Visual agnosia in an artist

This report describes a 73 year old left-handed male artist who presented with agnosic symptoms following an occipital cerebral vascular accident. Against a background of a memory disturbance, but otherwise essentially intact linguistic and cognitive capacities, the patient was generally unable to identify single objects on visual presentation, and displayed marked difficulty in interpreting complex objects, depicted scenes, and partially occluded figures. The patient's preserved ability to recognize geometric forms, to perceive optical illusions, and to copy designs, and objects with considerable accuracy suggested the clinical picture of visual agnosia. An examination was undertaken of the effects of this recognition disorder on the artist's capacity to draw. Despite an inability to recognize an object or scene, the patient retained various techniques (perspective, shadowing, designation of texture) which allowed him to copy the display in a veridical fashion. When displays were recognized, or when the patient was given only the name of the object and asked to draw it, he adopted a less slavish approach, characteristic of his pre-morbid artwork. While his post-morbid drawings bore a strong similarity to his earlier works, such features as insufficient differentiation of figure from ground, over-elaboration of detail, and areas of neglect revealed the debilitating effects of the recognition disorder. Moreover, an examination of the patient's strategies revealed numerous compensatory verbal and motor procedures which guided his drawing. Acknowledgments. We wish to acknowledge Dr. Prather Palmer, J.R.'s neurologist, for his cooperation and for making available his very thorough examination notes. Thanks also to Dr. Kent Stevens for providing the stereograms, and to Dr. Frank Benson and Dr. Edgar Zurif for their helpful comments on the manuscript.

Sensitivity to musical denotation and connotation in organic patients

Musical segments convey at least two kinds of meaning: The "real-world" events referred to by lyrics and by occasions of performance constitute musical denotation: the formal expressive patterns suggested by such constituents as pitch, timbre, and intensity constitute musical connotation. To ascertain sensitivity to these musical facets among brain-injured patients, tests assessing appreciation of musical denotation and connotation were administered to unilaterally brain-injured subjects in the United States and Italy. On the musical denotation test, right hemisphere patients excelled on items where knowledge of lyrics was required; in contrast, anterior aphasics surpassed both posterior aphasics and right hemisphere patients on items where acquaintance with lyrics was unnecessary. On the musical connotation test, right hemisphere patients performed relatively better in matching sound patterns to temporally-sequenced designs than to gestalten; these patients also performed better than left hemisphere patients on a number of other dimensions. The relatively high performance of posterior aphasics on the connotation test, along with the lack of correlation between connotative and denotative scores received by aphasic patients, suggest a behavioral and neurological dissociation between the two forms of musical sensitivity.

A study of confabulation

Confabulation consequent to organic amnesia is a well-described clinical finding. A number of plausible theories of confabulation have been proposed, but the various claims and counterclaims have not been systematically tested. A standardized test battery that included four different kinds of questions plus measures of suggestibility and the tendency to utilize external cues was administered to ten amnesic patients who demonstrated varying degrees of confabulation. One additional patient, whose clinical condition changed dramatically during his hospital course, received the battery on a number of occasions. Differences among patients were found in overall performance, degree of confabulation, and ability to use cues. Hypothesized relationships between confabulation and suggestibility, degree of memory disorder, and degree of disorientation were not confirmed. However, confabulation proved to be strongly related to the inability to withhold answers, to monitor one's own responses and to provide verbal self-corrections. These results suggest a tentative model of the process of confabulation as well as a number of useful clinical signs indicationg recovery from amnesia.

Reduplicative paramnesia

A striking behavioral abnormality is described in three individuals who had severe head trauma. At a point when general mnestic capabilities had returned to a near normal level, the patients persistently relocated the hospital at another geographical site, even in the face of compelling counter-evidence. The strong parallels in the etiology and course of the three cases justify the positing of a syndrome, here termed reduplicative paramnesia. A neuropsychologic analysis of the disorder stresses the cognitive operations entailed in geographical localization and confabulation. Clinical-pathologic considerations underline the role of right hemisphere and frontal lobe structures in the syndrome.

Comprehension and appreciation of humorous material following brain damage

The effects of brain damage on cognitive and affective status have been assessed separately; however, a dearth of information exists about the interaction of these facets in the brain-damaged patient. Because appreciation of humour involves both cognitive and affective dimensions, an investigation of response to humorous materials should yield information relevant to this issue. In addition, a study of response to humour in aphasic patients can reveal the extent to which appreciation of humour is dependent upon an intact language system. Accordingly a test of humour, in which an individual chose the "funniest" of four cartoons, was administered to a population of brain-damaged and control patients. Ability to detect the most humorous cartoon was impaired in all brain-damaged patients, more in severe than in mild aphasics, but there was no significant difference between patients with left and right hemisphere lesions in their overall performance on the test. A different order of difficulty across items, and a different profile of "mirth" responses to the items did, however, correlate with site of lesion. Right hemisphere patients tended either to laugh throughout or, more frequently, not at all; they often confabulated answers to made impossible inferences; and they performed better on items with captions. Their cognitive reactions appeared "dissociated" from their affective responses. In contrast left hemisphere patients performed better on the captionless items and behaved in a manner which more closely approximated normal subjects in their humorous reactions, their order of item difficulty, and their explanations. All brain-damaged patients found it relatively easier to locate the humorous cartoons when the members of a set differed appreciably from one another. These results provide information about the altered cognitive and affective states of brain-damaged patients, the impairment of cognitive operations in aphasic patients, and the respective "life-spaces" of left and right hemisphere injured patients.

Nasolacrimal duct anomaly in calves

Supernumerary openings of the nasolacrimal drainage apparatus were found in 13 Brown Swiss calves. The cause of the anomaly was not determined but was assumed to be similar to that in man.

Comprehending a word: the influence of speed and redundancy on auditory comprehension in aphasia

To assess the contribution of various factors to comprehension of a target word, an auditory comprehension test was devised and administered to a series of aphasic patients. Patients were required to select from an array that picture which corresponded to a spoken target word. Each patient heard the target word under five conditions: (1) target spoken alone; (2) target embedded in a neutral (low redundancy) sentence enunciated at a normal rate of speaking; (3) target in a neutral sentence enunciated at a slow rate of speaking; (4) target embedded in a sentence containing semantic support (high redundancy); (5) target embedded in a sentence containing a semantically-deceptive element. Semantic redundancy and rate of presentation made contributions to comprehensibility. Semantic confusions were prevalent among all aphasics but, contrary to earlier reports, posterior patients were especially prone to acoustic confusions. Except for conduction aphasics, patients were more likely to confuse words which began with the same sounds than words which ended with the same sounds. Patients with adequate comprehension at the start of the testing displayed a uniform tendency to improve on the conditions administered later, while those with impaired comprehension at the start usually did not.

Critical reading at the sentence level in aphasia

A sentence-reading test was devised in order to assess the aphasic's ability to detect errors in written discourse. One hundred pairs of sentences, each containing one correct and one erroneous sentence, were presented to the patients, who were required to locate the error in one of the two sentences. So that comprehension in the auditory and visual modalities might be compared, the identical test was administered orally to a subset of the aphasic population. Contrary to expectations, there was no difference in overall scores between patients with anterior and posterior pathology. Anterior patients performed somewhat better on the oral version, posterior patients on the written version of the test. Finally, an examination of errors revealed a regular order of difficulty in sentences which featured contradictions to "real-world" knowlege, irrespective of the locus of brain damage, while the order of difficulty of sentences featuring syntactic deviations differed appreciably, depending on the locus of lesion. An attempt is made to relate these findings to current experimental and clinical knowledge.