Double dissociation of letter and category fluency following left frontal and temporal lobe lesions

Background: A number of studies have suggested that temporal cortex is critical for the ability to generate exemplars belonging to a particular semantic category (i.e., category fluency), while frontal cortex is critical for generating words beginning with a particular letter (i.e., letter or phonemic fluency). However, previous studies have often focused on relative, quantitative differences in performance across groups of patients and primarily in the oral domain.

Aims: The current study analysed verbal fluency data from two individuals with chronic aphasia, one with a large left temporal lobe lesion and a severe Wernicke's aphasia, and a second individual with a large left frontal lobe lesion and a moderately severe non-fluent aphasia. The goal of the study was to do both qualitative and quantitative analyses of letter and category fluency performance in these two individuals across oral and written fluency domains.

Methods & Procedures: Participants were administered both oral and written versions of letter fluency (FAS) and category fluency conditions (fruits, animals, and supermarket items). Participants were given 90 seconds to generate as many items as possible, and their responses were scored for both overall output, as well as qualitative structure using a clustering analysis.

Outcomes & Results: The individual with an extensive temporal lobe lesion generated a large number of exemplars on the letter fluency task. Some of these items were neologisms (e.g., frest, anth, and swink), but remarkably all adhered to the phonological constraints of the task. However, this individual was very poor at generating items belonging to semantic categories. In contrast, the individual with a large frontal lesion generated many exemplars on the category fluency task but only two items on the letter fluency task. The same pattern was replicated in the written domain in both individuals, and results from the clustering analysis paralleled these quantitative findings.

Conclusions: This report describes two individuals with aphasia who exhibited a double dissociation between letter and category fluency performance in both oral and written domains. The current findings provide further evidence for the notion that left frontal cortex is critical for word retrieval based on phonology, while left temporal cortex is critical for word retrieval based on semantics. The findings have implications for the types of strategies that may be most effective in individuals with lesions to these brain regions critical for word retrieval.     

Trace-Objects: Discovering Negative Identification in the Schizoid Transference

This article describes parallel disclosure, a form of clinical self-disclosure that addresses the schizoid patient's use of negation to omnipotently deny the impact of other. Negation is described as obstructing projective identification and disabling object use, creating a blank space where the negated object exists in the psyche and in the schizoid transference. The author refers to this blank space as the undifferentiated trace of a traumatizing historical object (a trace-object), and reasons that the trace-object—though amorphous and depersonified—can be conceptualized as a human object. Perceiving negative space as if it were an object in its own right is referred to as negative identification. The parallel disclosures illustrated in this article involve the author's personalized version of the patient's trace-object, offering it as a parallel to the patient's trace-object for the patient to use.     

Paradoxical Transference

The author analyzes a section of Walt Whitman's poem Song of Myself and relates it to Winnicott's concept of the noncommunicating core of the self as a vital part of mental health.     

Activity and Masochism

The author draws on his own experience of traumatized states to explicate what he calls the ontological unconscious—the loss of one's sense of being. He proposes that it is in the process through which emotional experience comes into language that the sense of being is born, and that the aborting of this process brings a loss of the sense of being. The loss and regaining of one's sense of being are profoundly context-dependent, hinging on whether the intersubjective contexts of one's living prohibit or welcome the coming into language of one's emotional experiences.     

Voice in the Garden

The aim of this paper is to substitute a psychoanalytic frame for the existential and even nihilistic context in which Beckett's writing has long been explored. When considered in light of Beckett's life experience, what comes to the fore is why he wrote as he did—plays and fiction in which physical decrepitude is the sine qua non of each characterization and stasis the plight of all who inhabit the author's imaginative world. Philosophical interpretations of the metaphor for the human condition that characterizes the ensemble of Beckett's work are always of interest. But why does this metaphor predominate? How was making art of therapeutic value for the author? In a word, what was the origin of his preoccupation and what dynamic purpose did its textual and theatrical rendering serve?     

Treatment of written verb and written sentence production in an individual with aphasia: A clinical study

Background: Although the efficacy of treatments for spoken verb and sentence production deficits in aphasia has been documented widely, less is known about interventions for written verb and written sentence production deficits.

Aims: This study documents a treatment aiming to improve production of (a) written subject-verb sentences (involving intransitive verbs) and (b) written subject-verb-object sentences (involving transitive verbs).

Methods & Procedures: The participant, a 63-year-old female aphasic speaker, had a marked language comprehension deficit, apraxia of speech, relatively good spelling abilities, and no hemiplegia. The treatment involved intransitive verbs producing subject-verb active sentences and transitive verbs producing subject-verb-object active non-reversible sentences. The treatment was undertaken in the context of current UK clinical practice.

