Number reading in pure alexia--a review

Identifying conceptual neural responses to symbolic numerals

The goal of measuring conceptual processing in numerical cognition is distanced by the possibility that neural responses to symbolic numerals are influenced by physical stimulus confounds. Here, we targeted conceptual responses to parity (even versus odd), using electroencephalogram (EEG) frequency-tagging with a symmetry/asymmetry design. Arabic numerals (2-9) were presented at 7.5 Hz in 50 s sequences; odd and even numbers were alternated to target differential, 'asymmetry' responses to parity at 3.75 Hz (7.5 Hz/2). Parity responses were probed with four different stimulus sets, increasing in intra-numeral stimulus variability, and with two control conditions composed of non-conceptual numeral alternations. Significant asymmetry responses were found over the occipitotemporal cortex to all conditions, even for the arbitrary controls. The large physical-differences control condition elicited the largest response in the stimulus set with the lowest variability (one font). Only in the stimulus set with the highest variability (20 drawn, coloured exemplars/numeral) did the response to parity surpass both control conditions. These findings show that physical differences across small sets of Arabic numerals can strongly influence, and even account for, automatic brain responses. However, carefully designed control conditions and highly variable stimulus sets may be used towards identifying truly conceptual neural responses.

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.

Right hemi-alexia

While pure alexia was long considered a disconnection syndrome, it may also be a selective visual word agnosia due to damage to the visual word form area. Disconnection is still the likely explanation of hemi-alexias, though, particularly when splenial lesions damage inter-hemispheric projections and cause left hemi-alexia. An intra-hemispheric disconnection causing right hemi-alexia is theoretically possible but seems very rare, with only a single report that has been challenged on the grounds of inadequate perimetry. We describe the case of PH, who had a severe reading deficit in her right hemifield. Detailed perimetry showed only a small relative hemi-scotoma along the horizontal meridian, while word reading was impaired over a much larger expanse of her right hemifield, in which object recognition was spared. Reading, lexical decisions, and perceptual discrimination of words were impaired in the right hemifield, and this extended to letters and numbers, with a trend to an effect on the perception of an unfamiliar script, namely Korean. On magnetic resonance imaging she had a large left lateral occipital meningioma with vasogenic edema of occipital white matter tracts. Functional magnetic resonance imaging showed that the visual word form area was located just anterior to the mass. Her perceptual abnormalities resolved after resection of the tumor. We conclude that right hemi-alexia exists and is most likely due to intra-hemispheric disconnection of occipital input to the visual word form area.

Visual Occipito-Temporal N1 Sensitivity to Digits Across Elementary School

Number processing abilities are important for academic and personal development. The course of initial specialization of ventral occipito-temporal cortex (vOTC) sensitivity to visual number processing is crucial for the acquisition of numeric and arithmetic skills. We examined the visual N1, the electrophysiological correlate of vOTC activation across five time points in kindergarten (T1, mean age 6.60 years), middle and end of first grade (T2, 7.38 years; T3, 7.68 years), second grade (T4, 8.28 years), and fifth grade (T5, 11.40 years). A combination of cross-sectional and longitudinal EEG data of a total of 62 children (35 female) at varying familial risk for dyslexia were available to form groups of 23, 22, 27, 27, and 42 participants for each of the five time points. The children performed a target detection task which included visual presentation of single digits (DIG), false fonts (FF), and letters (LET) to derive measures for coarse (DIG vs. FF) and fine (DIG vs. LET) digit sensitive processing across development. The N1 amplitude analyses indicated coarse and fine sensitivity characterized by a stronger N1 to digits than false fonts across all five time points, and stronger N1 to digits than letters at all but the second (T2) time point. In addition, lower arithmetic skills were associated with stronger coarse N1 digit sensitivity over the left hemisphere in second grade (T4), possibly reflecting allocation of more attentional resources or stronger reliance on the verbal system in children with poorer arithmetic skills. To summarize, our results show persistent visual N1 sensitivity to digits that is already present early on in pre-school and remains stable until fifth grade. This pattern of digit sensitivity development clearly differs from the relatively sharp rise and fall of the visual N1 sensitivity to words or letters between kindergarten and middle of elementary school and suggests unique developmental trajectories for visual processing of written characters that are relevant to numeracy and literacy.

