Clinical and audiological findings in a case of auditory agnosia

Situating word deafness within aphasia recovery: A case report

Word deafness is a rare neurological disorder often observed following bilateral damage to superior temporal cortex and canonically defined as an auditory modality-specific deficit in word comprehension. The extent to which word deafness is dissociable from aphasia remains unclear given its heterogeneous presentation, and some have consequently posited that word deafness instead represents a stage in recovery from aphasia, where auditory and linguistic processing are affected to varying degrees and improve at differing rates. Here, we report a case of an individual (Mr. C) with bilateral temporal lobe lesions whose presentation evolved from a severe aphasia to an atypical form of word deafness, where auditory linguistic processing was impaired at the sentence level and beyond. We first reconstructed in detail Mr. C's stroke recovery through medical record review and supplemental interviewing. Then, using behavioral testing and multimodal neuroimaging, we documented a predominant auditory linguistic deficit in sentence and narrative comprehension-with markedly reduced behavioral performance and absent brain activation in the language network in the spoken modality exclusively. In contrast, Mr. C displayed near-unimpaired behavioral performance and robust brain activations in the language network for the linguistic processing of words, irrespective of modality. We argue that these findings not only support the view of word deafness as a stage in aphasia recovery but also further instantiate the important role of left superior temporal cortex in auditory linguistic processing.

Stroke-Associated Cortical Deafness: A Systematic Review of Clinical and Radiological Characteristics

BACKGROUND

Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD.

METHODS

PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: "deafness" and "stroke", or "hearing loss" and "stroke" or "auditory agnosia" and "stroke".

RESULTS

We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl's gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions.

CONCLUSIONS

Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.

Identifying environmental sounds: a multimodal mapping study

Our environment is full of auditory events such as warnings or hazards, and their correct recognition is essential. We explored environmental sounds (ES) recognition in a series of studies. In study 1 we performed an Activation Likelihood Estimation (ALE) meta-analysis of neuroimaging experiments addressing ES processing to delineate the network of areas consistently involved in ES processing. Areas consistently activated in the ALE meta-analysis were the STG/MTG, insula/rolandic operculum, parahippocampal gyrus and inferior frontal gyrus bilaterally. Some of these areas truly reflect ES processing, whereas others are related to design choices, e.g., type of task, type of control condition, type of stimulus. In study 2 we report on 7 neurosurgical patients with lesions involving the areas which were found to be activated by the ALE meta-analysis. We tested their ES recognition abilities and found an impairment of ES recognition. These results indicate that deficits of ES recognition do not exclusively reflect lesions to the right or to the left hemisphere but both hemispheres are involved. The most frequently lesioned area is the hippocampus/insula/STG. We made sure that any impairment in ES recognition would not be related to language problems, but reflect impaired ES processing. In study 3 we carried out an fMRI study on patients (vs. healthy controls) to investigate how the areas involved in ES might be functionally deregulated because of a lesion. The fMRI evidenced that controls activated the right IFG, the STG bilaterally and the left insula. We applied a multimodal mapping approach and found that, although the meta-analysis showed that part of the left and right STG/MTG activation during ES processing might in part be related to design choices, this area was one of the most frequently lesioned areas in our patients, thus highlighting its causal role in ES processing. We found that the ROIs we drew on the two clusters of activation found in the left and in the right STG overlapped with the lesions of at least 4 out of the 7 patients' lesions, indicating that the lack of STG activation found for patients is related to brain damage and is crucial for explaining the ES deficit.

