Semantic errors in naming,repetition, spelling and drawing from memory: a new Italian case

Semantic errors in aphasic patients are frequent and their study has helped understanding the structure and processing of the lexical/semantic system. Most of the patients with semantic errors in reading and writing are English-speaking and it has been argued that this depends on the type of the orthographic systems: in opaque orthographies semantic errors are more frequent than in transparent orthographies. The paper reports the case of an Italian patient, AM, with semantic damage and semantic errors in comprehension and production tasks, except reading aloud. AM was also impaired in non-word repetition and writing but his reading of non-words was only mildly impaired. The absence of semantic errors in reading and the co-occurring absence of severe damage to the non-lexical reading route is consistent with interaction between lexical and non-lexical processing. The discussion addresses the question of the relative frequency of semantic errors in reading and writing tasks in languages with different types of orthographies.     

Semantic Errors in Naming,Repetition, Spelling and Drawing from Memory: A New Italian Case

Semantic errors in aphasic patients are frequent and their study has helped understanding the structure and processing of the lexical/semantic system. Most of the patients with semantic errors in reading and writing are English-speaking and it has been argued that this depends on the type of the orthographic systems: in opaque orthographies semantic errors are more frequent than in transparent orthographies. The paper reports the case of an Italian patient, AM, with semantic damage and semantic errors in comprehension and production tasks, except reading aloud. AM was also impaired in non-word repetition and writing but his reading of non-words was only mildly impaired. The absence of semantic errors in reading and the co-occurring absence of severe damage to the non-lexical reading route is consistent with interaction between lexical and non-lexical processing. The discussion addresses the question of the relative frequency of semantic errors in reading and writing tasks in languages with different types of orthographies.     

Reading morphemes

Abstract

By studying the oral reading of morphologically decomposable pseudowords by a Finnish-speaking deep dyslexic, we searched for evidence of morphological decomposition in a morphologically rich language. As the patient's non-lexical reading was abolished, any effects obtained with pseudowords carrying morphemes were assumed to reflect the functions of the lexical route. Oral reading of bound stems in pseudowords was facilitated by the presence of a real but illegal inflectional suffix. As the constituents of these pseudowords were non-freestanding morphemes, the facilitation effect indicates that morphological parsing into stem and suffix took place during lexical access. This is also supported by the fact that the presence of morphological structure in pseudoword stimuli increased the rate of morphologically complex neologistic responses.     

A letter-by-letter reader who could not read nonwords

Letter-by-letter reading is a neuropsychological syndrome characterized by oral reading which seems to be mediated by explicit naming of constituent letters of the printed string. Thus reading time rises abnormally as a function of the length of the items to-be-read. This syndrome is generally interpreted as indicating a disconnection within the normal reading system prior to the activation of the visual and phonological lexical access routes. The patient retains a subsidiary strategy of spelling words by naming their constituent letters and uses this strategy for planning their pronunciation. If this interpretation is correct then reading aloud in letter-by-letter reading should not be affected by the features of the letter string which are stored lexically as the functional disconnection is postulated to occur prior to this stage. In this paper we report the case of a letter-by-letter reader who shows some signs which are puzzling in terms of current interpretations of the syndrome. They can be summarized as follows: (1) The patient reads words better than he reads nonwords; (2) Concrete words are processed more holistically while abstract words are processed more letter-by-letter; (3) Lexical decisions can be made far more rapidly than words can be read aloud. These three signs are very difficult to account for if reading is accomplished solely through a non-lexical reversed spelling strategy. Our experimental investigations of this patient are reported and alternative models assuming strategic control over the reading mechanism are discussed.     

