordance with the model proposed by Kohn and Friedman
(1986), we propose that, in this case, auditory information
can contact phonological representations (see ‘a’ in Fig. 1),
but not semantic representations (see ‘b’ in Fig. 1). Writing
to dictation in Spanish might be phonological transcription
(phoneme-grapheme correspondence) without comprehension, as opposed to other languages in which homophones
are determined by diVerent spellings. As a consequence, it
seems that Spanish language might not be ideal for discriminating whether writing is possible through graphemephoneme conversion. Nevertheless, Kohn and Friedman
(1986) point out that writing ability in word-meaning deafness implies a preserved access to correct representations in
the phonological lexicon, and that this enables writing both

218

P.M. Plasencia et al. / Brain and Language 97 (2006) 214–218

of regular and irregular words. Thus, we assumed that
GGM carried out the task by means of the preserved connections between the subsystems of phonological analysis
and of phonological representation, and between this and
orthographic lexical representation. In such a case, the
auditory information can be correctly represented phonologically, and can access orthographic representations.
Related to the nature of the deWcits observed and the
cerebral location of the lesion, it could be noted that wordmeaning deafness bears more speciWc characteristics than
pure-word deafness. These speciWc characteristics could
explain why the latter is usually associated with bilateral
injuries which aVect secondary and tertiary areas of association, whereas the case we are presenting corresponds to a left
parieto-occipital injury. Moreover, the location of GGM’s
cerebral injury is compatible with the proposals of recent
models on the cerebral organisation of language.
SpeciWcally, Damasio (1992) refers that left temporo-parieto-occipital areas form an interconnecting system between
linguistic analysis (lexical and phonological) and the system
that modulates the individual’s interaction with the environment (conceptual system). Along these same lines, Mesulam
(1998) points out that left parieto-occipital areas would
aVect the functional networks that communicate Wernicke’s
and hetero-modal associative areas that provide meaning.
In sum, all of the symptoms observed Wt the characteristics of “word-meaning deafness” as initially described by
Branwell (1897). DeWciencies observed are compatible with
a disconnection between semantic and phonological representation. Through the preserved connection between phonological analysis and phonological representation it would
seem possible to address the orthographic representations
of the word shown by CGG.
Acknowledgments
Preparation of the manuscript was supported by a grant
from the Comunidad de Madrid (Grant 06/0168/2000) and
Ministerio de Ciencia y Tecnología (Grant BS02000/0114).
We are most grateful for the review and comments made by
Dr. John C. Marshall and Dr. Michel Paradis with regard
to an earlier version of this work.
References
Allport, A., & Funnell, E. (1981). Components of the mental lexicon.
Philosophical Transactions of the Royal Society of London, B295,
397–410.
Beauvois, M. F., Derousne, J., & Bastard, V. (1980). Auditory parallel to
phonological alexia. In Paper presented at the third european conference of the International Neuropsychological Society. Chianciano,
Italy.

Benton, A. L. (1963). The revised visual retention text. New York: The Psychological Corporation.
Branwell, B. (1897). Illustrative cases of aphasia. The Lancet, 1, 1256–1259.
Christensen, A. (1987). El diagnóstico neuropsicológico de Luria (2nd ed.).
Madrid: Aprendizaje Visor.
Coltheart, M. (1987). Functional architecture of the language processing
system. In M. Coltheart, G. Sartori, & R. Jobs (Eds.), The cognitive neuropsychology of language (pp. 1–23). London: LEA.
Damasio, A. (1992). Aphasia. New England Journal of Medicine, 326, 531–539.
Ellis, A. W. (1984). Reading, writing and dyslexia. A cognitive analysis.
London: LEA.
Ellis, A. W., & Young, A. W. (1988). Human cognitive neuropsychology.
London: LEA.
Goldstein, K. C. (1915). Die transkorticale aphasien. Jena: Gustav Fischer.
Goodglass, H., & Kaplan, E. (1972). The assessment of aphasia and related
disorders. Philadelphia: Lea and Febiger.
Hart, D. C., Berndt, R. S., & Caramazza, A. (1985). Category speciWc naming deWcit following cerebral infarction. Nature, 316, 439–440.
Henschen, S. E. (1919). On the hearing sphere. Acta Oto-Laryngologica, 1,
433–484.
Howard, D., & Orchard-Lisle, V. (1984). On the origin of semantic errors
in naming: Evidence from a case of the global aphasic. Cognitive Neuropsychology, 1, 163–190.
Kleist, K. (1934). Gehirnpathologie. Leipzig: Barth.
Kohn, S. E., & Friedman, R. B. (1986). Word meaning deafness: a phonological-semantic dissociation. Cognitive Neuropsychology, 3,
291–308.
Liepmann, M. (1915). Diseases of the brain. In C. W. Bart (Ed.),
Churchmann’s textbook on nervous diseases (Vol. 1). Philadelphia:
Blakiston.
Luria, A. R. (1976). Basic problems in neurolinguistics. The Hague:
Morton.
Luria, A. R. (1980). Fundamentos de neurolingüística. Barcelona: Masson.
Martín, P., Serrano, J. M., & Iglesias, J. (1999). Phonological/semantic
errors in two Spanish-speaking patients with anomic aphasia. Aphasiology, 13, 225–236.
McCarthy, R., & Warrington, E. (1984). A two routes model of speaking
production: Evidence from aphasia. Brain, 107, 463–485.
Mesulam, M. M. (1998). From sensation to cognition. Brain, 121, 1013–
1052.
Patterson, K., & Shewell, C. (1987). Speak and spell: dissociations and
word-class eVects. In M. Coltheart, G. Sartori, & R. Job (Eds.), The
cognitive neuropsychology of language (pp. 273–294). London: LEA.
Shivashankar, N., Shashikala, H. R., Nagaraja, D., Jayakumar, P. N., &
Ratnavally, E. (2001). Pure word deafness in two patients with subcortical lesions. Clinical Neurology and Neurosurgery, 103, 201–205.
Snodgrass, J. G., & Vanderwart, M. (1980). A standardized set of 260 pictures: norms for name agreement, image agreement, familiarity and
visual complexity. Journal of Experimental Psychology: Human Learning and Memory, 6, 174–211.
Symonds, C. (1953). Aphasia. Journal of Neurology, Neurosurgery and Psychiatry, 16, 1–16.
Vignolo, A. L. (1978). Afasia. In F. Denes & C. Umilta (Eds.), I due cervilli:
Neuropsichologia dei processi cognitivi. Bologna: Il Mulino.
Wechsler, D. A. (1945). Wechsler memory scale manual. New York: Psychological Corporation.
Wechsler, D. A. (1955). Wechsler adult intelligent manual. New York: Psychological Corporation.
Yamadori, A., & Albert, M. L. (1973). Word category aphasia. Cortex, 9,
112–125.