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Carranza-Rentería O, Swerdloff MA. Clinicoradiological Features of Alexia Without Agraphia. Cureus 2024; 16:e58309. [PMID: 38752100 PMCID: PMC11094510 DOI: 10.7759/cureus.58309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Alexia without agraphia is a striking vascular syndrome of the acquired inability to read words just written down. This syndrome occurs after lesions in the splenium of the corpus callosum that disconnect the angular gyrus from the visual pathway. Most of the time, a lesion in the left occipital lobe is also present, and patients present with a visual field deficit. It is a classic neurological syndrome that is rarely seen. We present two cases of alexia without agraphia seen in our hospital the same week.
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Affiliation(s)
| | - Marc A Swerdloff
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
- Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, USA
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Mohamad NA, Che Adinan SN, Yusof Khan AHK, Nik Abdul Ghani NNH, Kamis MFAK, Wan Sulaiman WA, Salim MS, Basri H. Transcranial direct current stimulation with multiple oral re-reading therapy for pure alexia without agraphia: a case report. Neurocase 2021; 27:391-395. [PMID: 34478345 DOI: 10.1080/13554794.2021.1974487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pure alexia without agraphia is characterized by impaired reading due to damage to the occipitotemporal cortex with preserved writing skills. In this case report, we investigate the effect of multiple oral re-reading (MOR) therapy adjunct with transcranial direct current stimulation (tDCS) in improving reading recovery of a 64-year-old patient with pure alexia without agraphia following a stroke. His MRI revealed an area of infarct with microhemorrhages at the left occipitotemporal region. The patient was blinded to each therapy and underwent seven consecutive sessions of sham tDCS followed by seven consecutive sessions of real tDCS, coupled with 1-hour MOR therapy during each session. Western Aphasia Battery (WAB) was performed at baseline, before sham and real-tDCS, and 6 weeks after completing tDCS therapy. The patient showed improvement using both sham and real-tDCS with better reading comprehension, average reading time, and word per minute after real-tDCS. This study suggests that MOR, coupled with tDCS therapy may accelerate the reading recovery in patients with pure alexia.
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Affiliation(s)
- Nur Afiqah Mohamad
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nadia Che Adinan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura Sf Salim
- Department of Rehabilitation Medicine, Hospital Pengajar Universiti Putra Malaysia, Serdang, Malaysia.,Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hamidon Basri
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Gilmore N, Dwyer M, Kiran S. Benchmarks of Significant Change After Aphasia Rehabilitation. Arch Phys Med Rehabil 2019; 100:1131-1139.e87. [PMID: 30240594 PMCID: PMC6422764 DOI: 10.1016/j.apmr.2018.08.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/30/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type). DATA SOURCES A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted. STUDY SELECTION Randomized controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. Seventy-eight studies met criteria for inclusion. DATA EXTRACTION Data were extracted independently, and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level. DATA SYNTHESIS Random-effects meta-analyses were conducted separately for each study design group (ie, within-/between-group comparisons). For within-group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval, 3.95-6.10, P<.001) on the WAB-AQ, 10.37 points (6.08-14.66, P<.001) on the CETI, and 3.30 points (2.43-4.18, P<.001) on the BNT. For between-group designs, the summary effect size was 5.05 points (1.64-8.46, P=.004) on the WAB-AQ and 0.55 points (-1.33 to 2.43, P=.564) on the BNT, the latter of which was not significant. Subgroup analyses for the within-group designs showed no significant differences in the summary effect size as a function of dose frequency or treatment type. CONCLUSIONS This study established benchmarks of significant change on 3 standardized outcome measures used in aphasia rehabilitation.
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Affiliation(s)
- Natalie Gilmore
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA.
| | - Michaela Dwyer
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Swathi Kiran
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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Watter K, Copley A, Finch E. Discourse level reading comprehension interventions following acquired brain injury: a systematic review. Disabil Rehabil 2016; 39:315-337. [PMID: 26887257 DOI: 10.3109/09638288.2016.1141241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose Reading comprehension can change following acquired brain injury (ABI), impacting independence and participation. This review aims to identify and evaluate the interventions used for rehabilitation of discourse level reading in adults with ABI. Methods A systematic review was conducted of published journal articles. Methodological quality of studies was reviewed using formal and informal rating scales. Inclusion criteria involved adults with non-progressive ABI who experienced discourse level reading deficits related to aphasia or cognitive-communication disorders. Results A total of 23 studies were identified; these included randomized controlled trials, cohort and case studies. Six different types of reading interventions were found, overall results of these interventions were mixed. Reading deficits were reportedly related to language (aphasia) and/or cognitive deficits, with assessment processes varying. Questions arose regarding comparability of assessment methods and diagnostic issues across the studies. Conclusions Interventions for discourse level reading comprehension can make positive changes to reading function. However, no intervention was identified as a gold standard. A trend toward strategy-based reading was found, with these offering a potential for (comparatively) cost-effective lower-dosage reading treatments with positive-trend results. Cognitive and language features should be considered for assessment and intervention planning for discourse reading in ABI. Implications for Rehabilitation Six different types of discourse reading comprehension interventions for people with ABI were identified, with mixed evidence for each intervention. Clinicians need to consider both the linguistic and cognitive features of reading for assessment and intervention planning for discourse level reading. There is a research trend toward strategy-based reading interventions, which use a lower treatment dosage.