Neonatal nicotine exposure impairs development of auditory temporal processing

Accurate temporal processing of sound is essential for detecting word structures in speech. Maternal smoking affects speech processing in newborns and may influence child language development; however, it is unclear how neonatal exposure to nicotine, present in cigarettes, affects the normal development of temporal processing. The present study used the gap-induced prepulse inhibition (gap-PPI) of the acoustic startle response to investigate the effects of neonatal nicotine exposure on the normal development of gap detection, a behavioral testing procedure of auditory temporal resolution. Neonatal rats were injected twice per day with saline (control), 1mg/kg nicotine (N-1 mg) or 5 mg/kg nicotine (N-5 mg) from postnatal day 8-12 (P8-P12). During the first month after birth, rats showed poor gap-PPI in all three groups. At P45 and P60, gap-PPI in control rats improved significantly, whereas rats exposed to nicotine exhibited less improvement. At P60, the gap-detection threshold in the N-5 mg group was significantly higher than in the control group, suggesting that neonatal nicotine exposure affects the normal development of gap-detection acuity. Additionally, 1h after receiving an acute nicotine injection (1 mg/kg), gap-PPI recorded in adult rats from the N-5 mg group showed a temporary significant improvement. These results suggest that neonatal nicotine exposure reduces gap-PPI implying an impairment of the normal development of auditory temporal processing by inducing changes in cholinergic systems.

Age-Related Differences in Brain Activity Underlying Working Memory for Spatial and Nonspatial Auditory Information

We used functional magnetic resonance imaging and a 1-back task to assess working memory (WM) for spatial (sound location) and nonspatial (sound category) auditory information in younger and older adults. A mixed block-event-related design was used to measure sustained activity during each task block and transient activity to targets (repetitions of location or category). In both groups, there was increased sustained activity for category WM in left anterior temporal cortex and inferior prefrontal cortex (PFC) and increased activity for location WM in right inferior parietal cortex and dorsal PFC. There were no reliable age differences in this pattern of activity. Older adults had more sustained activity than younger adults in left PFC during both tasks, suggesting that additional PFC recruitment in older adults reflects nonspecific engagement of frontally mediated task-monitoring processes. Both groups showed lower transient than sustained activity in auditory cortex bilaterally; however, older adults showed smaller target-related reductions of activity during the category task. A greater reduction of activity to category targets in left auditory cortex was associated with better performance on this task in older adults, suggesting that a failure to modulate activity appropriately when a stimulus is repeated, or when a particular feature of the stimulus is repeated, could lead to reduced ability to detect this repetition.

Primary progressive aphasia accompanied by environmental sound agnosia: a neuropsychological, MRI and PET study

As part of the frontotemporal dementias, primary progressive aphasia (PPA) is typically characterized by nonfluent speech with paraphasias, but there is growing evidence that also a fluent variant of PPA exists. We describe a patient suffering from PPA who adds to the broad clinical spectrum of this disorder. Moreover, we report for the first time that PPA may be associated with severe impairment in meaningful nonverbal sound recognition (environmental sound agnosia). These neuropsychological findings were found to be associated with distinct focal alterations in functional and structural neuroimaging.

Equivalent dipoles of the binaural interaction components and their comparison with binaurally evoked human auditory 40 Hz steady-state evoked potentials

OBJECTIVE

The purpose of this study was to acquire the Binaural Interaction (BI) components of the auditory middle-latency steady-state 40 Hz potentials, compare them with those of the binaurally evoked 40 Hz response and with transient-evoked Auditory Middle Latency Evoked Potentials (AMEP) and suggest possible contributors and generators of the composite 40 Hz BI.

METHODS

Potentials were recorded from 15 normal-hearing adults in response to 40/sec clicks. BI was derived by subtracting the binaurally evoked potentials from the algebraic sum of the evoked potentials to left and to right ear stimulation. Latencies, magnitudes and orientations of the dipole equivalents of 40 Hz components were compared with their BI counterparts, as estimated by three-channel Lissajous' trajectories. Comparison of the transient AMEP to binaural stimulation with the BI of the steady-state 40 Hz response was also conducted to elucidate the contributions of different levels along the auditory pathway to the 40 Hz BI responses.