Academic skills in the long term after epilepsy surgery in childhood

ObjectiveWe evaluated the progression of academic skills in a cohort of patients who underwent, or were considered for, epilepsy surgery in childhood, four to eleven years before. The few existing studies that have evaluated cognitive function in the long term after surgery have examined intelligence and memory.MethodParticipants were 97 patients with childhood-onset intractable epilepsy; 61 had undergone resective epilepsy surgery. Participants completed standardized tests of reading, spelling, arithmetic, and intelligence at baseline and, on average, 7 years after. Surgical patients were additionally assessed one year postsurgery.ResultsAt baseline and long-term follow-up, 61% and 69% of patients, respectively, scored at least one standard deviation below normative data in at least one academic domain. Evaluation of change over time while controlling for IQ showed that arithmetic scores were lower at long-term follow-up in comparison with those at baseline among all patient groups, whereas reading and spelling scores remained unchanged. Few advantages were associated with seizure control. Multiple regression analyses found that older age at surgery, cessation of antiepileptic medications, improved IQ, and low baseline scores were independently associated with improvement in some academic domains among all patient groups.ConclusionWe found that arithmetic scores were lower at long-term follow-up, suggesting a lack of ongoing development or deterioration in skills. Reading and spelling scores remained stable suggesting that patients made gains in abilities at a rate expected for their increase in age; this finding contrasts with recent short-term outcome studies identifying significantly lower scores over time in these areas.     

A patient with aphasia using the nonsemantic lexical route for Kanji reading

We report a patient with aphasia, caused by cerebral hemorrhage, who probably used the nonsemantic lexical route when reading words aloud. To investigate the mechanisms underlying her reading dysfunction, we analyzed her reading abilities using the Dual-Route Cascaded Model. Language tests resulted in low correct percentages for both reading comprehension and reading nonwords aloud, suggesting problems in the semantic system and the nonlexical route. Conversely, the patient showed high scores on the reading words aloud task. Although she failed to understand many inconsistent-atypical words in the reading comprehension test, she correctly read most words aloud, suggesting that she used the nonsemantic lexical route. In addition, the lexical reading route was analyzed in detail by using inconsistent-atypical Kanji words as stimuli. Finally, we analyzed her reading dysfunction compared with previous cases.     

Does letter-by-letter reading involve the spelling system?

Warrington and Shallice (Brain 103, 99-112, 1980) proposed that letter-by-letter readers can no longer access the visual word-form system, and read by using the spelling system 'in reverse'. Contrary to their suggestion, this paper presents the case of a letter-by-letter reader who appears to use quite different strategies in word reading and spelling. Reading and spelling are both impaired, but they appear to be impaired in different ways. Most strikingly, the patient's spelling errors consist largely of phonological regularizations--indeed there is little evidence that he has any lexical spelling knowledge available--whereas there are virtually no regularizations amongst his reading errors. These are largely visual paralexias and letter misidentifications. It is suggested that this pattern is more easily explained in terms of compensatory mechanisms that access the reading lexicon than by use of the spelling system 'in reverse'.     

"Blocking" lexical competitors in severe global agraphia: a treatment of reading and spelling

Severe global agraphia in Patient MM is analyzed via anagram spelling. Errors in word spelling reflect conflict among lexical competitors and "blocking" of semantic errors by sublexical and lexical cues. Lexical graphemic competition predominates in the context of MM's nearly absent sublexical transcoding of phonemes into graphemes. His orthographic lexicon is severely impaired, resulting in poor activation of lexemes and impaired activation and inhibition of the grapheme level in spelling. In MM's multiple revisions of spelling errors, graphemes from more than one lexical competitor persist in an active state simultaneously. Experimental treatment addressed MM's impaired sublexical reading and spelling, and facilitated sentence spelling through functional computer tasks. Spelling treatment resulted in evolution of MM's global agraphia to surface agraphia. MM's spelling performance supports the claim that lexical and sublexical processes interact during normal spelling, and shows that severe global agraphia is amenable to treatment.     

Patterns of breakdown in spelling in primary progressive aphasia

Introduction

The objective of this study is to determine which cognitive processes underlying spelling are most affected in the three variants of primary progressive aphasia (PPA): Logopenic variant primary progressive aphasia (lvPPA), Semantic variant primary progressive aphasia (svPPA), and Nonfluent variant primary progressive aphasia (nfvPPA).

