independent syndrome among disorders of spoken language has gradually gained international recognition. But whether the pattern of the kanji-kana dissociation described by Imura is an integral part of the syndrome remains unsettled. A recently proposed concept of semantic dementia suggests symptomatic continuation of word meaning loss with non-linguistic semantic memory loss.
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In 1943 Tsuneo Imura, a neuropsychiatrist at Tokyo University, reported a new aphasic syndrome which he proposed to be called “Gogi aphasia” in an article published in Japanese [1]. “Go” of “gogi” means word, and “gi” means meaning. He admitted that the syndrome belongs to a broad category of transcortical sensory aphasia but claimed it has a unique characteristic and should be treated as a syndrome. The proposal remained unnoticed outside Japan until 1955 when Imura’s contribution to Japanese aphasiology was introduced along with his concept of “semantische Aphasie” in a German journal as a 2-part article by Panse and Shimoyama [2, 3]. The first part of this article was later translated into English [4]. In 1975, Sasanuma and Monoi [5] published a detailed linguistic study of a case with Gogi aphasia emphasizing the uniqueness of the syndrome because its symptomatology is inherently correlated with the complicated writing system of Japanese. In the article, Imura’s original concept of Gogi aphasia and its later impact on Japanese aphasiology were summarized briefly.
A Brief Introduction of the Japanese Script System
Since the symptom of Gogi aphasia is believed to be closely associated with a peculiar difficulty in reading and writing, a brief introduction of the Japanese script system might be necessary before describing the syndrome. In short, Japanese script is a hybrid of two different types of characters. Kan-ji was originally imported from China and literally means Han-letter. The Japanese applied these Han-letters to corresponding Japanese names with the similar concept as well as to Japanese syllables with similar Chinese sounds. This effort resulted in the complicated use of kanji for both names of concept and notification of pronunciation. Since Japanese system of syllables are quite different from Chinese, kana characters for Japanese syllables simplifying kanji form slowly developed. Kana has one letter-one syllable regularity, and the number is rather small, that is, 46. A kanji has multiple readings with no regularity. Also, its inventory is huge. For instance, the Japanese Government recommends using no more than 2,136 kanji in newspapers or laws to curb the kanji numbers in daily use. In usual Japanese script, semantic part is written by kanji and morphemic part (grammatical part) is written by kana.
The Syndrome of Gogi Aphasia
According to Imura, Gogi aphasia is characterized by 4 features [1]:
The first is difficulty in comprehending the meaning of a sentence spoken to. Although a typical patient could grasp the sound of the sentence correctly, he does not understand what they mean. He would repeat the sentence either automatically or intentionally to grasp the meaning. The most difficult part of a sentence to comprehend is substantive words that have restrictive meaning such as names of object or content.
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