RESULTS

Each cycle of the BI of the steady-state 40 Hz AMEP included four components that corresponded in latency, amplitude, and dipole orientation to their counterparts in the binaurally evoked waveform. Amplitudes of BI components were 50 to 60% of the respective values in the binaurally evoked potentials. Orientations of BI components matched those of the cortical components in the transient-evoked AMEP.

CONCLUSIONS

The results suggest that the main contribution to the 40 Hz BI is from rate resistant thalamo-cortical neurons. The results also suggest that the binaural cortical neurons contributing to the 40 Hz BI are less affected by increased rate than monaural neurons.

Distinct pathways involved in sound recognition and localization: a human fMRI study

Evidence from psychophysical studies in normal and brain-damaged subjects suggests that auditory information relevant to recognition and localization are processed by distinct neuronal populations. We report here on anatomical segregation of these populations. Brain activation associated with performance in sound identification and localization was investigated in 18 normal subjects using fMRI. Three conditions were used: (i) comparison of spatial stimuli simulated with interaural time differences; (ii) identification of environmental sounds; and (iii) rest. Conditions (i) and (ii) required acknowledgment of predefined targets by pressing a button. After coregistering, images were normalized and smoothed. Activation patterns were analyzed using SPM99 for individual subjects and for the whole group. Sound recognition and localization activated, as compared to rest, inferior colliculus, medial geniculate body, Heschl gyrus, and parts of the temporal, parietal, and frontal convexity bilaterally. The activation pattern on the fronto-temporo-parietal convexity differed in the two conditions. Middle temporal gyrus and precuneus bilaterally and the posterior part of left inferior frontal gyrus were more activated by recognition than by localization. Lower part of inferior parietal lobule and posterior parts of middle and inferior frontal gyri were more activated, bilaterally, by localization than by recognition. Regions selectively activated by sound recognition, but not those selectively activated by localization, were significantly larger in women. Passive listening paradigm revealed segregated pathways on superior temporal gyrus and inferior parietal lobule. Thus, anatomically distinct networks are involved in sound recognition and sound localization.

Generalized auditory agnosia with spared music recognition in a left-hander. Analysis of a case with a right temporal stroke

After a right temporoparietal stroke, a left-handed man lost the ability to understand speech and environmental sounds but developed greater appreciation for music. The patient had preserved reading and writing but poor verbal comprehension. Slower speech, single syllable words, and minimal written cues greatly facilitated his verbal comprehension. On identifying environmental sounds, he made predominant acoustic errors. Although he failed to name melodies, he could match, describe, and sing them. The patient had normal hearing except for presbyacusis, right-ear dominance for phonemes, and normal discrimination of basic psychoacoustic features and rhythm. Further testing disclosed difficulty distinguishing tone sequences and discriminating two clicks and short-versus-long tones, particularly in the left ear. Together, these findings suggest impairment in a direct route for temporal analysis and auditory word forms in his right hemisphere to Wernicke's area in his left hemisphere. The findings further suggest a separate and possibly rhythm-based mechanism for music recognition.

Long-term follow-up of auditory agnosia as a sequel of herpes encephalitis in a child

We report a pediatric patient with auditory agnosia as a sequel of herpes encephalitis. His early development was completely normal. He uttered three words at 12 months old. Disease onset was 1 year and 2 months of age. He was discharged from the hospital seemingly with no sequel; however, he could not recover his intelligible words even at age 2 years. He was diagnosed as having auditory agnosia caused by bilateral temporal lobe injury. We began to train him at once, individually and intensively. Adult patients with pure auditory agnosia followed by two episodes of temporal lobe infarction have impairment in central hearing but not inner language. Therefore, they can communicate by reading and writing. Moreover, impairment in hearing is not always severe and is often transient. However, despite long-term (more than 15 years) energetic education and almost normal intellectual ability (Performance IQ of Wechsler Intelligence Scale for Children-Revised was 91), our patient's language ability was extremely poor. Cerebral plasticity could not work fully on our patient, whose bilateral temporal lobe was severely injured in early childhood. The establishment of a systematic training method in such patients is an urgent objective in this field.

