Fusiform type alexia: Pure alexia for words in contrast to posterior occipital type pure alexia for letters

Ventral Variant Posterior Cortical Atrophy with Occipito-temporal Accumulation of Tau Proteins/Astrocyte Gliosis

A 73-year-old woman with posterior cortical atrophy (PCA) presented with progressive apperceptive visual agnosia, alexia, agraphia, ventral simultanagnosia, prosopagnosia, and allocentric (stimulus-centered) left-sided hemispatial neglect. All of these symptoms were attributed to damage to the bilateral occipito-temporal cortices, consistent with ventral variant PCA. While the Pittsburgh compound B uptake was extensively distributed throughout the occipito-parietal (dorsal) and occipito-temporal (ventral) areas, the THK5351 (ligand binding to tau aggregates/astrocyte gliosis) accumulation was limited to the ventral area. These findings suggest that local accumulation of tau proteins and/or astrocyte gliosis over the occipito-temporal cortices can result in ventral variant PCA.

Phonological properties of logographic words modulate brain activation in bilinguals: a comparative study of Chinese characters and Japanese Kanji

The brain networks for the first (L1) and second (L2) languages are dynamically formed in the bilingual brain. This study delves into the neural mechanisms associated with logographic-logographic bilingualism, where both languages employ visually complex and conceptually rich logographic scripts. Using functional Magnetic Resonance Imaging, we examined the brain activity of Chinese-Japanese bilinguals and Japanese-Chinese bilinguals as they engaged in rhyming tasks with Chinese characters and Japanese Kanji. Results showed that Japanese-Chinese bilinguals processed both languages using common brain areas, demonstrating an assimilation pattern, whereas Chinese-Japanese bilinguals recruited additional neural regions in the left lateral prefrontal cortex for processing Japanese Kanji, reflecting their accommodation to the higher phonological complexity of L2. In addition, Japanese speakers relied more on the phonological processing route, while Chinese speakers favored visual form analysis for both languages, indicating differing neural strategy preferences between the 2 bilingual groups. Moreover, multivariate pattern analysis demonstrated that, despite the considerable neural overlap, each bilingual group formed distinguishable neural representations for each language. These findings highlight the brain's capacity for neural adaptability and specificity when processing complex logographic languages, enriching our understanding of the neural underpinnings supporting bilingual language processing.

Detection of deviance in Japanese kanji compound words

Reading fluency is based on the automatic visual recognition of words. As a manifestation of the automatic processing of words, an automatic deviance detection of visual word stimuli can be observed in the early stages of visual recognition. To clarify whether this phenomenon occurs with Japanese kanji compounds—since their lexicality is related to semantic association—we investigated the brain response by utilizing three types of deviants: differences in font type, lexically correct or incorrect Japanese kanji compound words and pseudo-kanji characters modified from correct and incorrect compounds. We employed magnetoencephalography (MEG) to evaluate the spatiotemporal profiles of the related brain regions. The study included 22 adult native Japanese speakers (16 females). The abovementioned three kinds of stimuli containing 20% deviants were presented during the MEG measurement. Activity in the occipital pole region of the brain was observed upon the detection of font-type deviance within 250 ms of stimulus onset. Although no significant activity upon detecting lexically correct/incorrect kanji compounds or pseudo-kanji character deviations was observed, the activity in the posterior transverse region of the collateral sulcus (pCoS)—which is a fusiform neighboring area—was larger when detecting lexically correct kanji compounds than when detecting pseudo-kanji characters. Taken together, these results support the notion that the automatic detection of deviance in kanji compounds may be limited to a low-level feature, such as the stimulus stroke thickness.

Visual feedback of finger writing in a patient with sensory aphasia: a case report and theoretical considerations

Through cognitive task performance, we examined the functional role of finger writing (kūsho) in a Japanese patient with moderate sensory aphasia and reading difficulties. We hypothesized that the visual feedback of kūsho would improve visual language processing, which we tested with a "kanji construction task" using character subparts. Results showed a higher number of correct responses 1) when the patient used kūsho and 2) when visual feedback of finger movements was available. The results suggest that kūsho may not improve the retrieval of phonological information but does aid the visual processing necessary to assemble character subparts.

