Spontaneous speech. Note the patient's fluency, including phrase length, rate, and abundance of spontaneous speech. Also note tonal modulation and whether paraphasic errors (inappropriately substituted words or syllables), neologisms (nonexistent words), or errors in grammar are present.
Comprehension. Can the patient understand simple questions and commands? Comprehension of grammatical structure should be tested as well; for example, "Mike was shot by John. Is John dead?"
Naming. Ask the patient to name some easy (pen, watch, tie, etc.) and some more difficult (fingernail, belt buckle, stethoscope, etc.) objects. Naming parts of objects is often more difficult. Write down what was said to enable follow-up comparisons.
Repetition. Can the patient repeat single words and sentences (a standard is "no ifs ands or buts")? Again, titrate function using a range of easy to difficult tests, and write down what the patient says.
Reading. Ask the patient to read single words, a brief passage, and the front page of the newspaper aloud and test for comprehension. Writing. Ask the patient to write their name and write a sentence.
Different kinds of language abnormalities are caused by lesions in the dominant (usually left) frontal lobe, including Broca's area; the left temporal and parietal lobes, including Wernicke's area (see Neuroanatomy through Clinical Cases Figure 2.25); subcortical white matter and gray matter structures, including thalamus and caudate nucleus; as well as the nondominant hemisphere. For further details regarding the neuroanatomy of specific language disorders, see Neuroanatomy through Clinical Cases, Chapter 19.