Methods

23 PPA patients were administered The Johns Hopkins Dysgraphia Battery to assess spelling. Subtests evaluate for effects of word frequency, concreteness, word length, grammatical word class, lexicality (words vs pseudowords), and “regularity” by controlling for the other variables. Significant effects of each variable were identified with chi square tests. Responses on all spelling to dictation tests were scored by error type. 16 of the 23 subjects also had a high resolution MRI brain scan to identify areas of atrophy.

Results

We identified 4 patterns of spelling that could be explained by damage to one or more cognitive processes underlying spelling. Nine patients (3 unclassifiable, 4 with lvPPA, 2 with svPPA) had dysgraphia explicable by impaired access to lexical representations, with reliance on sublexical phonology-to-orthography conversion (POC). Two patients (with nfvPPA) showed dysgraphia explicable by impaired access to lexical representations and complete disruption of sublexical POC. Seven patients (4 with lvPPA, 1 with svPPA, 2 unclassifiable) showed dysgraphia explicable by impaired access to lexical-semantic representations and/or lexical representations with partially spared sublexical POC mechanisms. Five patients (1 with nfvPPA, 2 with svPPA, 1 with lvPPA, and 1 unclassifiable) showed dysgraphia explicable by impairment of the graphemic buffer.

Conclusions

Any cognitive process underlying spelling can be affected in PPA. Predominance of phonologically plausible errors, more accurate spelling of regular words than irregular words, and more accurate spelling of pseudowords than words (indicating spared POC mechanisms) may indicate a low probability of progression to nfvPPA.     

Treatment of single word oral reading in an individual with deep dyslexia

Background: Deep dyslexia is an acquired reading disorder in which the lexical and nonlexical reading routes are impaired, resulting in poor nonword reading, semantic errors in oral reading, visual-perceptual errors in oral reading, poor reading of functors, and imageability effects. There is evidence that individuals combine information from the lexical (semantic system) and the non-lexical routes to read words aloud. This evidence shows that partial phonological and semantic information combined at the level of the phonological output lexicon reduces semantic errors in reading aloud and increases the ability to produce the correct words. Aims: The aim of the present study was to use a phonologically based oral reading treatment to treat impaired single word oral reading in an individual with deep dyslexia. We hypothesised that phonologically based treatment would improve oral reading of real words, decreasing the amount of semantic errors. Methods & Procedures: The Wilson Reading System was used in therapy. This phonics-based programme focuses on the use of grapheme-phoneme correspondences, blending, and phonological awareness. A multiple-baseline design was used to evaluate the treatment effects in a single individual with deep dyslexia. Outcomes & Results: Following treatment at the single word level, the individual showed a significant improvement in single word oral reading for the targeted syllabic structure and in nonword reading. There was also a significant reduction in semantic errors in oral reading. One month post-treatment, the individual maintained treatment gains. Conclusions: Results support the hypothesis that the partial use of phonological information, combined with semantic information, results in improved accuracy of oral reading. This suggests that treatment of oral reading in people with deep dyslexia may benefit from attention to the non-lexical (phonological) component of reading in addition to the lexical/semantic component.     

Surface Dysgraphia in a Regular Orthography: Apostrophe use by an Italian Writer

The dual-route model of writing assumes two basic procedures involved in writing: lexical and non-lexical. The lexical route is fundamental in opaque orthographies such as English; from its impairment surface dysgraphia arises. Evidence for the role of a lexical route in transparent languages such as Italian, which have a regular orthography, has been more limited. We report a case study of ES, an Italian patient suffering from degenerative brain disease, who presented with a selective disorder of writing. He showed the unusual phenomenon of inserting an apostrophe inappropriately in the spellings of words. Neuropsychological evaluation provided evidence of loss of orthographic meaning of the apostrophe and a pattern of writing performance consistent with surface dysgraphia. There was also evidence of an accompanying surface dyslexia. We conclude that examination of apostrophe use provides a valuable means of detecting surface dysgraphia in the Italian language. The findings point to the need for cognitive models of writing to account for “dumb symbols” of language such as the apostrophe. This unique case provides a further example of the variety of clinical presentations of focal cerebral degeneration.     