Auditory agnosia and auditory spatial deficits following left hemispheric lesions: evidence for distinct processing pathways

Auditory recognition and auditory spatial functions were studied in four patients with circumscribed left hemispheric lesions. Patient FD was severely deficient in recognition of environmental sounds but normal in auditory localisation and auditory motion perception. The lesion included the left superior, middle and inferior temporal gyri and lateral auditory areas (as identified in previous anatomical studies), but spared Heschl's gyrus, the acoustic radiation and the thalamus. Patient SD had the same profile as FD, with deficient recognition of environmental sounds but normal auditory localisation and motion perception. The lesion comprised the postero-inferior part of the frontal convexity and the anterior third of the temporal lobe; data from non-human primates indicate that the latter are interconnected with lateral auditory areas. Patient MA was deficient in recognition of environmental sounds, auditory localisation and auditory motion perception, confirming that auditory spatial functions can be disturbed by left unilateral damage; the lesion involved the supratemporal region as well as the temporal, postero-inferior frontal and antero-inferior parietal convexities. Patient CZ was severely deficient in auditory motion perception and partially deficient in auditory localisation, but normal in recognition of environmental sounds; the lesion involved large parts of the parieto-frontal convexity and the supratemporal region. We propose that auditory information is processed in the human auditory cortex along two distinct pathways, one lateral devoted to auditory recognition and one medial and posterior devoted to auditory spatial functions.

Event-related potentials in brain-injured patients with neuropsychological disorders: a review

Investigations using event-related potentials (ERPs) in brain-injured patients affected by neuropsychological disorders of perception, attention, memory, and language, and other special syndromes such as blind-sight, neglect, prosopagnosia, and apraxia are reviewed. These electrophysiological techniques can be used to assess the integrity of specific brain processes during the performance of cognitive tasks in which behavioral impairments are observed. A special feature of ERP technique is that it reveals ongoing and covert processing which may not be fully assessed by measuring only overt behavioral performance.

Middle latency auditory evoked potentials in epilepsy

Middle latency auditory evoked potentials (MLAEPs) have been recorded after cortical lesions and seizure surgery. We recorded interictal MLAEPs in 14 patients with well documented complex partial and secondary generalized seizures. Na and Pa potentials did not differ in latency between patients and controls, although both were longer among seizure patients. Pa and Na were significantly reduced in amplitude in complex partial seizure patients compared to controls. These findings accord with previous suggestions that MLAEPs may be generated subcortically but modulated by temporal lobe structures. MLAEPs may be of value in differentiating temporal and extratemporal epilepsy. They may also help clarify interictal cognitive or behavioral symptoms related to epilepsy or the effects of antiepileptic medication.

Non-verbal auditory recognition in normal subjects and brain-damaged patients: evidence for parallel processing

Three different aptitudes involved in sound object recognition were tested in 60 normal subjects and 20 brain-damaged patients: (i) capacity to segregate sound objects on different cues (intensity steps, coherent temporal modulations or signal onset synchrony); (ii) asemantic recognition of sounds of real objects by judging whether two different sound samples belonged to the same object; and (iii) semantic identification of sounds of real objects as judged by means of a multiple choice response test. In 12 patients, different aptitudes involved in auditory recognition were disrupted separately and in a way which speaks in favour of parallel rather than hierarchical processing. There was no strong association between deficits in non-verbal auditory recognition and aphasia or the side of lesion.

Middle latency response in children with learning disabilities: preliminary findings

The objective of this investigation was to determine if auditory middle latency responses (MLR) obtained from children with learning disabilities (LD) differ from those obtained from children without LD. Simultaneous recordings of auditory brainstem and middle latency responses were obtained in both vertex-ipsilateral (V-I) and vertex-contralateral derivations (V-C) in 22 children (11 LD and 11 normal) in the age range of eight to twelve years whose peripheral hearing was within normal limits to bilateral. The results indicate that for specific recording conditions, the latencies of middle latency responses differ significantly between children with LD and a normal group of children.