The spatiotemporal characteristics of N170s for faces and words: A meta-analysis study

N170 is a negative event-related potential (ERP) component in response to visual stimuli, such as faces. It remains controversial whether N170 reflects the specific processing of faces or can also be elicited by objects of expertise (e.g., words). In this research, we conducted a meta-analysis for the spatiotemporal characteristics of N170 of face and word stimuli from 24 studies in which both stimuli were presented for each subject. We observed that (1) both face and word stimuli can elicit conspicuous N170s and that there was no difference between the amplitude of face-N170 and word-N170; (2) there is no difference in the latencies between the two N170s; and (3) both N170s are distributed in the occipitotemporal regions but with a reversed hemispheric distribution pattern-face-N170 is more negative in the right than left occipitotemporal regions, while word-N170 is the opposite. These results showed that the face- and word-N170s are qualitatively the same but have different hemispheric lateralization advantages-N170 might be a general neural index of the expertise-dependent object-recognition process in occipitotemporal regions.

Acquired dyslexias following temporal lesions

The acquisition of reading by children is supported by deep changes in the brain systems devoted to vision and language. The left temporal lobe contributes critically to both systems, and lesions affecting it may therefore cause both peripheral vision-related and central language-related reading impairments. The diversity of peripheral dyslexias reflects the anatomical and functional division of the visual cortex into early visual regions, whose lesions have a limited impact on reading; ventral regions, whose lesions are mostly associated to Pure Alexia; and dorsal regions, whose lesions may yield spatial, neglect-related, and attentional dyslexias. Similarly, central alexias reflect the broad distinction, within language processes, between phonological and lexico-semantic components. Phonological and surface dyslexias roughly result from impairment of the former and the latter processes, respectively, while deep dyslexia may be seen as the association of both. In this chapter, we review such types of acquired dyslexias, their clinical features, pathophysiology, and anatomical correlates.

Dysnumeria in Sign Language: Impaired Construction of the Decimal Structure in Reading Multidigit Numbers in a Deaf ISL Signer

We report on the first in-depth analysis of a specific type of dysnumeria, number-reading deficit, in sign language. The participant, Nomi, is a 45-year-old signer of Israeli Sign Language (ISL). In reading multidigit numbers (reading-then-signing written numbers, the counterpart of reading aloud in spoken language), Nomi made mainly decimal, number-structure errors- reading the correct digits in an incorrect (smaller) decimal class, mainly in longer numbers of 5-6-digits. A unique property of ISL allowed us to rule out the numeric-visual analysis as the source of Nomi's dysnumeria: In ISL, when the multidigit number signifies the number of objects, it is signed with a decimal structure, which is marked morphologically (e.g., 84 → Eight-Tens Four); but a parallel system exists (e.g., for height, age, bus numbers), in which multidigit numbers are signed non-decimally, as a sequence of number-signs (e.g., 84 → Eight, Four). When Nomi read and signed the exact same numbers, but this time non-decimally, she performed significantly better. Additional tests supported the conclusion that her early numeric-visual abilities are intact: she showed flawless detection of differences in length, digit-order, or identity in same-different tasks. Her decimal errors did not result from a number-structure deficit in the phonological-sign output either (no decimal errors in repeating the same numbers, nor in signing multidigit numbers written as Hebrew words). Nomi had similar errors of conversion to the decimal structure in number comprehension (number-size comparison tasks), suggesting that her deficit is in a component shared by reading and comprehension. We also compared Nomi's number reading to her reading and signing of 406 Hebrew words. Nomi's word reading was in the high range of the normal performance of hearing controls and of deaf signers and significantly better than her multidigit number reading, demonstrating a dissociation between number reading, which was impaired, and word reading, which was spared. These results point to a specific type of dysnumeria in the number-frame generation for written multidigit numbers, whereby the conversion from written multidigit numbers to the abstract decimal structure is impaired, affecting both reading and comprehension. The results support abstract, non-verbal decimal structure generation that is shared by reading and comprehension, and also suggest the existence of a non-decimal number-reading route.

