VARIETIES OF PURE ALEXIA: THE CASE OF FAILURE TO ACCESS GRAPHEMIC REPRESENTATIONS

Neuropsychological Diagnosis and Assessment of Alexia: A Mixed-Methods Study

The neuropsychological diagnosis and assessment of alexia remain formidable due to its multifaceted presentations and the intricate neural underpinnings involved. The current study employed a mixed-method design, incorporating cluster and thematic analyses, to illuminate the complexities of alexia assessment. We used the Web of Science and Scopus to retrieve articles spanning from 1985 to February 2024. Our selection was based on identified keywords in relation to the assessment and diagnosis of alexia. The analysis of 449 articles using CiteSpace (Version 6.3.R1) and VOSviewer (Version 1.6.19) software identified ten key clusters such as 'pure alexia' and 'posterior cortical atrophy', highlighting the breadth of research within this field. The thematic analysis of the most cited and recent studies led to eight essential categories. These categories were synthesized into a conceptual model that illustrates the interaction between neural, cognitive, and diagnostic aspects, in accordance with the International Classification of Functioning, Disability, and Health (ICFDH) framework. This model emphasizes the need for comprehensive diagnostic approaches extending beyond traditional reading assessments to include specific tasks like character identification, broader visual processing, and numerical tasks. Future diagnostic models should incorporate a diverse array of alexia types and support the creation of advanced assessment tools, ultimately improving clinical practice and research.

Functional and representational differences between bilateral inferior temporal numeral areas

The processing of numerals as visual objects is supported by an "Inferior Temporal Numeral Area" (ITNA) in the bilateral inferior temporal gyri (ITG). Extant findings suggest some degree of hemispheric asymmetry in how the bilateral ITNAs process numerals. Pollack and Price (2019) reported such a hemispheric asymmetry by which a region in the left ITG was sensitive to digits during a visual search for a digit among letters, and a homologous region in the right ITG that showed greater digit sensitivity in individuals with higher calculation skills. However, the ITG regions were localized with separate analyses without directly contrasting their digit sensitivities and relation to calculation skills. So, the extent of and reasons for these functional asymmetries remain unclear. Here we probe whether the functional and representational properties of the ITNAs are asymmetric by applying both univariate and multivariate region-of-interest analyses to Pollack and Price's (2019) data. Contrary to the implications of the original findings, digit sensitivity did not differ between ITNAs, and digit sensitivity in both left and right ITNAs was associated with calculation skills. Representational similarity analyses revealed that the overall representational geometries of digits in the ITNAs were also correlated, albeit weakly, but the representational contents of the ITNAs were largely inconclusive. Nonetheless, we found a right lateralization in engagement in alphanumeric categorization, and that the right ITNA showed greater discriminability between digits and letters. Greater right lateralization of digit sensitivity and digit discriminability in the left ITNA were also related to higher calculation skills. Our findings thus suggest that the ITNAs may not be functionally identical and should be directly contrasted in future work. Our study also highlights the importance of within-individual comparisons for understanding hemispheric asymmetries, and analyses of individual differences and multivariate features to uncover effects that would otherwise be obscured by averages.

Deep problems with neural network models of human vision

Deep neural networks (DNNs) have had extraordinary successes in classifying photographic images of objects and are often described as the best models of biological vision. This conclusion is largely based on three sets of findings: (1) DNNs are more accurate than any other model in classifying images taken from various datasets, (2) DNNs do the best job in predicting the pattern of human errors in classifying objects taken from various behavioral datasets, and (3) DNNs do the best job in predicting brain signals in response to images taken from various brain datasets (e.g., single cell responses or fMRI data). However, these behavioral and brain datasets do not test hypotheses regarding what features are contributing to good predictions and we show that the predictions may be mediated by DNNs that share little overlap with biological vision. More problematically, we show that DNNs account for almost no results from psychological research. This contradicts the common claim that DNNs are good, let alone the best, models of human object recognition. We argue that theorists interested in developing biologically plausible models of human vision need to direct their attention to explaining psychological findings. More generally, theorists need to build models that explain the results of experiments that manipulate independent variables designed to test hypotheses rather than compete on making the best predictions. We conclude by briefly summarizing various promising modeling approaches that focus on psychological data.

