When a rose is a rose in speech but a tulip in writing

The Orthographic Ambiguity of the Arabic Graphic System: Evidence from a Case of Central Agraphia Affecting the Two Routes of Spelling

The Arabic writing system includes ambiguities that create difficulties in spelling. These ambiguities relate mainly to the long vowels, some phoneme-grapheme conversions, lexical particularities, and the connectivity of letters. In this article, the first to specifically explore acquired spelling impairments in an Arabic-speaking individual, we report the case of CHS, who presented with agraphia following a stroke. Initial testing indicated substantial impairment of CHS’s spelling abilities in the form of mixed agraphia. The experimental study was specifically designed to explore the influence of the orthographic ambiguity of the Arabic graphemic system on CHS’s spelling performance. The results revealed that CHS had substantial difficulties with orthographic ambiguity and tended to omit ambiguous graphemes. Some of the errors she produced suggested reliance on the sublexical route of spelling, while others rather reflected the adoption of the lexical-semantic route. These findings from a case involving a non-Western, non-Indo-European language contribute to discussions of theoretical models of spelling. They show that CHS’s pattern of impairment is consistent with the summation hypothesis, according to which the lexical-semantic and the sublexical routes interactively contribute to spelling.

Language impairment in the moderate stage of dementia due to Alzheimer's disease

BACKGROUND

During the moderate stage of dementia due to Alzheimer's disease (AD), language disorder is more evident and it impacts on communication. An overview of language impairment could be helpful to find compensatory communication strategies for these patients.

OBJECTIVE

To identify all language impairments among patients with moderate-stage of AD.

METHODS

20 patients diagnosed with probable AD based on the criteria of the NINCDS-ARDRA, with a MMSE score of 13-23 points and CDR=2, who were undergoing treatment for AD with therapeutic doses of acetyl cholinesterase inhibitors, were assessed using the Boston Diagnostic Aphasia Examination (BDAE), a test that provides a broad assessment of language. The results were compared with the performance of a normal population.

RESULTS

The patients assessed in this study presented normal scores for oral and written word recognition, repetition, mechanics of writing, primer-level dictation and spelling to dictation but also had impairment at most levels of linguistic processing, in oral and written comprehension and production. In general, as expected, the tasks relying on access to the mental lexicon were most significantly affected. However, they performed well in the naming task, in which semantic cues were presented. Moreover, the patients assessed in this study had better performance in written comprehension tasks than in oral ones.

CONCLUSION

The severity of the language impairments was not homogenous, with some linguistic abilities more impaired than others. The abilities that were found to be preserved can help to guide strategies for aiding in communication at this stage of AD.

Pseudoword spelling ability predicts response to word spelling treatment in acquired dysgraphia

Although rehabilitation of acquired dysgraphia can be quite effective, identifying predictors of responsiveness to treatment is useful for prognosis and individualization of treatment protocols. This study examined whether various features of treatment response were predicted by the integrity of one or more of the central cognitive components of spelling: orthographic long-term memory, orthographic working memory, and phoneme-grapheme conversion. Twenty dysgraphic individuals received 12 weeks of bi-weekly, individualized, lexically-based spelling rehabilitation using a spell-study-spell paradigm. Linear multiple regression modelling examined whether the type and severity of the dysgraphic deficit, assessed before rehabilitation, predicted the magnitude and rate of improvement, generalization to untrained items and maintenance of treatment gains. The results revealed that pseudoword spelling accuracy - indexing the integrity of the phoneme-grapheme conversion system - was the only factor examined that significantly predicted the rate of accuracy gains for trained words as well as the extent of generalization to untrained words. Pre-treatment pseudoword spelling accuracy also predicted retention of gains for trained and untrained words at 3-month follow-up. These findings reveal that the integrity of the phoneme-grapheme conversion system prior to dysgraphia rehabilitation may play a key role in rehabilitation-driven recovery, even when the treatment approach targets lexical rather than pseudoword spelling processes.

Orthographic texture effects during spelling are due to variations in representational strength

In this study, we investigated the source of the orthographic texture effect during familiar word spelling. Orthographic texture refers to the differential strength that individual letters in a word may be activated for output. Prior work indicates that strongly activated letters are more accurately produced than weakly activated ones (Jones, Folk, & Rapp, 2009, All Letters are not Equal: Sub-Graphemic Texture in Orthographic Working Memory. Journal of Experimental Psychology: Learning, Memory, and Cognition, 35, 1389-1402. DOI: 10.1037/a0017042). According to an orthographic lexical strength account, differences in activation of individual letters within words are the result of learning; more easily learned letters are more strongly represented and, thus, activated for output. However, an online-competition hypothesis indicates that the contribution of sublexical assembly processes during familiar word spelling may account for the effect. Current results support the orthographic lexical strength account; the lexical orthographic representations used for spelling are themselves textured.