Category-selective deficits are the exception and not the rule: Evidence from a case-series of 64 patients with ventral occipito-temporal cortex damage

The organisational principles of the visual ventral stream are still highly debated, particularly the relative association/dissociation between word and face recognition and the degree of lateralisation of the underlying processes. Reports of dissociations between word and face recognition stem from single case-studies of category selective impairments, and neuroimaging investigations of healthy participants. Despite the historical reliance on single case-studies, more recent group studies have highlighted a greater commonality between word and face recognition. Studying individual patients with rare selective deficits misses (a) important variability between patients, (b) systematic associations between task performance, and (c) patients with mild, severe and/or non-selective impairments; meaning that the full spectrum of deficits is unknown. The Back of the Brain project assessed the range and specificity of visual perceptual impairment in 64 patients with posterior cerebral artery stroke recruited based on lesion localization and not behavioural performance. Word, object, and face processing were measured with comparable tests across different levels of processing to investigate associations and dissociations across domains. We present two complementary analyses of the extensive behavioural battery: (1) a data-driven analysis of the whole patient group, and (2) a single-subject case-series analysis testing for deficits and dissociations in each individual patient. In both analyses, the general organisational principle was of associations between words, objects, and faces even following unilateral lesions. The majority of patients either showed deficits across all domains or in no domain, suggesting a spectrum of visuo-perceptual deficits post stroke. Dissociations were observed, but they were the exception and not the rule: Category-selective impairments were found in only a minority of patients, all of whom showed disproportionate deficits for words. Interestingly, such selective word impairments were found following both left and right hemisphere lesions. This large-scale investigation of posterior cerebral artery stroke patients highlights the bilateral representation of visual perceptual function.

Complementary deficits in perceptual classification in pure alexia and acquired prosopagnosia - New insights from two classic cases

Pure alexia and prosopagnosia traditionally have been seen as prime examples of dissociated, category-specific agnosias affecting reading and face recognition, respectively. More recent accounts have moved towards domain-independent explanations that postulate potential cross-links between different types of visual agnosia. According to one proposal, abnormal crowding, i.e. the impairment of recognition when features of adjacent objects are positioned too closely to each other, might provide a unified account for the perceptual deficits experienced by an agnosic patient. An alternative approach is based on the notion of complementary visual subsystems favouring the processing of abstract categories and specific exemplars, respectively. To test predictions of these two approaches with regard to pure alexia and prosopagnosia, we present previously unpublished data on digit recognition and visual crowding from two in the neuropsychological literature extensively studied patients, KD and MT (e.g., Campbell et al., 1986; Landis and Regard, 1988; Rentschler et al., 1994). Patient MT, diagnosed with pure alexia, showed pronounced abnormal foveal crowding, whereas KD, diagnosed with prosopagnosia, did not. These results form a distinct double dissociation with the performance of the two patients in other perceptual classification tasks involving Gabor micropatterns and textures, as well as Glass patterns, which revealed a significantly greater impairment in KD relative to MT. Based on an analysis of the specific task demands we argue that prosopagnosia and pure alexia may involve complementary deficits in instantiation and abstraction, respectively, during perceptual classification, beyond any category specificity. Such an explanation appears in line with previous distinctions between a predominantly left-hemispheric, abstract-category and a predominantly right-hemispheric, specific-exemplar subsystem underlying object recognition.

Reading and alexia

Alexia refers to a reading disorder caused by some form of acquired brain pathology, most commonly a stroke or tumor, in a previously literate subject. In neuropsychology, a distinction is made between central alexia (commonly seen in aphasia) and peripheral alexia (a perceptual or attentional deficit). The prototypical peripheral alexia is alexia without agraphia (pure alexia), where patients can write but are impaired in reading words and letters. Pure alexia is associated with damage to the left ventral occipitotemporal cortex (vOT) or its connections. Hemianopic alexia is associated with less extensive occipital damage and is caused by a visual field defect, which creates problems reading longer words and passages of text. Reading impairment can also arise due to attentional deficits, most commonly following right hemisphere or bilateral lesions. Studying patients with alexia, along with functional imaging studies of normal readers, has improved our understanding of the neurobiological processes involved in reading. A key question is whether an area in the left ventral occipitotemporal cortex is specialized for or selectively involved in word processing, or whether reading relies on tuning of more general purpose perceptual areas. Reading deficits may also be observed in dementia and traumatic brain injury, but often with less consistent deficit patterns than in patients with focal lesions.

Lateralized Neural Responses to Letters and Digits in First Graders

The emergence of visual cortex specialization for culturally acquired characters like letters and digits, both arbitrary shapes related to specific cognitive domains, is yet unclear. Here, 20 young children (6.12 years old) were tested with a frequency‐tagging paradigm coupled with electroencephalogram recordings to assess discrimination responses of letters from digits and vice‐versa. One category of stimuli (e.g., letters) was periodically inserted (1/5) in streams of the other category (e.g., digits) presented at a fast rate (6 Hz). Results show clear right‐lateralized discrimination responses at 6 Hz/5 for digits within letters, and a trend for left‐lateralization for letters. These results support an early developmental emergence of ventral occipito‐temporal cortex specialization for visual recognition of digits and letters, potentially in relation with relevant coactivated brain networks.

