Varieties of alexia from fusiform, posterior inferior temporal and posterior occipital gyrus lesions

Reading impairments of three alexia patients, two pure alexia and one alexia with agraphia, due to different lesions were examined quantitatively, using Kanji (Japanese morphogram) words, Kana (Japanese phonetic writing) words and Kana nonwords. Kana nonword reading was impaired in all three patients, suggesting that widespread areas in the affected occipital and occipitotemporal cortices were recruited in reading Kana characters (corresponding to European syllables). In addition, the findings in patient 1 (pure alexia for Kanji and Kana from a fusiform and lateral occipital gyri lesion) and patient 2 (pure alexia for Kana from a posterior occipital gyri lesion) suggested that pure alexia could be divided into two types, i.e. ventromedial type in which whole-word reading, together with letter identification, is primarily impaired because of a disconnection of word-form images from early visual analysis, and posterior type in which letter identification is cardinally impaired. Another type of alexia, alexia with agraphia for Kanji from a posterior inferior temporal cortex lesion (patient 3), results from deficient whole-word images of words per se, and thus should be designated "orthographic alexia with agraphia". To account for these impairments, a weighted dual-route hypothesis for reading is suggested.     

Unilateral agraphia after section of the posterior half of the truncus of the corpus callosum

A Japanese patient who had undergone section of the posterior half of the truncus of the corpus callosum in the process of removing an arteriovenous malformation was examined with a battery of special tests. He showed agraphia only with the left hand (unilateral agraphia). The agraphia was more prominent for the words written in Kana characters (phonograms) than for the words written in Kanji characters (ideograms). The patient showed neither unilateral apraxia, nor tactile alexia, nor tactile anomia.     

Alexia with agraphia due to the left posterior inferior temporal lobe lesion--neuropsychological analysis and its pathogenetic mechanisms

We report three cases of alexia with agraphia due to the left posterior inferior temporal lesions. In Case 1, the reading disability was more prominent in the use of Kana than in the use of Kanji, which is similar to previously reported cases of alexia with agraphia due to angular gyrus lesion. In Cases 2 and 3, by contrast, the reading disability was more prominent in the use of Kanji than in the use of Kana. In spontaneous writing and dictation, the disability was more pronounced in the use of Kanji compared with the use of Kana. In each of the three cases, the CT scan and positron emission tomography showed a localized lesion in the lower part of the left posterior temporal lobe. A typical form of an alexia with agraphia could be caused not only by the left angular lesion but also by the left posterior inferior temporal lesion. We discuss the neuropsychological analysis and pathogenetic mechanisms of alexia with agraphia due to the left posterior inferior temporal lesion in the comparison of alexia with agraphia caused by the left angular lesion.     

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.     

Progressive agraphia can be a harbinger of degenerative dementia

By investigating three patients with progressive agraphia, we explored the possibility that this entity is an early sign of degenerative dementia. Initially, these patients complained primarily of difficulties writing Kanji (Japanese morphograms) while other language and cognitive impairments were relatively milder. Impairments in writing Kana (Japanese syllabograms), verbal language, executive function, visuo- and visuospatial cognition and memory were identified by neuropsychological testing. The agraphia was compatible with a peripheral type, based on deficits at the interface between the central letter selection and the graphemic motor execution (Patient 1) or at the stage of central letter selection as well (Patients 2 and 3). Agraphia was generally more prominent, although not exclusive, for Kanji probably because of later acquisition and larger total number of Kanji letters leading to lower frequency of use and familiarity per letter. Concurrent or subsequent emergence of non-fluent aphasia, ideomotor apraxia, executive dysfunction and asymmetric akinetic-rigid syndrome in two patients suggested degenerative processes involving the parietal-occipital-temporal regions, basal ganglia and striato-frontal projections. We propose that progressive agraphia may be one of the early symptoms of degenerative dementia such as corticobasal degeneration.     

Transient beneficial effects of excitatory theta burst stimulation in a patient with phonological agraphia after left supramarginal gyrus infarction

We report a patient showing isolated phonological agraphia after an ischemic stroke involving the left supramarginal gyrus (SMG). In this patient, we investigated the effects of focal repetitive transcranial magnetic stimulation (rTMS) given as theta burst stimulation (TBS) over the left SMG, corresponding to the Brodmann area (BA) 40. The patient and ten control subjects performed a dictational words and nonwords writing task before, and 5 and 30 min after they received excitatory intermittent TBS (iTBS) over the left BA 40, the right hemisphere homologous to BA 40, the Wernicke’s area, or the primary visual cortex.ITBS over the left SMG lead to a brief facilitation of phonological non-words writing to dictation. This case study report illustrates that rTMS is able to influence, among other language functions, the phonological loading processes during the written language production in stroke patients.     

