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Coverbal gestures in Alzheimer's type dementia.

Patterns of conversational gestures were analysed in subjects with Alzheimer's type dementia (DAT), fluent aphasics with a primarily lexical-semantic deficit (FA) and normal subjects. The FA subjects produced twice as many gestures as the normal participants with a normal percentage of gestures that showed semantic features of the lexical items in concurrent speech (iconic). A comparable lexical-semantic deficit together with a deficit in conceptual organisation of information corresponded to a normal gesturing rate in the DAT subjects; however, the percentage of iconic gestures was reduced. Gestures were also analysed in four DAT patients whose communicative performance indicated primarily lexical-semantic (2 patients) or conceptual deficit (2 patients). In the two DAT patients with lexical-semantic deficit, the gesture pattern was like that of the FA patients; in the other two, the pattern of the DAT group was observed. These results agree with previous findings that DAT "empty" speech corresponds to reduced production of gestures showing semantic features (Glosser et al., 1998). However, the comparison between DAT with primarily lexical-semantic or conceptual deficits indicates that the nature of the cognitive impairment underlying poor information content and lack of reference in DAT discourse constrains the production of conversational gestures by patients with this disease. These findings are at variance with the hypothesis of parallel dissolution of speech and gestures in language disorders after brain damage (Cicone et al., 1979; McNeill, 1992; Glosser et al., 1998).

Alzheimer Disease↗

When Ciarli Ciaplin drives a Pejio' in Itali: writing loan words in a shallow language.

With increasing frequency the lexicon of every language incorporates words taken from other languages (loan words) that become of common use, but whose orthography does not necessarily conform to the rules of the native language. This is particularly true for languages like Italian, where most words can be correctly written by the application of a sublexical phonology-to-orthography conversion procedure. Here we report the case of a neurologically unimpaired, highly educated Italian person, with a specific deficit in writing loan words. The aim of the study is to clarify the nature of her dysgraphic impairment, if linked to a semantic deficit, or alternatively reflecting an acquisition deficit, present both in the phonological and orthographic output lexicons, or specific only for the orthographic lexicon. A qualitative analysis of her errors and a comparison with the performance of a group of age and education matched subjects showed that her error pattern was not an amplification of the task difficulty effect observed in the control subjects, but rather an expression of an impairment in acquiring specific writing procedures.

Adult↗

Distinct frontal regions for processing sentence syntax and story grammar.

Time is a fundamental dimension of cognition. It is expressed in the sequential ordering of individual elements in a wide variety of activities such as language, motor control or in the broader domain of long range goal-directed actions. Several studies have shown the importance of the frontal lobes in sequencing information. The question addressed in this study is whether this brain region hosts a single supramodal sequence processor, or whether separate mechanisms are required for different kinds of temporally organised knowledge structures such as syntax and action knowledge. Here we show that so-called agrammatic patients, with lesions in Broca's area, ordered word groups correctly to form a logical sequence of actions but they were severely impaired when similar word groups had to be ordered as a syntactically well-formed sentence. The opposite performance was observed in patients with dorsolateral prefrontal lesions, that is, while their syntactic processing was intact at the sentence level, they demonstrated a pronounced deficit in producing temporally coherent sequences of actions. Anatomical reconstruction of lesions from brain scans revealed that the sentence and action grammar deficits involved distinct, non-overlapping sites within the frontal lobes. Finally, in a third group of patients whose lesions encompassed both Broca's area and the prefrontal cortex, the two types of deficits were found. We conclude that sequence processing is specific to knowledge domains and involves different networks within the frontal lobes.

Analysis of Variance↗

A case of amnesia at an early age.

A dissociation between short- and long-term memory (LTM) and between the episodic and the semantic component of LTM is reported in a young girl who became amnesic at the age of 6 after an episode of acute encephalopathy resulting in bilateral frontal, insular, thalamic, ponto-mesencephalic, hippocampal and temporal lesions, as documented by MRI. The girl became amnesic a few months after starting school. A follow-up investigation showed that she was able to learn to read, write and acquire number facts and procedures and to improve her semantic knowledge. Our results show that the features of adult amnesia can also be found in children and that new semantic knowledge can be acquired in spite of an anterograde memory deficit. This dissociation does not agree with theories viewing long-term declarative memory as a unitary process mediated by the hippocampal system, but supports recent hypotheses that the acquisition of semantic knowledge is independent from episodic memory processes, and takes place through spared cortical regions subjacent to the hippocampi (Vargha-Khadem et al., 1997).

Amnesia↗

Comprehension of spatial language terms in Williams syndrome: evidence for an interaction between domains of strength and weakness.