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.

Exploring the neural correlates of the reversed letter effect: Evidence from left and right parietal patients

To investigate the hemispheric lateralization of attentional processes during visual search tasks depending on the stimulus material embedding the target, twelve patients with unilateral left (n = 7) or right (n = 5) parietal lesions and 20 age and education matched healthy controls (HC) were recruited. We used a visual search task for a uniquely tilted oblique bar embedded in an object shape 'N' or in its mirror reversal 'И'. The accuracy and the averaged reaction times (RTs) in each stimulus type ('N' or 'И') were analysed. HC presented significantly longer RTs when the target bar was embedded in 'N' among its mirror reversed 'И' (p < .05). This "reversed letter effect" was also found in the right parietal patients (p < .001), while no evidence of a reversed letter effect was found in the left parietal patients.

Visual form perception is fundamental for both reading comprehension and arithmetic computation

Visual perception has been found to be a critical factor for reading comprehension and arithmetic computation in separate lines of research with different measures of visual form perception. The current study of 1099 Chinese elementary school students investigated whether the same visual form perception (assessed by a geometric figure matching task) underlies both reading comprehension and arithmetic computation. The results showed that visual form perception had close relations with both reading comprehension and arithmetic computation, even after controlling for age, gender, and cognitive factors such as processing speed, attention, working memory, visuo-spatial processing, and general intelligence. Results also showed that numerosity comparison's relations with reading comprehension and arithmetic computation were fully accounted for by visual form perception. These results suggest that reading comprehension and arithmetic computation might share a similar visual form processing mechanism.

Neuroplasticity and the logic of cognitive neuropsychology

More than thirty years ago, Alfonso Caramazza laid out assumptions for drawing inferences about the undamaged cognitive system from individuals with brain damage. Since then, these assumptions have been challenged including the transparency or subtractivity assumption, that the cognitive system does not reorganize following brain damage. It has been repeatedly demonstrated that brains are highly plastic. However, there is no clear connection between brain plasticity and cognitive reorganization. Brain plasticity research does not require a rethinking of the core logic of cognitive neuropsychology. Differences in task-based activation between damaged and undamaged brains provide little insight into the cognitive architectures of brain-damaged patients. Theory and methods are needed to understand cognitive neuroplasticity, or how neural reorganization that follows brain damage relates to reorganization of functions. We discuss alternative types of cognitive neuroplasticity that may occur in damaged brains and consider how they impact the basic logic of cognitive neuropsychology.

The role of allograph representations in font-invariant letter identification

The literate brain must contend with countless font variants for any given letter. How does the visual system handle such variability? One proposed solution posits stored structural descriptions of basic letter shapes that are abstract enough to deal with the many possible font variations of each letter. These font-invariant representations, referred to as allographs in this paper, while frequently posited, have seldom been empirically evaluated. The research reported here helps to address this gap with 2 experiments that examine the possible influence of allograph representations on visual letter processing. In these experiments, participants respond to pairs of letters presented in an atypical font in 2 tasks-visual similarity judgments (Experiment 1) and same/different decisions (Experiment 2). By using representational similarity analysis (RSA) in conjunction with linear mixed effect models (LMEM; RSA-LMEM) we show that the similarity structure of the responses to the atypical font is influenced by the predicted similarity structure of allograph representations even after accounting for font-specific visual shape similarity. Similarity due to symbolic (abstract) identity, name, and motor representations of letters are also taken into account providing compelling evidence for the unique influence of allograph representations in these tasks. These results provide support for the role of allograph representations in achieving font-invariant letter identification. (PsycINFO Database Record

The Cognitive Neuroplasticity of Reading Recovery following Chronic Stroke: A Representational Similarity Analysis Approach

