Developmental trends and precursors of English spelling in Chinese children who learn English-as-a-second language: Comparisons between average and at-risk spellers

BACKGROUND

Invented spelling has been viewed as a window to young children's spelling development.

AIMS

This longitudinal study investigated the developmental trends in invented spelling as a function of phoneme position in very young ESL children. It also investigated cognitive-linguistic precursors of L2 spelling difficulties.

METHODS AND PROCEDURES

We identified 2 groups of spellers in kindergarten based on their invented spelling performances at the end of kindergarten: average spellers and at-risk spellers. The two groups were compared on invented spelling performance at varied phoneme positions of a word. They were also administered a battery of cognitive-linguistic tasks, including letter knowledge, phonemic awareness, vocabulary and rapid automatized naming at an earlier timepoint.

OUTCOMES AND RESULTS

Both groups performed better in invented spelling on initial consonants than on medial vowels, which in turn were better than final consonants at two time points. In addition, the average spellers improved significantly more than the at-risk spellers at all phoneme positions. Vocabulary was a significant predictor of spelling difficulties when other crucial cognitive-linguistic variables were taken into consideration simultaneously.

CONCLUSIONS AND IMPLICATIONS

The current findings suggest the unique features of invented spelling development in L2 learners and identified precursors to L2 spelling difficulties. Very young average and at-risk L2 spellers showed differential gains in L2 invented spelling. Implications of the present study are (1) invented spelling at kindergarten is able to differentiate average and at-risk spellers and (2) invented spelling training and vocabulary intervention could be useful in the remediation of spelling difficulties.

An Exploratory Study of Reading Comprehension in College Students After Acquired Brain Injury

PURPOSE

This exploratory study builds on the small body of existing research investigating reading comprehension deficits in college students with acquired brain injury (ABI).

METHOD

Twenty-four community college students with ABI completed a battery of questionnaires and standardized tests to characterize self-perceptions of academic reading ability, performance on a standardized reading comprehension measure, and a variety of cognitive functions of this population. Half of the participants in the sample reported traumatic brain injury (n = 12) and half reported nontraumatic ABI (n = 12).

RESULTS

College students with both traumatic and nontraumatic ABI cite problems with reading comprehension and academic performance postinjury. Mean performance on a standardized reading measure, the Nelson-Denny Reading Test (Brown, Fischo, & Hanna, 1993), was low to below average and was significantly correlated with performance on the Speed and Capacity of Language Processing Test (Baddeley, Emslie, & Nimmo-Smith, 1992). Injury status of traumatic versus nontraumatic ABI did not differentiate results. Regression analysis showed that measures of verbal attention and suppression obtained from the California Verbal Language Test-II (Delis, Kramer, Kaplan, & Ober, 2000) predicted total scores on the Nelson-Denny Reading Test.

CONCLUSIONS

College students with ABI are vulnerable to reading comprehension problems. Results align with other research suggesting that verbal attention and suppression problems may be contributing factors.

Musical alexia with recovery: a personal account

I describe the experience of an acute loss of ability to read music and play the piano accurately and expressively following an embolic infarct of the right angular and supramarginal gyri in a setting of chronic migraine. Other parietal deficits included a small visual field defect, visual hallucinations, prosopagnosia, topographical disorientation, disturbance of perception of velocity of moving objects and dyscalculia. Recovery began within a month of the ictus after instituting a regular practice routine. The ability to read and play polyphony recovered before the ability to read homophonic music. A substantial degree of recovery of musical function occurred within 6 months and of the other parietal deficits over a year. Failure to maintain regular practice led to marked though recoverable deterioration. An increased frequency of migraine persisted for some 18 months.

Left neglect dyslexia and the effect of stimulus duration

The present study investigated the effects of the duration of the stimulus on the reading performance of right-brain-damaged patients with left neglect dyslexia. Three Italian patients read aloud words and nonwords, under conditions of unlimited time of stimulus exposure and of timed presentation. In the untimed condition, the majority of the patients' errors involved the left side of the letter string (i.e., neglect dyslexia errors). Conversely, in the timed condition, although the overall level of performance decreased, errors were more evenly distributed across the whole letter string (i.e., visual - nonlateralized - errors). This reduction of neglect errors with a reduced time of presentation of the stimulus may reflect the read out of elements of the letter string from a preserved visual storage component, such as iconic memory. Conversely, a time-unlimited presentation of the stimulus may bring about the rightward bias that characterizes the performance of neglect patients, possibly by a capture of the patients' attention by the final (rightward) letters of the string.

Deep dyslexia and semantic errors: A test of the failure of inhibition hypothesis using a semantic blocking paradigm

Deep dyslexia is an acquired reading disorder that involves the production of semantic errors and the inability to read aloud nonwords successfully. Several explanations for this reading impairment posit multiple loci of damage to account for the various error types produced in deep dyslexia. In contrast, the failure of inhibition hypothesis suggests that damage in the phonological output lexicon alone can explain these errors. Specifically, this hypothesis proposes normal processing via orthographic and phonological reading routes, as well as an intact semantic system. However, slowed or reduced inhibitory connections result in the failure to suppress spuriously activated neighbours in the phonological output lexicon, where neighbourhood can be defined in terms of phonology, orthography, or semantics. Given a failure to inhibit semantically related candidates, semantic reading errors occur. Important to the test of this hypothesis is that it evolves several predictions that are contrary to performance observed in the normal population. In particular, semantic errors are predicted to be greater in conditions where words are blocked according to semantic category than in random presentations. In addition, a semantic interference effect is expected. The results of semantic blocking were consistent with these predictions and lend support to the failure of inhibition hypothesis.

