Impairment of right brain-damaged patients on a linguistic cognitive task

Effects on cognition of 20-day anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex in patients affected by mild cognitive impairment: a case-control study

BACKGROUND

Mild cognitive impairment (MCI) is a common disorder affecting as much as 15% of the elderly population. Transcranial direct current stimulation (tDCS) is a non-invasive technique of neuromodulation that has proven to influence performance in different cognitive domains.

OBJECTIVE/HYPOTHESIS

We investigated the effects on cognition of 20-day anodal tDCS in 17 MCI patients compared with 17 matched MCI patients.

METHODS

Patients underwent neuropsychological evaluation at baseline and then were randomly assigned to the anodal or sham group. The tDCS protocol consisted in 20 min, 5 days per week (up to a total of 20 days), of 2-mA anodal stimulation over the left dorsolateral prefrontal cortex (DLPFC). The location of anodal electrode was chosen in accordance with previous reports which relate anodal stimulation of this site with cognitive enhancement. At the end of the last day of stimulation, a second neuropsychological evaluation was performed. We compared baseline and post-stimulation neuropsychological results in the anodal vs sham group using repeated measures ANOVA as a statistical analysis test.

RESULTS

At follow-up, patients exposed to anodal stimulation showed improvement in episodic verbal memory (p < 0.001) and figure naming test (p < 0.01), in a general index of cognitive function (Brief Mental Deterioration Battery) (p < 0.0001) and in a mood measurement test (Beck Depression Inventory) (p < 0.01).

CONCLUSION

Anodal tDCS could be a useful tool to improve cognitive symptoms in MCI although more evidence is needed to understand the exact underlying mechanisms. Confirmation of its potential benefits in MCI would be significant.

Impaired performance of right-brain-damaged patients on a sentence anagram task

A sentence anagram task was used to examine the right cerebral hemispheres's role in core grammatical functioning at the syntactic level. The test consisted of two subsets of stimuli involving empty categories: (a) those that required the empty category to be filled, and (b) those that allowed the category to remain empty. Three hypotheses were presented: (1) right-brain-damaged patients (RBDs) would be more sensitive to subset (a) than (b), (2) RBDs would perform similarly to left-brain-damaged subjects, and (3) non-brain-damaged controls would outerperform both brain-damaged groups. With all hypotheses supported, the discussion focuses on an explanation for RBDs' sensitivity to the first subset of stimuli.

Memory and encoding of spoken discourse following right hemisphere damage: evidence from the Auditory Moving Window (AMW) technique

We investigated the hypotheses that impaired discourse processing following right hemisphere damage is mediated by task difficulty and is associated with deficits in discourse encoding. Spoken discourse passages differing in contextual predictability were presented to right hemisphere-damaged (RHD) patients and to non-brain-damaged (NBD) controls for subsequent recall using the Auditory Moving Window paradigm. To manipulate processing difficulty, speech segments were of normal or accelerated speech rates. The recall results showed that RHD adults recalled less than NBD controls overall and failed to recall major idea units better than minor idea units for high predictability passages presented at accelerated speech rates. Both RHD patients and NBD controls failed to recall major idea units better than minor idea units for low predictability passages, regardless of speech rate. The encoding results showed that RHD adults were both slower overall and differentially slower than NBD controls when listening to accelerated passage segments. Taken together, the encoding and recall results are consistent with the view that extracting passage gist under difficult listening conditions is especially vulnerable for patients with right hemisphere strokes.

Factor analysis of an outcome interview for use in clinical trials of traumatically brain-injured patients: a preliminary study

OBJECTIVE

To study the factor structure, internal consistency, concurrent validity, and sensitivity to detect change in patient report of problems of a structured interview in relationship with accepted outcome measures.

DESIGN

Outcome status of patients with severe traumatic brain injury participating in a randomized, phase III, multicenter clinical trial was assessed at 6 mo postinjury using the Glasgow Outcome Scale, the Disability Rating Scale, and the Severe Traumatic Brain Injury Outcome Interview.

RESULTS

Exploratory factor analysis of the Severe Traumatic Brain Injury Outcome Interview produced a meaningful five-factor model: (1) activities of daily living; (2) cognitive; (3) affective; (4) behavioral; and (5) instrumental activities of daily living. The internal consistency of the factors ranged from moderate (0.61 instrumental activities of daily living) to high (0.94 activities of daily living); the interfactor correlations were moderate. The summed factor scores were significantly correlated with measures of global outcome: the Glasgow Outcome Scale (r = 0.66; P < 0.0001) and the Disability Rating Scale (r = 0.61; P < 0.0001). Patient report of cognitive problems correlated moderately with the neuropsychological tests. The summed factor scores were sensitive to change over time.

CONCLUSIONS

Overall, the interview assessed the major important features of outcome pertinent to traumatic brain injury and demonstrated greater sensitivity to subtle changes over time than the unidimensional approaches, such as the Glasgow Outcome Scale and Disability Rating Scale.

Topography of evoked brain activity during mental arithmetic and language tasks: sex differences

We studied visual information processing using two different tasks in a group of 10 female and 10 male healthy, right-handed adults. Subjects solved arithmetic tasks shown sequentially on a computer monitor, and they also compared words presented as anagrams. The experimental design allowed us to compare the effects of reading or actively processing a given stimulus. Task difficulty was varied in three steps ('easy', 'medium', 'hard') after an independent group of 81 young adults had judged the stimulus material according to difficulty by answering questionnaires. Brain activity was recorded from an array of 30 electrodes extending from the inion to 5% anterior of F2. For each subject mean potentials were averaged off-line after screening the EEG for artifacts. Components were determined quantitatively as epochs of stable topography resulting in 10 independent components occurring within 1200 ms after stimulus onset. Significant effects were seen with field strength and scalp topography: simply reading the stimuli yielded significantly smaller amplitudes than when the subjects actively processed the same stimuli. Females had consistently larger global field power than males, and they also displayed different scalp field topography of various components. In addition, processing anagrams was accompanied by larger field strength than mental arithmetic. The scalp field distributions were also affected by sex, task type and difficulty indicating the activation of different neuronal assemblies during visual information processing of males and females. Many effects were seen at short latencies in the order of 70-120 ms indicating very early selective processing of visual stimuli where specific differences were introduced by sex and task parameters.