The evolution of cognitive models: From neuropsychology to neuroimaging and back

This paper provides a historical and future perspective on how neuropsychology and neuroimaging can be used to develop cognitive models of human brain functions. Section 1 focuses on the emergence of cognitive modelling from neuropsychology, why lesion location was considered to be unimportant and the challenges faced when mapping symptoms to impaired cognitive processes. Section 2 describes how established cognitive models based on behavioural data alone cannot explain the complex patterns of distributed brain activity that are observed in functional neuroimaging studies. This has led to proposals for new cognitive processes, new cognitive strategies and new functional ontologies for cognition. Section 3 considers how the integration of data from lesion, behavioural and functional neuroimaging studies of large cohorts of brain damaged patients can be used to determine whether inter-patient variability in behaviour is due to differences in the premorbid function of each brain region, lesion site or cognitive strategy. This combination of neuroimaging and neuropsychology is providing a deeper understanding of how cognitive functions can be lost and re-learnt after brain damage - an understanding that will transform our ability to generate and validate cognitive models that are both physiologically plausible and clinically useful.

Where arithmetic and phonology meet: The meta-analytic convergence of arithmetic and phonological processing in the brain

Arithmetic facts can be solved using different strategies. Research suggests that some arithmetic problems, particularly those solved by fact retrieval, are related to phonological processing ability and elicit activity in left-lateralized brain regions that support phonological processing. However, it is unclear whether common brain regions support both retrieval-based arithmetic and phonological processing, and if these regions differ across children and adults. This study used activation likelihood estimation to investigate functional neural overlap between arithmetic and phonological processing, separately for children and adults. The meta-analyses in children showed six clusters of overlapping activation concentrated in bilateral frontal regions and in the left fusiform gyrus. The meta-analyses in adults yielded two clusters of concordant activity, one in the left inferior frontal gyrus and one in the left inferior parietal lobule. A qualitative comparison across the two age groups suggests that children show more bilateral and diffuse activation than adults, which may reflect attentional processes that support more effortful processing in children. The present meta-analyses contribute novel insights into the relationship between retrieval-based arithmetic and phonological processing in the brain across children and adults, and brain regions that may support processing of more complex symbolic representations, such as arithmetic facts and words.

The neural circuits of number and letter copying: an fNIRS study

In our daily lives, we are constantly exposed to numbers and letters. However, it is still under debate how letters and numbers are processed in the brain, while information on this topic would allow for a more comprehensive understanding of, for example, known influences of language on numerical cognition or neural circuits shared by numerical cognition and language processing. Some findings provide evidence for a double dissociation between numbers and letters, with numbers being represented in the right and letters in the left hemisphere, while the opposing view suggests a shared neural network. Since processing may depend on the task, we address the reported inconsistencies in a very basic symbol copying task using functional near-infrared spectroscopy (fNIRS). fNIRS data revealed that both number and letter copying rely on the bilateral middle and left inferior frontal gyri. Only numbers elicited additional activation in the bilateral parietal cortex and in the left superior temporal gyrus. However, no cortical activation difference was observed between copying numbers and letters, and there was Bayesian evidence for common activation in the middle frontal gyri and superior parietal lobules. Therefore, we conclude that basic number and letter processing are based on a largely shared cortical network, at least in a simple task such as copying symbols. This suggests that copying can be used as a control condition for more complex tasks in neuroimaging studies without subtracting stimuli-specific activation.

Distinct but Overlapping Patterns of Response to Words and Faces in the Fusiform Gyrus

Converging evidence suggests that the fusiform gyrus is involved in the processing of both faces and words. We used fMRI to investigate the extent to which the representation of words and faces in this region of the brain is based on a common neural representation. In Experiment 1, a univariate analysis revealed regions in the fusiform gyrus that were only selective for faces and other regions that were only selective for words. However, we also found regions that showed both word-selective and face-selective responses, particularly in the left hemisphere. We then used a multivariate analysis to measure the pattern of response to faces and words. Despite the overlap in regional responses, we found distinct patterns of response to both faces and words in the left and right fusiform gyrus. In Experiment 2, fMR adaptation was used to determine whether information about familiar faces and names is integrated in the fusiform gyrus. Distinct regions of the fusiform gyrus showed adaptation to either familiar faces or familiar names. However, there was no adaptation to sequences of faces and names with the same identity. Taken together, these results provide evidence for distinct, but overlapping, neural representations for words and faces in the fusiform gyrus.