[Neglect dyslexia owing to traumatic fronto-temporal right hemisphere bleeding]

Apart from unilateral disturbance of the egocentric reference system, as it is traditionally known of neglect, there are also cases with unilateral disturbances of a stimulus-centered or object-centered reference system. In these cases the spatial position of the object, from the observer's perspective, plays only a limited role in the explanation of the problems with object perception. We describe a patient who, following head-brain trauma and a fronto-temporal bleeding, showed, beside traditional neglect, also a stimulus-centered left-sided disorder in word and object perception. Our investigations showed that this disorder (a) is independent of the position of the object in the environmental space, (b) comprises words and objects, and (c) is especially sensitive for changes in the first letters of a word. Conclusively, it yields from this case that at least three different reference systems of object representation should be distinguished in neglect, which can be disturbed independently from each other and may negatively influence the behavioral potential of the patients.

Routes to reading: a report of a non-semantic reader with equivalent performance on regular and exception words

This study reports the case of a stroke patient, EW, who had severely-impaired comprehension of written words but could read aloud regular and exception words, non-words and sentences flawlessly. EW's auditory comprehension was also impaired. It is argued that these results support a three-route model of reading, where the phonological output lexicon can be activated directly from the orthographic input lexicon, as her reading performance did not conform to the pattern that would be expected from a combination of lexical-semantic and sublexical processing alone. It is suggested that normal reading may be better conceptualised as a summation of three routes, rather than two.

Does the spelling dyslexic read by recognizing orally spelled words? An investigation of a letter-by-letter reader

In this single case report we describe our further observations of a patient (ROC) with a classical spelling dyslexia. A word length effect and a script effect were demonstrated. No evidence of semantic processing was obtained with brief tachistoscopic presentations. Single letter identification was unimpaired. In a series of experiments it was shown that her letter-by-letter reading strategy was mediated by explicit letter naming. In particular, it was observed that with successive presentation of the individual letters there was a stepwise function relating her whole word reading to the single letter presentation times. These durations permitted explicit letter naming. When explicit letter naming was prevented by a simultaneous articulatory suppression task, her letter-by-letter reading was significantly impaired. Her performance was compared with a second patient (MRF) who could read but could not spell. His reading was unaffected by articulatory suppression and significantly impaired by a successive presentation of the individual letters of a word. It is argued that explicit letter naming provides an input to the spelling system and thus can be recognized as orally spelled words. We conclude that in the reading-impaired patient there was a lexical deficit compensated for by the operation of a component of her intact spelling system.

Alexia caused by a fusiform or posterior inferior temporal lesion

We evaluated the alexia and agraphia of three patients with different lesions using Japanese kanji (morphograms) and kana (phonograms) and made a lesion-to-symptom analysis. Patient 1 (pure alexia for both kanji and kana and minor agraphia for kanji after a fusiform lesion) made more paragraphic errors for kanji, whereas patient 2 (alexia with agraphia for kanji after a posterior inferior temporal lesion) showed severe reading and writing disturbances and more agraphic errors for kanji. Brodmann Area 37 was affected in both patients, but in patient 2 the lesion was located lateral to that in patient 1. Patient 3 showed agraphia without alexia after restricted lesion to the angular gyrus. We believe that pure alexia (patient 1) results from a disconnection between the medial fusiform gyrus and posterior inferior temporal area (the lateral fusiform and inferior temporal gyri), whereas alexia with agraphia for kanji (patient 2), corresponding to lexical agraphia in Western countries, results from damage to the posterior inferior temporal area, in which whole-word images of words are thought to be stored. Furthermore, restricted lesion in the angular gyrus (patient 3) does not produce alexia; the alexic symptom of "angular" alexia with agraphia may be the result of damage to the adjacent lateral occipital gyri.

[Acquired dyslexias and dysgraphias under the prism of cognitive neuropsychology: a model for the Spanish language]

The present paper discusses the different clinical manifestations of acquired disorders of reading and writing from a neurocognitive viewpoint. Based on a specific functional architecture of reading and writing--a cognitive model; presented as well--the different syndromes of acquired dyslexias and dysgraphias, that have been described in the specialized literature during the last 25 years, will be reviewed. The different pathologies are distributed along three different functional axes: a plurimodal component, including the semantic system, for the description of peripheric disorders of reading and writing; a lexical block which is justified by the findings in patients with surface dyslexia/dysgraphia; and a third, sublexical component, in order to illustrate the different functional impairments in phonological dyslexia/dysgraphia. Following the description of syndromes due to selective "functional lesions", we discuss deep dyslexia/dysgraphia, a syndrome due to multiple functional lesions. All of the syndromes will be justified and discussed with respect to the different components of the functional architecture presented and are based on cases of the literature and personal observations. Concluding remarks will evaluate the new insights gained by the presented functional arquitecture in relation to other cognitive models for the analysis of reading aloud and writing to dictation of single words.

The representation of sublexical orthographic-phonologic correspondences: evidence from phonological dyslexia

Although there is considerable evidence that grapheme and body units are involved in assembling phonology from print, there is little evidence supporting the involvement of syllabic representations. We provide evidence on this point from a phonological dyslexic patient (ML) who, as a result of brain damage, is relatively unable to read nonwords. ML was found to be able to perform tasks assumed to reflect processes involved in assembled phonology (i.e. segmentation, orthographic-phonologic conversion, and blending) when the units involved were syllables, but demonstrated considerable difficulty when they were onset, body, or phoneme units. Additionally, both ML and matched controls were much better able to find words in an anagrams task (Treiman & Chafetz, 1987) when they resulted from the combination of segments corresponding to syllables than when they did not. It is suggested that the relationship between print and sound is represented at multiple levels (including the syllable) (Shallice, Warrington, & McCarthy, 1983) and that ML's nonword reading impairment is the result of disruption of representations below the level of the syllable.