Dorsal type letter-by-letter reading accompanying alexia with agraphia due to a lesion of the lateral occipital gyri

We report a patient with alexia with agraphia accompanied by letter-by-letter reading after hemorrhage in the left middle and inferior occipital gyri that spared the angular gyrus and the fusiform gyrus. Kanji (Japanese morphograms) and kana (Japanese phonetic writing) reading and writing tests revealed that alexia with agraphia was characterized by kana-predominant alexia and kanji-predominant agraphia. This type of "dorsal" letter-by-letter reading is discernable from conventional ventral type letter-by-letter reading that is observed in pure alexia in that (1) kinesthetic reading is less effective, (2) kana or literal agraphia coexists, and (3) fundamental visual discrimination is nearly normal.

Selective impairment of On-reading (Chinese-style pronunciation) in alexia with agraphia for kanji due to subcortical hemorrhage in the left posterior middle temporal gyrus

We report a patient with alexia with agraphia for kanji after hemorrhage in the left posterior middle temporal gyrus. The results of single-character kanji reading and two-character on- (Chinese-style pronunciation), kun- (native Japanese pronunciation), and Jukujikun (irregular kun-) reading word tests revealed that the patient could not read kanji characters with on-reading but read the characters with kun-reading. We consider that this on-reading alexia was caused by disconnection between the posterior inferior temporal cortex (orthographic lexicon) and the posterior superior temporal gyrus (phonological lexicon), and preserved kun- and Jukujikun-reading was realized by bypassing the orthography-to-phonology route by the semantic route.

Ideographic Alexia without Involvement of the Fusiform Gyrus in a Korean Stroke Patient: A Serial Functional Magnetic Resonance Imaging Study

Background

Korean orthography is composed of Hanja (ideograms) and Hangul (phonograms). Based on previous studies, the fusiform gyrus has been associated with ideogram reading. We examine serial functional magnetic resonance imaging (fMRI) images in a patient exhibiting dissociation of Hanja and Hangul reading to identify brain areas associated with Hanja reading.

Case Report

fMRI were taken of a 63-year-old man showing profound Hanja alexia with normal Hangul reading after an acute stroke involving the left frontal and parietal lobes, who later spontaneously recovered his Hanja reading ability. Scans were taken while performing Hanja and Hangul reading tasks on three occasions. As a result, in spite of having profound Hanja alexia, partial activation of the fusiform gyrus was observed on the first fMRI. Serial fMRI scans showed activation of the bilateral middle frontal gyri that increased in parallel with the patient's recovery of Hanja reading.

Conclusions

The frontal lobe, not only fusiform gyrus, may play role in reading Hanja, although more evidence is needed.

Ventral simultanagnosia and prosopagnosia for unfamiliar faces due to a right posterior superior temporal sulcus and angular gyrus lesion

We report a patient with ventral simultanagnosia, prosopagnosia for "unfamiliar faces" (dorsal prosopagnosia), spatial agraphia, and constructional disorder, particularly on the left spatial side, due to a lesion in the right posterior superior and middle temporal gyri and angular gyrus. The patient showed impairment of fundamental visual and visuospatial recognition, such as in object size, configuration, and horizontal point location, which probably underlay the mechanism of simultanagnosia and prosopagnosia. This case also suggests that the coexistence of simultanagnosia and prosopagnosia results from a right hemispheric insult, and damage to the temporoparietal area interrupts the incorporation of spatial information into object recognition. This disconnection of information flow, together with impaired object recognition per se, may impair the parallel processing of multiple objects, leading to object-by-object or part-by-part recognition.

