Alexia and quadrant-amblyopia: Reading disability after a minor visual field deficit

Right hemi-alexia

While pure alexia was long considered a disconnection syndrome, it may also be a selective visual word agnosia due to damage to the visual word form area. Disconnection is still the likely explanation of hemi-alexias, though, particularly when splenial lesions damage inter-hemispheric projections and cause left hemi-alexia. An intra-hemispheric disconnection causing right hemi-alexia is theoretically possible but seems very rare, with only a single report that has been challenged on the grounds of inadequate perimetry. We describe the case of PH, who had a severe reading deficit in her right hemifield. Detailed perimetry showed only a small relative hemi-scotoma along the horizontal meridian, while word reading was impaired over a much larger expanse of her right hemifield, in which object recognition was spared. Reading, lexical decisions, and perceptual discrimination of words were impaired in the right hemifield, and this extended to letters and numbers, with a trend to an effect on the perception of an unfamiliar script, namely Korean. On magnetic resonance imaging she had a large left lateral occipital meningioma with vasogenic edema of occipital white matter tracts. Functional magnetic resonance imaging showed that the visual word form area was located just anterior to the mass. Her perceptual abnormalities resolved after resection of the tumor. We conclude that right hemi-alexia exists and is most likely due to intra-hemispheric disconnection of occipital input to the visual word form area.

Dissociations within neglect-related reading impairments: Egocentric and allocentric neglect dyslexia

Consistently lateralized reading errors are commonly understood as side-effects of visuospatial neglect impairment. There is however a qualitative difference between systematically omitting full words presented on one side of passages (egocentric neglect dyslexia) and lateralized errors when reading single words (allocentric neglect dyslexia). This study aims to investigate the relationship between egocentric and allocentric neglect dyslexia and visuospatial neglect.

1209 stroke survivors completed standardized reading and cancellation tests. Stringent criteria identified unambiguous cases of allocentric neglect dyslexia (N = 17) and egocentric neglect dyslexia (N = 35). These conditions were found to be doubly dissociated with all cases of egocentric and allocentric neglect dyslexia occurring independently. Allocentric neglect dyslexia was dissociated from both egocentric and allocentric visuospatial neglect. Additionally, two cases of allocentric neglect dyslexia which co-occurred with oppositely lateralized domain-general visuospatial neglect were identified. Conversely, all cases of egocentric neglect dyslexia were found in the presence of domain-general visuospatial neglect. These findings suggest that allocentric neglect dyslexia cannot be fully understood as a consequence of visuospatial neglect. In contrast, we found no evidence for a dissociation between egocentric neglect dyslexia and visuospatial neglect. These findings highlight the need for new, neglect dyslexia specific rehabilitation strategies to be designed and tested.

A Componential Analysis of Visual Attention in Children With ADHD

OBJECTIVE

Inattentive behaviour is a defining characteristic of ADHD. Researchers have wondered about the nature of the attentional deficit underlying these symptoms. The primary purpose of the current study was to examine this attentional deficit using a novel paradigm based upon the Theory of Visual Attention (TVA).

METHOD

The TVA paradigm enabled a componential analysis of visual attention through the use of a mathematical model to estimate parameters relating to attentional selectivity and capacity. Children's ability to sustain attention was also assessed using the Sustained Attention to Response Task. The sample included a comparison between 25 children with ADHD and 25 control children aged 9-13.

RESULTS

Children with ADHD had significantly impaired sustained attention and visual processing speed but intact attentional selectivity, perceptual threshold and visual short-term memory capacity.

CONCLUSION

The results of this study lend support to the notion of differential impairment of attentional functions in children with ADHD.

Clinical TVA-based studies: a general review

In combination with whole report and partial report tasks, the theory of visual attention (TVA) can be used to estimate individual differences in five basic attentional parameters: the visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a) neglect and simultanagnosia, (b) reading disturbances, (c) aging and neurodegenerative diseases, and most recently (d) neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method's most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.

How low can you go: spatial frequency sensitivity in a patient with pure alexia

Pure alexia is a selective deficit in reading, following lesions to the posterior left hemisphere. Writing and other language functions remain intact in these patients. Whether pure alexia is caused by a primary problem in visual perception is highly debated. A recent hypothesis suggests that a low level deficit - reduced sensitivity to particular spatial frequencies - is the underlying cause. We tested this hypothesis in a pure alexic patient (LK), using a sensitive psychophysical paradigm to examine her performance with simple patterns of different spatial frequency. We find that both in a detection and a classification task, LK's contrast sensitivity is comparable to normal controls for all spatial frequencies. Thus, reduced spatial frequency sensitivity does not constitute a general explanation for pure alexia, suggesting that the core deficit in this disorder is at a higher level in the visual processing stream.