Visual complexity in letter-by-letter reading: "pure" alexia is not pure

Standard accounts of pure alexia have favoured the view that this acquired disorder of reading arises from damage to a left posterior occipital cortex mechanism dedicated to the processing of alphanumeric symbols. We challenge these accounts in two experiments and demonstrate that patients with this reading deficit are also impaired at object identification. In the first experiment, we show that a single subject, EL, who shows all the hallmark features of pure alexia, is impaired at picture identification across a large set of stimuli. As the visual complexity of pictures increases, so EL's reaction time to identify the stimuli increases disproportionately relative to the control subjects. In the second experiment, we confirm these findings with a larger group of five pure alexic patients using a selected subset of high- and low-visual complexity pictures. These findings suggest that the deficit giving rise to pure alexia is not restricted to orthographic symbols per se but, rather, is a consequence of damage to a more general-purpose visual processing mechanism.

Testing the direct-access model: GOD does not prime DOG

In three repetition priming experiments that employed identical (e.g., DOG-DOG) and reversed repetitions (e.g., GOD-DOG), it was found that relative to controls (e.g., DOG-DOG), GOD-type words did not prime DOG-type words. Also, neither DUT-type nor TUD-type nonwords primed DUT-type nonwords. In Experiments 1 and 2, these results occurred using both long- and short-term repetition priming conditions, respectively. In Experiment 3, the word results held under conditions of short-term priming coupled with stimulus misorientation. However, the nonword results resembled the word results (i.e., identical but not reversed repetitions primed nonwords). The failure to provide explicit evidence for direct visual access (e.g., GOD does not prime DOG while DOG does) irrespective of other sources of lexical activation supports theories of words recognition that postulate multiple and varied lexical representations that are activated through a matrix of connections.

Evolution of a form of pure alexia without agraphia in a child sustaining occipital lobe infarction at 2 1/2 years

The progress of cognitive visual dysfunction over an 8-year period of a child who sustained bilateral occipital-lobe infarctions at the age of 2 1/2 years is described. She survived with normal intelligence and went on to attend mainstream school. She manifested many features of cognitive visual impairment and, in particular, developed a form of pure alexia without agraphia. She achieved some letter-by-letter reading but no sight vocabulary development, including to her own name. She learned to write imaginatively employing phonetically true spelling but cannot read what she has written. Her progress and the difficulties encountered during the management of her condition are discussed in this first case report of the evolution of pure alexia without agraphia in childhood. The features of this syndrome in the developing child who has never developed the capacity to read are contrasted with that seen in affected adults.

Prosopagnosia and alexia without object agnosia

Following a trauma causing bilateral posterior brain damage, a patient complained of dyslexia and prosopagnosia, but not object agnosia. On testing she showed intact recognition of object drawings, even when it was assessed with perceptually demanding tasks such as Ghent's overlapping figures and Street completion test. This pattern of deficit is inconsistent with Farah's (1990) prediction that the simultaneous occurrence of alexia and prosopagnosia is invariably associated with object agnosia. The patient's reading performance had the features typically found in letter-by-letter readers. On face tests, she showed a discrepancy between the impairment exhibited in familiarity recognition and famous face naming and the correct (though slow) performance in matching the names of famous persons with their photographs. This apparent contradiction was clarified by showing that the patient had maintained the ability to generate the mental images of famous faces in response to the presentation of their names. We assume that face recognition units were intact, but partially disconnected from the output of perceptual processing.

Cognitive mechanisms for processing nonwords: evidence from Alzheimer's disease

Repetition and reading of various types of pronounceable nonwords (pseudowords) was examined in patients with probable Alzheimer's disease (AD) and healthy elderly controls. Overall accuracy of performance was lower in AD patients compared to controls, but the two groups showed qualitatively similar response patterns when reading different kinds of pseudowords aloud and when repeating pseudowords composed of familiar phonological forms, analogous to those in real English words. AD patients diverged in performance from controls, however, when repeating pseudowords composed of phonologically unusual forms. These results support two conclusions: (1) Aspects of phonological processing may become disrupted in AD patients in association with increasing dementia severity, while orthographic processing remains comparatively less impaired. (2) The results are consistent with the view that the processing of pseudowords is achieved through the same system as real words, and further show that the influence of prior language experience on the processing of novel linguistic forms occurs primarily at the level of phonological, rather than orthographic processing.

The contribution of attentional mechanisms to an irregularity effect at the graphemic buffer level

This study analyzes acquired dysgraphia observed in a French-speaking woman. The results point to an impairment of the graphemic buffer, i.e., the processing stage where abstract orthographic representations are temporarily stored while planning the written production. However, the spelling errors were more frequent in the irregular than in the regular words. A qualitative analysis of the errors in the irregular misspelled words showed that, in general, these were not "regularization" errors, but rather the same characteristics as the phonologically implausible errors found in the regular words, such as letters substitutions, deletions, additions, and transpositions. Furthermore, in a list of regular and irregular words of same length and graphemic structure, the errors not only tended to concentrate on the irregularity itself but also tended to be more frequent elsewhere in the irregular words compared to the regular words. These finding are discussed in terms of a post-lexical sensitivity to irregular spelling. It is also shown that when focusing attention on the irregularity becomes necessary, this can cause a detriment to the surrounding graphemic constituents. Interaction between attentional resources and processing of orthographic representations at the graphemic buffer level is considered.