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Affiliation(s)
- Kerrin Watter
- a School of Health and Rehabilitation Sciences, the University of Queensland , Brisbane , Australia.,b Speech Pathology Department , Princess Alexandra Hospital, Metro South Health , Brisbane , Australia
| | - Anna Copley
- a School of Health and Rehabilitation Sciences, the University of Queensland , Brisbane , Australia
| | - Emma Finch
- a School of Health and Rehabilitation Sciences, the University of Queensland , Brisbane , Australia.,b Speech Pathology Department , Princess Alexandra Hospital, Metro South Health , Brisbane , Australia.,c Centre for Function and Health Research, Metro South Health , Brisbane , Australia
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Kim ES, Rising K, Rapcsak SZ, Beeson PM. Treatment for Alexia With Agraphia Following Left Ventral Occipito-Temporal Damage: Strengthening Orthographic Representations Common to Reading and Spelling. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:1521-1537. [PMID: 26110814 PMCID: PMC4686312 DOI: 10.1044/2015_jslhr-l-14-0286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/30/2015] [Accepted: 06/20/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE Damage to left ventral occipito-temporal cortex can give rise to written language impairment characterized by pure alexia/letter-by-letter (LBL) reading, as well as surface alexia and agraphia. The purpose of this study was to examine the therapeutic effects of a combined treatment approach to address concurrent LBL reading with surface alexia/agraphia. METHOD Simultaneous treatment to address slow reading and errorful spelling was administered to 3 individuals with reading and spelling impairments after left ventral occipito-temporal damage due to posterior cerebral artery stroke. Single-word reading/spelling accuracy, reading latencies, and text reading were monitored as outcome measures for the combined effects of multiple oral re-reading treatment and interactive spelling treatment. RESULTS After treatment, participants demonstrated faster and more accurate single-word reading and improved text-reading rates. Spelling accuracy also improved, particularly for untrained irregular words, demonstrating generalization of the trained interactive spelling strategy. CONCLUSION This case series characterizes concomitant LBL with surface alexia/agraphia and demonstrates a successful treatment approach to address both the reading and spelling impairment.
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Affiliation(s)
| | | | - Steven Z. Rapcsak
- University of Arizona, Tucson
- Neurology Section, Southern Arizona VA Health Care System, Tucson
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Lacey EH, Jiang X, Friedman RB, Snider SF, Parra LC, Huang Y, Turkeltaub PE. Transcranial direct current stimulation for pure alexia: effects on brain and behavior. Brain Stimul 2015; 8:305-7. [PMID: 25511797 PMCID: PMC5808439 DOI: 10.1016/j.brs.2014.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- E H Lacey
- Department of Neurology, Georgetown University, 4000 Reservoir Road, NW Building D, 165, Washington, DC 20057, USA; MedStar National Rehabilitation Hospital, USA.
