Ideogram writing in a disconnection syndrome

A case of disconnection-type agraphia coupled with alexia was reported. The patient showed several asymmetrical manual capacities between the two hands, i.e., dissociated difficulty of Kanji (ideogram) writing between the two hands, left unilateral difficulty of Kana (phonogram) writing, right unilateral dyscopia of letters as well as geometrical figures, and right unilateral difficulty in drawing without a model. Anatomically, lesions involved most of the corpus callosum in its posterior portion including the splenium and the left medial occipital lobe. From these data, a possible liguistic capacity of the right hemisphere was suggested.     

Subcortical functions in language: A working model

The current paper explains a model of subcortical language functions that focuses on dynamic interactions between the cortex, the thalamus, and the basal ganglia in the production of spoken language. The model was derived from (a) studies of subcortical lesions and language, (b) studies of subcortical stimulation and language, (c) knowledge regarding neural pathways between various cortical and subcortical structures, and (d) indications that preverbal monitoring of language occurs. In the current model, the thalamus plays roles in cortical arousal and activation and in preverbal semantic monitoring. The basal ganglia function to regulate the degree of excitation conveyed from the thalamus to the cortex and to time the release of formulated language for motor programming. Consistency with classical syndromes of aphasia and potential applications to other areas in the neurosciences are discussed. The current theory, unlike previous formulations, is specific enough that testable hypotheses can be derived.     

Comprehension of directly and indirectly stated main ideas and details in discourse by brain-damaged and non-brain-damaged listeners

Aphasic, right-hemisphere-damaged, and non-brain-damaged subjects heard short narrative paragraphs. Each paragraph contained four main ideas and one or more details related to each main idea. After each paragraph was presented, subjects' comprehension and retention of main ideas and details from the paragraph were tested. Some of the test items directly restated information from paragraphs and others paraphrased information from paragraphs. All groups of subjects remembered main ideas better than they remembered details, and no group of subjects was significantly affected by whether test items directly or indirectly stated information from paragraphs. Disfluent aphasic and right-hemisphere-damaged subjects' overall paragraphs comprehension scores were not significantly poorer than those of non-brain-damaged subjects. Fluent and mixed aphasic subjects' overall paragraph comprehension scores were significantly worse than those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores. right-hemisphere-damaged subjects' overall paragraph comprehension scores were not significantly those of non-brain-damaged and right-hemisphere-damaged subjects. Token Test and Boston Diagnostic Aphasia Examination auditory comprehension scores did not predict aphasic subjects' paragraph comprehension scores.     

Comprehension of main ideas and details in coherent and noncoherent discourse by aphasic and nonaphasic listeners

Aphasic and nonaphasic listeners' comprehension of main ideas and details within coherent and noncoherent narrative discourse was examined. Coherent paragraphs contained one topic to which all sentences in the paragraph related. Noncoherent paragraphs contained a change in topic with every third or fourth sentence. Each paragraph contained four main ideas and one or more details that related to each main idea. Listeners' responses to yes/no questions following each paragraph yielded the following results: (1) Nonaphasic listeners comprehended the paragraphs better than aphasic listeners. (2) Both aphasic and nonaphasic listeners comprehended main ideas better than they comprehended details. (3) Coherence did not affect comprehension of main ideas for either group. (4) Coherence did not affect comprehension of details by nonaphasic subjects. (5) Coherence affected comprehension of details by aphasic subjects, and their comprehension of details in coherent paragraphs was worse than their comprehension of details in noncoherent paragraphs. There was no significant correlation between Token Test scores and measures of paragraph comprehension.     

The processing of the sounds and meanings of ongoing speech by aphasic subjects

The ability of aphasic subjects to process the sounds and meanings of ongoing speech was tested. Subjects, 10 aphasic and 20 control, heard test sentences which contained one member of phonemically similar word pairs in one of three semantic contexts: congruent, neutral, and noncongruent. Immediately after hearing a sentence, subjects were to indicate which member of the word pair had been in the sentence. All subject groups had similar overall patterns of response to the different semantic contexts. The division of aphasic subjects into groups of high and low comprehenders revealed response differences. High comprehending aphasic subjects, like control subjects, demonstrated interactive processing of the sounds and meaning of speech while low comprehending aphasic subjects did not.     

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.     

Gerstmann syndrome without aphasia: a longitudinal study

A case of "pure" and complete Gerstmann syndrome resulting from a focal vascular lesion in the posterior parietal area of the left hemisphere and not associated with aphasic disorder or general mental impairment is described. The initial symptom presentation of this patient supported the concept of the autonomous nature of the Gerstmann aggregate but longitudinal findings suggested that these symptoms did not in fact represent a coherent syndrome.     