Visual processing speed in old age

Mental speed is a common concept in theories of cognitive aging, but it is difficult to get measures of the speed of a particular psychological process that are not confounded by the speed of other processes. We used Bundesen's (1990) Theory of Visual Attention (TVA) to obtain specific estimates of processing speed in the visual system controlled for the influence of response latency and individual variations of the perception threshold. A total of 33 non-demented old people (69-87 years) were tested for the ability to recognize briefly presented letters. Performance was analyzed by the TVA model. Visual processing speed decreased approximately linearly with age and was on average halved from 70 to 85 years. Less dramatic aging effects were found for the perception threshold and the visual apprehension span. In the visual domain, cognitive aging seems to be most clearly related to reductions in processing speed.

A neural theory of visual attention and short-term memory (NTVA)

The neural theory of visual attention and short-term memory (NTVA) proposed by Bundesen, Habekost, and Kyllingsbæk (2005) is reviewed. In NTVA, filtering (selection of objects) changes the number of cortical neurons in which an object is represented so that this number increases with the behavioural importance of the object. Another mechanism of selection, pigeonholing (selection of features), scales the level of activation in neurons coding for a particular feature. By these mechanisms, behaviourally important objects and features are likely to win the competition to become encoded into visual short-term memory (VSTM). The VSTM system is conceived as a feedback mechanism that sustains activity in the neurons that have won the attentional competition. NTVA accounts both for a wide range of attentional effects in human performance (reaction times and error rates) and a wide range of effects observed in firing rates of single cells in the primate visual system.

Amblyopic dyslexia: a little investigated reading disorder

We present a case of a little investigated reading disorder we call 'amblyopic dyslexia'. The reading impairment in this patient resulted from a left extrastriate and white matter lesion causing a scotomatic area of partial deficit within the right visual field. The visual deficit was consistent with cerebral amblyopia, that is, reduced form, colour, and light sensitivity without a complete loss of vision. The patient's reading deficit was characterized by accurate single letter naming and almost accurate but effortful single word reading, with no letter-by-letter strategy. The criteria for distinguishing amblyopic dyslexia from other reading disorders and the most appropriate treatment are discussed.

Too little, too late: reduced visual span and speed characterize pure alexia

Whether normal word reading includes a stage of visual processing selectively dedicated to word or letter recognition is highly debated. Characterizing pure alexia, a seemingly selective disorder of reading, has been central to this debate. Two main theories claim either that 1) Pure alexia is caused by damage to a reading specific brain region in the left fusiform gyrus or 2) Pure alexia results from a general visual impairment that may particularly affect simultaneous processing of multiple items. We tested these competing theories in 4 patients with pure alexia using sensitive psychophysical measures and mathematical modeling. Recognition of single letters and digits in the central visual field was impaired in all patients. Visual apprehension span was also reduced for both letters and digits in all patients. The only cortical region lesioned across all 4 patients was the left fusiform gyrus, indicating that this region subserves a function broader than letter or word identification. We suggest that a seemingly pure disorder of reading can arise due to a general reduction of visual speed and span, and explain why this has a disproportionate impact on word reading while recognition of other visual stimuli are less obviously affected.

Visual attention capacity after right hemisphere lesions

Recently there has been a growing interest in visual short-term memory (VSTM) including the neural basis of the function. Processing speed, another main aspect of visual attention capacity, has received less investigation. For both cognitive functions human lesion studies are sparse. We used a whole report experiment for estimation of these two parameters in 22 patients with right side stroke. Psychophysical performance was analyzed using Bundesen's [Bundesen, C. (1990). A theory of visual attention. Psychological Review, 97, 523-547] Theory of Visual Attention (TVA) and compared statistically to lesion location and size measured by MRI. Visual processing speed was impaired in the contralesional hemifield for most patients, but typically preserved ipsilesionally, even after large cortico-subcortical lesions. When bilateral deficits in processing speed occurred, they were related to damage in the right middle frontal gyrus or leukoaraiosis. The storage capacity of VSTM was also normal for most patients, but deficits were found after severe leukoaraiosis or large strokes extending deep into white matter. Thus, the study demonstrated the importance of white-matter connectivity for both VSTM capacity and ipsilesional processing speed. The study also showed that lesions in a large region of the right hemisphere, including the putamen, insula, and inferior frontal cortex, do not lead to general deficits in the capacity of visual attention.