Individuals with Williams syndrome show an unusual neuropsychological profile, with relatively strong language abilities and impoverished visual and spatial abilities. Two studies are reported that examine the interaction between these two domains in Williams syndrome by assessing individuals' comprehension of spoken language with a spatial component. In a first study, the Test for Reception of Grammar (Bishop, 1983) was given to 32 individuals with Williams syndrome and to controls matched individually for total number of errors on the task. Individuals with Williams syndrome had particular problems when asked to comprehend sentences containing spatial prepositions, making significantly more errors on these items than control groups. A second study examined in more detail comprehension of sentences with spatial and non-spatial components, comparing the performance of 15 individuals with Williams syndrome and control groups matched for vocabulary ability. Individuals with Williams syndrome again showed impaired comprehension of spoken spatial terms. In contrast, they were unimpaired in comprehending utterances without a spatial component, with the exception of descriptions testing comprehension of non-spatial comparatives (lighter than and darker than). These results suggest that the spatial difficulties experienced by individuals with Williams syndrome may constrain language comprehension in certain circumstances. They also shed light on the ways in which spatial cognition may interact with language comprehension more generally.

Adolescent↗

Dissociations of language functions in aphasics with speech automatisms (recurring utterances).

The linguistic performance of 27 aphasics with frequent production of non-lexical speech automatisms (recurrent utterances; e.g. do-do-do...) in spontaneous speech was investigated. Of the 26 patients examined with the Aachen aphasia test (AAT), 24 cases suffered from global aphasia, one from Broca's aphasia, and one was not classifiable but most resembled the fluent types as Wernicke's or conduction aphasia. While most patients were severely impaired in language comprehension, a subgroup showed impairments on a moderate level. In four cases clear dissociations between oral and written output performance were found. Only one patient, and very rarely so, interspersed his written output with his speech automatism. Analysis of written output within the theoretical framework of the logogen model provided evidence for the possibility of a partially intact phonological system in patients with speech automatisms. Results are interpreted as supporting a sub-phonemic hypothesis of the generation of non-lexical speech automatisms.

Adult↗

A letter-by-letter reader who could not read nonwords.

Letter-by-letter reading is a neuropsychological syndrome characterized by oral reading which seems to be mediated by explicit naming of constituent letters of the printed string. Thus reading time rises abnormally as a function of the length of the items to-be-read. This syndrome is generally interpreted as indicating a disconnection within the normal reading system prior to the activation of the visual and phonological lexical access routes. The patient retains a subsidiary strategy of spelling words by naming their constituent letters and uses this strategy for planning their pronunciation. If this interpretation is correct then reading aloud in letter-by-letter reading should not be affected by the features of the letter string which are stored lexically as the functional disconnection is postulated to occur prior to this stage. In this paper we report the case of a letter-by-letter reader who shows some signs which are puzzling in terms of current interpretations of the syndrome. They can be summarized as follows: (1) The patient reads words better than he reads nonwords; (2) Concrete words are processed more holistically while abstract words are processed more letter-by-letter; (3) Lexical decisions can be made far more rapidly than words can be read aloud. These three signs are very difficult to account for if reading is accomplished solely through a non-lexical reversed spelling strategy. Our experimental investigations of this patient are reported and alternative models assuming strategic control over the reading mechanism are discussed.

Adult↗

Auditory sound agnosia without aphasia following a right temporal lobe lesion.

A 55-year-old right-handed man showed inability to recognize the meaning of non-verbal sounds without impairment of language comprehension after a cerebrovascular accident. His auditory acuity was intact and no other sign of agnosia, apraxia or aphasia was detectable. His errors on a test of sound recognition were acoustic rather than semantic. Brain CT scan showed a small lesion in the posterior part of the right temporal lobe. This case suggests that auditory sound agnosia without language disorder can ensure a lesion confined to the right hemisphere, and that the deficit is discriminative rather than associative in nature.

Agnosia↗

The influence of sex and age on the incidence and type of aphasia.

The relation of sex and age to the incidence and type of aphasia was investigated in 200 aphasic patients. The following conclusions were drawn: (1) Males and females show language disorder with equal frequency. (2) There is a prevalence of non-fluent aphasics in males as compared to females. (3) Broca's aphasics are mildly, but significantly young than Wernicke's aphasics.

Age Factors↗

Factors influencing type and severity of aphasia.

The influence of etiology and sex on aphasia type and the relation of age to the severity and type of language disorders have been assessed in 718 right-handed aphasic patients. Both trauma and neoplasia are associated with fluent aphasia significantly more often, while sex proved to have no influence on aphasia type. The frequency distribution of age according to type and severity of aphasia - studied in vascular patients only (N = 566) - demonstrated that fluency and severity are significantly associated with older age.

Age Factors↗

Subcortical aphasia: two clinical-CT scan correlation studies.