Processes of verbal memory failure in Alzheimer-type dementia

Multiple aspects of verbal learning and memory performance in mild as compared to moderate Alzheimer-type dementia (ATD) were studied with the Buschke selective reminding paradigm. Results show that (1) both groups of ATD subjects depend less on long-term memory (LTM) and more on short-term memory (STM) relative to elderly control subjects, (2) mild ATD subjects show less LTM encoding than moderate ATD subjects, (3) moderate ATD subjects retrieve a smaller portion of the items presumed to be encoded into LTM than do mild ATD subjects, and (4) high-imagery words increase LTM encoding and retrieval as compared to low-imagery words for moderate ATD subjects only. These results are explained by the inability of ATD subjects to attend to more than one component of the list-learning task, in conjunction with differences in the deployment of attention between mild and moderate ATD subjects.     

An experimental analysis of exposure to “explicit” heterosexual stimuli as an effective variable in changing arousal patterns of homosexuals

The effect of exposure to explicit heterosexual stimuli on heterosexual arousal was experimentally analyzed in four homosexuals in a series of single case experimental designs. Each subject was sequentially exposed to films of female or male sexual content under positive therapeutic instructions. Penile response to female slides in separate measurement sessions increased during exposure to the female film, decreased during exposure to the male film, and increased once again when the female film was reinstated. The increase in penile response to female stimuli was paralleled in many instances by changes in masturbatory fantasy, reports of arousal and heterosexual behavior outside the laboratory. Increasing heterosexual arousal had little effect on homosexual responsivity. Results are discussed in terms of exposure facilitating extinction of avoidance responses toward females and providing new sexual fantasy content.     

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.     

Self-monitoring behavior in a case of severe auditory agnosia with aphasia

This case report describes an unusual combination of speech and language deficits secondary to bilateral infarctions in a 62-year-old woman. The patient was administered an extensive series of speech, language, and audiologic tests and was found to exhibit a fluent aphasia in which reading and writing were extremely well preserved in comparison to auditory comprehension and oral expression, and a severe auditory agnosia. In spite of her auditory processing deficits, the patient exhibited unexpected self-monitoring ability and the capacity to form acoustic images on visual tasks. The manner in which she corrected and attempted to correct her phonemic errors, while ignoring semantic errors, suggests that different mechanisms may underlie the monitoring of these errors.     

Development of differences in response latencies to right and left visual fields

Robust lateralization developed in right-handed adults who were asked to judge letter pairs as "same" or "different" during 4608 trials. By the end of the first two blocks (768 trials) "same" responses were favored when presented in the RVF (transmitted directly to the left hemisphere) and "different" responses were favored when presented in the LVF (transmitted direction to the right hemisphere). This gradually reversed over sessions with "same" responses becoming faster for letters presented in the LVF, and "different" responses becoming faster for stimuli presented in the RVF. The laterality acquired under these conditions was cumulative and reproducible, appeared in all 16 subjects, and was preserved between sessions a week apart. The data suggest that laterality is a flexible and reversible characteristic of the human brain even when stimulus and task remain constant.     

Psychometric and CT scan measurements in a case of crossed aphasia in a dextral

A case of crossed aphasia with lesion deep to the right supramarginal gyrus was studied to determine (1) if this patient behaved similar to patients with the same lesion site in the left hemisphere, (2) if visuospatial deficits were present, and (3) if the CT scan asymmetries were similar to those of other right-handers. Speech and language skills were similar to those patients with similar lesions in the left hemisphere. Visuospatial and arithmetic deficits were similar to those described after right-hemisphere and left-hemisphere damage. CT scan asymmetries were atypical. These results provide behavioral and neuroradiological confirmation of atypical hemispheric dominance.     

Reconstructive retrieval deficits in Broca's aphasia

Anterior aphasic patients' ability to utilize the phonemic and/or semantic features of verbal material for retention purposes was investigated. In the first experiment, patients were asked to either detect word repetitions, phoneme repetitions, or rhymes in a list of items. The aphasics performed well on word and phoneme repetition detection but below both normals and amnesic Korsakoffs on rhyme detection. In the second experiment the patients were instructed to analyze either the physical, phonemic, or semantic features of words they were later asked to recognize. Aphasics were differentially affected (as were normals) by these instructions: semantic feature analysis resulted in the best performance, followed by phonemic feature analysis. It was concluded that anterior aphasics can analyze, recirculate, and even store the phonemic features of words, but find difficulty in reconstructing the originally presented item from these features.     

Time for auditory processing of object names by aphasics

Ten Wernicke's and ten Broca's aphasics were compared with normal controls and brain-damaged nonaphasics with respect to the time required for the auditory decoding of object names. This value was obtained by using a subtraction method with two reaction time determinations, one of which included an auditory processing phase while the other did not. The overall mean of approximately 200 msec for Broca's aphasics did not differ significantly from the normal, while the mean of 650 msec for the Wernicke aphasics was much slower. All groups responded more quickly to high-frequency than low-frequency words and all but the Wernicke aphasics improved in the second trial block over their performance in the first trial block.     

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.