Participation of the Insula in Language

  • Alfredo ArdilaEmail author


Since the beginning of aphasia history, it has been known that the insula has a crucial role in language. The interest in the insula somehow decreased during the twentieth century, because it has not directly included in the perisylvian language area proposed by Dejerine. During the late twentieth century, it was proposed that the insula plays a crucial role on speech praxis. Since Wernicke, it has been observed that insula damage is frequently associated with aphasia; different types of aphasia have been reported in cases of insula damage: motor planning and organization of speech in Broca’s aphasia, repetition defects associated with conduction aphasia, and the word-deafness component of Wernicke’s aphasia. Mutism and oral apraxia have also been reported to be associated with left insula pathology. Neuroimaging studies have corroborated that the insula has extensive brain connection, including not only the frontal motor language area but also posterior language areas. Anatomical connections of the insula point also to an important viscero-limbic role, and it may accordingly be suggested that the insula is involved in verbal motivation.


Insula Language Apraxia of speech Language understanding fMRI Broca’s aphasia Conduction aphasia Wernicke’s aphasia 


  1. 1.
    Freud S. On aphasia : a critical study. London: Imago Publishing Co. Ltd.; 1891.Google Scholar
  2. 2.
    Dejerine J. Semiologie des Aåections du Systeme Nerveux. Paris: Masson; 1914.Google Scholar
  3. 3.
    Head H. Aphasia and kindred disorders. Cambridge, UK: Cambridge University Press; 1920.Google Scholar
  4. 4.
    Nielsen JM. Agnosia, apraxia and aphasia: their value in cerebral localization. New York, NY: Hafner; 1936.Google Scholar
  5. 5.
    Luria AR. Higher cortical functions in man. New York, NY: Basic Books; 1966.Google Scholar
  6. 6.
    Benson DF, Geschwind N. The aphasias and related disturbances. In: Baker AB, Bake LH, editors. Clinical neurology, vol. 1. New York, NY: Harper and Row; 1971. p. 112–40.Google Scholar
  7. 7.
    Goodglass H, Kaplan E. The assessment of aphasia and related disorders. Philadelphia: Lippincott Williams & Wilkins; 1972.Google Scholar
  8. 8.
    Gasquoine PG. Contributions of the insula to cognition and emotion. Neuropsychol Rev. 2014;24(2):77–87.CrossRefPubMedGoogle Scholar
  9. 9.
    Wernicke C. Der Aphasische Symtomenkomplex. Breslau: Cohn and Weigert; 1874.Google Scholar
  10. 10.
    Bernheim F. De l’Aphasie Motrice. Paris: These de Paris; 1900.Google Scholar
  11. 11.
    Liepmann H, Storck E. Ein Fall von reiner Sprachtaubheit. Manuschfrift Psychiatrie und Neurologie. 1902;17:289–311.CrossRefGoogle Scholar
  12. 12.
    Alexander MP, Naeser MA, Palumbo CL. Correlations of subcortical CT lesions sites and aphasia profiles. Brain. 1987;110:961–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Nielsen JM, Friedman AP. The quadrilateral space of Marie. Bull Los Angeles Neurol Soc. 1942;8:131–6.Google Scholar
  14. 14.
    Starkstein SE, Berthier M, Leiguarda R. Bilateral opercular syndrome and crossed aphemia due to a right insular damage: a clinicopathological study. Brain Lang. 1988;34:253–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Fifer RC. Insular stroke causing unilateral auditory processing disorder: case report. J Am Acad Audiol. 1993;4:364–9.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Habib M, Daquin G, Milandre L, Royere ML, Rey M, Lanteri A, Slamanon G, Khalil R. Mutism and auditory agnosia due to bilateral insular damage—role of the insula in human communication. Neuropsychologia. 1995;33:327–39.CrossRefPubMedGoogle Scholar
  17. 17.
    Baratelli E, Laiacona M, Capitani E. Language disturbances associated to insular and entorhinal damage: study of a patient affected by herpetic encephalitis. Neurocase. 2015;21(3):299–308.CrossRefPubMedGoogle Scholar
  18. 18.
    Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C, Nguyen DK. Insular ischemic stroke: clinical presentation and outcome. Cerebrovasc Dis Extra. 2012;2(1):80–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Schiff HB, Alexander MP, Naeser MA, Galaburda AM. Aphemia: clinical-anatomical correlations. Arch Neurol. 1983;40:720–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Alexander MP, Benson DF, Stuss DT. Frontal lobes and language. Brain Lang. 1989;37:656–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Sussman NM, Gur RC, Gur RF, O’Connor MJ. Mutism as a consequence of callosotomy. J Neurosurg. 1983;59:514–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Cappa SF, Guidotti M, Papagno C, Vignolo LA. Speechlessness with occasional vocalization after bilateral opercular lesions: a case study. Aphasiology. 1987;1:35–9.CrossRefGoogle Scholar
  23. 23.