Outcomes & Results: Statistical improvements were noted for the trained sets of verbs and sentences. Other improvements were also noted in LW's ability to retrieve some non-treated verbs and construct written sentences. Treatment did not generalise to sentence comprehension and letter spelling to dictation.

Conclusions: Our participant's ability to write verbs and sentences improved as a result of the treatment.     

What's the story? The tale of reading fluency told at speed

Fluent readers process written text rapidly and accurately, and comprehend what they read. Historically, reading fluency has been modeled as the product of discrete skills such as single word decoding. More recent conceptualizations emphasize that fluent reading is the product of competency in, and the coordination of, multiple cognitive sub‐skills (a multi‐componential view). In this study, we examined how the pattern of activation in core reading regions changes as the ability to read fluently is manipulated through reading speed. We evaluated 13 right‐handed adults with a novel fMRI task assessing fluent sentence reading and lower‐order letter reading at each participant's normal fluent reading speed, as well as constrained (slowed) and accelerated reading speeds. Comparing fluent reading conditions with rest revealed regions including bilateral occipito‐fusiform, left middle temporal, and inferior frontal gyral clusters across reading speeds. The selectivity of these regions' responses to fluent sentence reading was shown by comparison with the letter reading task. Region of interest analyses showed that at constrained and accelerated speeds these regions responded significantly more to fluent sentence reading. Critically, as reading speed increased, activation increased in a single reading‐related region: occipital/fusiform cortex (left > right). These results demonstrate that while brain regions engaged in reading respond selectively during fluent reading, these regions respond differently as the ability to read fluently is manipulated. Implications for our understanding of reading fluency, reading development, and reading disorders are discussed. Hum Brain Mapp, 2012. © 2011 Wiley Periodicals, Inc.     

Self-cueing of word retrieval by a woman with aphasia: Why a letter board works

Abstract

This study reports the case of an aphasic patient, S.D., who demonstrates a spontaneous ability to self-cue for items she is unable to name, by pointing to the initial letter of the target word. The effectiveness of S.D.'s cueing strategy is demonstrated and, by comparing it with other methods of cueing, it is shown that the written form of the initial letter is required for self-cueing. It is shown that S.D.'s self-cueing can be explained, in an information processing theory, by a lexically-mediated cascade of activation from input orthography to output phonology.     

Explanation of the “virtual input” phenomenon

We write this letter to comment on the “virtual input” phenomenon reported by Thaler (Neural Networks, 8(1) (1995) 55–65). The author attributed the phenomenon to the network's ability to perform pattern classification and completion, and reported that pruning probability affects the number of virtual inputs observed. Our independent study of Thaler's results, however, reveals a simpler explanation of the “virtual input” phenomenon.     

Communicative behaviour in aphasia

Abstract

Confrontation naming of famous faces was studied in 33 individuals with aphasia (anomic, Broca's, and conduction) and 27 individuals with mild or moderate Alzheimer's disease (AD). Naming failures were examined for evidence of tip-of-the-tongue (TOT) state by probing semantic and word-form knowledge (initial letter and word shape). Basic semantic information was provided for many of the recognized faces by all subject groups. Conduction and Broca's groups showed strongest evidence of TOT, performing above chance on initial letter identification. There was little evidence of word-form knowledge in anomic and AD groups.     

Home literacy environments, interest in reading and emergent literacy skills of children with Down syndrome versus typical children

Background The present study examined home literacy environments, children's interest in reading and emergent literacy skills of pre‐school‐aged children with Down syndrome (DS; n = 20), school‐aged children with DS (n = 17) and typically developing children (n = 18) matched on chronological age with the younger DS group and mental age (MA) with the older DS group. Method Parents filled out questionnaires on their home literacy environments and their children's interest in reading. School‐aged children with DS and typical children were assessed on cognitive functioning, receptive vocabulary, alphabet knowledge, familiarity with print conventions and comprehension of meaning. Results School‐aged children with DS and typical children – as opposed to pre‐school‐aged children with DS – were exposed to more literacy‐rich home environments and had greater interest in reading. School‐aged children with DS also outperformed the MA‐matched typical group on letter and sight word knowledge and familiarity with print conventions. Conclusions Parents of children with DS tailor home literacy environments to their children's developmental levels. Confirming earlier studies, children with DS achieved some higher literacy skills than what was expected for their MA, emphasising the importance of early reading interventions for this population.     

