Wernicke’s area has been assumed since the 1800s to be the primary region supporting word and sentence comprehension. However, in 2015 and 2019, Mesulam and colleagues raised what they termed the ‘Wernicke conundrum’, noting widespread variability in the anatomical definition of this area and presenting data from primary progressive aphasia that challenged this classical assumption. To resolve the conundrum, they posited a ‘double disconnection’ hypothesis: that word and sentence comprehension deficits in stroke-based aphasia result from disconnection of anterior temporal and inferior frontal regions from other parts of the brain due to white matter damage, rather than dysfunction of Wernicke’s area itself. To test this hypothesis, we performed lesion-deficit correlations, including connectome-based lesion-symptom mapping, in four large, partially overlapping groups of English-speaking chronic left hemisphere stroke survivors. After removing variance due to object recognition and associative semantic processing, the same middle and posterior temporal lobe regions were implicated in both word comprehension deficits and complex noncanonical sentence comprehension deficits. Connectome lesion-symptom mapping revealed similar temporal-occipital white matter disconnections for impaired word and noncanonical sentence comprehension, including the temporal pole. We found an additional significant temporal-parietal disconnection for noncanonical sentence comprehension deficits, which may indicate a role for phonological working memory in processing complex syntax, but no significant frontal disconnections. Moreover, damage to these middle-posterior temporal lobe regions was associated with both word and noncanonical sentence comprehension deficits even when accounting for variance due to the strongest anterior temporal and inferior frontal white matter disconnections, respectively. Our results largely agree with the classical notion that Wernicke’s area, defined here as middle superior temporal gyrus and middle-posterior superior temporal sulcus, supports both word and sentence comprehension, suggest a supporting role for temporal pole in both word and sentence comprehension, and speak against the hypothesis that comprehension deficits in Wernicke’s aphasia result from double disconnection.

中文翻译：

---

重新审视 Wernicke 难题：来自基于连接组的病变症状映射的证据

自 1800 年代以来，韦尼克区一直被认为是支持单词和句子理解的主要区域。然而，在 2015 年和 2019 年，Mesulam 及其同事提出了他们称之为“Wernicke 难题”的问题，指出该区域的解剖学定义存在广泛差异，并提出了挑战这一经典假设的原发性进行性失语症数据。为了解决这个难题，他们提出了一个“双重断开”假设：卒中性失语症中的单词和句子理解缺陷是由于白质损伤导致前颞区和下额叶区域与大脑其他部分断开，而不是功能障碍韦尼克地区本身。为了检验这一假设，我们在四个大的、部分重叠的讲英语的慢性左半球中风幸存者群体。在去除由于对象识别和联想语义处理引起的差异后，相同的中颞叶区域与单词理解缺陷和复杂的非规范句子理解缺陷有关。连接体损伤症状映射揭示了受损单词和非规范句子理解的类似颞枕白质断开，包括颞极。我们发现非规范句子理解缺陷存在额外的显着时间-顶叶脱节，这可能表明语音工作记忆在处理复杂语法中的作用，但没有显着的额叶脱节。而且，这些中后颞叶区域的损伤与单词和非规范句子理解缺陷有关，即使分别考虑到最强的前颞叶和下额叶白质断开导致的差异。我们的结果在很大程度上与经典观点一致，即韦尼克区（此处定义为颞上回中部和颞上沟中后部）支持单词和句子理解，表明颞极在单词和句子理解中具有支持作用，并且说反对 Wernicke 失语症的理解缺陷是由双重断开引起的假设。