Altered brain activity for phonological manipulation in dyslexic Japanese children

Because of unique linguistic characteristics, the prevalence rate of developmental dyslexia is relatively low in the Japanese language. Paradoxically, Japanese children have serious difficulty analysing phonological processes when they have dyslexia. Neurobiological deficits in Japanese dyslexia remain unclear and need to be identified, and may lead to better understanding of the commonality and diversity in the disorder among different linguistic systems. The present study investigated brain activity that underlies deficits in phonological awareness in Japanese dyslexic children using functional magnetic resonance imaging. We developed and conducted a phonological manipulation task to extract phonological processing skills and to minimize the influence of auditory working memory on healthy adults, typically developing children, and dyslexic children. Current experiments revealed that several brain regions participated in manipulating the phonological information including left inferior and middle frontal gyrus, left superior temporal gyrus, and bilateral basal ganglia. Moreover, dyslexic children showed altered activity in two brain regions. They showed hyperactivity in the basal ganglia compared with the two other groups, which reflects inefficient phonological processing. Hypoactivity in the left superior temporal gyrus was also found, suggesting difficulty in composing and processing phonological information. The altered brain activity shares similarity with those of dyslexic children in countries speaking alphabetical languages, but disparity also occurs between these two populations. These are initial findings concerning the neurobiological impairments in dyslexic Japanese children.

An ERP investigation of visual word recognition in syllabary scripts

The bimodal interactive-activation model has been successfully applied to understanding the neurocognitive processes involved in reading words in alphabetic scripts, as reflected in the modulation of ERP components in masked repetition priming. In order to test the generalizability of this approach, in the present study we examined word recognition in a different writing system, the Japanese syllabary scripts hiragana and katakana. Native Japanese participants were presented with repeated or unrelated pairs of Japanese words in which the prime and target words were both in the same script (within-script priming, Exp. 1) or were in the opposite script (cross-script priming, Exp. 2). As in previous studies with alphabetic scripts, in both experiments the N250 (sublexical processing) and N400 (lexical-semantic processing) components were modulated by priming, although the time course was somewhat delayed. The earlier N/P150 effect (visual feature processing) was present only in "Experiment 1: Within-script priming", in which the prime and target words shared visual features. Overall, the results provide support for the hypothesis that visual word recognition involves a generalizable set of neurocognitive processes that operate in similar manners across different writing systems and languages, as well as pointing to the viability of the bimodal interactive-activation framework for modeling such processes.

Inter- and intrahemispheric connectivity differences when reading Japanese Kanji and Hiragana

Unlike most languages that are written using a single script, Japanese uses multiple scripts including morphographic Kanji and syllabographic Hiragana and Katakana. Here, we used functional magnetic resonance imaging with dynamic causal modeling to investigate competing theories regarding the neural processing of Kanji and Hiragana during a visual lexical decision task. First, a bilateral model investigated interhemispheric connectivity between ventral occipito–temporal (vOT) cortex and Broca's area (“pars opercularis”). We found that Kanji significantly increased the connection strength from right-to-left vOT. This is interpreted in terms of increased right vOT activity for visually complex Kanji being integrated into the left (i.e. language dominant) hemisphere. Secondly, we used a unilateral left hemisphere model to test whether Kanji and Hiragana rely preferentially on ventral and dorsal paths, respectively, that is, they have different intrahemispheric functional connectivity profiles. Consistent with this hypothesis, we found that Kanji increased connectivity within the ventral path (V1 ↔ vOT ↔ Broca's area), and that Hiragana increased connectivity within the dorsal path (V1 ↔ supramarginal gyrus ↔ Broca's area). Overall, the results illustrate how the differential processing demands of Kanji and Hiragana influence both inter- and intrahemispheric interactions.

[Lesion localization of non-aphasic alexia and agraphia]

The author reviews the lesion localization of non-aphasic alexia and agraphia and proposes a new classification of alexia and agraphia on this basis. The newly proposed alexia and agraphia are pure alexia for kana (Japanese phonograms), or more generally pure alexia for letters, caused by a lesion in the posterior occipital area (posterior fusiform/inferior occipital gyri), and pure agraphia for kanji (Japanese morphograms) caused by a lesion in the posterior middle temporal gyrus and also a lesion restricted to the angular gyrus. In addition, the anatomical lesions presumably responsible for the parietal apraxic agraphia, frontal pure agraphia and thalamic agraphia are discussed.