Idiopathic phrenic neuropathies: A case series and review of the literature

Introduction: Phrenic neuropathies (PNs) are a major cause of dyspnea, orthopnea, and hypercapnic respiratory failure. The aim of the study was to obtain diagnostic findings, assess therapeutic options, and review outcomes in PN patients. Methods: From 2004 to 2013, patients with PN referred to the author's institution were studied using clinical, pulmonary function, and electrodiagnostic tests. A PubMed search of published PN reports was also done. Unilateral PN (UPN) and bilateral PN (BPN) patients were compared. Results: The analysis consisted of 10 UPN and 9 BPN patients seen by the author, plus previous reports of 18 UPN and 40 BPN patients. BPN patients were older (in the author's series) and were more often hypertensive. They reported pain less often, dyspnea and orthopnea more often, and had worse results on pulmonary function tests than UPN patients. Conclusions: UPN and BPN are probably 2 variants of the same, immune‐mediated focal neuropathy. Electrodiagnosis is a valuable confirmatory test for PN. Muscle Nerve 52 : 986–992, 2015     

Images on the void: An enquiry into the nature of depression through reflections on five commonly presented images

Abstract

This paper concerns five images of: (1) Blackness, the void; (2) Black hole, vortex spiral; (3) Desert, barren landscape; (4) Prison, cell, pit or well; (5) The crux, divide, dilemma at heart. These images are explored with reference to clinical material and of the theories of Freud, Kristeva, and Kalsched. Particular reference is given to Freud, Mourning and Melancholia (1917), Kristeva, Black Sun, Depression and Melancholia (1989), and Kalsched, The Inner World of Trauma—Archetypal Defenses of the Personal Spirit (1996). The paper is intended as an aid to practitioners working with people with chronic depression and other diagnoses with depression as an important factor in the interaction. The author believes it is the therapist's role to firstly give value to the patient's expression, and secondly to perceive and enter into a compressed inner dialogue at the heart of depression.     

Retraction: ‘Sunlight exposure is important for preventing hip fractures in patients with Alzheimer's disease,Parkinson's disease,or stroke’ by J. Iwamoto,T. Takeda and H. Matsumoto

The above article from Acta Neurologica Scandinavica, published online on 18 June 2011 in Wiley Online Library ( http://wileyonlinelibrary.com ) and in Volume 125, pp. 279‐284, has been retracted by agreement between the authors, the Journal Editor‐in‐Chief Elinor Ben‐Menachem and John Wiley & Sons Ltd. The Retraction has been agreed due to extensive duplication of previously published material on the part of Dr Sato, who has acknowledged full responsibility. Dr. Iwamoto would like to note the following information related to this retraction:

• Dr. Sato admitted that he was solely involved in the scientific misconducts.
• I did not actually participate in Dr. Sato's studies. I am an honorary author of Sato's Papers.
• When I was preparing the Subject Paper in the year 2012, I clearly was unaware of the fact Dr. Sato was involved in scientific misconducts.

REFERENCES Sato Y, Iwamoto J, Kanoko T, Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in hospitalized, elderly women with Alzheimers disease: a randomized controlled trial. J Bone Miner Res. 2005;20:1327‐1333. Sato Y, Iwamoto J, Honda Y. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson's disease. Parkinsonism Relat Disord. 2011;17:22‐26. Sato Y, Metoki N, Iwamoto J, Satoh K. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology. 2003;61:338‐342. Iwamoto J, Takeda T, Matsumoto H. Sunlight exposure is important for preventing hip fractures in patients with Alzheimer's disease, Parkinson's disease, or stroke. Acta Neurol Scand. 2012;125:279‐284.     

Normative data for phonemic and semantic verbal fluency test in the adult French–Quebec population and validation study in Alzheimer’s disease and depression

Objective: Verbal fluency tasks are principally used to assess lexical access and have shown usefulness for differential diagnosis. The purpose of Study 1 was to provide normative data in the adult French–Quebec population (Canada) for semantic verbal fluency (animals), for two sets of phonemic verbal fluency (TNP and PFL), and for letter P alone (60 seconds per category/letter). The objectives of Study 2 were to establish the diagnostic and predictive validity of the present tasks and normative data in Alzheimer’s disease (AD) and major depressive episode (MDE). Method: The normative sample consisted of 932 participants aged 19–91 years. Based on multiple linear regressions, equations to calculate Z-scores were provided. To assess validity, performance of 62 healthy participants was compared to 62 participants with AD and 41 with MDE aged over 50. Results: Age and education, but not gender, predicted performance on each verbal fluency task. Healthy adults aged 50 and younger had a better performance on semantic than phonemic verbal fluency. In comparison to MDE, AD participants had lower performance on animals and TNP, but not on letter P. Ninety percent of people with a Z-score ≤ ?1.50 on semantic verbal fluency had AD and the global accuracy was 76.6%. Test–retest reliability over one year was high for both animals (r = .711) and TNP (r = .790) in healthy older participants, but dropped for animals in people with AD (r = .493). Conclusions: These data will strengthen accurate detection of verbal fluency deficits in French–Quebec adults.     