Processing deficits for familiar and novel faces in patients with left posterior fusiform lesions

Pure alexia (PA) arises from damage to the left posterior fusiform gyrus (pFG) and the striking reading disorder that defines this condition has meant that such patients are often cited as evidence for the specialisation of this region to processing of written words. There is, however, an alternative view that suggests this region is devoted to processing of high acuity foveal input, which is particularly salient for complex visual stimuli like letter strings. Previous reports have highlighted disrupted processing of non-linguistic visual stimuli after damage to the left pFG, both for familiar and unfamiliar objects and also for novel faces. This study explored the nature of face processing deficits in patients with left pFG damage. Identification of famous faces was found to be compromised in both expressive and receptive tasks. Discrimination of novel faces was also impaired, particularly for those that varied in terms of second-order spacing information, and this deficit was most apparent for the patients with the more severe reading deficits. Interestingly, discrimination of faces that varied in terms of feature identity was considerably better in these patients and it was performance in this condition that was related to the size of the length effects shown in reading. This finding complements functional imaging studies showing left pFG activation for faces varying only in spacing and frontal activation for faces varying only on features. These results suggest that the sequential part-based processing strategy that promotes the length effect in the reading of these patients also allows them to discriminate between faces on the basis of feature identity, but processing of second-order configural information is most compromised due to their left pFG lesion. This study supports a view in which the left pFG is specialised for processing of high acuity foveal visual information that supports processing of both words and faces.

Neural foundations and functional specificity of number representations

Number is a complex category, as with the word "number" we may refer to different entities. First, it is a perceptual property that characterizes any set of individual items, namely its cardinality. The ability to extract the (approximate) cardinality of sets is almost universal in the animal domain and present in humans since birth. In primates, posterior parietal cortex seems to be a crucial site for this ability, even if the degree of selectivity of numerical representations in parietal cortex reported to date appears much lower compared to that of other semantic categories in the ventral stream. Number can also be intended as a mathematical object, which we humans use to count, measure, and order: a (verbal or visual) symbol that stands for the cardinality of a set, the intensity of a continuous quantity or the position of an item on a list. Evidence points to a convergence towards parietal cortex for the semantic coding of numerical symbols and to the bilateral occipitotemporal cortex for the shape coding of Arabic digits and other number symbols.

Numbers are not like words: Different pathways for literacy and numeracy

Literacy and numeracy are two fundamental cognitive skills that require mastering culturally-invented symbolic systems for representing spoken language and quantities. How numbers and words are processed in the human brain and their temporal dynamics remain unclear. Using MEG (magnetoencephalography), we find brain activation differences for literacy and numeracy from early stages of processing in the temporal-occipital and temporal-parietal regions. Native speakers of Spanish were exposed to visually presented words, pseudowords, strings of numbers, strings of letters and strings of symbols while engaged in a go/no-go task. Results showed more evoked neuromagnetic activity for words and pseudowords compared to symbols at ~120-130ms in the left occipito-temporal and temporal-parietal cortices (angular gyrus and intra-parietal sulcus) and at ~200ms in the left inferior frontal gyrus and left temporal areas. In contrast, numbers showed more activation than symbols at similar time windows in homologous regions of the right hemisphere: occipito-temporal and superior and middle temporal cortices at ~100-130ms. A direct comparison between the responses to words and numbers confirmed this distinct lateralization for the two stimulus types. These results suggest that literacy and numeracy follow distinct processing streams through the left and right hemispheres, respectively, and that the temporal-parietal and occipito-temporal regions may interact during processing alphanumeric stimuli.

Assessment of the hemispheric lateralization of grapheme-color synesthesia with Stroop-type tests

Grapheme-color synesthesia, the idiosyncratic, arbitrary association of colors to letters or numbers, develops in childhood once reading is mastered. Because language processing is strongly left-lateralized in most individuals, we hypothesized that grapheme-color synesthesia could be left-lateralized as well. We used synesthetic versions of the Stroop test with colored letters and numbers presented either in the right or the left visual field of thirty-four synesthetes. Interference by synesthetic colors was stronger for stimuli in the right hemifield (first experiment, color naming task). Synesthetes were also faster in the right hemifield when naming the synesthetic color of graphemes (second experiment). Overall, the lateralization effect was 7 ms (the 95% confidence interval was [1.5 12] ms), a delay compatible with an additional callosal transfer for stimuli presented in the left hemifield. Though weak, this effect suggests that the association of synesthetic colors to graphemes may be preferentially processed in the left hemisphere. We speculate that this left-lateralization could be a landmark of synesthetic grapheme-color associations, if not found for color associations learnt by non-synesthete adults.