Surface dysgraphia in a regular orthography: apostrophe use by an Italian writer

The dual-route model of writing assumes two basic procedures involved in writing: lexical and non-lexical. The lexical route is fundamental in opaque orthographies such as English; from its impairment surface dysgraphia arises. Evidence for the role of a lexical route in transparent languages such as Italian, which have a regular orthography, has been more limited. We report a case study of ES, an Italian patient suffering from degenerative brain disease, who presented with a selective disorder of writing. He showed the unusual phenomenon of inserting an apostrophe inappropriately in the spellings of words. Neuropsychological evaluation provided evidence of loss of orthographic meaning of the apostrophe and a pattern of writing performance consistent with surface dysgraphia. There was also evidence of an accompanying surface dyslexia. We conclude that examination of apostrophe use provides a valuable means of detecting surface dysgraphia in the Italian language. The findings point to the need for cognitive models of writing to account for "dumb symbols" of language such as the apostrophe. This unique case provides a further example of the variety of clinical presentations of focal cerebral degeneration.     

Lexical agraphia from focal lesion of the left precentral gyrus

Lexical agraphia reflects a dysfunction of the lexical spelling system and is characterized by better spelling of nonwords and regular words than irregular words. All previously reported cases with documented focal lesions had involvement of temporo-parieto-occipital regions. We now report a case of lexical agraphia following a discrete lesion of the left precentral gyrus. Our case complements previous neuroanatomical accounts of agraphia and provides further support for the independence of neuronal systems that mediate spelling from those involved in spoken language and reading.     

A Third Route for Reading? Implications from a Case of Phonological Dyslexia

Models of reading in the neuropsychological literature sometimes only include two routes from print to sound, a lexical semantic route and a sublexical phonological route. Other researchers hypothesize an additional route that involves a direct connection between lexical orthographic representations and lexical phonological representations. This so-called ‘third route’ has been invoked to account for the preserved oral reading of some patients who show severe semantic impairments and a disruption of the sublexical phonological route. In their summation hypothesis, Hillis and Caramazza proposed that reading in these cases could result from a combination of partial lexical semantic information and partial sublexical phonological information, thus obviating the need for the third route. The present study examined the case of a phonological dyslexic patient (ML) who exhibited preserved word reading, even for items he could not name, along with a non-word reading impairment. The relationship between ML’s naming and reading, and the influence of semantic variables on his reading were examined. The results of this examination are interpreted as supporting the existence of the third route.     

A third route for reading? Implications from a case of phonological dyslexia

Models of reading in the neuropsychological literature sometimes only include two routes from print to sound, a lexical semantic route and a sublexical phonological route. Other researchers hypothesize an additional route that involves a direct connection between lexical orthographic representations and lexical phonological representations. This so-called 'third route' has been invoked to account for the preserved oral reading of some patients who show severe semantic impairments and a disruption of the sublexical phonological route. In their summation hypothesis, Hillis and Caramazza proposed that reading in these cases could result from a combination of partial lexical semantic information and partial sublexical phonological information, thus obviating the need for the third route. The present study examined the case of a phonological dyslexic patient (ML) who exhibited preserved word reading, even for items he could not name, along with a non-word reading impairment. The relationship between ML's naming and reading, and the influence of semantic variables on his reading were examined. The results of this examination are interpreted as supporting the existence of the third route.     

