Fluent Aphasia, by Susan Edwards. 2006. New York: Cambridge University Press. 230 pp., $75.00 (HB).

The 21st-century aphasiologist may be surprised to find a new book with such a title as Fluent Aphasia. Three decades of cognitive neuropsychology advances would seem sufficient to relegate a fuzzy concept like “fluent aphasia” as a relic of the past, or, at best, restrict it to the realm of shorthand descriptions meant to facilitate daily communication among clinicians. Even among those accustomed to strict collaboration, a concept like “fluent aphasia” may cause misunderstanding. I personally learned about aphasia directly from the Boston school. Yet, when I speak with my Italian colleagues from Milan, whom I have known for most of my professional life, and with whom I have written quite a few papers on aphasia, I am often unsure about what they mean when they label an aphasic patient as “fluent.” I still remember Harold Goodglass telling me, in almost the same words Susan Edwards quotes from him, how “fluency is best rated in terms of the longest occasional uninterrupted strings of words that are produced.” My own understanding of his teaching included the concept that the presence of phonetic problems and/or abnormal articulation effort was not so essential in drawing the fluency-non fluency distinction: according to his rule of thumb, fluent aphasia should be diagnosed when a patient can produce at least five connected words. This rule derived from observations made in Goodglass, Quadfasel, and Timberlake's (1964) study on phrase length and type of aphasia, whereby it was shown that aphasics can be dichotomized on the basis of the number of words that they can typically utter as an uninterrupted string. Edwards reports that other people entertain different beliefs about what is fluent aphasia. Surely several, heterogeneous criteria such as phrase length, verbal agility, melodic line, amount of articulation effort, and grammatical form are differently weighted by different aphasiologists as they consider their diagnosis.

Warrington and Shallice's (1984) report on patient J.B.R. [4] was the first and most influential study about the living/nonliving semantic dissociation.

The aim of this study was to investigate numerical difficulties in 50 patients with left hemispheric lesions. Aphasic patients were grouped according to their type of aphasia diagnosed by the Aachener Aphasia Test. The overall error rate in various transcoding and calculation tasks was clearly correlated with the severity of the language deficit, global aphasics being the most impaired patients. Broca's and Wernicke's aphasics scored similarly at the quantitative level, and amnesic aphasics were less impaired. Interestingly, qualitative analysis of the errors indicated that each group presented with specific difficulties, partially reflecting the nature of the language problems. In simple calculation, multiplication was found to be the most impaired operation, in particular in Broca's aphasics. This result supports the hypothesis that the retrieval of multiplication facts is preferentially mediated by verbal processing. Calculation procedures were mainly impaired in Wernicke's and global aphasics. (JINS, 1999, 5, 213–221.)

Recent aphasiological findings, not mentioned in the target article, have been accounted for by Levelt et al.'s theory and have, in turn, provided it with empirical support and new leads. This interaction is especially promising in the domain of complex word retrieval. Examples of particular categories of compounds are discussed.