Grey and white matter substrates of action naming

Despite a persistent interest in verb processing, data on the neural underpinnings of verb retrieval are fragmentary. The present study is the first to analyze the contributions of both grey and white matter damage affecting verb retrieval through action naming in stroke. We used voxel-based lesion-symptom mapping (VLSM) with an action naming task in 40 left-hemisphere stroke patients. Within the grey matter, we revealed the critical involvement of the left precentral and inferior frontal gyri, insula, and parts of basal ganglia. An overlay of white matter tract probability masks on the VLSM lesion map revealed involvement of left-hemisphere long and short association tracts with terminations in the frontal areas; and several projection tracts. The involvement of these structures is interpreted in the light of existing picture naming models, semantic control processes, and the embodiment cognition framework. Our results stress the importance of both cortico-cortical and cortico-subcortical networks of language processing.

The processing of inflected and derived words in writing

We report on an English-speaking, aphasic individual (RB) with a spelling deficit more severely affecting orthographically irregular words for which phonologically plausible errors (PPEs) were produced. PPEs were observed for all word forms, with the exception of inflectional suffixes, despite the irregular sound-print mappings of many inflectional suffixes (e.g., walked → /wɔkt/). RB's pattern replicates that reported in Badecker, Rapp, and Caramazza (Badecker, W., Rapp, B., & Caramazza, A. (1996). Lexical Morphology and the Two Orthographic Routes. Cognitive Neuropsychology, 13, 161-176). We extended their investigation by examining RB's spelling of derived words and found a selective deficit for derived words compared to inflected words in writing. This selective deficit did not appear to reflect differences in morphological transparency or suffix frequencies that exist between inflection and derivation. This is the first evidence that distinct neural mechanisms support inflection and derivation in spelling.

Lexical processing and distributional knowledge in sound-spelling mapping in a consistent orthography: A longitudinal study of reading and spelling in dyslexic and typically developing children

This study examined the ability to master lexical processing and use knowledge of the relative frequency of sound-spelling mappings in both reading and spelling. Twenty-four dyslexic and dysgraphic children and 86 typically developing readers were followed longitudinally in 3rd and 5th grades. Effects of word regularity, word frequency, and probability of sound-spelling mappings were examined in two experimental tasks: (a) spelling to dictation; and (b) orthographic judgment. Dyslexic children showed larger regularity and frequency effects than controls in both tasks. Sensitivity to distributional information of sound-spelling mappings was already detected by third grade, indicating early acquisition even in children with dyslexia. Although with notable differences, knowledge of the relative frequencies of sound-spelling mapping influenced both reading and spelling. Results are discussed in terms of their theoretical and empirical implications.

Do reading and spelling share orthographic representations? Evidence from developmental dysgraphia

Both spelling and reading depend on knowledge of the spellings of words. Despite this commonality, observed dissociations between spelling and reading in cases of acquired and developmental deficits suggest some degree of independence between the cognitive mechanisms involved in these skills. In this paper, we examine the relationship between spelling and reading in two children with developmental dysgraphia. For both children, we identified significant deficits in spelling that affected the processing of orthographic long-term memory representations of words. We then examined their reading skills for similar difficulties. Even with extensive testing, we found no evidence of a reading deficit for one of the children. We propose that there may be an underlying difficulty that specifically affects the learning of orthographic word representations for spelling. These results lead us to conclude that at least some components of lexical orthographic representation and processing develop with considerable independence in spelling and reading.

Neuroanatomical foundations of naming impairments across different neurologic conditions

The ability to name objects or abstract entities is an essential feature of speech and language, being commonly considered a central component of normal neurologic function. For this reason, the bedside testing of naming performance is part of the neurologic examination, especially since naming impairments can signify the early onset of a progressive disease or the occurrence of a more established problem. Modern neuroscience research suggests that naming relies on specific and distributed networks that operate in concert to support various processing stages, spanning from object recognition to spoken words. Likewise, studies evaluating the types of naming impairments in patients with neurologic conditions have contributed to the understanding of acquired forms of naming impairments and the underlying stages during normal language processing. In this article, we review the neurobiological mechanisms supporting naming, with a focus on the clinical application of these concepts. We provide an overview of the stages of cognitive processing that are hypothesized to support naming. For each stage, we explore the evidence revealing its neural basis, drawing parallels to clinical syndromes that commonly disrupt each stage. We review the patterns of naming impairment across various neurologic conditions, including classic language disorders, such as poststroke aphasia or primary progressive aphasia, as well as other diseases where language impairments may be subtle but helpful for the appropriate diagnosis. In this context, we provide a structured and practical guide for the bedside naming assessments rooted in modern neuroscience, aimed at supporting the evaluation and diagnosis of neurologic conditions that affect language.