Optic aphasia with pure alexia: a mild form of visual associative agnosia? A case study

A single-case study is reported of a naming disorder selective to the visual modality. The patient showed intact access to structural knowledge of objects and letters, but impaired access to complete semantic knowledge of objects and alphabetical knowledge of letters from visual input. The impairment was most striking when the patient had to discriminate between semantically similar objects or within a given symbolic repertoire, i.e. letters. The co-occurrence of a partial deficit of visual recognition for objects and for letters indicated features of optic aphasia and pure alexia. This symmetric performance between object and letter processing may also constitute a mild form of visual associative agnosia.

Progressive ventral posterior cortical degeneration presenting as alexia for music and words

Patients with posterior cortical atrophy may have dorsal visual system (occipital-parietal) dysfunction (optic ataxia, visuospatial disorientation, and simultanagnosia), ventral visual system (occipital-temporal) dysfunction (pure alexia, prosopagnosia, visual anomia, and agnosia), or both. We report a professional musician with ventral system dysfunction whose first symptom was alexia for music. Subsequently, she developed pure alexia for words but had preserved sorting of words. These observations suggest that the ventral visual system is important in music and word reading. However, sorting of words may be mediated by the dorsal visual system.

Reading ability as an estimator of premorbid intelligence: does it remain stable in emergent dementia?

The 6-year stability of reading performance was investigated in subjects who were normal at baseline but suspect for dementia at follow-up (MMSE score < or = 23; n = 197), and in a cognitively intact control group (n = 117). The Dutch version of the National Adult Reading Test (DART) was used. The DART-based estimate of IQ appeared to be very stable in healthy elderly. In the "suspect" group, the decline after 6 years was about 3 IQ-points in subjects who were still not demented, minimally demented, or mildly demented. Reliability remained satisfactory in these subgroups. In cases with moderate and severe dementia, the decline was considerable (> or = 15 IQ points). The decline of DART IQ was related to deterioration of semantic memory as reflected in verbal abstraction and category fluency. It is concluded that the DART remains a valid estimator of premorbid verbal intelligence in mild and questionable dementia. A formula is presented which can correct the underestimation on the basis of the MMSE score.

Sources of priming in text rereading: intact implicit memory for new associations in older adults and in patients with Alzheimer's disease

The contributions of text meaning, new between-word associations, and single-word repetition to priming in text rereading in younger and older adults, and in patients with Alzheimer's disease. (AD), were assessed in Experiment 1. Explicit recognition memory for text was also assessed. Equivalent single-word and between-word priming was observed for all groups, even though patients with AD showed impaired explicit memory for individual words in the text. The contribution of generalized reading task skill to priming in meaningless text rereading in younger adults was assessed in Experiment 2. Generalized reading task skill was also found to contribute to priming. These results reveal 3 mechanisms of priming: new between-word associations for meaningful and meaningless text, individual word repetition for meaningless text, and general task or skill factors for meaningless text. All priming mechanisms appear to be intact in older adults and in patients with AD.

Optic aphasia: evidence of the contribution of different neural systems to object and action naming

Visual stimulus naming was studied in a 66-year-old male patient with optic aphasia subsequent to left occipito-temporal infarction. While having difficulty in naming objects perceived visually, he was able to name objects by viewing gestures illustrating their use, and to name actions shown in pictures. These results suggest that naming performance depends on the kind of stimulus that is visually presented (object vs. action). The present findings lend support to congnitive models which postulate the existence of visual and functional semantic systems.

Activation of the phonological lexicon for reading and object naming in deep dyslexia

Poor oral reading in some cases of deep dyslexia could be due to difficulty in inhibiting the phonological lexical entries of words semantically related to the correct reading responses. If this is the case, then additional activation of the correct phonological entries should improve reading performance, whereas additional activation of competing entries should lead to errors. This should hold true for object naming as well as for reading, since both depend on a semantically mediated lexical route. These predictions were borne out with an "output" deep dyslexic patient, who made many semantic errors in both reading and naming. Providing phonetic cues (the initial portions of the correct responses) increased his reading and naming accuracy, and providing miscues (the initial portions of words related semantically to the correct responses) led to errors. Furthermore, when the patient was shown a printed word or pictured object and the examiner spoke a correct reading or naming response in isolation, the patient almost always accepted the response as correct, but he also judged that many semantically related foils were correct. Finally, a comparison of reading and naming errors suggested that "visual" errors may sometimes have a phonological basis.

Acquired dysgraphia in alphabetic and stenographic handwriting

We report the unusual case of AZO, who professionally used handwritten shorthand writing, and became dysgraphic after a stroke. AZO suffered from a complex cognitive impairment, and part of her spelling errors resulted from damage to auditory input processing, to phonology-orthography conversion procedures and to the ortographic output lexicon. However, analysis of her writing performance showed that the same variables affected response accuracy in alphabetic and shorthand writing; and, that the same error types, including transpositions, were observed in all tasks in the two types of writing. These observations are consistent with damage to the graphemic buffer. They suggest that, in multiple-code writing systems (e.g., stenography, Japanese, or in the case of multilingual speakers of languages that use different spelling codes), the graphemic buffer is shared by all codes.

Identification of side of seizure onset in temporal lobe epilepsy using memory tests in the context of reading deficits

Sixty patients with temporal lobe epilepsy were classified into reading deficient (RD; n = 21) and non-reading deficient (non-RD; n = 39) groups. Selective deficits in verbal or nonverbal memory, consistent with side of seizure onset, were evident in the non-RD patients. Both verbal and nonverbal memory performance were reduced equivalently in individuals with RD, regardless of side of seizure onset. As a result, memory tests that were accurate in identifying side of seizure onset in the non-RD group were not as accurate in the RD group. When individual cases were classified using a clinically applicable decision rule, significantly more RD patients were either unclassifiable or incorrectly classified than were non-RD patients. Findings suggest that preoperative memory data obtained from individuals with epilepsy and evidence of RD may not be as valid an indicator of side of seizure onset as are those obtained from patients without RD.