Three-channel Lissajous' trajectory of the binaural interaction components of human auditory middle-latency evoked potentials

Three-channel Lissajous' trajectories (3-CLTs) of the binaural interaction component (BI) of auditory middle latency evoked potentials (AMLEPs) were derived from 14 normally hearing adults by subtracting the response to binaural clicks from the algebraic sum of monaural responses. AMLEPs were recorded in response to 65 dB nHL, rarefaction clicks, presented at a rate of 3.3/s. A normative set of BI 3-CLT measures was calculated and compared with the corresponding measures of simultaneously recorded, single-channel vertex-left mastoid and vertex-neck derivations of BI and of AMLEP to binaural stimulation (B). 3-CLT measures included: apex latency, amplitude and orientation, as well as planar segment duration, orientation, size and shape. The results showed seven main apices and associated planar segments ('Be', 'Bf', 'Bg', 'Bh', 'Bi1', 'Bi2' and 'Bj') in the 3-CLT of BI. Apex latencies of the BI 3-CLT were comparable to peak latencies of the vertex-left mastoid and vertex-neck AMLEP and BI records, both in their absolute values and in intersubject variability. Durations of BI planar segments were approximately 5.0 ms. Apex amplitudes of BI 3-CLT were larger than the respective peak amplitudes of the vertex-mastoid and vertex-neck BI records, while their intersubject variabilities were comparable. The lateralization of BI components may indicate asymmetric processing of binaural auditory input, or may be connected with anatomical asymmetry such as skull thickness. Preliminary analyses did not reveal a clear correlation between the lateralization of the BI component 'Bi2' and the handedness of the subject. We suggest that BI components of AMLEP may be associated with the primary auditory cortex and subcortical ascending structures.

Midlatency auditory evoked responses: P1 abnormalities in adult autistic subjects

MLR recordings from a group of 11 high-functioning adult autistic subjects were compared with those from a control group of 11 normal subjects. Components selected for analysis were "Pa", the maximum positivity in the 25-40 msec latency range following stimulus onset, "P1", the maximum positivity within the 50-65 msec latency range, and "Nb," the maximum negative deflection in the 40-50 msec latency range. Statistical analyses of amplitude and latency data were conducted using repeated measures analysis of variance and t test group comparisons. The Pa component showed no significant difference between autistic and control groups. However, 2 types of abnormality were noted in the P1 component: (1) the P1 component was significantly smaller in the autistic subjects at slow rates of stimulation, and (2) the autistic P1 did not change as rates of click stimulation increased from 0.5 to 10/sec, in contrast to the normally produced P1 decrement. Data from the P1 model in the cat, and complementary data from the human, closely link the generator substrate of the P1 potential to cholinergic components of the ascending reticular activating system (RAS) and their thalamic target cells. This is the first report of abnormal P1 responses in autism and strongly suggests that the RAS and/or its post-synaptic thalamic targets may be dysfunctional in this syndrome.

Midlatency auditory evoked responses: differential effects of a cholinergic agonist and antagonist

