Refractory semantics in global aphasia: on semantic organisation and the access-storage distinction in neuropsychology.

A single case study is reported of a global aphasic patient, JM, with impaired access to semantic information which was particularly severe for the class of proper names. JM's ability to perform matching tasks with printed words and pictures to auditory words deteriorated when items were repeated, especially when the response-stimulus interval was short. Performance was also inconsistent across items. The effect of repeated testing on items generalised to other, previously untested members of the same category. Despite this, JM was able to access general semantic information about stimuli from the affected categories (e.g. to categorise boys' and girls' names), and showed good ability to access an input lexicon concerning these stimuli. There was also a close relationship between the categories affected when he was tested with pictures and printed words. We propose that JM's deficit can be attributed to his semantic system entering an abnormal refractory state once semantic access for a particular item has been achieved, and with this stage being isolated from the procedures providing access to stored lexical knowledge. Furthermore, the representations affected seem common to pictures and printed words. We discuss the implications of the results for understanding the nature of semantic representations in general and for proper names in particular, and for the distinction between access and storage deficits in neuropsychology.