Damage to certain left hemisphere regions leads to reading impairments, at least acutely, though some individuals eventually recover reading. Previous neuroimaging studies have shown a relationship between reading recovery and increases in contralesional and perilesional activation during word reading tasks, relative to controls. Questions remain about how to interpret these changes in activation. Do these changes reflect functional take-over, a reorganization of functions in the damaged brain? Or do they reveal compensatory masquerade or the use of alternative neural pathways to reading that are available in both patients and controls? We address these questions by studying a single individual, CH, who has made a partial recovery of reading familiar words following stroke. We use an fMRI analysis technique, representational similarity analysis (RSA), which allows us to decode cognitive function from distributed patterns of neural activity. Relative to controls, we find that CH shows a shift from visual to orthographic processing in contralesional regions, with a marginally significant result in perilesional regions as well. This pattern supports a contralesional reorganization of orthographic processing following stroke. More generally, these analyses demonstrate how powerful RSA can be for mapping the neural plasticity of language function.

Cognitive neuropsychological analysis of differential reading and spelling disorder mechanisms in a patient with aphasia

The purpose of this study was to determine if differential reading and spelling mechanisms were involved in a Japanese patient with aphasia. In our case, the patient scored low on all of the administered reading tasks, suggesting that both the reading lexical and non-lexical routes were impaired. In contrast, his writing-to-dictation score for Kana nonwords was high, suggesting that the spelling non-lexical route was intact. However, the patient scored low on a writing-to-dictation task comprised of high-familiarity Kanji words. The spelling lexical route was thought to be impaired. Therefore, the mechanism(s) involved in reading and spelling may differ in this case.

The time course of visual influences in letter recognition

This study builds on a specific characteristic of letters of the Roman alphabet-namely, that each letter name is associated with two visual formats, corresponding to their uppercase and lowercase versions. Participants had to read aloud the names of single letters, and event-related potentials (ERPs) for six pairs of visually dissimilar upper- and lowercase letters were recorded. Assuming that the end product of processing is the same for upper- and lowercase letters sharing the same vocal response, ERPs were compared backward, starting from the onset of articulatory responses, and the first significant divergence was observed 120 ms before response onset. Given that naming responses were produced at around 414 ms, on average, these results suggest that letter processing is influenced by visual information until 294 ms after stimulus onset. This therefore provides new empirical evidence regarding the time course and interactive nature of visual letter perception processes.

Grammatical number elicits SNARC and MARC effects as a function of task demands

Despite the robustness of the spatial–numerical association of response codes (SNARC) and linguistic markedness of response codes (MARC) effect, the mechanisms that underlie these effects are still under debate. In this paper, we investigate the extraction of quantity information from German number words and nouns inflected for singular and plural using two alternative forced choice paradigms. These paradigms are applied to different tasks to investigate how access to quantity representation is modulated by task demands. In Experiment 1, we replicated previous SNARC findings for number words—that is, a relative left-hand advantage for words denoting small numbers and a right-hand advantage for words denoting large numbers in semantic tasks (parity decision and quantity comparison). No SNARC effect was obtained for surface or lexical processing tasks (font categorization and lexical decision). In Experiment 2, we found that German words inflected for singular had a relative left-hand advantage, and German words inflected for plural a relative right-hand advantage, showing a SNARC-like effect for grammatical number. The effect interfered, however, with a MARC-like effect based on the markedness asymmetry of singulars and plurals. These two effects appear to be dissociated by response latency rather than task demands, with MARC being more pronounced in early responses and SNARC being more pronounced in late responses. The present findings shed light on the relationship of conceptual number and grammatical number and constrain current accounts of the SNARC and MARC effects.

Fast word reading in pure alexia: "fast, yet serial"

Pure alexia is a severe impairment of word reading in which individuals process letters serially with a pronounced length effect. Yet, there is considerable variation in the performance of alexic readers with generally very slow, but also occasionally fast responses, an observation addressed rarely in previous reports. It has been suggested that "fast" responses in pure alexia reflect residual parallel letter processing or that they may even be subserved by an independent reading system. Four experiments assessed fast and slow reading in a participant (DN) with pure alexia. Two behavioral experiments investigated frequency, neighborhood, and length effects in forced fast reading. Two further experiments measured eye movements when DN was forced to read quickly, or could respond faster because words were easier to process. Taken together, there was little support for the proposal that "qualitatively different" mechanisms or reading strategies underlie both types of responses in DN. Instead, fast responses are argued to be generated by the same serial-reading strategy.