The effects of lateralized temporal lobe dysfunction on formal and semantic word fluency

Word fluency performance was studied in 32 patients with unilateral temporal lobe epilepsy (TLE) and 25 healthy dextral controls. Two word fluency tasks were administered conforming to either formal-based criteria or semantic-based criteria. Performance for TLE patients was assessed both pre-operatively and approximately 1 week following anterior temporal lobectomy. Both formal and semantic word fluency decreased regardless of resection laterality. Left TLE patients performed significantly worse at both pre- and post-operative assessments compared to the right TLE patients, while right TLE patients performed significantly poorer than controls on all verbal fluency criteria at pre- and post-operative assessments. In addition, both TLE and control groups produced significantly fewer formal and semantic words during the second 30-sec portion of each task. These findings are discussed in terms of temporal lobe contributions to word fluency production and lexical semantic processing.

Apparent shift in visual field preference after unilateral stroke

Patients with either a left- or a right-hemisphere stroke lesion scored higher in tasks of word-picture matching and of nonverbal shape matching when information was presented tachistoscopically (120 msec) to the visual field (VF) projecting to their undamaged hemisphere. Left-hemisphere stroke patients (n = 13) were dissociated from right-hemisphere stroke patients (n = 15) by low word recognition from memory and by low right VF but nearly normal left VF accuracy in word-picture matching or shape matching; the former appeared to rely upon processing of word meaning by the right hemisphere. In contrast, right-stroke patients had higher right than left VF scores in both tasks, and their discrimination of nonverbal shapes via the right VF was not different from that of controls (n = 15). Preferred processing by the VF projecting to the undamaged hemisphere appeared as a shift in perceptual asymmetry but may indicate, in support of a "direct access" model, that each hemisphere responds more or less efficiently to word and to nonverbal shape discriminations.

Stimulus categorization by brain-damaged patients

Patients with localized insult to the right hemisphere, or to either the anterior or the posterior portion of the left hemisphere, as well as neurologically intact controls, evaluated stimuli on a seven-point rating scale for their degree of category membership. The stimuli were taken from one of two continua, one composed of fruit and vegetable items, and the other of items differing in hue and shape. Different subsets of stimuli provided different contexts for the judgments of category membership. The two left-hemisphere groups showed anomalies in categorizing the fruit and vegetable items but not the perceptual items, while the reverse was true for the right-hemisphere patients. Moreover, both left-hemisphere groups demonstrated context effects in their judgments of the representativeness of the fruit and vegetable items, but differed in the way in which they responded to changing contexts. Left posterior patients demonstrated weak category boundaries and even reclassified items. In contrast, patients with left anterior damage showed highly categorical responses and less differentiation of items within a category. All groups showed striking context effects in judgments of perceptual items in terms of changes in representativeness ratings and the location of a category boundary. Alternative interpretations of the results are offered.

Does reversed laterality really exist in dextrals? A case study

We report a case of a right-handed patient who, after a massive left-hemisphere infarction, had neuropsychological disturbances compatible with a right-hemisphere lesion. This has been previously called 'reversed laterality'. Two new aspects of this pattern are described: the right hemisphere is as capable as the left in processing complex syntactic and higher psycholinguistic stimuli; reversed laterality is not complete, ideomotor praxis is the only function that does not follow an inverted representation. The existence of different forms of cerebral organization in dextrals is discussed.

The transmission of information in natural systems

An isomorphism of information storage and transmission in natural systems is presented. First, a structural and functional dichotomy found in the control centres of the predominant systems in the physical, biological and psychological realms is outlined. The dichotomy of control is shown to allow for an intrinsic balance between the preservation of a system's information, on the one hand, and its alteration and usage, on the other. It is then shown that the mechanisms of communication between the control centre elements are isomorphic among these diverse systems. That is, the transmission of information from one control element to another entails its "double-inversion", which allows for the retrieval of the information in its original form by means of a second transfer process. This mechanism of information transmission leads to novel conclusions concerning the nature of the "brain code".

Callosal inhibition: the key to the brain code

A mechanism for interhemispheric communication is proposed based upon the assumption of homotopic callosal inhibition. The implied pattern of cortical activity in each cerebral hemisphere is shown to be the mirror-image and "photographic negative" of the contralateral pattern. Mirror-imagery is a direct consequence of (1) approximate cerebral hemispheric bilateral symmetry and (2) homotopic callosal connections. The photographic negative relationship is a direct consequence of (1) bilaterally symmetrical activation of the cortex via subcortical "attentional" mechanisms and (2) inhibition by a unilaterally established engram of an identical cortical pattern contralaterally. In language generation and understanding, excitation predominantly in the left hemisphere produces on the right inhibition of language-related neurons as well as excitation of all surrounding "contextual" neurons. The suggested dichotomy of verbal and contextual functions of the cerebral hemispheres is shown to be supported by previous findings concerned with cognition in brain-damaged patients. Unlike earlier suggestions of linguistic and paralinguistic specializations in the left and right, the mirror-image negative hypothesis is based upon an explicit physiological process rather than unspecified differences in "information processing."