The relationship between visual crowding and letter confusability: towards an understanding of dyslexia in posterior cortical atrophy

Visual crowding is a form of masking in which target identification is hindered by excessive feature integration from other stimuli in the vicinity. It has previously been suggested that excessive visual crowding constitutes one specific form of early-visual-processing deficit, which may be observed in individuals with posterior cortical atrophy (PCA). This study investigated whether excessive visual crowding plays a significant role in the acquired dyslexia of two PCA patients, whose reading was characterized by visual paralexias. The patients were administered a series of letter, flanked letter, and word recognition tasks, and the effects of letter spacing and letter confusability upon response accuracy and latency were measured. In both patients, the results showed (a) evidence of excessive visual crowding, (b) a significant interaction between letter spacing and confusability on flanked letter identification tasks, and (c) effects of letter confusability affecting flanked but not unflanked letter identification. However, only mild improvements in reading accuracy were achieved in the experimental manipulations of interletter spacing within words because these manipulations had a dual effect: Increasing spacing improved individual letter identification but damaged whole-word form and/or parallel letter processing. We consider the implications of these results for the characterization of dyslexia in PCA, the design of reading rehabilitation strategies, and the relationship between visual crowding and letter confusability. In particular, we argue that the reading deficits observed in our patients cannot be accounted for solely in terms of a very low signal-to-noise ratio for letter identification, and that an additional crowding deficit is implicated in which excessive integration of fundamental letter features leads to the formation of incorrect letter percepts.

Alexia and agraphia with lesions of the angular and supramarginal gyri: evidence for the disruption of sequential processing

OBJECTIVE

To determine the features of alexia or agraphia with a left angular or supramarginal gyrus lesion.

METHODS

We assessed the reading and writing abilities of three patients using kanji (Japanese morphograms) and kana (Japanese syllabograms).

RESULTS

Patient 1 showed kana alexia and kanji agraphia following a hemorrhage in the left angular gyrus and the adjacent lateral occipital gyri. Patient 2 presented with minimal pure agraphia for both kanji and kana after an infarction in the left angular gyrus involving part of the supramarginal gyrus. Patient 3 also showed moderate pure agraphia for both kanji and kana after an infarction in the left supramarginal and postcentral gyri. All three patients made transposition errors (changing of sequential order of kana characters) in reading. Patient 1 showed letter-by-letter reading and a word-length effect and made substitution errors (changing hiragana [one form of kana] characters in a word to katakana [another form of kana] characters and vice versa) in writing.

CONCLUSION

Alexia occurs as "angular" alexia only when the lesion involves the adjacent lateral occipital gyri. Transposition errors suggest disrupted sequential phonological processing from the angular and lateral occipital gyri to the supramarginal gyrus. Substitution errors suggest impaired allographic conversion between hiragana and katakana attributable to a dysfunction in the angular/lateral occipital gyri.

Recognition and reading aloud of kana and kanji word: an fMRI study

It has been proposed that different brain regions are recruited for processing two Japanese writing systems, namely, kanji (morphograms) and kana (syllabograms). However, this difference may depend upon what type of word was used and also on what type of task was performed. Using fMRI, we investigated brain activation for processing kanji and kana words with similar high familiarity in two tasks: word recognition and reading aloud. During both tasks, words and non-words were presented side by side, and the subjects were required to press a button corresponding to the real word in the word recognition task and were required to read aloud the real word in the reading aloud task. Brain activations were similar between kanji and kana during reading aloud task, whereas during word recognition task in which accurate identification and selection were required, kanji relative to kana activated regions of bilateral frontal, parietal and occipitotemporal cortices, all of which were related mainly to visual word-form analysis and visuospatial attention. Concerning the difference of brain activity between two tasks, differential activation was found only in the regions associated with task-specific sensorimotor processing for kana, whereas visuospatial attention network also showed greater activation during word recognition task than during reading aloud task for kanji. We conclude that the differences in brain activation between kanji and kana depend on the interaction between the script characteristics and the task demands.