Modality and morphology: what we write may not be what we say

Written language is an evolutionarily recent human invention; consequently, its neural substrates cannot be determined by the genetic code. How, then, does the brain incorporate skills of this type? One possibility is that written language is dependent on evolutionarily older skills, such as spoken language; another is that dedicated substrates develop with expertise. If written language does depend on spoken language, then acquired deficits of spoken and written language should necessarily co-occur. Alternatively, if at least some substrates are dedicated to written language, such deficits may doubly dissociate. We report on 5 individuals with aphasia, documenting a double dissociation in which the production of affixes (e.g., the -ing in jumping) is disrupted in writing but not speaking or vice versa. The findings reveal that written- and spoken-language systems are considerably independent from the standpoint of morpho-orthographic operations. Understanding this independence of the orthographic system in adults has implications for the education and rehabilitation of people with written-language deficits.

Generalisation after treatment of acquired spelling impairments: A review

This paper provides a comprehensive review of treatment studies of acquired dysgraphia and the occurrence of generalisation after this treatment. The aim is to examine what determines the occurrence of generalisation by investigating the link between the level of impairment, the method of treatment, and the outcome of therapy. We present the outcomes of treatment with regard to generalisation in 40 treatment studies. We derive general principles of generalisation which provide us with a better understanding of the mechanism of generalisation: (1) Direct treatment effects on representations or processes; (2) interactive processing and summation of activation; and (3) strategies and compensatory skills. We discuss the implications of these findings for our understanding of the cognitive processes used for spelling. Finally, we provide suggestions for the direction of further research into this important area, as a better understanding of the mechanism of generalisation could maximise treatment effects for an individual with acquired dysgraphia.

Vocabulary acquisition in aphasia: Modality can matter

The present case study investigated modality-specific aspects of novel word acquisition in aphasia. It was prompted by recent aphasia case studies indicating great interindividual variability in the ability to learn and maintain novel words in aphasia. Moreover, two previous case studies revealed a striking effect of input modality by showing effective word learning and re-learning via visual input only (Kohen, Sola, Tuomiranta, Laine, & Martin, 2012; Tuomiranta et al., 2014). The present participant TS with chronic nonfluent aphasia and post-semantic anomia was administered novel word-referent learning tasks. In the first experiment, the learning phase included simultaneous phonological and orthographic input, while the follow-up was probed separately for spoken and written responses. In the second experiment, we studied the effect of four different input and output modality combinations on her ability to learn to name the novel items. In the first experiment, TS's spoken naming performance during the learning phase was just within the range of healthy controls. Maintenance declined and remained outside that range during the whole 6-month follow-up. However, TS maintained the learned words better in written than in spoken naming throughout the follow-up, and in written naming, her maintenance stayed within the control's range up to 8 weeks post-training. The second experiment indicated that the best learning outcome was achieved with orthographic input. Orthographic input combined with orthographic output resulted in fast and accurate learning of the novel words. Interestingly, TS's test profile was opposite to her learning profile, as she repeated better than she read aloud in the linguistic background assessment. The results from the present case highlight the importance of multiple learning channels for word acquisition in individuals with aphasia. Probing the functionality of different input and output channels for learning may also prove valuable in tailoring effective treatment for persons with aphasia.

Morphological-compound dysgraphia in an aphasic patient: "A wild write through the lexicon"

We describe the case of a dysgraphic aphasic individual--S.G.W.--who, in writing to dictation, produced high rates of formally related errors consisting of both lexical substitutions and what we call morphological-compound errors involving legal or illegal combinations of morphemes. These errors were produced in the context of a minimal number of semantic errors. We could exclude problems with phonological discrimination and phonological short-term memory. We also excluded rapid decay of lexical information and/or weak activation of word forms and letter representations since S.G.W.'s spelling showed no effect of delay and no consistent length effects, but, instead, paradoxical complexity effects with segmental, lexical, and morphological errors that were more complex than the target. The case of S.G.W. strongly resembles that of another dysgraphic individual reported in the literature--D.W.--suggesting that this pattern of errors can be replicated across patients. In particular, both patients show unusual errors resulting in the production of neologistic compounds (e.g., "bed button" in response to "bed"). These patterns can be explained if we accept two claims: (a) Brain damage can produce both a reduction and an increase in lexical activation; and (b) there are direct connections between phonological and orthographic lexical representations (a third spelling route). We suggest that both patients are suffering from a difficulty of lexical selection resulting from excessive activation of formally related lexical representations. This hypothesis is strongly supported by S.G.W.'s worse performance in spelling to dictation than in written naming, which shows that a phonological input, activating a cohort of formally related lexical representations, increases selection difficulties.

When does word frequency influence written production?