Reading speed in pure alexia

This study investigated possible causes of differences in reading speed between two alexic patients who read words letter by letter. As both patients appeared to rely on serial left-to-right processing of letters within words, the difference in reading speed did not seem to be related to any differences in the extent to which the patients could recognize letters in words in parallel or 'ends-in'. Differences in reading speed also seemed to be unrelated to the patients ability to identify individual letters since their letter recognition accuracy was very similar. Furthermore, although patient PD was significantly slower at reading words aloud than patient DC, PD was in fact significantly quicker than DC on a test that has previously been used to assess letter recognition skills in letter-by-letter readers. It is therefore concluded that PD reads words more slowly because of an additional impairment at the level of the word form system. The results therefore reinforce the distinction between Type 1 and Type 2 letter-by-letter readers that was first drawn by Patterson and Kay.

Reading lexically without semantics: evidence from patients with probable Alzheimer's disease

Recent modifications of the lexical model of oral reading make the prediction that under conditions where sublexical reading processes alone cannot achieve the target pronunciation (i.e., when words have exceptional spellings or when sublexical processes are impaired), patients with severe semantic impairment should have more difficulty reading aloud semantically impaired words than semantically retained words. In a battery of lexical-semantic and reading tasks, two neurologically normal control subjects and two subjects with probable Alzheimer's disease (AD) and only moderate semantic impairment read aloud all words accurately. One AD subject with severe semantic impairment was impaired in word reading but demonstrated no difference in reading words with regular and exceptional spellings. Another AD subject with severe semantic impairment read aloud without error virtually all regular and exception words. Neither severely impaired AD subject demonstrated any relationship between oral reading accuracy and semantic knowledge of exception words. These findings support a model of word reading incorporating lexical, nonsemantic processes by which lexical orthographic input representations directly activate lexical phonological output representations without the necessity of semantic mediation.

Response biases in oral reading: an account of the co-occurrence of surface dyslexia and semantic dementia

This paper reports a case study of a subject (EP) with a progressive impairment of semantic memory and a coincident surface dyslexia. These two disorders frequently occur together, but their association is not readily explained within current models of reading. This study investigated two theories that offer different principled accounts of this association, the "semantic glue hypothesis" (Patterson & Hodges, 1992) and the "summation hypothesis" (Hillis & Caramazza, 1991) and found both hypotheses wanting. Instead it was shown that when vestiges of word meaning remained, a lexical response was preferred, but when meaning was lost entirely, the evidence derived from sublexical processing appeared to bias selection of the response towards the regularized form.

Dyscalculia and dyslexia after right hemisphere injury in infancy

OBJECTIVE

To use the findings from neuropsychological evaluation and functional magnetic resonance imaging (fMRI) to assess interhemispheric reorganization of function after early unilateral brain injury.

DESIGN AND METHODS

The study focused on one case of early brain injury that resulted in both dyscalculia and dyslexia. Brain injury was studied using both structural and fMRI. Intellectual function was evaluated using the Wechsler Intelligence Scale for Children, Third Edition, while visuospatial skills were assessed using the Block Design subtest of the Wechsler Intelligence Scale for Children, Third Edition, and Judgment of Line Orientation subtest. The Selective Reminding Test and the Recurring Figures Test were used to evaluate memory and orientation; language and speech skills were evaluated using the Boston Naming Test, Controlled Oral Word Association, Gates-MacGinitie Reading Test, and color naming. Various methods were used to study arithmetic skills, including the Wide Range Achievement Test-Revised and the Peabody Individual Achievement Test. The control group for fMRI consisted of nine normal subjects.

SETTING

Neuropsychological laboratory in primary care hospital.

PATIENT

A 17-year-old boy who had sustained a closed head injury associated with a partially depressed, right parietal skull fracture, and right temporal hemorrhage in a motor vehicle crash at age 7 months (November 9, 1977). Subsequent social behavior was normal, but the patient had difficulty throughout school in mathematics and spelling and was characterized as having a "short attention span."

INTERVENTION

None.

MAIN OUTCOME MEASURES

Standardized tests of arithmetic and reading supplemented by an assessment of calculation and quantitative skills. While performing calculations, fMRI disclosed predominantly left hemisphere activation involving the frontal and posterior parietal regions, whereas this task produced bilateral activation of the supramarginal gyrus in seven of nine normal subjects.

RESULTS

Neuropsychological findings confirmed the presence of dyscalculia and dyslexia despite normal intellectual functioning. Visuospatial skills ranged from the low normal to average level. The fMRI findings were consistent with early interhemispheric transfer of visuospatial skills normally committed to the right parietal area to the left parietal region. The patient's dyscalculia and reading ability raise a question of acquired left parietal dysfunction as a consequence of the competition between verbal and visuospatial functions for left hemisphere representation.

CONCLUSION

Interhemispheric reorganization of function may be bidirectional rather than a feature unique to the left hemisphere substrate for language.

Further evidence that reading ability is not preserved in Alzheimer's disease

BACKGROUND

Pre-morbid intelligence level is routinely assessed in Alzheimer's disease using the National Adult Reading Test (NART). This practice is based on the assumption that pronunciation of irregular words remains unaffected by the disease process. Recent reports have suggested that reading ability may become compromised in moderately demented subjects.

METHOD

Sixty-eight probably Alzheimer patients were classified into stages of severity (minimal, mild and moderate) using the Mini-Mental State Examination (MMSE). NART and demographic equations were used to estimate pre-morbid ability.