Patterns of linguistic and numerical performance in aphasia

BACKGROUND

Empirical research on the relationship between linguistic and numerical processing revealed inconsistent results for different levels of cognitive processing (e.g., lexical, semantic) as well as different stimulus materials (e.g., Arabic digits, number words, letters, non-number words). Information of dissociation patterns in aphasic patients was used in order to investigate the dissociability of linguistic and numerical processes. The aim of the present prospective study was a comprehensive, specific, and systematic investigation of relationships between linguistic and numerical processing, considering the impact of asemantic vs. semantic processing and the type of material employed (numbers compared to letters vs. words).

METHODS

A sample of aphasic patients (n = 60) was assessed with a battery of linguistic and numerical tasks directly comparable for their cognitive processing levels (e.g., perceptual, morpho-lexical, semantic).

RESULTS AND CONCLUSIONS

Mean performance differences and frequencies of (complementary) dissociations in individual patients revealed the most prominent numerical advantage for asemantic tasks when comparing the processing of numbers vs. letters, whereas the least numerical advantage was found for semantic tasks when comparing the processing of numbers vs. words. Different patient subgroups showing differential dissociation patterns were further analysed and discussed. A comprehensive model of linguistic and numerical processing should take these findings into account.

A number-form area in the blind

Distinct preference for visual number symbols was recently discovered in the human right inferior temporal gyrus (rITG). It remains unclear how this preference emerges, what is the contribution of shape biases to its formation and whether visual processing underlies it. Here we use congenital blindness as a model for brain development without visual experience. During fMRI, we present blind subjects with shapes encoded using a novel visual-to-music sensory-substitution device (The EyeMusic). Greater activation is observed in the rITG when subjects process symbols as numbers compared with control tasks on the same symbols. Using resting-state fMRI in the blind and sighted, we further show that the areas with preference for numerals and letters exhibit distinct patterns of functional connectivity with quantity and language-processing areas, respectively. Our findings suggest that specificity in the ventral ‘visual’ stream can emerge independently of sensory modality and visual experience, under the influence of distinct connectivity patterns.

The human visual cortex includes areas with preference for various object categories. Here, Abboud et al. demonstrate using visual-to-music substitution, that the congenitally blind show a similar preference for numerals in the right inferior temporal cortex as sighted individuals, despite having no visual experience.

Functional specificity in the motor system: Evidence from coupled fMRI and kinematic recordings during letter and digit writing

A few intriguing neuropsychologial studies report dissociations where agraphic patients are severely impaired for writing letters whereas they write digits nearly normally. Here, using functional magnetic resonance imaging (fMRI) together with graphic tablet recordings, we tested the hypothesis that the motor patterns for writing letters are coded in specific regions of the cortex. We found a set of three regions that were more strongly activated when participants wrote letters than when they wrote digits and whose response was not explained by low-level kinematic features of the graphic movements. Two of these regions (left dorsal premotor cortex and supplementary motor complex) are part of a motor control network. The left premotor activation belongs to what is considered in the literature a key area for handwriting. Another significant activation, likely related to phoneme-to-grapheme conversion, was found in the right anterior insula. This constitutes the first neuroimaging evidence of functional specificity derived from experience in the cortical motor system.

Higher cortical visual deficits

PURPOSE OF REVIEW

This article reviews the various types of visual dysfunction that can result from lesions of the cerebral regions beyond the striate cortex.

RECENT FINDINGS

Patients with dyschromatopsia can exhibit problems with color constancy. The apperceptive form of prosopagnosia is associated with damage to posterior occipital and fusiform gyri, and an associative/amnestic form is linked to damage to more anterior temporal regions. Pure alexia can be accompanied by a surface dysgraphia. New word-length effect criteria distinguish pure alexia from hemianopic dyslexia. Subtler problems with perception of numbers and faces can be seen in patients with pure alexia as well. Also, a developmental form of topographic disorientation, which is due to problems with forming cognitive maps of the environment, has been discovered. In Balint syndrome, added features of decreased flexibility of attention in simultanagnosia include local and global capture. Balint syndrome can affect not just localization in space, but also in time, as manifest in sequence agnosia.