The aim of the present study was to explore the central (e.g., lexical processing) and peripheral processes (motor preparation and execution) underlying word production during typewriting. To do so, we tested non-professional typers in a picture typing task while continuously recording EEG. Participants were instructed to write (by means of a standard keyboard) the corresponding name for a given picture. The lexical frequency of the words was manipulated: half of the picture names were of high-frequency while the remaining were of low-frequency. Different measures were obtained: (1) first keystroke latency and (2) keystroke latency of the subsequent letters and duration of the word. Moreover, ERPs locked to the onset of the picture presentation were analyzed to explore the temporal course of word frequency in typewriting. The results showed an effect of word frequency for the first keystroke latency but not for the duration of the word or the speed to which letter were typed (interstroke intervals). The electrophysiological results showed the expected ERP frequency effect at posterior sites: amplitudes for low-frequency words were more positive than those for high-frequency words. However, relative to previous evidence in the spoken modality, the frequency effect appeared in a later time-window. These results demonstrate two marked differences in the processing dynamics underpinning typing compared to speaking: First, central processing dynamics between speaking and typing differ already in the manner that words are accessed; second, central processing differences in typing, unlike speaking, do not cascade to peripheral processes involved in response execution.

Lexical neighborhood effects in pseudoword spelling

The general aim of this study is to contribute to a better understanding of the cognitive processes that underpin skilled adult spelling. More specifically, it investigates the influence of lexical neighbors on pseudo-word spelling with the goal of providing a more detailed account of the interaction between lexical and sublexical sources of knowledge in spelling. In prior research examining this topic, adult participants typically heard lists composed of both words and pseudo-words and had to make a lexical decision to each stimulus before writing the pseudo-words. However, these priming paradigms are susceptible to strategic influence and may therefore not give a clear picture of the processes normally engaged in spelling unfamiliar words. In our two Experiments involving 71 French-speaking literate adults, only pseudo-words were presented which participants were simply requested to write to dictation using the first spelling that came to mind. Unbeknownst to participants, pseudo-words varied according to whether they did or did not have a phonological word neighbor. Results revealed that low-probability phoneme/grapheme mappings (e.g., /o/ -> aud in French) were used significantly more often in spelling pseudo-words with a close phonological lexical neighbor with that spelling (e.g., /krepo/ derived from “crapaud,” /krapo/) than in spelling pseudo-words with no close neighbors (e.g., /frøpo/). In addition, the strength of this lexical influence increased with the lexical frequency of the word neighbors as well as with their degree of phonetic overlap with the pseudo-word targets. These results indicate that information from lexical and sublexical processes is integrated in the course of spelling, and a specific theoretical account as to how such integration may occur is introduced.

Patterns of dysgraphia in primary progressive aphasia compared to post-stroke aphasia

We report patterns of dysgraphia in participants with primary progressive aphasia that can be explained by assuming disruption of one or more cognitive processes or representations in the complex process of spelling. These patterns are compared to those described in participants with focal lesions (stroke). Using structural imaging techniques, we found that damage to the left extrasylvian regions, including the uncinate, inferior fronto-occipital fasciculus, and sagittal stratum (including geniculostriate pathway and inferior longitudinal fasciculus), as well as other deep white and grey matter structures, was significantly associated with impairments in access to orthographic word forms and semantics (with reliance on phonology-to-orthography to produce a plausible spelling in the spelling to dictation task). These results contribute not only to our understanding of the patterns of dysgraphia following acquired brain damage but also the neural substrates underlying spelling.

Spelling intervention in post-stroke aphasia and primary progressive aphasia

Spelling–a core language skill–is commonly affected in neurological diseases such as stroke and Primary Progressive Aphasia (PPA). We present two case studies of the same spelling therapy (learning of phoneme-to-grapheme correspondences with help from key words) in two participants: one who had a stroke and one with PPA (logopenic variant). Our study highlights similarities and differences in the time course of each indivdual's therapy. The study evaluates the effectiveness and generalization of treatment in each case, i.e. whether the treatment affected the trained items and/or untrained items, and whether or not the treatment gains were maintained after the end of therapy. Both participants were able to learn associations between phonemes and graphemes as well as between phonemes and words. Reliable generalization to untrained words was shown only for the participant with post-stroke aphasia, but we were not able to test generalization to untrained words in the individual with PPA. The same spelling therapy followed a different time course in each case. The participant with post-stroke aphasia showed a lasting effect of improved spelling, but we were unable to assess maintenance of improvement in the participant with PPA. We discuss these differences in light of the underlying nature of each disease.

The integration of information across lexical and sublexical processes in spelling

We report on a brain-injured subject, LAT, who made phonologically plausible errors in word spelling (e.g., "bouquet" spelled as BOUKET). Although many of his errors are phonologically plausible they contained low-frequency (yet lexically correct) spellings (/ei/ spelled as ET in BOUK ET). Because these errors are phonologically plausible they do not appear to have been generated by the lexical process, yet because they contain low probability, lexically correct elements they do not appear to be have been generated by the sublexical process. We present analyses that specifically support the conclusion that many of LAT's phonologically plausible responses to word stimuli consist of the integrated output of elements generated by both the lexical and sublexical processes. This evidence constitutes strong support for the notion that lexical and sublexical processes share information during the course of spelling a familiar word.

