The continuum of deep/surface dyslexia

Alexia With and Without Agraphia: An Assessment of Two Classical Syndromes

Background:

Current cognitive models propose that multiple processes are involved in reading and writing.

Objective:

Our goal was to use linguistic analyses to clarify the cognitive dysfunction behind two classic alexic syndromes.

Methods:

We report four experiments on two patients, one with alexia without agraphia following occipitotemporal lesions, and one with alexia with agraphia from a left angular gyral lesion.

Results:

The patient with occipital lesions had trouble discriminating real letters from foils and his reading varied with word-length but not with linguistic variables such as part of speech, word frequency or imageability. He read pseudo-words and words with regular spelling better, indicating preserved use of grapheme-to-phoneme pronunciation rules. His writing showed errors that reflected reliance on ‘phoneme-to-grapheme’ spelling rules. In contrast, the patient with a left angular gyral lesion showed better recognition of letters, words and their meanings. His reading was better for words with high imageability but displayed semantic errors and an inability to use ‘grapheme-to-phoneme’ rules, features consistent with deep dyslexia. His agraphia showed impaired access to both an internal lexicon and ‘phoneme-to-grapheme’ rules.

Conclusion:

Some cases of pure alexia may be a perceptual word-form agnosia, with loss of internal representations of letters and words, while the angular gyral syndrome of alexia with agraphia is a linguistic deep dyslexia. The presence or absence of agraphia does not always distinguish between the two; rather, writing can mirror the reading deficits, being more obvious and profound in the case of an angular gyral syndrome.

When does a deep dyslexic make a semantic error? The roles of age-of-acquisition, concreteness, and frequency

Semantic reading errors are the central and defining feature of deep dyslexia. This study compared the words the deep dyslexic patient LW read correctly with those she omitted and those to which she produced semantic errors in terms of their concreteness, age-of-acquisition, frequency, and length. Semantic errors were made to less concrete, later-acquired, and shorter words than were read correctly; there was no reliable effect of word frequency. More importantly, the actual semantic errors produced were later-acquired than the stimulus words, but they were not more concrete or reliably more frequent. These results implicate age-of-acquisition in the process that produces semantic errors. It is proposed that concreteness determines the specificity of the semantic system to activate a set of candidate responses and that age-of-acquisition biases the ease with which certain words can be selected from this set to be produced as reading responses.