The effects of a cholinergic antagonist (scopolamine) and agonist (physostigmine) on the auditory middle latency evoked responses (MLRs) were studied in 7 normal male volunteers. Scalp recordings were made from a central (Cz) electrode referenced to linked ear lobes on one channel and to a non-cephalic, sternovertebral reference on a second channel. Three components were statistically analyzed for changes in latency and amplitude: Pa, with peak positivity in the 25-40 msec latency range, Nb, with peak negativity 40-50 msec, and P1, with peak positivity 50-65 msec. Control recordings included responses to click rates of 1, 5, 8 and 10/sec; as has been previously reported, P1 showed a marked decrease and disappeared at the faster rates of stimulation whereas Pa showed no change in amplitude. Intravenous injections of scopolamine resulted in a rapid and complete disappearance of P1 and a slight increase in Pa; concurrently, the subjects reported feeling drowsy but were awake with eyes open through the recordings. Subsequent injections of physostigmine resulted in a rapid reversal of the scopolamine effects so that the subjects became alert, Pa decreased, and P1 reappeared and increased to control amplitudes. Rapid click rates caused P1 to diminish, as in the control period, indicating a common P1 recovery cycle in both the control and physostigmine conditions. These data are discussed in terms of the hypothesis that the P1 generator system is comprised of a cholinergic brain-stem-thalamic component of the ascending reticular activating system.

Subcortical and cortical components of the MLR generating system

The contributions of the auditory thalamo-cortical pathway, mesencephalic reticular formation, and inferior colliculus to the surface recorded auditory middle latency response (MLR) were assessed by selective inactivation of these areas with lidocaine. Evoked responses were recorded simultaneously from these areas and from the cortical surface. Lidocaine-induced changes were compared across recording sites. In the guinea pig, surface components measured from over the temporal lobe (waves A, B and C) and the midline (waves M- and M+) have been previously shown to reflect the activity of two distinct generating mechanisms. Effects of lidocaine injections corresponded to selective changes in components from these two systems. Injections in the medial geniculate body (MGB) were associated with total disruption of surface potentials measured over the temporal lobe, auditory cortex (AC) responses, and local activity in MGB. Thus the thalamo-cortical pathway appears to be important for the generation of MLRs recorded from the surface of the temporal lobe. These injections generally did not alter the surface midline responses or activity obtained from either the mesencephalic reticular formation (mRF) or the inferior colliculus (IC). Lidocaine injections within AC did not alter the basic response morphology of surface potentials, nor were significant changes measured within AC. Lidocaine injections into the mRF produced changes in all surface temporal potentials, the M+ midline surface potential, and in local potentials recorded from MGB and mRF. Injections into the IC changed surface and subcortical responses at all sites. This was the only injection to affect activity at the latency of surface midline wave, M-1. This wave may be the animal analogue for human wave Na. Control experiments indicated that the effects observed were specific to the neural inactivation of target areas. The MLR generating system appears to consist of contributions and interactions from multiple areas including the auditory thalamo-cortical pathway, mRF and IC. The animal model and experimental strategy described appear promising for linking the contributions from specific brain areas to surface MLR waves.

Acquired word deafness, and the temporal grain of sound representation in the primary auditory cortex

This paper explores the nature of the processing disorder which underlies the speech discrimination deficit in the syndrome of acquired word deafness following from pathology to the primary auditory cortex. A critical examination of the evidence on this disorder revealed the following. First, the most profound forms of the condition are expressed not only in an isolation of the cerebral linguistic processor from auditory input, but in a failure of even the perceptual elaboration of the relevant sounds. Second, in agreement with earlier studies, we conclude that the perceptual dimension disturbed in word deafness is a temporal one. We argue, however, that it is not a generalized disorder of auditory temporal processing, but one which is largely restricted to the processing of sounds with temporal content in the milliseconds to tens-of-milliseconds time frame. The perceptual elaboration of sounds with temporal content outside that range, in either direction, may survive the disorder. Third, we present neurophysiological evidence that the primary auditory cortex has a special role in the representation of auditory events in that time frame, but not in the representation of auditory events with temporal grains outside that range.

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.

