Second, in spontaneous speech the patient would show word amnesia, verbal paraphasia, and a kind of paragrammatism. The anomia is most prominent for names of concrete things and proper names. Unlike amnesic aphasia, the patient would show difficulty in recognition of the name even if the correct one is produced. Generally, speech is fluent and articulation clear. But sentences produced are incoherent and incomplete. No difficulty is seen in the use of grammatical words.
Third, ability to repeat spoken language is sufficiently preserved. The way the patient repeats cannot be considered as automatic echolalia. It implies his intention for comprehension.
Fourth, there is a unique difficulty in oral reading and writing. Imura summarized this difficulty as “oral reading without comprehension” and “writing without comprehension.” The difficulty manifests itself as a dissociated ability to handle kanji and kana. Kana can be read or written rather easily without comprehension, while kanji is difficult in both comprehension and writing.
Overall, Imura considered this symptom complex belongs to the category of transcortical sensory aphasia in Wernicke-Lichtheim diagram, but nonetheless emphasized its uniqueness because the difficulty is most conspicuous in comprehension of the meaning of substantive words rather than comprehension of spoken language in general and insisted it should be treated as a separate aphasic syndrome.
An Illustrative Case
In the 1943 paper, he wrote he had experienced 4 cases of Gogi aphasia. But only 3 cases were concretely described. He himself claimed that out of 4 cases, 3 cases showed a typical pattern of Gogi aphasia [1]. Of these 3, one illustrative case is quoted below which was originally described in 1940 [6].
Case E. is a 57-year-old businessman. He had been forgetful the previous year, and recently started having difficulty in reading. He also became obstinate and short tempered. No physical neurological signs were found on admission.
Comprehension of Spoken Language
He did not understand the examiner’s questions. For example, when asked to tell his address, he responded, “What is address?”
When asked whether he travels by airplane, he responded, “What is airplane?”
When asked to tell his hobby, he said, “What is hobby?”
When asked to choose a brush from a group of 10 pictures, he responded, “What is brush?”
When asked to choose a picture of a comb, he said, “What is comb?”
Naming of Objects
Very Difficult. He seemed to know the concept of an object that was shown but could not recall an appropriate name. For example, when asked to give the name of a matchbox, he responded, “this is not tobacco. Make a fire. Tobacco.”
Repetition
Almost always correct. Non-sense words could also be correctly repeated.
Oral Reading
Reading aloud kana words and sentences was on the whole correct, but reading aloud kanji words was severely impaired. As mentioned, a kanji has more than two ways of reading but only one of them is appropriate when it is embedded in a particular kanji-kana mixed sentence. The patient simply misread the kanji part of a sentence, either producing a correct but inappropriate name for the sentence, or confusing it with another kanji similar in form.
To make the point easy to understand for non-Japanese readers, an example of his reading errors is illustrated in Figures 1 and 2. In this reading of a sentence: “Three kaki trees stand outside the gate,” his errors were restricted to kanji characters (Fig. 1). He erroneously read the first kanji meaning gate for “ka-n,” which is a name for other characters similar in form (Fig. 2). The second kanji meaning outside he read as “ga-i,” which is wrong in this sentence but is one of the correct readings of the character (Fig. 3). The third kanji meaning tree should be read as “ki,” but he misread it as “ho-n,” probably confusing it with the visually similar fifth character (Fig. 2). The fourth kanji meaning three he read correctly as “sa-n.” The fifth kanji is usually used as postposition for numbers when counting long objects such as trees or sticks. His reading “po-n” is not acceptable in this context but one of its correct readings (Fig. 3). For example, one tree is counted as “i-ppo-n,” 2 trees as “ni ho-n”, and 3 trees as “sa-n bo-n.”
Fig. 1. Reading performance of Imura’s case E. The first row of the table shows a sentence from a contemporary primary school textbook which is written in mixed kanji and kana characters. Underlined characters are kanji. Others are kana. The second row shows its pronunciation in romanized letters (romaji). Each kana pronunciation is shown separately for the purpose of easy correspondence. Underlined parts correspond to kanji portion. The third row is reading by the patient. Errors are shown in italics and underlines. For details, see text. The fourth row is an English translation of the text [13].
Fig. 2. Reading performance of Imura’s case E. Confusion of kanji forms. The patient misread the first kanji “mo-n” in Figure 1 as “ka-n” which is like in form with such characters meaning quiet, between, or barrier. Also he misread the third kanji “ki” in Figure 1 as “ho-n,” which is similar in form.
Fig. 3. Reading performance of Imura’s case E. Selection errors of pronunciation. The upper kanji in the table has 5 ways of pronunciation. The lower kanji has four. The patient read the upper one (the second kanji in Figure 1) meaning outside as “ga-i, ” which is one of 5 correct readings for the character but wrong for the text. It should be read as “soto.” Similarly, he read the lower kanji (the fifth kanji in Figure 1) as “po-n” which is wrong, although the pronunciation itself for the character is correct. It should be “bo-n.”
Writing
He wrote his name and address correctly. He could write a few words with kana for dictation but impossible with kanji.
Copying Characters
He showed no difficulty in copying characters either in kanji or kana.
As this illustrative case demonstrates, the most conspicuous linguistic symptom of Gogi aphasia manifests itself in the patient’s verbal behavior. A typical patient would spontaneously respond to a question by picking up and repeating the substantive word in the question he does not understand. This peculiar verbal behavior was repeatedly confirmed and emphasized