Left-handers show greater test-retest variability in auditory and visual asymmetry

Left-right difference scores were analyzed for groups left- and right-handed subjects administered the same dichotic listening and visual half-tests on four separate days. The left-handed subjects showed greater test to test variability than the right handers for both modalities.     

Alexia and agraphia with spared spelling and letter recognition abilities

A patient with alexia and agraphia had intact spelling and comprehension of spelled words and used a letter-naming strategy to read and write. We propose that there is a graphemic area important for distinguishing graphemic features and for programming movements used in writing. In this patient this area was not functioning or did not have access to the area of visual word imagés. Therefore, he used an ideographic letter-naming strategy to verbally circumvent his disability and gain access to the area of visual word images.     

Selective involvement of the auditory-verbal modality in an acquired communication disorder: Benefit from sign language therapy

A 39-year-old female suffered bitemporal infarctions and exhibited an unusual behavioral syndrome of muteness and impaired auditory comprehension, with milder aphasic deficits in reading and writing. The anatomic basis of this modality-selective communication disorder appeared to involve both peripheral perceptual and motor as well as “central” language mechanisms. The patient's ability to communicate was greatly aided by instruction in Amerind and Ameslan Sign Language, in which she learned more than 100 signs. Patients whose acquired language deficits spare modalities of input or output may be ideal candidates for sign language therapy.     

The effect of voice and place among aphasic, nonaphasic right-damaged, and normal subjects on a metalinguistic task

Aphasic, nonaphasic right-damaged, and normal subjects sorted triads of stop consonants into pairs adjudged most similar. All groups sorted on the basis of linguistic features, but differed in their use of place versus voice: Normal and right-damaged subjects used place and voice equally often; aphasics relied significantly more upon voice than upon place. These results are interpreted to reflect an alteration at the level of linguistic representation in aphasics and not simply a perceptual difficulty. It is suggested that this altered representation stems from aphasics' extended use of normal linguistic capacities of the right hemisphere.     

Intrusions and perseverations

Twenty-two subjects with presumed senile dementia of the Alzheimer's type (SDAT), twenty-two with dementia other than SDAT, twenty with aphasia, and seventeen healthy controls over 50 years of age were examined for intrusions and perseverations. Perseverations were defined as the immediate inappropriate repetition of a prior response whereas intrusions were defined as the inappropriate repetition of prior responses after intervening stimuli. Intrusions and perseverations occurred in demented and aphasic subjects, but were rare in controls. Intrusions occurred most often in SDAT or Wernicke aphasia, but also in dementia other than SDAT. Intrusions were not correlated with dementia severity. Intrusions are a useful sign of dementia, but they cannot be considered pathognomonic of SDAT. They appear to arise when subjects are unable to access correct responses from long-term memory and instead substitute erroneous responses selected from short-term memory. Perseverations were most common in the Wernicke aphasics and subjects with dementia due to communicating hydrocephalus. Although frontal lobe dysfunction is prominent in communicating hydrocephalus, it is absent in cases of Wernicke aphasia. Thus, we have confirmed prior suggestions that perseveration can occur in the absence of frontal lobe injury. Failure to self-monitor speech as well as an inability to change mental set probably plays an important role in the genesis of perseverations. There was no statistically significant correlation between dementia severity and number of perseverations. Low correlations were found between intrusions and perseverations suggesting that these seemingly similar behaviors are distinct and are probably produced by separate neuropsychological mechanisms.     

Mirror-reading in right- and left-handers

In mirror-reading, words are read from right to left and letters are read in a reverse right-to-left orientation. In one experiment we compared the ability of normal right- and left-handed subjects to mirror-read and found that the left-handers made fewer errors and could read mirror print more rapidly. In a second experiment we attempted to learn whether there is a hemifield superiority for reading mirror words and whether there are any differences between left- and right-handers in a hemifield. We found that although both right- and left-handers more rapidly detected mirror words projected to the left visual half-field, there were no differences between groups. However, in the right visual half-field, the performance of left-handers was superior to that of the right-handers. The results of the hemifield study suggest that left-handers may be superior at reading mirror words because they can more easily reverse their scanning pattern.     

A case of subcortical dementia due to sarcoidosis of the hypothalamus and fornices

A patient with sarcoidosis involving predominantly the hypothalamus and fornices was evaluated for dementia. He showed a relative sparing of fund of knowledge and orientation. Memory skills, particularly short-term memory, were severely impaired. Behavioral changes included apathy and a lack of spontaneity. Insight was relatively preserved. The pattern of his deficits showed some similarities to the pattern reported in patients with Huntington's disease and was different from that described in Alzheimer's disease. The dementia caused by subcortical pathology may differ in important respects from that caused by diffuse cortical dysfunction.     

Spontaneous translation and language mixing in a polyglot aphasic

The literature on language mixing in polyglot aphasics is reviewed and a case report of a patient with spontaneous translation is presented. A microgenetic model of language processing provides an interpretive framework for language mixing and spontaneous translation as symptoms of polyglot aphasia. It is suggested that language mixing reflects a deficit at the linguistic level while spontaneous translation reflects a deficit at the prelinguistic level of language processing. A hypothesis about the organization of multiple languages in a single speaker is proposed.     