SUMMARY

Lesions at intermediate levels of a processing hierarchy can cause difficulty with color perception or motion perception. At a higher level, ventral lesions of the occipitotemporal lobes can lead to a variety of problems with object recognition. Dorsal lesions of the occipitoparietal lobes can cause difficulty with spatial localization and guidance.

From word superiority to word inferiority: visual processing of letters and words in pure alexia

Visual processing and naming of individual letters and short words were investigated in four patients with pure alexia. To test processing at different levels, the same stimuli were studied across a naming task and a visual perception task. The normal word superiority effect was eliminated in both tasks for all patients, and this pattern was more pronounced in the more severely affected patients. The relationship between performance with single letters and words was, however, not straightforward: One patient performed within the normal range on the letter perception task, while being severely impaired in letter naming and word processing, and performance with letters and words was dissociated in all four patients, with word reading being more severely impaired than letter recognition. This suggests that the word reading deficit in pure alexia may not be reduced to an impairment in single letter perception.

What lies beneath: a comparison of reading aloud in pure alexia and semantic dementia

Exaggerated effects of word length upon reading-aloud performance define pure alexia, but have also been observed in semantic dementia. Some researchers have proposed a reading-specific account, whereby performance in these two disorders reflects the same cause: impaired orthographic processing. In contrast, according to the primary systems view of acquired reading disorders, pure alexia results from a basic visual processing deficit, whereas degraded semantic knowledge undermines reading performance in semantic dementia. To explore the source of reading deficits in these two disorders, we compared the reading performance of 10 pure alexic and 10 semantic dementia patients, matched in terms of overall severity of reading deficit. The results revealed comparable frequency effects on reading accuracy, but weaker effects of regularity in pure alexia than in semantic dementia. Analysis of error types revealed a higher rate of letter-based errors and a lower rate of regularization responses in pure alexia than in semantic dementia. Error responses were most often words in pure alexia but most often nonwords in semantic dementia. Although all patients made some letter substitution errors, these were characterized by visual similarity in pure alexia and phonological similarity in semantic dementia. Overall, the data indicate that the reading deficits in pure alexia and semantic dementia arise from impairments of visual processing and knowledge of word meaning, respectively. The locus and mechanisms of these impairments are placed within the context of current connectionist models of reading.

Impaired reading not due to visual field loss in a patient with a right-hemipsheric lesion

We describe a right-handed patient (M.B.), who developed left hemianopsia and a severe reading impairment after right occipital-parietal hemorrhage. The pattern of his reading deficit was very similar to that of pure alexia (alexia-without-agraphia): extremely slow reading times with frequent grapheme substitutions and omissions. A test of letter reading while controlling for saccadic eye movements and hemifield of presentation ruled out hemianoptic alexia. Although there have already been reports of reading impairments in right handers following right- hemispheric lesions, ours is, to the best of our knowledge, the first where visual field loss can be definitely excluded as the main cause. Based on a standard neuropsychological assessment and on additional behavioral tests, we argue that M.B.'s difficulties are unlikely to be due to right-hemisphere dominance for language. After considering several candidate explanations, we suggest that M.B.'s symptoms may be related to an impairment in attentional processes related to reading.

How low can you go: spatial frequency sensitivity in a patient with pure alexia

Pure alexia is a selective deficit in reading, following lesions to the posterior left hemisphere. Writing and other language functions remain intact in these patients. Whether pure alexia is caused by a primary problem in visual perception is highly debated. A recent hypothesis suggests that a low level deficit - reduced sensitivity to particular spatial frequencies - is the underlying cause. We tested this hypothesis in a pure alexic patient (LK), using a sensitive psychophysical paradigm to examine her performance with simple patterns of different spatial frequency. We find that both in a detection and a classification task, LK's contrast sensitivity is comparable to normal controls for all spatial frequencies. Thus, reduced spatial frequency sensitivity does not constitute a general explanation for pure alexia, suggesting that the core deficit in this disorder is at a higher level in the visual processing stream.

A brain area for visual numerals

Is there a distinct area within the human visual system that has a preferential response to numerals, as there is for faces, words, or scenes? We addressed this question using intracranial electrophysiological recordings and observed a significantly higher response in the high-frequency broadband range (high γ, 65-150 Hz) to visually presented numerals, compared with morphologically similar (i.e., letters and false fonts) or semantically and phonologically similar stimuli (i.e., number words and non-number words). Anatomically, this preferential response was consistently localized in the inferior temporal gyrus and anterior to the temporo-occipital incisure. This region lies within or close to the fMRI signal-dropout zone produced by the nearby auditory canal and venous sinus artifacts, an observation that may account for negative findings in previous fMRI studies of preferential response to numerals. Because visual numerals are culturally dependent symbols that are only learned through education, our novel finding of anatomically localized preferential response to such symbols provides a new example of acquired category-specific responses in the human visual system.

