Simple dissociations for a higher-powered neuropsychology

Contrasting domain-general and domain-specific accounts in cognitive neuropsychology: An outline of a new approach with developmental prosopagnosia as a case

The backbone of cognitive neuropsychology is the observation of (double) dissociations in performance between patients, suggesting some degree of independence between cognitive processes (domain specificity). In comparison, observations of associations between disorders/deficits have been deemed less evidential in neuropsychological theorizing about cognitive architecture. The reason is that associations can reflect damage to independent cognitive processes that happen to be mediated by structures commonly affected by the same brain disorder rather than damage to a shared (domain-general) mechanism. Here we demonstrate that it is in principle possible to discriminate between these alternatives by means of a procedure involving large unbiased samples. We exemplify the procedure in the context of developmental prosopagnosia (DP), but the procedure is in principle applicable to all neuropsychological deficits/disorders. A simulation of the procedure on a dataset yields estimates of dissociations/associations that are well in line with existing DP-studies, and also suggests that seemingly selective disorders can reflect damage to both domain-general and domain-specific cognitive processes. However, the simulation also highlights some limitations that should be considered if the procedure is to be applied prospectively. The main advantage of the procedure is that allows for examination of both associations and dissociations in the same sample. Hence, it may help even the balance in the use of associations and dissociations as grounds for neuropsychological theorizing.

Contribution of cognitive and bodily navigation cues to egocentric and allocentric spatial memory in hallucinations due to Parkinson's disease: A case report

Parkinson's disease (PD) manifestations can include visual hallucinations and illusions. Recent findings suggest that the coherent integration of bodily information within an egocentric representation could play a crucial role in these phenomena. Egocentric processing is a key aspect of spatial navigation and is supported by the striatum. Due to the deterioration of the striatal and motor systems, PD mainly impairs the egocentric rather than the allocentric spatial frame of reference. However, it is still unclear the interplay between spatial cognition and PD hallucinations and how different navigation mechanisms can influence such spatial frames of reference. We report the case of A.A., a patient that suffers from PD with frequent episodes of visual hallucinations and illusions. We used a virtual reality (VR) navigation task to assess egocentric and allocentric spatial memory under five navigation conditions (passive, immersive, map, path decision, and attentive cues) in A.A. and a PD control group without psychosis. In general, A.A. exhibited a statistically significant classical dissociation between the egocentric and allocentric performance with a greater deficit for the former. In particular, the dissociation was statistically significant in the "passive" and "attentive cues" conditions. Interestingly in the "immersive" condition, the dissociation was not significant and, in contrast to the other conditions, trends showed better performance for egocentric than allocentric memory. Within the theories of embodiment, we suggest that body-based information, as assessed with VR navigation tasks, could play an important role in PD hallucinations. In addition, the possible neural underpinnings and the usefulness of VR are discussed.

Dissociations in neuropsychological single-case studies: Should one subtract raw or standardized (z) scores?

This work tackles the problem of whether the dissociation between two performances in a single-case study should be computed as the difference between the raw or between the standardized (e.g. z) scores. A wrong choice can lead to serious inflation of the probability of finding false dissociations and missing true dissociations. Two common misconceptions are that (i) standardized scores are a universally valid choice, or (ii) raw scores can be subtracted when the two performances concern the same "task/test", otherwise standardized scores are better. These and other rules are shown to fail in specific cases and a solution is proposed in terms of in-depth analysis of the meaning of each score. The scores that should be subtracted are those that better reflect "deficit severities" - the latent, unobservable degrees of damage to the cognitive systems that are being compared. Thus explicit theoretical modelling of the investigated cognitive function(s) - the "scenario" - is required. A flowchart is provided that guides such analysis, and shows how a given neuropsychological scenario leads to the selection of an appropriate statistical method for detecting dissociations, introducing the critical concept of "deficit equivalence criterion" - the definition of what exactly a non-dissociation should look like. One further, overlooked problem concerning standardized scores in general (as measures of effect size, of which neuropsychological dissociations are just one example) is that they cannot be meaningfully compared if they have different reliabilities. In conclusion, when studying dissociations, increases in false-positive and false-negative risks are likely to occur when no explicit neuropsychological theory is offered that justifies the definition of what are to be considered as equivalent deficit severities in both performances, and which would lead to appropriate selection of raw, standardized, or any other type of score. More generally, the choice of any measure in any research context needs explicit theoretical modelling, without which statistical risks cannot be controlled.