The interaction of lexical and sublexical information in spelling: What's the point?

Most theories of spelling propose two major processes for translating between orthography and phonology: a lexical process for retrieving the spellings of familiar words and a sublexical process for assembling the spellings of unfamiliar letter strings based on knowledge of the systematic correspondences between phonemes and graphemes. We investigated how the lexical and sublexical processes function and interact in spelling by selectively interfering with the sublexical process in a dysgraphic individual. By comparing spelling performance under normal conditions and under conditions of sublexical disruption we were able to gain insight into the functioning and the unique contributions of the sublexical process. The results support the hypothesis that the sublexical process serves to strengthen a target word and provide it with a competitive advantage over orthographically and phonologically similar word neighbours that are in competition with the target for selection.

Spelling and dysgraphia

Early cognitive models of spelling assumed that orthographic word representations are linear, ordered sequences of abstract letter identities (graphemes), activated only by word meaning information, and in some cases proposed that activating phonological information is a necessary stage of the spelling process. Over the past 20 years, studies on dysgraphia have shown that orthographic representations are autonomous from phonological representations and, just like the latter, are directly activated from semantics. The selection of an orthographic form for output relies on the convergence of activation from lexical-semantic information and from sublexical phoneme-grapheme conversion procedures. In addition, it is increasingly clear that orthographic representations are multidimensional objects that separately represent the graphosyllabic structure (or perhaps the nucleus/non-nucleus positions) of the target, and the identity, the CV status, and the quantity (doubling) of each grapheme. In spelling, the structure of orthographic knowledge and the mechanisms involved in processing serial order interact in complex ways and constrain performance accuracy. Further research is needed to clarify some critical issues: We need to specify in greater detail the mechanisms involved in the interaction between meaning and sublexical information; we must consider the possibility that orthographic representations have texture, in addition to structure; we must provide explicit hypotheses on the mechanisms that process orthographic knowledge; and we must gain a better understanding of the interaction between structure and serial order.

Grapheme-to-lexeme feedback in the spelling system: Evidence from a dysgraphic patient

This article presents an argument for grapheme-to-lexeme feedback in the cognitive spelling system, based on the impaired spelling performance of dysgraphic patient CM. The argument relates two features of CM's spelling. First, letters from prior spelling responses intrude into subsequent responses at rates far greater than expected by chance. This letter persistence effect arises at a level of abstract grapheme representations, and apparently results from abnormal persistence of activation. Second, CM makes many formal lexical errors (e.g., carpet → compute). Analyses revealed that a large proportion of these errors are "true" lexical errors originating in lexical selection, rather than "chance" lexical errors that happen by chance to take the form of words. Additional analyses demonstrated that CM's true lexical errors exhibit the letter persistence effect. We argue that this finding can be understood only within a functional architecture in which activation from the grapheme level feeds back to the lexeme level, thereby influencing lexical selection.

Single or dual orthographic representations for reading and spelling? A study of Italian dyslexic-dysgraphic and normal children

Italian children with surface dyslexia and dysgraphia show defective orthographic lexical processing in both reading and spelling. It is unclear whether this parallelism is due to impairment of separate orthographic input and output lexicons or to a unique defective lexicon. The main aim of the present study was to compare the single- versus dual-lexicon accounts in dyslexic/dysgraphic children (and in normal but younger children). In the first experiment, 9 Italian children with surface dyslexia and dysgraphia judged the orthographic correctness (input lexicon) of their phonologically plausible misspellings (output lexicon) and of phonologically plausible spellings experimentally introduced for words they consistently spelt correctly. The children were generally impaired in recognizing phonologically plausible misspellings. Parallel deficits in reading and spelling also emerged: Children were more impaired in judging items they consistently misspelt and more accurate in judging items they always spelt correctly. In a second experiment, younger normal children with reading/spelling ability similar to that of the dyslexic/dysgraphic children in the first experiment (but younger) were examined. The results confirmed a close parallelism between the orthographic lexical representations used for reading and spelling. Overall, findings support the hypothesis that a single orthographic lexicon is responsible for reading and spelling performance in both dyslexic/dysgraphic and normal (but younger) children.

A treatment sequence for phonological alexia/agraphia

PURPOSE

Damage to left perisylvian cortex often results in impaired phonological processing abilities with written language profiles consistent with phonological alexia and phonological agraphia. The purpose of this article was to examine a behavioral treatment sequence for such individuals intended to strengthen phonological processing and links between phonology and orthography, as well as train a means to maximize use of residual orthographic and phonological knowledge for spelling.