The decomposition of the middle latency auditory evoked potential (MLAEP) Pa component into superficial and deep source contributions

The results of recent investigations have suggested that the Middle Latency Auditory Evoked Potential (MLAEP) Pa component derives its physiological origins from both cortical and subcortical sources. The purpose of the present investigation was to determine if support for this hypothesis could be obtained from the off-line manipulation of the topographically recorded Pa component. The multichannel MLAEP from 15 normal hearing, neurologically intact subjects was collected following monaural left and right ear click stimulation. Data was originally collected using the linked ear reference and was subsequently re-referenced using the common average reference (CAR). These mapped data were converted off-line to source current density using the source derivation (SD) technique described by Hjorth (1975, 1980). This technique is sensitive to current activity that is generated in the superficial cerebral cortex. These SD maps of the MLAEP were subsequently subtracted from the CAR maps of the MLAEP. The derived CAR-SD maps are believed to represent that activity that is generated deep to the cerebral cortex (Hjorth and Rodin 1988). Interpretation of the mapped data have demonstrated support for the hypothesis that Pa is generated by a minimum of two systems including: 1) bilateral sources located in the posterior temporal lobes, and 2) a deeper midline generator system.

Midlatency auditory evoked responses: differential abnormality of P1 in Alzheimer's disease

The human 'P1' middle latency evoked potential is postulated to be generated in the thalamus by a cholinergic component of the ascending reticular activating system. To test the hypothesis that P1 and its generator substrate are abnormal in Alzheimer's disease (AD), a disorder of marked cholinergic deficiency, recordings of middle latency responses to click stimuli were carried out. Comparisons between the AD and age-matched control groups indicated normal auditory brain-stem and Pa responses but a significant decrease in P1 amplitude. This P1 abnormality suggests that the midbrain cholinergic cells in AD may be dysfunctional.

Midline and temporal lobe MLRs in the guinea pig originate from different generator systems: a conceptual framework for new and existing data

In the guinea pig and gerbil, individual components within the MLR time frame differ in optimal recording location. Specifically, MLR components obtained from the midline differ from those obtained over the temporal lobe. In the present paper midline and temporal lobe components were shown to differ not only in scalp topography but also in response to the following experimental manipulations: intracortical injection of neural inactivating agents (lidocaine and kainic acid), temporal lobe ablation, electrolytic lesions, systemic anesthesia, stimulation rate and course of development. Since midline and temporal lobe components respond differently to experimental manipulations, it can be concluded that the midline and temporal lobe responses are mediated by different generator sources. The particular orientation of the generators responsible for the MLR in the guinea pig and gerbil facilitates the identification of individual components. Results from simultaneous recordings of these components during experimental manipulations support the hypothesis of multiple MLR generators in laboratory animals and provide insight into the generators and developmental aspects of the MLR in humans.

Cortical auditory disorders: clinical and psychoacoustic features

The symptoms of two patients with bilateral cortical auditory lesions evolved from cortical deafness to other auditory syndromes: generalised auditory agnosia, amusia and/or pure word deafness, and a residual impairment of temporal sequencing. On investigation, both had dysacusis, absent middle latency evoked responses, acoustic errors in sound recognition and matching, inconsistent auditory behaviours, and similarly disturbed psychoacoustic discrimination tasks. These findings indicate that the different clinical syndromes caused by cortical auditory lesions form a spectrum of related auditory processing disorders. Differences between syndromes may depend on the degree of involvement of a primary cortical processing system, the more diffuse accessory system, and possibly the efferent auditory system.

Generators of middle- and long-latency auditory evoked potentials: implications from studies of patients with bitemporal lesions

