Correlation between EEG and auditory perceptual measures in auditory agnosia

We describe a child who acquired a gradual sustained speech deficit for which no specific etiology was found, and who had an associated epileptogenic abnormality on EEG. Assessment of auditory perceptual skills and receptive language confirmed that gradual parallel improvement occurred with the EEG after therapeutic anticonvulsant blood levels were obtained. Prospective trials of anticonvulsant drugs in conjunction with serial measures of central auditory abilities are necessary to establish their value in the management of the linguistic deficit in children with auditory agnosia.     

Developmental auditory agnosia in retarded adolescents: A preliminary investigation

Four mentally retarded adolescents who showed little or no expressive or receptive language were given a series of tests to determine if they could respond to meaningful nonlinguistic sounds. The tests required the subjects to respond to sounds on the basis of meaning by classifying the sounds according to the objects which produced them, i.e., the sound sources. The results show that the subject could not classify the sounds on the basis of their source although they could discriminate between them. These results are in contrast to the near perfect classification by another retarded subject who lacked speech due to a motor disorder but, nevertheless, showed good understanding of language. The finding that some nonverbal children have difficulty in responding to the meaning of nonlinguistic sounds suggests the possibility that the failure of these children to develop language may have been due to an agnosia not unlike that found in adult stroke patients.     

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.     

Developmental auditory agnosia in the severely retarded: A further investigation

The hypotheses were investigated that (a) ability to recognize the auditory perceptual stimuli for familiar events is a developmental correlate to language acquisition and (b) the low functioning mentally handicapped suffer from auditory agnosia and are impaired in this ability. The subjects were 42 nonretarded children of ages 3 through 6 and 53 severely and moderately retarded, noninstitutionalized students. The retarded subjects were matched by mental age to the chronological age of the nonretarded children. The stimuli were 49 environmental sounds; the task consisted of sound-and-picture matching-to-sample. Group membership and developmental age were the factors in an analysis of variance design. The results revealed a strong effect of developmental age (p <. 0001). The effect of group was not significant, indicating that auditory agnosia may not be common among the lower functioning retarded. The assumption that agnosia may be a major factor underlying the language disability of the severely retarded was reexamined. It was suggested that the severely retarded achieve the requisite perceptual-semantic knowledge base for language too late, after the critical age for spontaneous and efficient language learning has passed.     

Speech discrimination and lip reading in patients with word deafness or auditory agnosia

The purpose of this study was to assess the ability of four patients with word deafness or auditory agnosia to discriminate speech by reading lips. The patients were studied using nonsense monosyllables to test for speech discrimination, a lip reading test, the Token Test for auditory comprehension, and the Aphasia test. Our results show that patients with word deafness or auditory agnosia without aphasia can improve speech comprehension by reading lips in combination with listening, as compared with lip reading or listening alone. In conclusion, lip reading was shown to be useful for speech comprehension among these patients.     

Perception of dynamic acoustic patterns by an individual with unilateral verbal auditory agnosia

Previous studies have found that subjects diagnosed with verbal auditory agnosia (VAA) from bilateral brain lesions may experience difficulties at the prephonemic level of acoustic processing. In this case study, we administered a series of speech and nonspeech discrimination tests to an individual with unilateral VAA as a result of left-temporal-lobe damage. The results indicated that the subject's ability to perceive steady-state acoustic stimuli was relatively intact but his ability to perceive dynamic stimuli was drastically reduced. We conclude that this particular aspect of acoustic processing may be a major contributing factor that disables speech perception in subjects with unilateral VAA.     

Interhemispheric functional relationships in auditory agnosia : An analysis of the preconditions and a conceptual model

A statistical analysis revealed the following concerning auditory agnosia. (1) Bilateral temporal lobe lesions prevailed; in a minority of cases unilateral lesions were verified. (2) The syndrome occurred as a result of repeated insults. (3) There was a statistically significant correlation between the side of the first insult and the predilective type of the syndrome, i.e., agnosia preferably for linguistic with respect to nonlinguistic material. On the basis of these results we discuss the principle of contralateral compensation and the hypothesis of lesional interference. In doing so a conceptual model of interhemispheric functional relationships is developed. We made use of a set theory-oriented interpretation of Kinsbourne's “attention-model” (M. Kinsbourne, 1970, Acta Psychologica 33, 193–201).     

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual.     

Subcortical Aphasia

We critically review the literature on subcortical aphasia, suggest that a number of traditional concepts regarding mechanisms of aphasia are inconsistent with now abundant data, and propose several new hypotheses. The absence of aphasia in 17 reported cases of dominant hemisphere striatocapsular infarction and the finding of nearly every conceivable pattern of language impairment in 33 different reported cases of striatocapsular infarction provide strong evidence against a major direct role of the basal ganglia in language and against disconnection or diaschisis as mechanisms of nonthalamic subcortical aphasia. However, detailed consideration of the vascular events leading to striatocapsular infarction strongly suggests that associated linguistic deficits are predominantly related to sustained cortical hypoperfusion and infarction not visible on structural imaging studies. Thalamic disconnection, as may occur with striatocapsular infarcts with extension to the temporal stem and putamenal hemorrhages, may also contribute to the language deficits in some patients. Review of the literature on thalamic infarction, in conjunction with previously unreported anatomic details of four cases, suggests that what infarcts in the tuberothalamic artery territory and the occasional infarcts in the paramedian artery territory associated with aphasia have in common is damage to the frontal lobe–inferior thalamic peduncle–nucleus reticularis–center median system that may be involved in regulating the thalamic gate in attentional processes. Disruption of attentional gating in the pulvinar and lateral posterior nuclei resulting from such lesions may impair selection of specific neuronal networks in the projection field of these nuclei that serve as the substrate for lexical–semantic function, which is in effect a disruption of a type of working memory, as defined by Goldman–Rakic. We define this as a defect of selective engagement.     