RESULTS

A significant correlation emerged between dementia severity and reading ability, NART v. MMSE scores, r = 0.46, P < 0.01. When the total sample was subdivided into moderate, mild and minimal subgroups, significant between-group differences emerged, despite the groups being well matched for age, sex, and years of full-time education. Pre-morbid IQ, as estimated by demographic regression equations, did not correlate with dementia severity.

CONCLUSION

NART performance is compromised in moderate Alzheimer disease, and the measure provides a serious underestimate of pre-morbid IQ in patients with an MMSE of 13 or less.

A longitudinal study of reading ability in patients suffering from dementia

The aim of this study was to investigate whether reading is a preserved ability in patients suffering from dementia, as was first suggested by Nelson and McKenna (1975). The 57 patients included in the study had possible or probable Alzheimer's disease or similar degenerative conditions and were assessed longitudinally. Their performance on the National Adult Reading Test [(NART); Nelson, 1982, 1991] is compared to that on a shortened version of the WAIS-R. It is found that although performance on the NART does decline gradually over time, the deterioration on formal tests of IQ is more rapid and more severe. It seems that the decline in reading across the group is due to those patients who have a lower verbal IQ (VIQ) than performance IQ (PIQ). It is concluded that generally the NART can be used as a predictor of the premorbid intellectual functioning of a patient with dementia, given that the VIQ is greater than PIQ.

Objects and properties: a study of the breakdown of semantic memory

This paper reports a study of the breakdown of semantic memory in the case of a subject with semantic dementia. The first experiment shows that the subject failed to comprehend words of low familiarity and word frequency, even though the spoken word forms were recognised as familiar. Experiments 2 and 3 showed (a) that the recall of word meanings in definition tasks did not vary with the generality of the word meaning (e.g. category, basic level, or subordinate property) but varied instead with the concept familiarity and frequency of the name; (b) that the ability to verify properties of basic-level objects was not affected by the ability to comprehend the property name, but depended instead on the degree of knowledge demonstrated for the object name in definition tasks; (c) that properties were frequently verified correctly when the object had been defined only to the superordinate level. It is argued that the results do not support the widely held view that, in general, specific information is lost first when semantic memory breaks down. The selective failure to recall specific information for some word meanings is discussed with reference to two theoretical accounts.

The compositionality of lexical semantic representations: clues from semantic errors in object naming

We present evidence that semantic errors in object naming can arise not only from impairment to the semantic system but also from damage to input and output processes. Although each of these levels of disruption can result in similar types of semantic errors in object naming, they have different types of consequences for performance on other lexical tasks, such as comprehension and naming to definition. We show that the analysis of the co-occurrence of semantic errors in naming with different patterns of performance in other lexical processing tasks can be used to localise the source of semantic errors in the naming process. Finally, we argue that the similarity of semantic errors in object naming, resulting from damage to different components of the naming processes by which they are activated by visual input, as well as the processes by which they activate output representations.

Investigating semantic memory impairments: the contribution of semantic priming

The semantic priming task is a valuable tool in the investigation of semantic memory impairments in patients with acquired disorders of language. This is because priming performance reflects automatic or implicit access to semantic information, unlike most other tests of semantic knowledge, which rely on explicit, voluntary access. Priming results are important for two main reasons: First, normal priming results may be observed in patients who perform poorly on other semantic memory tests, enabling us to distinguish between loss of, or damage to, information in semantic memory, and voluntary access to that information. Second, we can investigate the detailed pattern of loss and preservation of different types of semantic information, by charting the priming effects for different kinds of words, and different kinds of semantic relations between primes and targets. We discuss the use of the priming task in this context, and address some of the theoretical and methodological criticisms that have been raised in connection with use of the priming task to address these issues. We then describe two recent studies in which we have employed semantic priming tasks, along with other more traditional methods, to investigate specific questions about the semantic memory deficits of three patients.

Contrasting effects of letter-spacing in alexia: further evidence that different strategies generate word length effects in reading

The reading behaviour of two alexic patients (SA and WH) is reported. Both patients are severely impaired at reading single words, and both show abnormally strong effects of word length when reading. These two symptoms are characteristic of letter-by-letter reading. Experiment 1 examined the pattern of errors when the patients read large and small words. Further experiments examined the effects of inter-letter spacing on word naming (Experiments 2a and 2b) and the identification of letters in letter strings (Experiment 3). For both patients, letter identification was better for widely spaced letters in letter strings, and this effect was most pronounced for the central letters in the strings. This is consistent with abnormally strong flanker interference in letter identification. However, inter-letter spacing affected word reading behaviour in the two patients in different ways. SA's word reading improved with widely spaced letters; WH's word reading was disrupted. This suggests that these patients adopted different strategies when reading words. We conclude that several reading behaviours can elicit word length effects, and that these different behaviours can reflect strategic adaptation to a common functional deficit in patients. We discuss the implications both for understanding alexia and for models of normal word identification.

Knowledge, implicit knowledge and metaknowledge in visual agnosia and pure alexia

Residual or implicit knowledge has been observed in patients with object agnosia, optic aphasia and pure alexia. Previous investigators have considered implicit knowledge in these patients to be dissociated from awareness on the basis of intact semantic capabilities that are consistent with right hemisphere processing. The absence of explicit verbal identification is presumably dependent upon damaged left hemisphere systems. We describe a 72-year-old woman with a left occipital infarction, object agnosia and pure alexia who was unable to explicitly identify visual stimuli (objects and words), but was able to make reliable judgements of her residual knowledge on forced-choice matching tasks. While the patient could not consistently demonstrate awareness of knowledge prior to stimulus matching ('Do you know what this is?'), she was able to reliably demonstrate awareness of knowledge for response accuracy ('Are you sure?') assessed after stimulus matching. Further, the extent of the patient's metaknowledge corresponded to her degree of preserved knowledge. We propose that this pattern of performance suggests limited or partial access to preserved semantic knowledge which, though degraded, is not 'non-conscious'.