Is lesion of Exner's area linked to progressive agraphia in amyotrophic lateral sclerosis with dementia? An autopsy case report

Agraphia, as a neuropsychological symptom of ALS, especially ALS with dementia (ALS-D), has recently attracted more attention. However, the brain lesion responsible has not been identified. Here we present an autopsy case of ALS-D of a patient with obvious agraphia, without aphasia, that also presented cerebrospinal degeneration with TDP-43-pathology compatible with ALS-D. Of the pre-motor frontal lobe cortices, degeneration and immuno-histochemical pathology were most obvious in the caudal area of the left middle frontal gyrus, or Exner's area. Assuring this area plays a pivotal role in the kanji and kana formation used in writing the Japanese language, this case of ALS-D showed both agraphia and Exner's area stressed pathological lesions. It may thus be the first case to indicate an intimate relationship between the neuropsychological symptoms and an associated lesion for ALS-D.     

A case study of an English-Japanese bilingual with monolingual dyslexia

We report the case of AS, a 16 year-old English/Japanese bilingual boy, whose reading/writing difficulties are confined to English only. AS was born in Japan to a highly literate Australian father and English mother, and goes to a Japanese selective senior high school in Japan. His spoken language at home is English. AS's reading in logographic Japanese Kanji and syllabic Kana is equivalent to that of Japanese undergraduates or graduates. In contrast, his performance in various reading and writing tests in English as well as tasks involving phonological processing was very poor, even when compared to his Japanese contemporaries. Yet he has no problem with letter names or letter sounds, and his phoneme categorisation is well within the normal range of English native speakers. In order to account for our data that show a clear dissociation between AS's ability to read English and Japanese, we put forward the ‘hypothesis of granularity and transparency'. It is postulated that any language where orthography-to-phonology mapping is transparent, or even opaque, or any language whose orthographic unit representing sound is coarse (i.e. at a whole character or word level) should not produce a high incidence of developmental phonological dyslexia.     

押韵加工的认知神经机制

押韵是指一对词语中从最后一个发音的元音到词尾的语音结构均相同的现象。现有押韵加工主要分为押韵识别与押韵产生两个研究领域,两者的认知加工过程相似,包括字形编码、形音转换、语音表征与语音分段等阶段。从语音加工与字形加工两方面对押韵过程的神经基础进行探讨,发现左半球颞上回与额下回分别负责语音表征与语音分段,左半球梭状回参与着字形编码,而有效的形音转换依赖于左半球顶下小叶与额下回组成的神经网络。今后应进一步整合不同研究方法与任务下的研究结果,并对押韵产生加工进行更深入的探讨。     

Reactive cognitive-control processes in free-report consonant–vowel dichotic listening

The relevance of cognitive-control processes has been frequently discussed and studied in the context of dichotic listening. Experimental and clinical studies indicate that directing attention to either of the two simultaneously presented phonological stimuli, but especially to the left-ear stimulus increases the requirements for cognitive-control processes. Here, we extend this view by reporting the results of a behavioural and a functional magnetic-resonance imaging (fMRI) experiment designed to analyse the involvement of cognitive-control processes also in a free-report dichotic-listening paradigm. It was hypothesised that dichotically presented pairs of stop–consonant–vowel syllables would provide different demands for cognitive-control processes as a function of the spectro-temporal overlap of the two stimuli. Accordingly, in Experiment 1 it was shown that dichotic syllables of high (e.g., /ba/ and /ga/) as opposed to low spectro-temporal overlap (e.g., /ba/ and /ka/) produce significantly faster and more correct answers, and are more often perceived as one syllable. In Experiment 2 it was further shown that pairs of low as compared to high spectro-temporal overlap trigger a more pronounced activation predominately in left-hemispheric, speech-associated brain regions, namely left posterior inferior sulcus/gyrus, bilaterally in pre-supplementary motor and mid-cingulate cortex as well as in the inferior parietal lobe. Taken together, behavioural and functional data indicate a stronger involvement of reactive cognitive control in the processing of low-overlap as opposed to high-overlap stimulus pairs. This supports the notion that higher-order, speech-related cognitive-control processes also are involved in a free-report dichotic-listening paradigm.     

Neural correlates of temporal auditory processing in developmental dyslexia during German vowel length discrimination: an fMRI study

This fMRI study investigated phonological vs. auditory temporal processing in developmental dyslexia by means of a German vowel length discrimination paradigm (Groth, Lachmann, Riecker, Muthmann, & Steinbrink, 2011). Behavioral and fMRI data were collected from dyslexics and controls while performing same-different judgments of vowel duration in two experimental conditions. In the temporal, but not in the phonological condition, hemodynamic brain activation was observed bilaterally within the anterior insular cortices in both groups and within the left inferior frontal gyrus (IFG) in controls, indicating that the left IFG and the anterior insular cortices are part of a neural network involved in temporal auditory processing. Group subtraction analyses did not demonstrate significant effects. However, in a subgroup analysis, participants performing low in the temporal condition (all dyslexic) showed decreased activation of the insular cortices and the left IFG, suggesting that this processing network might form the neural basis of temporal auditory processing deficits in dyslexia.     