Alexia With and Without Agraphia: An Assessment of Two Classical Syndromes

Background:

Current cognitive models propose that multiple processes are involved in reading and writing.

Objective:

Our goal was to use linguistic analyses to clarify the cognitive dysfunction behind two classic alexic syndromes.

Methods:

We report four experiments on two patients, one with alexia without agraphia following occipitotemporal lesions, and one with alexia with agraphia from a left angular gyral lesion.

Results:

The patient with occipital lesions had trouble discriminating real letters from foils and his reading varied with word-length but not with linguistic variables such as part of speech, word frequency or imageability. He read pseudo-words and words with regular spelling better, indicating preserved use of grapheme-to-phoneme pronunciation rules. His writing showed errors that reflected reliance on ‘phoneme-to-grapheme’ spelling rules. In contrast, the patient with a left angular gyral lesion showed better recognition of letters, words and their meanings. His reading was better for words with high imageability but displayed semantic errors and an inability to use ‘grapheme-to-phoneme’ rules, features consistent with deep dyslexia. His agraphia showed impaired access to both an internal lexicon and ‘phoneme-to-grapheme’ rules.

Conclusion:

Some cases of pure alexia may be a perceptual word-form agnosia, with loss of internal representations of letters and words, while the angular gyral syndrome of alexia with agraphia is a linguistic deep dyslexia. The presence or absence of agraphia does not always distinguish between the two; rather, writing can mirror the reading deficits, being more obvious and profound in the case of an angular gyral syndrome.

An eye movement study on the role of the visual field defect in pure alexia

Pure alexia is a severe impairment of word reading which is usually accompanied by a right-sided visual field defect. Patients with pure alexia exhibit better preserved writing and a considerable word length effect, claimed to result from a serial letter processing strategy. Two experiments compared the eye movements of four patients with pure alexia to controls with simulated visual field defects (sVFD) when reading single words. Besides differences in response times and differential effects of word length on word reading in both groups, fixation durations and the occurrence of a serial, letter-by-letter fixation strategy were investigated. The analyses revealed quantitative and qualitative differences between pure alexic patients and unimpaired individuals reading with sVFD. The patients with pure alexia read words slower and exhibited more fixations. The serial, letter-by-letter fixation strategy was observed only in the patients but not in the controls with sVFD. It is argued that the VFD does not cause pure alexic reading.

Representation of letter position in single-word reading: evidence from acquired dyslexia

Visual word recognition requires information about the positions as well as the identities of the letters in a word. This study addresses representation of letter position at prelexical levels of the word recognition process. We present evidence from an acquired dyslexic patient, L.H.D., who perseverates letters in single-word reading tasks: Far more often than expected by chance, L.H.D.'s reading responses include letters from preceding responses (e.g., SAILOR read as SAILOG immediately after FLAG was read correctly). Analyses carried out over two large data sets compared the positions of perseverated letters (e.g., the G in SAILOG) with the positions of the corresponding "source" letters (e.g., the G in FLAG). The analyses assessed the extent to which the perseverations preserved source position as defined by various theories of letter position representation. The results provided strong evidence for graded both-edges position representations, in which the position of each letter is encoded coarsely relative to both the beginning and the end of the word. Alternative position representation schemes, including letter-context and orthosyllabic schemes, were not supported.