METHOD

Two women with persistent impairments of written language and phonological processing following damage to left perisylvian cortical regions participated in this study. Both exhibited characteristic features of phonological alexia and agraphia in that reading and spelling performance for real words was better preserved than nonwords (lexicality effect). A 2-stage treatment protocol was administered to strengthen sublexical skills (phonological treatment) and to train interactive use of lexical and sublexical information to maximize spelling performance (interactive treatment).

RESULTS

Both participants improved phonological processing abilities and reading/spelling via the sublexical route. They also improved spelling of real words and were able to detect and correct most residual errors using an electronic spelling aid.

CONCLUSIONS

Behavioral treatment served to strengthen phonological skills supporting reading and spelling, and provided a functional compensatory strategy to overcome residual weaknesses.

Dyscravia: voicing substitution dysgraphia

We report a new type of dysgraphia, which we term dyscravia. The main error type in dyscravia is substitution of the target letter with a letter that differs only with respect to the voicing feature, such as writing "coat" for "goat", and "vagd" for "fact". Two Hebrew-speaking individuals with acquired dyscravia are reported, TG, a man aged 31, and BG, a woman aged 66. Both had surface dysgraphia in addition to their dyscravia. To describe dyscravia in detail, and to explore the rate and types of errors made in spelling, we administered tests of writing to dictation, written naming, and oral spelling. In writing to dictation, TG made voicing errors on 38% of the words, and BG made 17% voicing errors. Voicing errors also occurred in nonword writing (43% for TG, 56% for BG). The writing performance and the variables that influenced the participants' spelling, as well as the results of the auditory discrimination and repetition tasks indicated that their dyscravia did not result from a deficit in auditory processing, the graphemic buffer, the phonological output lexicon, the phonological output buffer, or the allographic stage. The locus of the deficit is the phoneme-to-grapheme conversion, in a function specialized in the conversion of phonemes' voicing feature into graphemes. Because these participants had surface dysgraphia and were forced to write via the sublexical route, the deficit in voicing was evident in their writing of both words and nonwords. We further examined whether the participants also evinced parallel errors in reading. TG had a selective voicing deficit in writing, and did not show any voicing errors in reading, whereas BG had voicing errors also in the reading of nonwords (i.e., she had dyslegzia in addition to dyscravia). The dissociation TG demonstrated indicated that the voicing feature conversion is separate for reading and writing, and can be impaired selectively in writing. BG's dyslegzia indicates that the grapheme-to-phoneme conversion also includes a function that is sensitive to phonological features such as voicing. Thus the main conclusion of this study is that a separate function of voicing feature conversion exists in the phoneme-to-grapheme conversion route, which may be selectively impaired without deficits in other functions of the conversion route, and without a parallel deficit in reading.

Patterns of breakdown in spelling in primary progressive aphasia

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Where (in the brain) do semantic errors come from?

BACKGROUND

Semantic errors result from the disruption of access either to semantics or to lexical representations. One way to determine the origins of these errors is to evaluate comprehension of words that elicit semantic errors in naming. We hypothesized that in acute stroke there are different brain regions where dysfunction results in semantic errors in both naming and comprehension versus those with semantic errors in oral naming alone.

METHODS

A consecutive series of 196 patients with acute left hemispheric stroke who met inclusion criteria were evaluated with oral naming and spoken word/picture verification tasks and magnetic resonance imaging within 48 h of stroke onset. We evaluated the relationship between tissue dysfunction in 10 pre-specified Brodmann's areas (BA) and the production of coordinate semantic errors resulting from (1) semantic deficits or (2) lexical access deficits.

RESULTS

Semantic errors arising from semantic deficits were most associated with tissue dysfunction/infarct of left BA 22. Semantic errors resulting from lexical access deficits were associated with hypoperfusion/infarct of left BA 37.

CONCLUSION

Our study shows that semantic errors arising from damage to distinct cognitive processes reflect dysfunction of different brain regions.

Speech and language functions that require a functioning Broca's area

A number of previous studies have indicated that Broca's area has an important role in understanding and producing syntactically complex sentences and other language functions. If Broca's area is critical for these functions, then either infarction of Broca's area or temporary hypoperfusion within this region should cause impairment of these functions, at least while the neural tissue is dysfunctional. The opportunity to identify the language functions that depend on Broca's area in a particular individual was provided by a patient with hyperacute stroke who showed selective hypoperfusion, with minimal infarct, in Broca's area, and acutely impaired production of grammatical sentences, comprehension of semantically reversible (but not non-reversible) sentences, spelling, and motor planning of speech articulation. When blood flow was restored to Broca's area, as demonstrated by repeat perfusion weighted imaging, he showed immediate recovery of these language functions. The identification of language functions that were impaired when Broca's area was dysfunctional (due to low blood flow) and recovered when Broca's area was functional again, provides evidence for the critical role of Broca's area in these language functions, at least in this individual.