Subcortical Functions in Cognition

Neuropsychology Review -     

Parallel pattern processing and visual agnosia.

A series of visual search experiments are reported examining pattern processing in a visual agnosic patient. We examined search for targets defined by: (I) the combination of their features relative to homogeneous distractors; (2) the combination of their features relative to heterogeneous distractors; and (3) a single feature difference relative to the distractors (their orientation). Normal subjects demonstrate evidence of spatially parallel search when combined-feature targets are detected against homogeneous distractors, and when targets are defined by a salient feature difference. There are non-linear effects of the number of distractors present, and absent responses can be as fast as present. In contrast, search times for combined-feature targets amongst heterogeneous distractors increase linearly with display size, with the slope for absent responses about twice that for present. The contrast between search for combined-feature targets amongst homogeneous and heterogeneous distractors can be attributed to the effects of grouping between distractors and between distractors and targets (Duncan & Humphreys, 1989, 1992; Humphreys & Muller, in press). Grouping between homogeneous distractors facilitates search. An agnosic patient, HJA, showed normal search functions for single-feature targets and for combined-feature targets amongst heterogeneous distractors. However, he was impaired at search for combined-feature targets amongst homogeneous distractors. This suggests that HJA is selectively impaired at grouping conjunctions of form features. The relations between HJA's agnosia and his problem in the parallel grouping of form conjunctions are discussed, as are the implications of the work for understanding normal vision.     

Ankle Intrinsic Stiffness in Subcortical Poststroke Subjects

The authors' purpose was to evaluate bilateral ankle intrinsic stiffness in subcortical poststroke subjects. Ten subcortical poststroke subjects and 10 healthy controls participated in this study. The ankle passive stiffness at 3 different speeds and the electromyographic activity of the soleus, the gastrocnemius, and the tibialis anterior muscles of poststroke contralesional (CONTRA) and ipsilesional (IPSI) limbs and of one limb of healthy subjects were assessed. Ankle electromyographic activity was collected to ensure that reflexive or voluntary muscle activity was not being elicited during the passive movements. A significant interaction was observed between the effects of the limb (IPSI vs. CONTRA vs. control) and ankle position, F(4, 28) = 3.285, p = .025, and between the effects of the limb and the velocity of stretch, F(2, 14) = 4.209, p = .037. While increased intrinsic stiffness was observed in the CONTRA limb of poststroke subjects at ankle neutral position when the passive stretch was applied with a velocity of 1°/s (p = .021), the IPSI limb of poststroke subjects presented increased stiffness at 20º of plantar flexion when the stretch was applied with a velocity of 5°/s (p = .009) when compared to healthy group. Subcortical poststroke subjects present increased intrinsic stiffness in both the CONTRA and IPSI limbs in specific ankle amplitudes.     

Subcortical anarthria: a case report.

A 56-year-old right-handed male with a history of hypertension and diabetes presented two episodes of stroke: The first affected territory was the left anterior coroidal artery (capsular and paracapsular infarcts at the level of the genu and posterior arm of the internal capsule) and the second was the right thalamus, due to a hematoma. Following the first stroke, the patient developed severe dysarthria and after the second stroke remained anarthric. The pathophysiology of the disorder is discussed, and the role of the left and right thalamus as far as speech is concerned is reviewed.     

Prosopagnosia and visual object agnosia: A behavioral study

A left-handed woman developed visual object agnosia, prosopagnosia, and visual disorientation after resection of the right occipital lobe. Color agnosia and alexia were absent. When asked to identify objects presented visually, the patient's errors represented visually related objects (underspecifications) or perseverations. Identification was facilitated when she observed the object being used in a natural way. Identification was impaired by surrounding the object with unrelated objects, decreasing the background illumination, decreasing the duration of exposure of the object to the patient, and probably also by decreasing the visual angle subtended by the object. In addition, there were disturbances of visualization (i.e., imaging in the absence of a visual stimulus) that paralleled the perceptual difficulties. We conclude that: (1) A deficit in visual perception, characterized by insufficient feature analysis of visual stimuli, was the basis of the visual agnosia in this case. (2) The visual agnosia could not be explained by (a) a vision-language disconnection syndrome, (b) decay of visual memory traces, or (c) deficiencies in the visual fields (pathologic Funktionswandel). (3) The ability to visualize (visual imagery) probably utilizes some of the same neural pathways used in perception. (4) The results in this case probably can be generalized to some but not all cases of visual agnosia; in particular, the deficit in most previously reported patients with prosopagnosia is similar to that of our case. However, agnosic alexia and color agnosia usually have a different neuropsychological basis.     

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.     

Effects of Subcortical Lesion Site on Human Emotional Behavior

This is the first quantitative group study of recognition, expression, and other social-emotional behaviors after third ventricle damage in humans. Hypothalamic damage often induced appetitive disorders without affecting other emotional functions. In contrast, lesions in several hemispheric sites, especially right medial temporal, impaired emotional recognition; frontal and basal ganglia damage impoverished facial emotional expressions, this deficit being dissociated from general facial-motor impairment. These functional dissociations indicate that social-emotional behavior is regulated by multiple neural circuits, many of which by-pass hypothalamic nuclei. This conclusion is shown to be consistent with (a) the considerable animal evidence linking appetitive-survival behaviors with hypothalamic activity and (b) the accumulating human data on the specific contributions of hemispheric cortical-subcortical systems in the regulation of emotional recognition and expression.