Effective brain connectivity in children with reading difficulties during phonological processing

Using Dynamic Causal Modeling (DCM) and functional magnetic resonance imaging (fMRI), we examined effective connectivity between three left hemisphere brain regions (inferior frontal gyrus, inferior parietal lobule, fusiform gyrus) and bilateral medial frontal gyrus in 12 children with reading difficulties (M age=12.4, range: 8.11-14.10) and 12 control children (M age=12.3, range: 8.9-14.11) during rhyming judgments to visually presented words. More difficult conflicting trials either had similar orthography but different phonology (e.g. pint-mint) or similar phonology but different orthography (e.g. jazz-has). Easier non-conflicting trials had similar orthography and phonology (e.g. dime-lime) or different orthography and phonology (e.g. staff-gain). The modulatory effect from left fusiform gyrus to left inferior parietal lobule was stronger in controls than in children with reading difficulties only for conflicting trials. Modulatory effects from left fusiform gyrus and left inferior parietal lobule to left inferior frontal gyrus were stronger for conflicting trials than for non-conflicting trials only in control children but not in children with reading difficulties. Modulatory effects from left inferior frontal gyrus to inferior parietal lobule, from medial frontal gyrus to left inferior parietal lobule, and from left inferior parietal lobule to medial frontal gyrus were positively correlated with reading skill only in control children. These findings suggest that children with reading difficulties have deficits in integrating orthography and phonology utilizing left inferior parietal lobule, and in engaging phonological rehearsal/segmentation utilizing left inferior frontal gyrus possibly through the indirect pathway connecting posterior to anterior language processing regions, especially when the orthographic and phonological information is conflicting.     

Computer‐based teaching of Kanji construction and writing in a student with developmental disabilities

Students with developmental disabilities often have difficulty with writing skills such as tracing, copying, and dictation writing. A student with writing difficulties participated in the present study, which used computer‐based teaching applied in the home. We examined whether a student could copy Japanese Kanji characters after training with a constructed response matching‐to‐sample (CRMTS) procedure. The procedure was designed to teach identity Kanji construction. The results showed that the student not only acquired the constructed responses through this procedure but also to spelling generalized to copy trained and untrained Kanji characters. The results are discussed in terms of the effect of the CRMTS procedure on the acquisition and transfer of writing characters and the applicability of computer‐based home teaching. Copyright © 2008 John Wiley & Sons, Ltd.     

Dissociating semantic and phonological maintenance using fMRI

Functional magnetic resonance imaging (fMRI) distinguished regions of neural activity associated with active maintenance of semantic and phonological information. Subjects saw a single word for 2 sec, and following a 10-sec delay, made a judgment about that word. In the semantic task, subjects focused on the meaning of the word and decided whether a second word was synonymous with it. In the phonological task, subjects repeated the word silently and decided whether it shared a vowel sound with a nonsense word. Analyses allowed for isolation of neural activity during the maintenance delay. Semantic maintenance elicited greater activity in bilateral inferior frontal gyrus and left middle temporal gyrus regions of interest (ROI). In contrast, there was greater activity for phonological maintenance in the left superior parietal ROI. These results show a frontal-temporal network involved in actively maintaining the meanings of words, and they indicate that semantic and phonological maintenance processes are dissociable within working memory.     

Writing with the right hemisphere

We studied writing abilities in a strongly right-handed man following a massive stroke that resulted in virtually complete destruction of the language-dominant left hemisphere. Writing was characterized by sensitivity to lexical-semantic variables (i.e., word frequency, imageability, and part of speech), semantic errors in writing to dictation and written naming, total inability to use the nonlexical phonological spelling route, and agrammatism in spontaneous writing. The reliance on a lexical-semantic strategy in spelling, semantic errors, and impaired phonology and syntax were all highly consistent with the general characteristics of right hemisphere language, as revealed by studies of split-brain patients and adults with dominant hemispherectomy. In addition, this pattern of writing closely resembled the syndrome of deep agraphia. These observations provide strong support for the hypothesis that deep agraphia reflects right hemisphere writing.     

发展性阅读障碍语音缺陷的脑科学研究及对阅读教学的启示

阅读障碍语音缺陷是阅读障碍的关键原因之一。脑科学研究发现,拼音文字系统中阅读障碍者在语音加工的神经机制上存在缺陷,相关脑区包括颞—顶—枕联合区和额下回;而汉语阅读障碍者语音加工时,激活的脑区和拼音文字系统阅读障碍者激活的脑区不同,涉及左额中回和右脑一些皮层。基于此,提出了相应的阅读教学建议。     

Semantic access in number processing investigated with Japanese Kanji and Kana numerals

In number processing, semantic representations are efficiently activated. These representations frequently affect task performance, as demonstrated by semantic effects such as the distance effect (longer reaction times to closer numerical pairs in comparison tasks). The objective of this study was to investigate whether efficient semantic access is a distinctive feature of number processing using the Japanese language. Japanese was chosen to investigate possible effects of ideographic processing and word frequency: Kanji numerals in Japanese are ideograms and are used frequently, while Kana numerals are phonograms and are used infrequently. The results confirmed a distance effect in the numerical and physical matching tasks with both Arabic and Kanji numerals regardless of notation or task (Experiment 1). However, the effect was not observed with the Kana pairs (Experiment 2), thereby suggesting that semantic access is not always efficient in number processing. The results can be explained coherently within a general framework of word recognition by assuming that both the type of character and the word frequency play a critical role in determining the efficiency of semantic access.