A developmental fMRI study of reading and repetition reveals changes in phonological and visual mechanisms over age

In this study of reading development, children (ages 7-10) and adults (ages 18-32) performed overt single-word reading and aural repetition tasks on high-frequency word stimuli during functional magnetic resonance imaging. Most regions showed similar activity across age groups. These widespread regions of similarity indicate that children and adults use largely overlapping mechanisms when processing high-frequency words. Significant task-related differences included greater activity in occipital cortex for the read task, and greater activity in temporal cortex for the repeat task; activity levels in these regions were similar for adults and children. However, age group differences were found in several posterior regions, including a set of regions implicated in adult reading: the left supramarginal gyrus, the left angular gyrus, and bilateral anterior extrastriate cortex. The angular and supramarginal gyrus regions, hypothesized to play a role in phonology, showed decreased activity in adults relative to children for high-frequency words. The extrastriate regions had significant activity for both the visual read task and auditory repeat task in children, but just for the read task in adults, showing significant task and age interactions. These results are consistent with decreasing reliance on phonological processing, and increasing tuning of visual mechanisms, with age.

Neural regions essential for reading and spelling of words and pseudowords

OBJECTIVE

To identify dysfunctional brain regions critical for impaired reading/spelling of words/pseudowords by evaluating acute stroke patients on lexical tests and magnetic resonance imaging, before recovery or reorganization of structure-function relationships.

METHODS

A series of 106 consenting patients were administered oral reading and spelling tests within 24 hours of left supratentorial stroke onset. Patients underwent diffusion- and perfusion-weighted magnetic resonance examination the same day to identify regions of hypoperfusion/infarct of 16 Brodmann areas.

RESULTS

Simultaneous logistic regression analysis demonstrated that dysfunction of left Brodmann areas 40 (supramarginal gyrus) and 37 (posterior-inferior temporal/fusiform gyrus) best predicted impairment in reading words (odds ratio [OR], 6.20 [95% confidence interval (CI), 1.54-24.96] and 2.71 [95% CI, 0.87-8.45], respectively), reading pseudowords (OR, 39.65 [95% CI 3.9-400.78] and 4.41 [95% CI, 1.1-17.51], respectively), spelling words (OR, 14.11 [95% CI 1.37-144.93] and 7.41 [95% CI, 1.48-37.24], respectively), and spelling pseudowords (OR, 4.84 [95% CI, 0.73-32.13] and 7.74 [95% CI, 1.56-38.51], respectively). Whole-brain voxel-wise analyses demonstrated voxel clusters within these regions that were most strongly associated with task deficits.

INTERPRETATION

Results indicate that a shared network of regions including parts of left Brodmann areas 37 and 40 is necessary for reading and spelling of words and pseudowords. Further studies may define the precise roles of these brain regions in language. Identification of any neural regions specific to one of these tasks or one type of stimuli will require study of more patients with selective deficits.

Neural regions essential for distinct cognitive processes underlying picture naming

We hypothesized that distinct cognitive processes underlying oral and written picture naming depend on intact function of different, but overlapping, regions of the left hemisphere cortex, such that the distribution of tissue dysfunction in various areas can predict the component of the naming process that is disrupted. To test this hypothesis, we evaluated 116 individuals within 24 h of acute ischaemic stroke using a battery of oral and written naming and other lexical tests, and with magnetic resonance diffusion and perfusion imaging to identify the areas of tissue dysfunction. Discriminant function analysis, using the degree of hypoperfusion in various Brodmann's areas--BA 22 (including Wernicke's area), BA 44 (part of Broca's area), BA 45 (part of Broca's area), BA 21 (inferior temporal cortex), BA 37 (posterior, inferior temporal/fusiform gyrus), BA 38 (anterior temporal cortex) and BA 39 (angular gyrus)--as discriminant variables, classified patients on the basis of the primary component of the naming process that was impaired (defined as visual, semantics, modality-independent lexical access, phonological word form, orthographic word form and motor speech by the pattern of performance and types of errors across lexical tasks). Additionally, linear regression analysis demonstrated that the areas contributing the most information to the identification of patients with particular levels of impairment in the naming process were largely consistent with evidence for the roles of these regions from functional imaging. This study provides evidence that the level of impairment in the naming process reflects the distribution of tissue dysfunction in particular regions of the left anterior, inferior and posterior middle/superior temporal cortex, posterior inferior frontal and inferior parietal cortex. While occipital cortex is also critical for picture naming, it is likely that bilateral occipital damage is necessary to disrupt visual recognition. These findings provide new evidence that a network of brain regions supports naming, but separate components of this network are differentially required for distinct cognitive processes or representations underlying the complex task of naming pictures.