Death Does Not Do Us Part

Abstract

The author illustrates cotexting (use of the therapist's verbal additions to the client's verbalization of the story) in a co-constructed ritual as a way of breaking up a rigid, locked position that is maintaining a bereaved widow's unresolved bereavement situation and suicidal preoccupation.     

When ‘slime’ becomes ‘smile’: Developmental letter position dyslexia in English

We report the first three cases of selective developmental letter position dyslexia in English. Although the parents and teachers of the children were concerned about these children's reading, standard tests did not reveal their deficit. It was only when the appropriate target words were presented, in this case, migratable words, that their letter position dyslexia was detected. Whereas previous research has described cases with acquired and developmental forms of letter position dyslexia in Hebrew and Arabic readers, this is the first report of this type of reading disorder in English. The cardinal symptom of letter position dyslexia is the migration of letters within the word (reading slime as ‘smile’; pirates as ‘parties’). These migration errors occur in reading aloud as well as in tasks of silent reading. This study provides further evidence that migration errors emerge at the level of early visual-orthographic analysis, in the letter position encoding function. Alternative explanations for the occurrence of migration errors such as poor phonological processing or a deficit in the orthographic input lexicon are ruled out.     

Hyphenation can improve reading in acquired phonological dyslexia

Background: We describe JD, a person with severe phonological dyslexia. JD is good at reading words yet is extremely poor at reading nonwords. She shows no effect of word regularity on her reading performance. However, she has only a very mild general phonological deficit. Although it is known that teaching grapheme–phoneme correspondence rules and learning bigraph syllables can improve dyslexic reading, we investigate the possibility that segmenting the input string using hyphens can also improve reading.

Aims: We investigate the locus of JD's reading deficit and explore means of improving her reading. We examine the extent to which hyphenation can improve nonword reading.

Methods & Procedures: We use a battery of tasks in a single‐case study. We test oral reading, writing and spelling ability, and lexical and semantic knowledge. We assess phonological processing using tests of repetition and phonological awareness. We focus on blending and segmentation, and test whether hyphenating the letter string can improve reading.

Outcomes & Results: JD is very good at reading words (overall about 90%), but very poor at reading nonwords (overall about 10%). She makes no semantic errors and shows little effect of word regularity. JD has only a mild concomitant phonological deficit. She also has a very good digit span (8). JD can read affixes in isolation, and can also read nonwords made up of inappropriately affixed morphemes (e.g., “dismove”) if a hyphen is inserted at the affixation point (e.g., “dis‐move”). We found that hyphenation improves nonword reading in general, but particularly if it is the grapheme units that are separated by hyphens.

Conclusions: We discuss the possibility that JD's phonological dyslexia arises from impaired graphemic parsing, and that affixes have inherent meaning for her. Hyphenation may be a therapeutic tool worthy of wider consideration for improving reading performance in people with dyslexia.     

The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease

Background. Most instruments that measure the impairments associated with Alzheimer's disease assess symptom severity. Little attention has been paid to the illness's impact on the time formal and informal caregivers spend caring for Alzheimer's individuals. A tool that measures the time spent caregiving would help to determine the economic impact of the illness. The Caregiver Activity Survey (CAS) was developed to measure the time caregivers spend aiding Alzheimer's patients with their day-to-day activities. Methods. The test–retest reliability of the CAS was assessed during a 3-week study with 42 Alzheimer's patients and their caregivers. The CAS was validated with the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog), the Mini Mental State Exam (MMSE) and the Physical Self Maintenance Scale (PSMS). Results. The final version of the CAS consists of six items (communicating with the person, using transportation, eating, dressing, looking after one's appearance and supervising the person). The six-item CAS total score has high test–retest reliability, with ICC = 0.88 between weeks 1 and 3. The scale has strong convergent validity with the ADAS-Cog (r = 0.61), MMSE (r = −0.57) and PSMS (r = 0.43). Efforts to include a dimension that reflects caregiver burden were not successful, in part due to the reluctance of caregivers to acknowledge that caregiving is bothersome. Conclusions. The CAS provides a new tool that measures time spent caring for Alzheimer's individuals. The instrument may be used to augment existing clinical assessments that measure the efficacy of potentially therapeutic agents for persons with Alzheimer's disease. © 1997 John Wiley & Sons, Ltd.