Selective deficit in processing double letters

This paper reports a patient with a selective difficulty in spelling words and pseudowords with geminate (double) consonants. In all writing tasks, deletions of a geminate consonant occurred ten times more often than deletions of a consonant in a non-geminate cluster. In addition, the probability of substituting both geminate consonants was indistinguishable from the probability of substituting one consonant in a non-geminate cluster; and, the probability of substituting only one geminate consonant was close to zero, and significantly lower than the probability of substituting one consonant in a non-geminate cluster. This pattern of performance is consistent with the hypothesis that grapheme quantity and identity are separately represented in orthographic representations. The fact that these errors occurred in the absence of a significant number of geminate transpositions is interpreted as support for the hypothesis that letter gemination is specified by a "doubling feature."

Looking with one's mind's eye

On the basis of clinical cases reported in the literature, an attempt is made to show that conscious mental representations of written words have a left-right dimension similar to their counterparts in the physical world. They may, therefore, be affected by unilateral neglect in much the same way as words on a written or printed page. Usually, real words and their representations run in the same direction. However, in some cases, they appear to run in opposite directions and this may result in the production of mirror writing.

[Alexia-agraphia of kanji (Japanese morphogram) after left posterior-inferior temporal lesion]

Several cases of selective alexia with agraphia of kanji have been reported in Japan in this decade. It is well known that the lesion in the posterior inferior temporal lobe of the dominant hemisphere is responsible for this cognitive syndrome. Neuropsychological data in our patient suggest that the postero-inferior region of the temporal lobe of the dominant hemisphere may be the visuo-verbal association area for the analysis of the complex visuo-verbal information. The symptoms caused by the same lesion in western patients might be subangular alexia (alexia without agraphia). Alexia with agraphia of kanji and subangular alexia would appear to be distinct entities, but a dual processing hypothesis of visuo-verbal information and the concept of the visuo-verbal association area might well explain both syndromes.

Semantic memory and reading abilities: a case report

We document the unexpected dissociation of preserved reading skills in a patient with severely impaired semantic memory. The common co-occurrence between impairment of word meaning and surface dyslexia has not been observed. The patient (hereafter called DRN) had marked naming and word comprehension difficulties. A strong word frequency effect was observed on tests of word comprehension but was absent in a test of word reading. DRN's ability to read both regular and exception words that he failed to comprehend was remarkably well preserved. We will argue that these findings provide further support for the independence of semantic and phonological processing.

Lexical factors in the word-superiority effect

In the Reicher-Wheeler paradigm, fluent readers can identify letters better when they appear in a word than when they appear in either a pronounceable pseudoword (a lexicality effect) or a single letter (a word-letter effect). It was predicted that if both of these effects involve a lexical factor, then adult acquired dyslexic subjects whose deficit prevents access to visual word form should show disruptions of the normal effects on the Reicher-Wheeler task. The results were that dyslexic subjects as well as matched control subjects showed a lexicality effect; however, while the control subjects showed a normal word-letter effect, the dyslexic subjects showed a reverse letter-superiority effect. Both effects, however, showed a systematic variation: As performance on lexical decision improved, the subjects' performance on words in the Reicher-Wheeler task was better than that for all the other conditions. These subject correlations were replicated by using data from a second lexical decision experiment, which utilized the same words and pseudowords that were used in the Reicher-Wheeler task. In addition, an item analysis showed that the words that the subjects had discriminated correctly in lexical decision showed a significant advantage over those that they had not, as well as an improvement relative to the other conditions. These results suggest that there is a lexical factor underlying the lexicality and word-letter effects, and it is proposed that the abnormal letter-superiority effect can be accounted for as the manifestation of other competing factors.

[Alexia without agraphia in the Arabic language. Neurolinguistic and and MRI study]

A 33 year-old woman developed an alexia without agraphia, a color anomia, a right hemianopia, an aphasic amnesia and a verbal amnesia. The brain MRI showed the lesions in the left splenium of corpus callosum, forceps major, optic radiations and anterieur temporal lobe. The fact that she measured writing comprehension and had complete recovery of reading impairment despite the persistence of anatomic lesions plead in favour of an active participation of the right hemisphere (RH) on reading; this capacity of the RH may be due to the linguistic particularities of arabic writing.

Reading of letters and words in a patient with Balint's syndrome

A patient with bilateral parietal damage, and Balint's syndrome, named visual letters. These were presented individually or within four-letter strings. Solitary letters were identified very accurately. In the case of strings, more letters were correctly reported for words than for nonwords, and more for pronounceable than for unpronounceable nonwords. When required to read words as a whole, performance was better than predicted by letter-reports. These results extend the object-based limitation apparent in Balint's syndrome to the case of reading. The component letters of a string benefit when they form a familiar global object, rather than requiring representation as multiple separate objects. The patient occasionally made homophonic errors when listing the letters in a visual word. This suggests an attempt to bypass visual simultanagnosia by treating the string as a single object, deriving a holistic phonological code for it, and then decomposing this into component letters via spelling rules.