We recorded middle- and long-latency auditory evoked potentials (AEPs) in 5 patients (ages 39-72 years) with bilateral lesions of the superior temporal plane. Reconstructions of CT sections revealed that primary auditory cortex had been damaged bilaterally in four of the patients, while in the fifth an extensive left hemisphere lesion included primary auditory cortex while a right hemisphere lesion had damaged anterior auditory association areas but spared primary auditory cortex. Normal middle-latency AEPs (MAEPs) were recorded at the vertex electrode in all of the patients. In 3 of the 5 patients, MAEPs also showed normal coronal scalp distributions and were comparable in amplitude following stimulation of either ear. Two patients showed abnormalities. In one case, Na (latency 17 msec)-Pa (latency 30 msec) amplitudes were reduced over both hemispheres following stimulation of the ear contralateral to the more extensive lesion. In another, with both subcortical and cortical involvement, the Pa was abolished over the hemisphere with the more extensive lesion. Long-latency AEPs were normal in 2 patients whose lesions were largely confined to the superior temporal plane. In 2 patients with lesions extending into the inferior parietal lobe, N1s were abolished bilaterally. In the fifth patient, the N1 showed a slight reduction over the hemisphere with the more extensive lesion. Middle- and long-latency AEPs were differentially affected by some lesions. For example, patients with absent N1s could produce normal Pas. A review of these results and those of previous studies of bitemporal patients suggests that abnormalities in middle- and long-latency AEPs do not necessarily reflect damage to primary auditory cortex per se, but rather the degree of damage to adjacent areas. Abnormalities in MAEPs are associated with subcortical lesions, or cortical lesions extensive enough to denervate thalamic projection nuclei. Abnormalities in the long-latency N1 reflect lesion extension into the multi-modal areas of the inferior parietal lobule. This area appears to exert a critical modulatory influence over N1 generators outside of the superior temporal plane.

Bitemporal lesions dissociate auditory evoked potentials and perception

We studied auditory evoked potentials (AEPs) in an 82-year-old female patient who became suddenly deaf following the second of two strokes. The patient showed markedly elevated pure tone thresholds, was unable to discriminate sounds and could not understand speech. Brain-stem auditory evoked potentials (BAEPs) were normal. CT scans revealed bilateral lesions of the superior temporal plane which included auditory cortex. Two experiments were performed. In the first, tones, complex sounds and speech stimuli were presented at intensities above and below the patient's perceptual threshold. P1, N1 and P2 components were elicited by each of the stimuli--whether or not they were perceived. In particular, stimuli presented below threshold evoked large amplitude, short latency responses comparable to those produced in a control subject. In a second experiment, the refractory properties of the N1-P2 were examined using trains of tones. They were also found to be similar to those of normal subjects. Shifts in the pitch of the tones near the end of the train (when refractory effects were maximal) evoked N1-P2s with enhanced amplitudes, although the change in pitch was not perceived by the patient. In both experiments AEP scalp topographies were normal. The results suggest that bitemporal lesions of auditory cortex can dissociate auditory perception and long-latency auditory evoked potentials. A review of evoked potential studies of cortical deafness suggests that the neural circuits responsible for N1-P2 generation lie in close proximity to those necessary for auditory perception.

Simultaneous recording of auditory evoked potentials. Relationships among the fast, middle and long latency components

The whole pattern of the fast, middle and long latency auditory evoked potentials (AEP) was recorded simultaneously from the scalp surface of 13 normal-hearing adults. The individual responses were displayed on a nonlinear time axis in order to improve identification of the components. Stimulation consisted of 2048 unfiltered clicks, delivered monaurally at 80, 60, 40 dB HL with an ISI of 750 ms. Changes in mean latency and amplitude of each AEP component were statistically evaluated in relation to intensity and electrode montage (vertex-mastoid ipsi- and contralateral to the stimulated ear). The latencies of fast components I-VI and the slow P1 increase significantly with declining stimulus intensity. The amplitudes of the fast, I, II, III, V and the slow P1-N1, P2-N2 decrease significantly with intensity. As regards differences due to the electrode montage the contralateral recording causes significant changes in latency of the fast potentials up to wave IV, and changes in amplitude of the fast up to wave V, and of the slow P1-N1 and P2-N2. Therefore, as their latency and amplitude seem to be less closely related to the stimulus and electrode placement, the middle components behave differently, compared with the preceding and following components. Based on parametric comparisons of potentials ranging widely in latency, but each one evoked by an equal sensory input, this kind of AEP evaluation may be useful both for neurophysiological and clinical studies of the whole auditory pathway function.