Prelexical representations and processes in reading: evidence from acquired dyslexia

We report a detailed and extensive single-case study of an acquired dyslexic patient, L.H.D., who suffered a left-hemisphere lesion as a result of a ruptured aneurysm. We present evidence that L.H.D.'s reading errors stem from a deficit in visual letter identification, and we use her deficit as a basis for exploring a variety of issues concerning prelexical representations and processes in reading. First, building on the work of other researchers, we present evidence that the prelexical reading system includes an allograph level of representation that represents each distinct visual shape of a letter (e.g., a, A, etc., for the letter A). We extend a theory proposed by Caramazza and Hillis [Caramazza, A., & Hillis, A. (1990a). Spatial representation of words in the brain implied by studies of a unilateral neglect patient. Nature, 346, 267-269] to include an allograph level, and we probe the nature of the allograph representations in some detail. Next, we explore the implications of visual similarity effects and letter perseverations in L.H.D.'s reading performance, arguing that these effects shed light on activation dynamics in the prelexical reading system and on the genesis of L.H.D.'s errors. We also probe the processing of letter case in the visual letter identification process, proposing that separate abstract letter identity and case representations are computed. Finally, we present evidence that the allograph level as well as the abstract letter identity level implement a word-based frame of reference.

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.

The similarity structure of distributed neural responses reveals the multiple representations of letters

Most cognitive theories of reading and spelling posit modality-specific representations of letter shapes, spoken letter names, and motor plans as well as abstract, amodal letter representations that serve to unify the various modality-specific formats. However, fundamental questions remain regarding the very existence of abstract letter representations, the neuro-topography of the different types of letter representations, and the degree of cortical selectivity for orthographic information. We directly test quantitative models of the similarity/dissimilarity structure of distributed neural representations of letters using Multivariate Pattern Analysis-Representational Similarity Analysis (MVPA-RSA) searchlight methods to analyze the BOLD response recorded from single letter viewing. These analyses reveal a left hemisphere ventral temporal region selectively tuned to abstract letter representations as well as substrates tuned to modality-specific (visual, phonological and motoric) representations of letters. The approaches applied in this research address various shortcomings of previous studies that have investigated these questions and, therefore, the findings we report serve to advance our understanding of the nature and format of the representations that occur within the various sub-regions of the large-scale networks used in reading and spelling.

Complete abolition of reading and writing ability with a third ventricle colloid cyst: implications for surgical intervention and proposed neural substrates of visual recognition and visual imaging ability

We report a rare case of a patient unable to read (alexic) and write (agraphic) after a mild head injury. He had preserved speech and comprehension, could spell aloud, identify words spelt aloud and copy letter features. He was unable to visualise letters but showed no problems with digits. Neuropsychological testing revealed general visual memory, processing speed and imaging deficits. Imaging data revealed an 8 mm colloid cyst of the third ventricle that splayed the fornix. Little is known about functions mediated by fornical connectivity, but this region is thought to contribute to memory recall. Other regions thought to mediate letter recognition and letter imagery, visual word form area and visual pathways were intact. We remediated reading and writing by multimodal letter retraining. The study raises issues about the neural substrates of reading, role of fornical tracts to selective memory in the absence of other pathology, and effective remediation strategies for selective functional deficits.

Letter identification processes in reading: Distractor interference reveals an automatically engaged, domain-specific mechanism

Recent neuroimaging studies have revealed that letters activate both the left and the right fusiform areas, but that only the left fusiform responds to letters more than to control stimuli (Cohen et al., 2003). Though these findings suggest that the left fusiform is specialized in its function of identifying letters, it does not rule out the possibility that the right fusiform contributes critically to letter identification processes. We used a behavioural word identification task in which we compared bilateral and unilateral displays to determine the cost of engaging the right hemisphere with a distractor stimulus. We found that while engaging the left hemisphere led to a robust interference effect, engaging the right hemisphere had no effect at all. We were able to rule out an attentional bias to the right visual field as a possible explanation of the asymmetrical interference effect. We conclude that while the right hemisphere may be able to assume letter identification processing responsibilities in some patients with brain damage, the right hemisphere does not contribute critically to abstract letter identification processes in healthy right-handed individuals.