    Groswaser Z, Korn C, Groswaser-Reider I, Solzi P. Mutism associated with buccofacial apraxia and bihemispheric lesions. Brain Lang. 1988;34:157–68.CrossRefGoogle Scholar
  24. 24.
    Pineda D, Ardila A. Lasting mutism associated with buccofacial apraxia. Aphasiology. 1992;6:285–92.CrossRefGoogle Scholar
  25. 25.
    Shuren J. Insula and aphasia. J Neurol. 1993;240:216–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Duffau H, Bauchet L, Lehéricy S, Capelle L. Functional compensation of the left dominant insula for language. Neuroreport. 2001;12(10):2159–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Dronkers NN. A new brain region for coordinating speech articulation. Nature. 1996;384:159–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Ardila A. The role of insula in language: an unsettled question. Aphasiology. 1999;13(1):79–87.CrossRefGoogle Scholar
  29. 29.
    Ardila A, Benson DF, Flynn FG. Participation of the insula in language. Aphasiology. 1997;11:1159–70.CrossRefGoogle Scholar
  30. 30.
    Nagao M, Takeda K, Komori T, Isozaki E, Hirai S. Apraxia of speech associated with an infarct in the precentral gyrus of the insula. Neuroradiology. 1999;41(5):356–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Baldo JV, Wilkins DP, Ogar J, Willock S, Dronkers NF. Role of the precentral gyrus of the insula in complex articulation. Cortex. 2011;47(7):800–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Baker SC, Frith CD, Dolan RJ. The interaction between mood and cognitive function studied with PET. Psychol Med. 1997;27:565–78.CrossRefPubMedGoogle Scholar
  33. 33.
    McCarthy G, Blamire AM, Rothman DL, Gruetter R, Shulman RG. Echo-plantar magnetic resonance imaging studies of frontal cortext activating during word generation in humans. Proc Natl Acad Sci. 1993;90:4952–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Price CJ, Moore CJ, Humphreys GW, Frackowiak RS, Friston KJ. The neural regions sustaining object recognition and naming. Proc Royal Soc Biol Sci. 1996;263:1501–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Rumsey JM, Horwitz B, Donohue BC, Nace K, Maisog JM, Andreason P. Phonological and orthographic components of word recognition. A PET-rCBF study. Brain. 1997;120:739–59.CrossRefPubMedGoogle Scholar
  36. 36.
    Ackermann H, Riecker A. The contribution of the insula to motor aspects of speech production: a review and a hypothesis. Brain Lang. 2004;89(2):320–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Owen WJ, Borowsky R, Sarty GE. fMRI of two measures of phonological processing in visual word recognition: ecological validity matters. Brain Lang. 2004;90(1):40–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Borowsky R, Cummine J, Owen WJ, Friesen CK, Shih F, Sarty GE. FMRI of ventral and dorsal processing streams in basic reading processes: insular sensitivity to phonology. Brain Topogr. 2006;18(4):233–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Friederici AD, Rueschemeyer SA, Hahne A, Fiebach CJ. The role of left inferior frontal and superior temporal cortex in sentence comprehension: localizing syntactic and semantic processes. Cereb Cortex. 2003;13(2):170–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Rousseaux M, Steinling M, Griffie G, Quint S, Cabaret M, Lesoin F, Mazingue M, Destee A. Correlation of thalamic aphasia and cerebral blood flow. Rev Neurol. 1990;146:345–53.PubMedGoogle Scholar
  41. 41.
    Bamiou DE, Musiek FE, Luxon LM. The insula (Island of Reil) and its role in auditory processing: literature review. Brain Res Rev. 2003;42(2):143–54.CrossRefPubMedGoogle Scholar
  42. 42.
    Zaccarella E, Friederici AD. Reflections of word processing in the insular cortex: a sub-regional parcellation based functional assessment. Brain Lang. 2015;142:1–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Fuertinger S, Horwitz B, Simonyan K. The functional connectome of speech control. PLoS Biol. 2015;13(7):e1002209.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Oh A, Duerden EG, Pang EW. The role of the insula in speech and language processing. Brain Lang. 2014;135:96–103.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ardila A, Bernal B, Rosselli M. Participation of the insula in language revisited: a meta-analytic connectivity study. J Neurolinguistics. 2014;29:31–41.CrossRefGoogle Scholar
  46. 46.
    Beaty RE, Silvia PJ, Benedek M. Brain networks underlying novel metaphor production. Brain Cogn. 2017;111:163–70.CrossRefPubMedGoogle Scholar
  47. 47.
    Clos M, Rottschy C, Laird AR, Fox PT, Eickhoff SB. Comparison of structural covariance with functional connectivity approaches exemplified by an investigation of the left anterior insula. Neuroimage. 2014;99:269–80.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Communication Sciences and DisordersFlorida International UniversityMiamiUSA

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