Emergence and progression of ‘non-semantic’ deficits in semantic dementia

Although semantic dementia (SD) is defined as a selective disruption of conceptual knowledge, a number of group studies have now demonstrated that SD patients also show impaired performance on tasks not usually considered to have a high semantic load (e.g., reading words aloud and lexical or object decision). The aim of the current study was to document the relative deterioration, over time, of a number of semantic and so-called ‘non-semantic’ tasks in LF, a single case of SD for whom - by virtue of his work as a published cartoonist - we also have extensive data regarding his pre-morbid linguistic and drawing skills.In five testing rounds over a period of five years we administered semantic tests of object naming and object definition (on both of which LF was progressively impaired, as expected for a diagnosis of SD), plus verbal and non-verbal ‘non-semantic’ tasks of reading aloud, spelling, object and lexical decision, and delayed copy drawing.Initially, his only striking ‘non-semantic’ deficit was in the domain of spelling - a pronounced surface dysgraphia in an individual with demonstrably superior pre-morbid spelling skill. Over time, and in line with his declining semantic system, LF's performance gradually deteriorated on all of the ‘non-semantic’ tasks. The most vulnerable items on most tasks were those with low frequency and an atypical form.This report adds to the growing body of evidence that a number of cognitive processes not usually considered to be ‘semantic’ in their demands rely on the integrity of semantic knowledge for successful execution. Furthermore, it provides the first indication that these non-semantic deficits might emerge in an order predictable from the typicality structure of the relevant domain.     

Delays in the reading and spelling of children with cerebral palsy: Associations with phonological and visual processes

BackgroundThis investigation addresses the question of whether there exists a significant discrepancy in the cognitive abilities of children with cerebral palsy (CP) who, despite the presence of age appropriate communication and language, have reading and spelling delays.AimsWe wanted to discover whether there was a relationship between the phonological and visual perceptual abilities of children with CP and their progress in reading and spelling.Methods and proceduresFifteen children with CP (aged between 6:9 years and 11:6 years) were assessed on reading and spelling; communication and language; non-verbal reasoning; phonological processing; and visual perception.Outcomes and resultsTen of the children had very weak reading and spelling skills. Five children had (mostly) age appropriate scores of reading and spelling. No differences were found between these two groups in non-verbal reasoning or communication and language. However, phonological abilities, visual sequential memory and perception of visuospatial relationships were found to be related to reading and spelling.Conclusions and implicationsThe findings suggest that children with CP are at risk for reading and spelling delays when they have poor phonological processing, visual sequential memory and perception of visuospatial relationships. The implications of the findings for classroom practice are discussed.     

Reading impairment in neurodegenerative diseases: a multiple single-case study

Background: Reading impairment is frequently associated with neurodegenerative diseases, such as Alzheimer disease (AD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Notwithstanding the clinical relevance of reading processes in these conditions, only a relatively small number of studies have been published on this topic so far.

Aims: We investigated the reading impairment in patients with different types of neurodegenerative diseases. In the light of the marked variability in pathological changes affecting brain areas potentially relevant to reading, it could be hypothesised that these neurodegenerative conditions may lead to different patterns of reading impairment.

Methods & Procedures: Three groups of patients (AD, PPA, and PCA) and a control sample of neurologically healthy participants were examined with five tasks to test the ability to read and to repeat words and nonwords, as well as with an auditory and visual lexical decision task.

Outcomes & Results: No specific pattern emerged as strongly diagnostic of a specific degenerative disease. Overall, AD and PPA patients were significantly more impaired in reading nonwords than words. Lexical decision impairment in the visual modality appears to be related to PCA, while a similar deficit in the auditory modality is more suggestive of AD. A multiple single-case analysis on the reading performance was run to identify the distribution of different kinds of dyslexia: phonological dyslexia occurred in 50% of patients affected by PCA: it occurred less often in patients affected by AD (15.8%) and PPA (16.7%). Surface dyslexia occurred only in one case of AD. Age of acquisition was predictive of the reading performance for AD patients, but not for PCA and PPA patients.

Conclusions: Phonological dyslexia predominates in PCA. Surface dyslexia occurred only in one AD patient. Reading nonwords was predominantly impaired in AD and PPA cases. Impairment in visual lexical decision was associated with PCA, whereas a lexical decision deficit in the auditory modality emerged in AD. Data indicate the importance of extensive testing of reading and input lexical abilities in neurodegenerative diseases.