Distributed circuits, not circumscribed centers, mediate visual recognition

Increasingly, the neural mechanisms that support visual cognition are being conceptualized as a distributed but integrated system, as opposed to a set of individual, specialized regions that each subserve a particular visual behavior. Consequently, there is an emerging emphasis on characterizing the functional, structural,and computational properties of these broad networks [corrected]. We present a novel theoretical perspective, which elucidates the developmental emergence, computational properties, and vulnerabilities of integrated circuits using face and word recognition as model domains. Additionally, we suggest that, rather than being disparate and independent, these neural circuits are overlapping and subject to the same computational constraints. Specifically, we argue that both word and face recognition rely on fine-grained visual representations but, by virtue of pressure to couple visual and language areas and to keep connection length short, the left hemisphere becomes more finely tuned for word recognition and, consequently, the right hemisphere becomes more finely tuned for face recognition. Thus, both hemispheres ultimately participate in both forms of visual recognition, but their respective contributions are asymmetrically weighted.

Bilateral hemispheric processing of words and faces: evidence from word impairments in prosopagnosia and face impairments in pure alexia

Considerable research has supported the view that faces and words are subserved by independent neural mechanisms located in the ventral visual cortex in opposite hemispheres. On this view, right hemisphere ventral lesions that impair face recognition (prosopagnosia) should leave word recognition unaffected, and left hemisphere ventral lesions that impair word recognition (pure alexia) should leave face recognition unaffected. The current study shows that neither of these predictions was upheld. A series of experiments characterizing speed and accuracy of word and face recognition were conducted in 7 patients (4 pure alexic, 3 prosopagnosic) and matched controls. Prosopagnosic patients revealed mild but reliable word recognition deficits, and pure alexic patients demonstrated mild but reliable face recognition deficits. The apparent comingling of face and word mechanisms is unexpected from a domain-specific perspective, but follows naturally as a consequence of an interactive, learning-based account in which neural processes for both faces and words are the result of an optimization procedure embodying specific computational principles and constraints.

Complementary neural representations for faces and words: a computational exploration

A key issue that continues to generate controversy concerns the nature of the psychological, computational, and neural mechanisms that support the visual recognition of objects such as faces and words. While some researchers claim that visual recognition is accomplished by category-specific modules dedicated to processing distinct object classes, other researchers have argued for a more distributed system with only partially specialized cortical regions. Considerable evidence from both functional neuroimaging and neuropsychology would seem to favour the modular view, and yet close examination of those data reveals rather graded patterns of specialization that support a more distributed account. This paper explores a theoretical middle ground in which the functional specialization of brain regions arises from general principles and constraints on neural representation and learning that operate throughout cortex but that nonetheless have distinct implications for different classes of stimuli. The account is supported by a computational simulation, in the form of an artificial neural network, that illustrates how cooperative and competitive interactions in the formation of neural representations for faces and words account for both their shared and distinctive properties. We set out a series of empirical predictions, which are also examined, and consider the further implications of this account.

An investigation of twenty/20 vision in reading

One functional anatomical model of reading, drawing on human neuropsychological and neuroimaging data, proposes that a region in left ventral occipitotemporal cortex (vOT) becomes, through experience, specialized for written word perception. We tested this hypothesis by presenting numbers in orthographical and digital form with two task demands, phonological and numerical. We observed a main effect of task on left vOT activity but not stimulus type, with increased activity during the phonological task that was also associated with increased activity in the left inferior frontal gyrus, a region implicated in speech production. Region-of-interest analysis confirmed that there was equal activity for orthographical and digital written forms in the left vOT during the phonological task, despite greater visual complexity of the orthographical forms. This evidence is incompatible with a predominantly feedforward model of written word recognition that proposes that the left vOT is a specialized cortical module for word recognition in literate subjects. Rather, the physiological data presented here fits better with interactive computational models of reading that propose that written word recognition emerges from bidirectional interactions between three processes: visual, phonological, and semantic. Further, the present study is in accord with others that indicate that the left vOT is a route through which nonlinguistic stimuli, perhaps high contrast two-dimensional objects in particular, gain access to a predominantly left-lateralized language and semantic system.