Covert reading of letters in a case of global alexia

This study describes the case of a global alexic patient with a severe reading deficit affecting words, letters and Arabic numbers, following a left posterior lesion. The patient (VA) could not match spoken letters to their graphic form. A preserved ability to recognize shape and canonical orientation of letters indicates intact access to the representation of letters and numbers as visual objects. A relatively preserved ability to match lowercase to uppercase letters suggests partially spared access to abstract letter identities independently of their visual forms. The patient was also unable to match spoken letters and numbers to their visual form, indicating that she could not access the graphemic representations of letters from their phonological representations. This pattern of performance suggests that the link between graphemic and phonological representations is disrupted in this patient. We hypothesize that VA' residual reading abilities are supported by the right hemisphere.

How number processing survives left occipito-temporal damage

We investigated the neural systems that support number processing in a patient (JL) who had damage to the left ventral occipito-temporal cortex (LvOT). JL had severely impaired written word recognition but he was remarkably accurate in number tasks, albeit slower than normal. This suggests LvOT activation is necessary for efficient but not for accurate number decisions. Here we investigated how JL made accurate number decisions using fMRI; we compared JL's brain activation to that in healthy controls and in two patients with frontal lobe damage who, like JL, made slow but accurate responses in number tasks. For semantic relative to perceptual decisions on numbers, JL did not activate the left occipito-temporal area that was involved in all other subjects. However, JL had significantly increased activation in a left posterior middle temporal region. In addition, during semantic and perceptual decisions on numbers, JL showed increased activation in: (1) the right occipito-temporal cortex, (2) right caudate, and (3) bilateral frontal regions. These effects were unique to JL and cannot be explained in terms of abnormally long response times because they were not observed in the other patients who made slow but accurate number decisions. Together these results show that although the LvOT usually contributes to efficient number processing, activation in this region is not essential for accurate performance because (i) perceptual processing of numbers can be supported by right occipital, right caudate, and bilateral frontal activation and (ii) semantic processing of numbers can be supported by increased left posterior middle temporal activation associated with hand actions.

Hemispheric asymmetries in hierarchical stimulus processing are modulated by stimulus categories and their predictability

Hemispheric dominance has been behaviourally documented for the local (left hemisphere, LH) or global (right hemisphere, RH) processing of hierarchical letters. However, Fink et al. (1997) indicated that stimulus category modulates this hemispheric asymmetry. The purpose of this study was to investigate the influence of the category (letters versus objects) on hemispheric specialisation for global and local processing using a visual half-field presentation in a task where participants ignored whether the target appeared at the global or local level. In Experiment 1 we replicated the classic hemispheric asymmetry for global/local processing of hierarchical letters. In Experiment 2, which consisted of hierarchical object processing, a RH dominance for the local level was observed. In Experiment 3 a within-participant design was used where anticipation about the stimulus category was precluded, resulting in the classic RH and LH specialisations for global and local processing for both letter-based and object-based stimuli. Taken together, these results suggest that the highly demanding local processing stage engages one hemisphere more than the other, according to the lateralisation of cerebral networks specialised for stimulus category. In addition, the direction of lateralisation for the local level was also modulated by the predictability of the stimulus category.

The unique role of the visual word form area in reading

Reading systematically activates the left lateral occipitotemporal sulcus, at a site known as the visual word form area (VWFA). This site is reproducible across individuals/scripts, attuned to reading-specific processes, and partially selective for written strings relative to other categories such as line drawings. Lesions affecting the VWFA cause pure alexia, a selective deficit in word recognition. These findings must be reconciled with the fact that human genome evolution cannot have been influenced by such a recent and culturally variable activity as reading. Capitalizing on recent functional magnetic resonance imaging experiments, we provide strong corroborating evidence for the hypothesis that reading acquisition partially recycles a cortical territory evolved for object and face recognition, the prior properties of which influenced the form of writing systems.