| | - X Jiang
- Department of Neuroscience, Georgetown University, USA
| | - R B Friedman
- Department of Neurology, Georgetown University, USA
| | - S F Snider
- Department of Neurology, Georgetown University, USA
| | - L C Parra
- Department of Biomedical Engineering, City College of New York, USA
| | - Y Huang
- Department of Biomedical Engineering, City College of New York, USA
| | - P E Turkeltaub
- Department of Neurology, Georgetown University, USA; MedStar National Rehabilitation Hospital, USA
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Kim ES, Lemke SF. Behavioural and eye-movement outcomes in response to text-based reading treatment for acquired alexia. Neuropsychol Rehabil 2015; 26:60-86. [PMID: 25582781 DOI: 10.1080/09602011.2014.999688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barton JJS, Hanif HM, Eklinder Björnström L, Hills C. The word-length effect in reading: A review. Cogn Neuropsychol 2014; 31:378-412. [DOI: 10.1080/02643294.2014.895314] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Woodhead ZVJ, Penny W, Barnes GR, Crewes H, Wise RJS, Price CJ, Leff AP. Reading therapy strengthens top-down connectivity in patients with pure alexia. ACTA ACUST UNITED AC 2013; 136:2579-91. [PMID: 23884814 PMCID: PMC3722354 DOI: 10.1093/brain/awt186] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study tested the efficacy of audio-visual reading training in nine patients with pure alexia, an acquired reading disorder caused by damage to the left ventral occipitotemporal cortex. As well as testing the therapy’s impact on reading speed, we investigated the functional reorganization underlying therapy-induced behavioural changes using magnetoencephalography. Reading ability was tested twice before training (t1 and t2) and twice after completion of the 6-week training period (t3 and t4). At t3 there was a significant improvement in word reading speed and reduction of the word length effect for trained words only. Magnetoencephalography at t3 demonstrated significant differences in reading network connectivity for trained and untrained words. The training effects were supported by increased bidirectional connectivity between the left occipital and ventral occipitotemporal perilesional cortex, and increased feedback connectivity from the left inferior frontal gyrus. Conversely, connection strengths between right hemisphere regions became weaker after training.
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Affiliation(s)
- Zoe V J Woodhead
- Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London, WC1N 3BG, UK.
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Abstract
Acquired reading problems caused by brain injury (alexia) are common, either as a part of an aphasic syndrome, or as an isolated symptom. In pure alexia, reading is impaired while other language functions, including writing, are spared. Being in many ways a simple syndrome, one would think that pure alexia was an easy target for rehabilitation efforts. We review the literature on rehabilitation of pure alexia from 1990 to the present, and find that patients differ widely on several dimensions, such as alexia severity and associated deficits. Many patients reported to have pure alexia in the reviewed studies, have associated deficits such as agraphia or aphasia and thus do not strictly conform to the diagnosis. Few studies report clear and generalisable effects of training, none report control data, and in many cases the reported findings are not supported by statistics. We can, however, tentatively conclude that Multiple Oral Re-reading techniques may have some effect in mild pure alexia where diminished reading speed is the main problem, while Tacile-Kinesthetic training may improve letter identification in more severe cases of alexia. There is, however, still a great need for well-designed and controlled studies of rehabilitation of pure alexia.
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Affiliation(s)
- Randi Starrfelt
- a Department of Psychology , University of Copenhagen , Denmark
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Harris L, Olson A, Humphreys G. Overcoming the effect of letter confusability in letter-by-letter reading: A rehabilitation study. Neuropsychol Rehabil 2013; 23:429-62. [DOI: 10.1080/09602011.2013.776500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sheldon CA, Abegg M, Sekunova A, Barton JJ. The word-length effect in acquired alexia, and real and virtual hemianopia. Neuropsychologia 2012; 50:841-51. [DOI: 10.1016/j.neuropsychologia.2012.01.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Both monkey and human neuroimaging studies show that visual processing beyond the striate cortex involves a highly complex network of regions with modular functions. Lesions within this network lead to specific clinical syndromes. In this review we discuss studies on blindsight, which is the ability of remaining regions to support vision in the absence of striate cortex or visual awareness, recent work on 'ventral stream' syndromes such as object agnosia, alexia, prosopagnosia, and topographagnosia, which follow damage to medial occipitotemporal structures, and simultanagnosia, the classic 'dorsal stream' deficit related to bilateral occipitoparietal lesions. RECENT FINDINGS We highlight work on the anatomic basis of blindsight, the recent description of the new disorder developmental topographic disorientation, and studies contrasting global and local perception in simultanagnosia. SUMMARY These studies advance our understanding of the mechanisms of complex visual processing and provide an important neuropsychological complement to our expanding knowledge about vision from functional neuroimaging.
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Abstract
Reading and writing are complex forms of communication. Disorders of these abilities reflect this complexity. Although distinct syndromes do exist, it is more common to see these disorders in the context of related dysfunction. For example, alexia and agraphia commonly occur together. Not only do they occur together, but frequently, although not exclusively, a patient with both has similar patterns of performance in each modality. Reading, the transformation of written symbols into spoken output, is intimately related to visual input and speech. Disorders of these abilities are commonly reflected in alexia. Writing, the transformation of oral input (writing to dictation) or conceptual thought into written symbols, is interconnected with speech and motor function. Again, disorders of these abilities are commonly reflected in agraphia. Understanding alexia and agraphia allows insight into multiple realms of left hemispheric dysfunction and provides significant clinical insight into patients with left hemispheric lesions.
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