Synaesthesia as a model system for understanding variation in the human mind and brain

The aim of this article is to reposition synaesthesia as model system for understanding variation in the construction of the human mind and brain. People with synaesthesia inhabit a remarkable mental world in which numbers can be coloured, words can have tastes, and music is a visual spectacle. Key questions remain unanswered about why it exists, and how the study of synaesthesia might inform theories of the human mind. This article argues we need to rethink synaesthesia as not just representing exceptional experiences, but as a product of an unusual neurodevelopmental cascade from genes to brain to cognition of which synaesthesia is only one outcome. Specifically, differences in the brains of synaesthetes support a distinctive way of thinking (enhanced memory, imagery etc.) and may also predispose towards particular clinical vulnerabilities. In effect, synaesthesia can act as a paradigmatic example of a neuropsychological approach to individual differences.

Bayesian multilevel single case models using 'Stan'. A new tool to study single cases in neuropsychology

Single case studies continue to play an important role in neuropsychological research. However, the range of statistical tools specifically designed for single cases is still limited. The current gold standard is the Crawford's t-test, but it is crucial to note that this is limited to simple designs and it is not possible to make inferences relevant to support for the null hypothesis with it. The Bayesian Multilevel Single Case models (BMSC) provide a novel tool that grants the flexibility of linear mixed model designs. BMSC is also able to support both null and alternative hypotheses in complex experimental designs using the Bayesian framework. We compared the BMSC and Crawford's t-test in a simulation study involving a case of no-dissociation and a case of simple dissociation between a single case patient and a series of control groups of different sizes (N = 5, 15, or 30). We then showed how BMSC is useful in complex designs by means of an example using real data. The BMSC proved to be more reliable than the Crawford's test, in terms of first-type errors and more precise estimating the parameters. Notably, the BMSC model provides a comprehensive vision of the whole experimental design, interpolating a single model. It follows the recent trend which involves a shift in attention from p-values to other inferential indices and estimates.

Patterns of perceptual performance in developmental prosopagnosia: An in-depth case series

Developmental prosopagnosia (DP) is a syndrome characterized by lifelong impairment in face recognition in the absence of brain damage. A key question regarding DP concerns which process(es) might be affected to selectively/disproportionally impair face recognition. We present evidence from a group of DPs, combining an overview of previous results with additional analyses important for understanding their pattern of preserved and impaired perceptual abilities. We argue that for most of these individuals, the common denominator is a deficit in (rapid) processing of global shape information. We conclude that the deficit in this group of DPs is not face-selective, but that it may appear so because faces are more visually similar-and recognized at a more fine-grained level-than objects. Indeed, when the demand on perceptual differentiation and visual similarity are held constant for faces and objects, we find no evidence for a disproportionate deficit for faces in this group of DPs.

Power calculations in single-case neuropsychology: A practical primer

Researchers and clinicians in neuropsychology often compare individual patients against healthy control samples, to quantify evidence for cognitive-behavioural deficits and dissociations. Statistical methods for these comparisons have been developed that control Type I (false positive) errors effectively. However, remarkably little attention has been given to the power of these tests. In this practical primer, we describe, in minimally technical terms, the origins and limits of power for case-control comparisons. We argue that power calculations can play useful roles in single-case study design and interpretation, and we make suggestions for optimising power in practice. As well as providing figures, tables and tools for estimating the power of case-control comparisons, we hope to assist researchers in setting realistic expectations for what such tests can achieve in general.

The size-weight illusion in visual form agnosic patient DF

The size-weight illusion is a perceptual illusion where smaller objects are judged as heavier than equally weighted larger objects. A previous informal report suggests that visual form agnosic patient DF does not experience the size-weight illusion when vision is the only available cue to object size. We tested this experimentally, comparing the magnitudes of DF's visual, kinesthetic and visual-kinesthetic size-weight illusions to those of 28 similarly-aged controls. A modified t-test found that DF's visual size-weight illusion was significantly smaller than that of controls (z_cc = -1.7). A test of simple dissociation based on the Revised Standardized Difference Test found that the discrepancy between the magnitude of DF's visual and kinesthetic size-weight illusions was not significantly different from that of controls (z_dcc = -1.054), thereby failing to establish a dissociation between the visual and kinesthetic conditions. These results are consistent with previous suggestions that visual form agnosia, following ventral visual stream damage, is associated with an abnormally reduced size-weight illusion. The results, however, do not confirm that this reduction is specific to the use of visual size cues to predict object weight, rather than reflecting more general changes in the processing of object size cues or in the use of predictive strategies for lifting.