Number reading in pure alexia--a review

It is commonly assumed that number reading can be intact in patients with pure alexia, and that this dissociation between letter/word recognition and number reading strongly constrains theories of visual word processing. A truly selective deficit in letter/word processing would strongly support the hypothesis that there is a specialized system or area dedicated to the processing of written words. To date, however, there has not been a systematic review of studies investigating number reading in pure alexia and so the status of this assumed dissociation is unclear. We review the literature on pure alexia from 1892 to 2010, and find no well-documented classical dissociation between intact number reading and impaired letter identification in a patient with pure alexia. A few studies report strong dissociations, with number reading less impaired than letter reading, but when we apply rigorous statistical criteria to evaluate these dissociations, the difference in performance across domains is not statistically significant. There is a trend in many cases of pure alexia, however, for number reading to be less affected than letter identification and word reading. We shed new light on this asymmetry by showing that, under conditions of brief exposure, normal participants are also better at identifying digits than letters. We suggest that the difference observed in some pure alexic patients may possibly reflect an amplification of this normal difference in the processing of letters and digits, and we relate this asymmetry to intrinsic differences between the two types of symbols.

Spatiotemporal dynamics of bilingual word processing

Studies with monolingual adults have identified successive stages occurring in different brain regions for processing single written words. We combined magnetoencephalography and magnetic resonance imaging to compare these stages between the first (L1) and second (L2) languages in bilingual adults. L1 words in a size judgment task evoked a typical left-lateralized sequence of activity first in ventral occipitotemporal cortex (VOT: previously associated with visual word-form encoding) and then ventral frontotemporal regions (associated with lexico-semantic processing). Compared to L1, words in L2 activated right VOT more strongly from approximately 135 ms; this activation was attenuated when words became highly familiar with repetition. At approximately 400 ms, L2 responses were generally later than L1, more bilateral, and included the same lateral occipitotemporal areas as were activated by pictures. We propose that acquiring a language involves the recruitment of right hemisphere and posterior visual areas that are not necessary once fluency is achieved.

Too little, too late: reduced visual span and speed characterize pure alexia

Whether normal word reading includes a stage of visual processing selectively dedicated to word or letter recognition is highly debated. Characterizing pure alexia, a seemingly selective disorder of reading, has been central to this debate. Two main theories claim either that 1) Pure alexia is caused by damage to a reading specific brain region in the left fusiform gyrus or 2) Pure alexia results from a general visual impairment that may particularly affect simultaneous processing of multiple items. We tested these competing theories in 4 patients with pure alexia using sensitive psychophysical measures and mathematical modeling. Recognition of single letters and digits in the central visual field was impaired in all patients. Visual apprehension span was also reduced for both letters and digits in all patients. The only cortical region lesioned across all 4 patients was the left fusiform gyrus, indicating that this region subserves a function broader than letter or word identification. We suggest that a seemingly pure disorder of reading can arise due to a general reduction of visual speed and span, and explain why this has a disproportionate impact on word reading while recognition of other visual stimuli are less obviously affected.

Visuoperceptual deficits in letter-by-letter reading?

A longstanding and controversial issue concerns the underlying mechanisms that give rise to letter-by-letter (LBL) reading: while some researchers propose a prelexical, perceptual basis for the disorder, others postulate a postlexical, linguistic source for the problem. To examine the nature of the deficit underlying LBL reading, in three experiments, we compare the performance of seven LBL readers, matched control participants and one brain-damaged patient, OL, with no reading impairment. Experiment 1 revealed that the LBL patients were impaired, relative to the controls and to OL, on a same/different matching task using checkerboards of black and white squares. Given that the perceptual impairment extends beyond abnormalities with alphanumeric stimuli, the findings are suggestive of a more general visual processing deficit. This interpretation was confirmed in Experiments 2 (matching words and symbol strings) and 3 (visual search of letter and symbol targets), which compared the processing of linguistic and non-linguistic written stimuli, matched for visual complexity. In both experiments, the LBL patients displayed qualitatively similar effects of length and left-to-right sequential ordering on linguistic and non-linguistic stimuli. Moreover, there was a clear association between the perceptual impairments on these tasks and the slope of the reading latency function for the LBL patients. Taken together, these findings are consistent with a significant visuoperceptual impairment in LBL that adversely affects reading performance as well as performance on other non-reading tasks.