Transcortical alexia with agraphia following a right temporo-occipital hematoma in a right-handed patient

We describe the case of a 51-year-old right-handed man who was affected by a transcortical alexia with agraphia and aphasia. Transcortical alexia produces errors in both reading and writing while copying is preserved. The patient had a severe alexia and was unable to read letters, words or sentences. Language examination showed mild aphasia with reduced fluency, intermittent paraphasia but a good comprehension and a normal repetition. Spontaneously and from dictation, writing was impaired by an agraphic jargon, but copying was excellent even though the patient was unable to read his own written production. There was no visual agnosia nor hemianopia. CT scan and MRI of the brain showed that there was a single right temporo-occipital hemorrhage but no lesion in the left hemisphere. Following surgical evacuation of the hematoma, the patient improved. One month after onset, his language was quite intact and reading was possible. We hypothesize that this particular syndrome was the result of a double disconnection: alexia would result from a disconnection of the right angular gyrus and the occipital associative areas by a subangular lesion; agraphia would result from a disconnection of the right angular gyrus and the semantic store, probably located in the right hemisphere.

Associative visual agnosia and alexia without prosopagnosia

Disagreement over the neuroanatomical substrate of associative visual agnosia encompasses such basic issues as: (1) the necessity for bilateral lesions; (2) the intrahemispheric locus of damage; and (3) the roles of disconnection versus cortical damage. We examined three patients whose associative visual agnosia encompassed objects and printed words but spared faces. CAT scans revealed unilateral dominant occipitotemporal strokes. CAT scans of four previously reported cases with this same profile of associative agnosia were obtained. Dominant parahippocampal, fusiform and lingual gyri were the most extensively damaged cortical regions surveyed and were involved in all cases. Of white matter tracts surveyed, only temporal white matter including inferior longitudinal fasciculus was severely and universally involved. Splenium of the corpus callosum was frequently but not always involved. We conclude there is a form of associative visual agnosia with agnosia for objects and printed words but sparing face recognition which has a characteristic unilateral neuropathology. Damage or disconnection of dominant parahippocampal, fusiform and lingual gyri is the necessary and sufficient lesion.

Visual repetition priming for words relies on access to the visual input lexicon: evidence from a dyslexic patient

In this study we tested the hypothesis that visual repetition priming for words depends upon the accessibility of lexical units in the visual input lexicon. For this purpose, we investigated a dyslexic patient, A.M., whose neuropsychological performances suggested an impaired access to the lexical route of reading. According to the predictions, Experiments 1 and 2 demonstrated deficient priming in tests involving the visual presentation of words (Word Identification and Stem Completion). In Experiment 3, we demonstrated that A.M.'s deficient priming was specific for visually presented words, in that the auditory presentation elicited a normal priming effect (auditory Stem Completion). These data are discussed in the light of a theoretical framework suggesting a fractionation of the modalities by which repetition priming can be elicited, each mediated by a particular memory subsystem.

Pure dysgraphia with relative sparing of lower-case writing

We describe the cognitive analysis of a patient with acquired pure dysgraphia. She presented a peculiar dissociation between lower- and upper-case handwriting: lower-case writing was relatively spared and showed a significant superiority of words versus nonwords. Upper-case writing and oral spelling did not show lexical effects, but were affected by item length. In all modalities errors consisted mainly of single graphemic substitutions, deletions, insertions and transpositions, resulting in legal or illegal nonwords, and showed a similar distribution across letter positions. These findings were suggestive of an impairment of the graphemic output buffer, which however revealed itself to different degrees in the two handwriting styles.

Agnosia, alexia and a remarkable form of amnesia in an adolescent boy

Childhood cases of global anterograde amnesia, visual agnosia or alexia without agraphia, either alone or in any combination, are extremely rare. Here we report the case of a male adolescent, Neil (a pseudonym), who consequent to a pineal tumour began to exhibit all three disorders in the presence of normal verbal intelligence. The most surprising aspect of Neil's case, however, is his ability to retrieve postmorbid memories through the act of writing without being able to provide any oral account of the content of his written reports. His memory retrieval thus has some of the character of 'automatic writing'. This evidence pointing to Neil's possession of a dissociated form of episodic memory presents a new challenge to our understanding of the organization of memory and of the cerebral systems underlying it.

Syndromes of acquired dyslexia and patterns of recovery: a 6- to 10-year follow-up study of seven brain-injured people

Seven subjects who were neurologically impaired following encephalitis (n = 2), head injury (n = 3), and stroke (n = 2) were referred several years previously because of acquired dyslexia. Two were almost totally alexic, 2 were surface dyslexic, 2 were deep dyslexic and 1 was a letter-by-letter reader. Following a period of rehabilitation, the 2 with alexia became surface dyslexic and letter-by-letter readers; 1 of the deep dyslexics showed some improvements but remained a deep dyslexic; and the letter-by-letter reader learned to read more quickly. At follow-up, 6 to 10 years later, there had been little significant change. The 2 subjects whose alexia resolved into surface dyslexia with letter-by-letter reading had increased their reading ages but remained surface dyslexic and letter-by-letter readers. The subject who had been a letter-by-letter reader was faster at easier and more frequently used words but slower at harder, less frequently used words. Changes in the other 4 subjects were negligible. Implications for rehabilitation are discussed.

Nonconscious reading? Evidence from neglect dyslexia

In this study we present evidence which supports the view that reading mechanisms, if implicit assessed, are available also in the presence of a severe deficit of spatial awareness. A Stroop-like task was performed by a right brain-damaged patient affected by severe extrapersonal neglect and neglect dyslexia. In reading words and color words, the patient showed the usual pattern of neglect errors; omission, substitution and addition errors. However, when asked to name the colors in which color words were written, naming time was found to be affected by the meaning of those words he was not able to read correctly. The pattern of results in MD and in a group of normal subjects, who performed a modified version of the Stroop test performed by MD, have been interpreted as evidence of MD's implicit reading of the left-hand letters of color words during the Stroop test. The theoretical implications of this finding are discussed. Moreover, the comparison between the performance of MD and the performance of another group of normal subjects suggested that implicit processing in MD was carried out at a lower level of efficiency than in normals.