Hemispheric Organization for Visual Object Recognition: A Theoretical Account and Empirical Evidence

Despite the similarity in structure, the hemispheres of the human brain have somewhat different functions. A traditional view of hemispheric organization asserts that there are independent and largely lateralized domain-specific regions in ventral occipitotemporal (VOTC), specialized for the recognition of distinct classes of objects. Here, we offer an alternative account of the organization of the hemispheres, with a specific focus on face and word recognition. This alternative account relies on three computational principles: distributed representations and knowledge, cooperation and competition between representations, and topography and proximity. The crux is that visual recognition results from a network of regions with graded functional specialization that is distributed across both hemispheres. Specifically, the claim is that face recognition, which is acquired relatively early in life, is processed by VOTC regions in both hemispheres. Once literacy is acquired, word recognition, which is co-lateralized with language areas, primarily engages the left VOTC and, consequently, face recognition is primarily, albeit not exclusively, mediated by the right VOTC. We review psychological and neural evidence from a range of studies conducted with normal and brain-damaged adults and children and consider findings which challenge this account. Last, we offer suggestions for future investigations whose findings may further refine this account.

Dissociating frontal and temporal correlates of phonological and semantic fluency in a large sample of left hemisphere stroke patients

Previous lesion studies suggest that semantic and phonological fluency are differentially subserved by distinct brain regions in the left temporal and the left frontal cortex, respectively. However, as of yet, this often implied double dissociation has not been explicitly investigated due to mainly two reasons: (i) the lack of sufficiently large samples of brain-lesioned patients that underwent assessment of the two fluency variants and (ii) the lack of tools to assess interactions in factorial analyses of non-normally distributed behavioral data. In addition, previous studies did not control for task resource artifacts potentially introduced by the generally higher task difficulty of phonological compared to semantic fluency.

We addressed these issues by task-difficulty adjusted assessment of semantic and phonological fluency in 85 chronic patients with ischemic stroke of the left middle cerebral artery. For classical region-based lesion-behavior mapping patients were grouped with respect to their primary lesion location. Building on the extension of the non-parametric Brunner-Munzel rank-order test to multi-factorial designs, ANOVA-type analyses revealed a significant two-way interaction for cue type (semantic vs. phonological) by lesion location (left temporal vs. left frontal vs. other as stroke control group). Subsequent contrast analyses further confirmed the proposed double dissociation by demonstrating that (i) compared to stroke controls, left temporal lesions led to significant impairments in semantic but not in phonological fluency, whereas left frontal lesions led to significant impairments in phonological but not in semantic fluency, and that (ii) patients with frontal lesions showed significantly poorer performance in phonological than in semantic fluency, whereas patients with temporal lesions showed significantly poorer performance in semantic than in phonological fluency.

The anatomical specificity of these findings was further assessed in voxel-based lesion-behavior mapping analyses using the multi-factorial extension of the Brunner-Munzel test. Voxel-wise ANOVA-type analyses identified circumscribed parts of left inferior frontal gyrus and left superior and middle temporal gyrus that significantly double-dissociated with respect to their differential contribution to phonological and semantic fluency, respectively. Furthermore, a main effect of lesion with significant impairments in both fluency types was found in left inferior frontal regions adjacent to but not overlapping with those showing the differential effect for phonological fluency.

The present study hence not only provides first explicit evidence for the anatomical double dissociation in verbal fluency at the group level but also clearly underlines that its formulation constitutes an oversimplification as parts of left frontal cortex appear to contribute to both semantic and phonological fluency.

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Lesion study on neural correlates of phonological and semantic fluency

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Evidence for dissociable and for overlapping contributions

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Left superior and middle temporal gyri specifically crucial for semantic fluency

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Left IFG pars opercularis specifically crucial for phonological fluency

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Left IFG pars triangularis critical for both semantic and phonological fluency