Foveal crowding in posterior cortical atrophy: a specific early-visual-processing deficit affecting word reading

Visual crowding is a form of masking in which single-letter identification is compromised by the presence of additional letters or other simple visual forms in close proximity. This behavioural phenomenon has been studied most frequently in the context of amblyopic and normal peripheral vision. In the current study, we investigate this phenomenon in the context of two patients with peripheral dyslexia and a third with visual disorientation consequent to bilateral posterior cortical atrophy. In one case, reading showed the effects of word length typical of letter-by-letter reading, whereas the second case was unable to read any whole words. In a series of letter identification tasks, recognition accuracy was shown to decrease significantly in the presence of a range of flanking stimuli (e.g., letters, digits, letter fragments). Compatible with previous reports of the crowding phenomenon, the flanking effect was strengthened by increasing flanker proximity but was unaffected by target or flank size, flank contrast, target-flank lexicality, or flank category. One patient also showed amelioration of the flanking effect when the target and flankers were of opposite contrast polarity. To the best of our knowledge, this is the first demonstration of visual crowding in individuals with posterior cortical atrophy. We consider the relevance of these empirical findings to accounts of the letter-by-letter reading form of peripheral dyslexia. In particular, we suggest that crowding constitutes one specific form of early-visual-processing deficit, which impairs the reading process.

A comparison of letter and digit processing in letter-by-letter reading

The extent to which letter-by-letter reading results from a specific orthographic deficit, as compared with a nonspecific disturbance in basic visuoperceptual mechanisms, is unclear. The current study directly compared processing of letters and digits in a letter-by-letter reader, G.M., using a rapid serial visual presentation (RSVP) task and a speeded matching task. Comparisons were made to a group of six brain-damaged individuals without reading deficits. In the RSVP task, G.M. had increased difficulty reporting the target identities when they were letters, as compared with digits. Although this general pattern was also evident in the control group, the magnitude of the letter-digit accuracy difference was greater in G.M. Similarly, in the matching task, G.M. was slower to match letters than digits, relative to the control group, although his response times to both item types were increased. These data suggest that letter-by-letter reading, at least in this case, results from a visuoperceptual encoding deficit that particularly affects letters, but also extends to processing of digits to a lesser extent. Results are consistent with the notion that a left occipitotemporal area is specialized for letter processing with greater bilaterality in the visual processing of digits.

Top-down and bottom-up effects in pure alexia: evidence from eye movements

The eye movements of a patient with pure alexia, GJ, were recorded as he read sentences in order to explore the roles of top-down and bottom-up information during letter-by-letter reading. Specifically, the effects of word frequency and word predictability were examined. Additional analyses examined the interaction of these effects with the lower level influences of word length and letter confusability. The results indicate that GJ is sensitive to all four of these variables in sentence reading. These findings support an interactive account of reading where letter-by-letter readers use both bottom-up and top-down information to decode words. Due to the disrupted bottom-up processes caused by damage to the Visual Word Form Area or the input connections to it, pure alexic patients rely more heavily on intact top-down information in reading.

Associative (prosop)agnosia without (apparent) perceptual deficits: A case-study

In associative agnosia early perceptual processing of faces or objects are considered to be intact, while the ability to access stored semantic information about the individual face or object is impaired. Recent claims, however, have asserted that associative agnosia is also characterized by deficits at the perceptual level, which are too subtle to be detected by current neuropsychological tests. Thus, the impaired identification of famous faces or common objects in associative agnosia stems from difficulties in extracting the minute perceptual details required to identify a face or an object. In the present study, we report the case of a patient DBO with a left occipital infarct, who shows impaired object and famous face recognition. Despite his disability, he exhibits a face inversion effect, and is able to select a famous face from among non-famous distractors. In addition, his performance is normal in an immediate and delayed recognition memory for faces, whose external features were deleted. His deficits in face recognition are apparent only when he is required to name a famous face, or select two faces from among a triad of famous figures based on their semantic relationships (a task which does not require access to names). The nature of his deficits in object perception and recognition are similar to his impairments in the face domain. This pattern of behavior supports the notion that apperceptive and associative agnosia reflect distinct and dissociated deficits, which result from damage to different stages of the face and object recognition process.