Two clinical-CT scan studies were undertaken in order to investigate the frequency and the characteristics of aphasia following strictly subcortical left hemisphere lesions. In Study 1, all patients whose CT scan, carried out within a given period, showed subcortical lesions in both hemispheres, were evaluated for presence and type of aphasia; conversely, in Study 2 the records of all patients referred to our Aphasia Unit for language evaluation within a given period, were examined for presence of subcortical lesions on the CT scan. In Study 1 aphasia was found in two out of six patients. In Study 2 stabilized, strictly subcortical lesions of the left hemisphere were found in six out of 250 patients referred to the Aphasia Unit; 4 out of 6 were aphasics. Closer scrutiny of the type of language disorder in the aphasics from both studies (N = 6) suggests the possibility of differentiating two types of defect: an atypical non fluent aphasia, sometimes associated with anterior capsular-putaminal lesions, and a mild fluent aphasia, sometimes associated with posterior capsular-putaminal lesions.

Adult↗

Perseveration in aphasia.

We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13 normal controls). Several major findings emerged: left hemispheric, posteriorly located, aphasia producing lesions also produced abundant perseverations, both verbal and non-verbal, which were primarily recurrent in type; right hemispheric lesions produced few perseverations, and these were primarily of the continuous type; more than half of the verbal recurrent perseverations of aphasia on a naming task were semantic in nature. We conclude that recurrent perseveration has a special, perhaps integral, link to language disorders of aphasia, particularly fluent aphasia associated with posterior lesions.

Anomia↗

Slowly progressive visual agnosia or apraxia without dementia.

Two patients manifested a progressive impairment of visuoperceptive abilities and one patient a progressive generalized apraxia, in the absence of dementia and oral language disorders. The disease started in the presenium and the follow-up was of five, two and half and two years, respectively. The relation of these clinical pictures to cases of generalized dementia and to cases with isolated, progressive aphasia is discussed.

Aged↗

Orthographic ambiguity: comments on Baxter and Warrington.

In this note, I comment on a recent study by Baxter and Warrington of an acquired dysgraphic patient, KT, that appeared in Cortex, 23, 1987. The focus of my discussion centers around Baxter and Warrington's findings that: (1) KT shows a striking orthographic "regularity" effect in his spelling performance and; (2) KT's use of sound-to-spelling mapping options does not reflect the distribution of use of these options in the word corpus examined. If well-founded, the implications of these results call into question specific features of the dominant model of spelling. However, a close scrutiny of the procedures used by Baxter and Warrington in analyzing their data indicates that they collapsed across factors that have elsewhere been shown to influence spelling performance (i.e., within-syllable frequency of occurrence of phoneme-grapheme mapping options). Therefore, results obtained for patient KT cannot, in their current form, be used to speak to the specific issues of spelling that Baxter and Warrington originally set out to address.

Brain↗

The role of the right hemisphere in recovery from aphasia. Two case studies.

We report two female patients who became global aphasic following a large left hemisphere lesion. With passage of time they recovered to a considerable extent, but three years and six months, respectively, after the former CVA, a new stroke lateralized to the right hemisphere occurred and they showed a definite worsening of language disturbances. Possibilities and limits of the right hemisphere in "taking over" language functions are discussed.

Aphasia↗

An emergent account of language impairments in children with SLI: implications for assessment and intervention.

While current theoretical accounts of language impairments in children with specific language impairment (SLI) provide clear direction with regard to intervention goal setting, these same accounts say little with regard to the intervention process. Current developments in connectionist modeling and the extension of principles of dynamical systems theory to cognitive and language development have resulted in a new theory of language development known as emergentism. In contrast to traditional formal linguistic accounts, the emergentist view holds that language is a dynamic evolving system that can be represented as a distribution of probabilistic information. Language acquisition, from this perspective, emerges from the child's simultaneous integration of multiple acoustic, linguistic, social and communicative cues within the context of the communicative interaction. An alternative account of SLI grounded within this emergentist view is presented, and preliminary implications are explored with respect to assessment and intervention.

Child↗

Diagnostic accuracy and test-retest reliability of nonword repetition and digit span tasks administered to preschool children with specific language impairment.

UNLABELLED: To assess diagnostic accuracy and test-retest reliability, two forms of a nonword repetition task were administered to 22 preschool children with specific language impairment (SLI) and to 22 age- and gender-matched children with normal language (NL). Results were compared with performance on a digit span task and norm-referenced test scores. Nonword repetition scores provided excellent sensitivity and specificity for discriminating between groups. Scores on both nonword repetition and digit span tasks improved significantly from first to second administrations for both groups, but remained relatively stable at the third administration. The SLI group appeared to benefit more from repetition than the NL group. Acceptable levels of test-retest reliability were achieved for the digit span task, but not for the NL group on the nonword repetition task. These preliminary findings suggest that with further refinement to improve test-retest reliability, nonword repetition holds promise as a diagnostic measure for SLI in preschool children. EDUCATIONAL OBJECTIVES: As a result of this activity, the participant will be able to (1) describe the content and administration of nonword repetition tasks; (2) explain why evidence of test-retest reliability is necessary before a measure may be considered reliable for diagnostic purposes; and (3) accurately compare the sensitivity and specificity of the nonword repetition task utilized in this study to standardized language test scores.

Child, Preschool↗