Alterações de linguagem nas fases iniciais da doença de Alzheimer

A doença de Alzheimer (DA) está associada a alterações cognitivas, de linguagem e de comportamento que se agravam durante seu curso. O objetivo deste estudo foi verificar a presença de alterações de linguagem, em pacientes com DA em fase inicial. Foram avaliados 12 pacientes com diagnóstico de provável (DA). Todos tinham pontuação no Mini Exame do Estado Mental acima de 23 pontos. Os pacientes foram submetidos à aplicação do Teste de Boston e os resultados comparados aos da população normal. Todos os pacientes apresentaram alterações de linguagem. Foram encontradas diferenças estatisticamente significantes nas tarefas de Compreensão auditiva e na tarefa de denominação. Nas demais tarefas de expressão e compreensão oral, bem como nas de leitura e escrita, os pacientes tiveram desempenho similar aos normais. Embora com um grupo pequeno,esta investigação identificou alterações bem definidas de linguagem em uma fase bastante inicial da DA.

Paradoxical features of word finding difficulty in primary progressive aphasia

Impaired word retrieval is a main symptom of primary progressive aphasia (PPA). The cognitive features of this impairment in PPA are poorly understood. We studied 12 patients with PPA (6 English-speaking and 6 Dutch-speaking), 7 patients with early-stage clinically probable Alzheimer's disease (PRAD), 5 patients with mild cognitive impairment (MCI), and 15 age-matched, cognitively intact, control subjects. Subjects had to name a picture (the probe), which was preceded by a written word (the prime) that could be the correct name of the picture, a noun belonging to the same semantic subcategory (related prime), a semantically unrelated noun (unrelated prime), or a pseudoword (neutral control). Naming latencies were longer in PPA and PRAD patients than in control subjects. Critically, the interaction between group and prime type was highly significant. PPA patients named the probe more slowly after a related compared with an unrelated prime. In contrast, PRAD patients, mild cognitive impairment patients, and healthy control subjects tended to name the probe faster when it was preceded by a related prime. The semantic interference effect in PPA generalized across languages and PPA subtypes. Selection among competing word forms sharing a same semantic field is abnormal in PPA. The semantic interference effect constitutes a positive distinguishing feature between PPA and PRAD.

The impact of deep dysgraphia on graphemic buffer disorders

This article describes an investigation into the residual writing skills of a severely dysgraphic patient (DA). We found that they were powerfully influenced by a number of lexical variables (lexicality, frequency, imageability, length and geminates). His error pattern was characterized by semantic, lexical, substitution, deletion errors and fragment responses that preserved the first letter. Thus, DA's written spelling was characterized by both deep dysgraphic and graphemic output buffer effects. It is proposed that this pattern of performance represents a new"putative functional syndrome."

Lexical learning of the English language: a PET study in healthy French subjects

To investigate the neural correlates of word learning in adults, 10 right-handed French subjects who had learned English without mastering it performed an English and a French naming task during two PET sessions, one before (PET1) and the second after (PET2) a 4-week lexical training in English. Behavioral performance was collected during the two PET exams and 2 months after (T3). At T2, performance on English naming increased in all subjects; this improvement persisted at T3, with no correlation between English performance at T2 and T3. Cerebral activation during French naming mainly showed a left frontal temporal network. The pattern specifically associated with English lexical learning included, in addition to the anterior cingulate cortex involved in attentional processing and BAs 4/6 reflecting speech output, the right cerebellum and the left insular cortex that are linked to speech gesture learning, and the right medial temporal regions, likely to reflect the involvement of episodic memory during verbal learning. Correlations between English T2/T1 performance and English T2/T1 rCBF changes reinforced the hypothesis of intervention of episodic memory since they interested right frontal, hippocampal, and lateral temporal regions. 'Predictive' correlations between English T3/T2 performance and English T2/T1 rCBF changes showed, in good reminders, increased activities in the left posterior superior temporal sulcus and middle temporal cortex probably related to efficient semantic storage of learned words.

Deterioration of naming nouns versus verbs in primary progressive aphasia

Disproportionate impairment of naming nouns versus verbs and the opposite pattern have been reported in cases of focal brain damage or degenerative disease, indicating that processing of nouns and verbs may rely on different brain regions. However, it has not been clear whether it is the spoken word forms or the meanings (or both) of nouns and verbs that depend on separate neural regions. We tested oral and written naming of nouns and verbs, matched in difficulty, in patients with nonfluent primary progressive aphasia (nonfluent PPA; n = 15), fluent primary progressive aphasia (fluent PPA; n = 7), and amyotrophic lateral sclerosis with frontotemporal dementia (ALS-FTD; n = 6). Patients with nonfluent PPA and ALS-FTD, both individually and as groups, were significantly more impaired on verb naming than on noun naming and significantly more impaired on oral naming than written naming. Patients with fluent PPA showed the opposite pattern for both word class and modality, significantly more impaired naming of nouns versus verbs and significantly more impaired written versus oral naming. Results indicate that separate regions of the brain are essential for access to oral and written word forms of verbs and nouns, and that these neural regions can be differentially damaged in separate forms of PPA.