Non-organic language disorders: Three case reports

Background: Non-organic disorders are frequently encountered in clinical medicine, but the number of reports on non-organic language disorders is limited. There is a lack of diagnostic criteria for this entity. Aims: The paper describes three patients with a language disorder that is not ascribed to concomitantly present brain lesions and compares the clinical and linguistic features with those of previously reported cases of non-organic language disorder. Methods & Procedures: Case studies and cross-tabulation of characteristics of our reported patients and of patients reported earlier in the literature. Outcomes & Results: All three reported patients had a prior history of psychiatric disorders, and lived alone or were involved in conflicting situations. All of them presented cerebral lesions as documented by neuro-imaging but with a linguistic presentation that is totally incompatible with true aphasia and therefore not related to the documented lesions. Characteristic linguistic features included abrupt onset of a nonfluent language disorder with agrammatism, overgeneralisations, paraphasias preceded by pauses, and error variations. Comprehension was unaffected. Additionally dysarthria with hypophonia and reduced speech rate was striking. The linguistic symptoms fluctuated over time, dependent on cognitive distraction and context. Conclusion: The presence of a brain lesion does not imply the organic nature of all symptoms including language deficits. We argue the necessity of taking into account non-organic language behaviour in the differential diagnosis of aphasia. The common characteristics reported in our cases may serve as a basis for the future development of diagnostic criteria.