Visual problem solving in the absence of lexical semantics: Evidence from dementia

A case of dissociation between visual and praxic skills and linguistic, referential, and semantic skills is described in a case of dementia. Testing revealed that her visual processing was intact and that she was capable of a wide range of visually based tasks. These included copying geometric figures and block designs; matching items on the basis of number, color, or relative size, matching upper and lower case letters, sequencing numerals, orienting pictures, coins, and letters appropriately, and solving problems based on the identification of geometric patterns or on the identification of logical sequences based on pattern alternation, number, and size increases. In contrast, she was completely incapable of matching pictures on the basis of their semantic or referential meaning; similarly she had lost all comprehension of language. It was argued that this case demonstrates the capacities of a visual system cut off from all symbolic and semantic processes. When examined with other case studies this case provides information about the nature of and interaction between modality-specific perceptual processing and semantic processing, and information about the various cognitive factors involved in visual gnosis. The CT scan indicated frontal atrophy and marked anterior temporal atrophy, a pattern that is consistent with Pick's disease. The case was discussed in terms of the correlation between the pattern of observed strengths and deficits and the neurological pattern of atrophy.     

Dementia in Parkinson disease: A neuropsychological analysis

An extensive set of neuropsychological measures was administered to 60 Parkinson's disease patients and age-, sex-, and education-matched controls in order to investigate the nature and prevalence of the cognitive deficit in the disease. Parkinsonian patients performed significantly poorer on all measures with the exception of tests for apraxia and object recognition, and on a test of vocabulary knowledge. Discriminant analysis of the test data revealed that over 93% of patients are impaired relative to matched controls, but that assigning a prevalence rate for dementia in the disease may be difficult due to the continuous distribution of cognitive deficits.     

Multiple component agraphia in a patient with atypical cerebral dominance: an error analysis

A 52-year-old man with atypical cerebral dominance (left-handed for writing but mixed handedness for other tasks) suffered an extensive right hemisphere stroke, resulting in a combination of deficits that has not been previously reported. There were profound visual constructive and visual perceptual disturbances and a spatial agraphia, which were consistent with a nondominant hemisphere lesion. There was also a severe apraxic agraphia, which is typically associated with a dominant hemisphere lesion, but no other signs of dominant hemisphere dysfunction such as linguistic disturbance or limb-motor apraxia were present. This case serves to highlight the functional and anatomical relationship between handwriting and other forms of praxis; the various sources of error in letter formation; the need to be specific in labeling and describing agraphias ; and the role of a detailed analysis of writing errors in delineating the neuropsychological processes involved in handwriting.     

Effects of erotic stimuli on sexually functional and dysfunctional women: Multiple measures before and after sex therapy

A group of 11 women entering sex therapy for treatment of low arousal, and a comparison group of 11 women experiencing no arousal deficit, viewed an erotic film, listened to an erotic audiotape, and engaged in sexual fantasy during two experimental sessions. Session I occurred pre-treatment for the low arousal group. Session II occurred post-treatment. The adequate arousal group was tested at comparable points in time. Sexual arousal was measured subjectively by self-rating and physiologically by a vaginal photoplethysmograph. Contrary to expectation, the two groups showed equivalent significant increases in physiological response during the erotic stimuli in both sessions. However, the adequate arousal group rated subjective arousal significantly higher than the low arousal group in Session I, while no difference was found between the groups in Session II. Significant correlations were present between physiological response and ratings of several affective reactions to the audiotape, though few significant correlations were found between physiological and subjective sexual arousal measures. These data indicate a discrepancy between genital responses and ratings of sexual arousal for which several interpretations are offered.     

Altered patterns of word associations in dementia and aphasia

The word associations of 38 demented, 17 aphasic, and 22 normal subjects were studied. Both normal and brain-injured subjects appear to make judgments about the grammatical class of the word stimulus. Certain stimulus words (especially nouns and adjectives) elicit paradigmatic responses whereas other words (especially verbs and adverbs) elicit syntagmatic responses. The mechanism producing syntagmatic responses seems relatively resistant to deterioration in dementia or aphasia. However, in dementia the mechanism that generates paradigmatic responses becomes progressively less efficient (possibly due to a loss of semantic markers) and consequently more random (idiosyncratic) responses emerge. Perseverative responses, inhibited in normal subjects, are more prevalent in dementia. Anomic aphasics show a pattern of word associations similar to that of subjects with mild dementia. Broca's aphasics, while making fewer paradigmatic associations than normals, retain enough self-monitoring mechanisms so that few idiosyncratic and perseverative responses are made while more null responses occur. Wernicke's aphasics show a marked shift away from a paradigmatic word association strategy, possibly due to an inability to access semantic markers or a true loss of these markers. Metalinguistic deficits (i.e., a failure to adopt an appropriate strategy) may also contribute to this shift away from paradigmatic associations. Furthermore, a disruption of self-monitoring mechanisms in Wernicke's aphasia leads to an increase in perseverative and idiosyncratic responses.     

Right-hemispheric language evidence from cortical stimulation

While the left-hemispheric dominance for language in most right-handers is unquestionable, clinical observations suggest that the right, nondominant hemisphere has a considerable capacity for language. Under certain neuroanatomical conditions, the right-hemispheric capacity becomes functional and, thus, measurable. This study focuses on evoked language responses during electrical stimulation of the right hemisphere in three left-dominant patients undergoing temporal lobe resections for medically intractable seizures.     

A within-subject analysis of stimulus control therapy with severe sleep-onset insomnia.

Stimulus control, a behavioral technique designed to reduce sleep difficulties, has been demonstrated to be effective when compared with control procedures. These comparisons, mainly involving between-subjects analyses, have neglected the contribution of the stimulus control procedure to the production of clinically significant amelioration of sleep dysfunction. In contrast, the present within-subjects experiment was conducted to assess the capability of stimulus control to produce clinically relevant reductions in multiple measures of sleep disturbance. A comparison with the credible placebo procedure indicated that the stimulus control techniques reduced subjects' sleep onset latency to a mean latency below 30 min per week. Additionally, sedative-hypnotic usage was greatly reduced.