Efficient visual object and word recognition relies on high spatial frequency coding in the left posterior fusiform gyrus: evidence from a case-series of patients with ventral occipito-temporal cortex damage

Simultaneous simulations of pure, surface and phonological acquired dyslexia within a full computational model of the primary systems hypothesis

According to the primary systems hypothesis, reading requires interactions of visual-orthographic, phonological and semantic systems. Damage to each primary system generates very different types of acquired dyslexia. Variants of the connectionist 'triangle' models of reading have been developed to investigate individual acquired dyslexia. However, only a few studies have investigated multiple acquired alexia within one framework. Importantly, there are no studies that simultaneously simulate both central dyslexia (e.g. surface and phonological dyslexia) and peripheral dyslexia (e.g. pure alexia). That is largely due to the lack of a visual component in the traditional reading models. To verify the predictions made by the primary systems hypothesis, we developed a connectionist 'deep' multi-layer triangle model of reading including visual, orthographic, phonological and semantic processing layers. We investigated whether damage to the model could produce the general behavioural patterns of impaired performance observed in patients with the corresponding reading deficits. Crucially, damage to the visual-orthographic, phonological or semantic components of the model resulted in the expected reading impairments associated with pure alexia, phonological dyslexia and surface dyslexia, respectively. The simulation results demonstrated for the first time that neurologically-impaired reading including both central and peripheral dyslexia could be addressed within a single triangle model of reading. The findings are consistent with the predictions made by the primary systems hypothesis.

Developmental surface dyslexia and dysgraphia in a child with corpus callosum agenesis: an approach to diagnosis and treatment

We present a case study detailing cognitive performance, functional neuroimaging, and effects of a hypothesis-driven treatment in a 10-year-old girl diagnosed with complete, isolated corpus callosum agenesis. Despite having average overall intellectual abilities, the girl exhibited profound surface dyslexia and dysgraphia. Spelling treatment significantly and persistently improved her spelling of trained irregular words, and this improvement generalized to reading accuracy and speed of trained words. Diffusion weighted imaging revealed strengthened intrahemispheric white matter connectivity of the left temporal cortex after treatment and identified interhemispheric connectivity between the occipital lobes, likely facilitated by a pathway crossing the midline via the posterior commissure. This case underlines the corpus callosum's critical role in lexical reading and writing. It demonstrates that spelling treatment may enhance interhemispheric connectivity in corpus callosum agenesis through alternative pathways, boosting the development of a more efficient functional organization of the visual word form area within the left temporo-occipital cortex.

Post-stroke Chinese pure alexia: linguistic features and neuropsychological profiles

PURPOSE

Very few cases of Chinese pure alexia have been reported to date. We aim to summarize the linguistic features and neuropsychological profiles of Chinese pure alexia through a case series study.

METHODS

11 consecutive patients with post-stroke Chinese pure alexia and 11 healthy controls were included. The Aphasia Battery of Chinese (ABC) and 68-Chinese character oral reading test (68-character test) were used to evaluate the reading and writing ability. Reading errors were classified based on the performance of 68-character test. Neuropsychological profiles were evaluated with corresponding scales. The possible correlation between the reading ability and the writing ability or neuropsychological performance was analyzed.

RESULTS

The patients had a correct rate of 43.7 ± 23.2% in the 68-character test, significantly lower (P < 0.001) than that of controls. Shape-similar error was the most common type of reading error (101/209, 48.3%). The ABC total writing score rate of the patients ranged from 68.9% to 98.7% (median, 90.5%), significantly lower (P < 0.001) than that of the controls. The patients also showed worse performance in MMSE, auditory verbal learning test, Boston naming test, intersecting pentagons copying and clock-drawing test (all P < 0.05). In the patient group, the correct rate of 68-character test was significantly correlated with the ABC total writing score rate (P = 0.008), the score rate of Boston naming test (P = 0.017), and the clock-drawing test score (P = 0.010).

CONCLUSION

Shape-similar errors may be a characteristic of Chinese pure alexia. The correlation between visuospatial dysfunction and pure alexia might explain the frequent occurrence of shape-similar errors in Chinese pure alexia.

A Potential Mechanism of Neurological Impairment in Children With Infantile Spasm: Based on Microanatomic Structure Analysis Employing Voxel-Based Morphometry and Surface-Based Morphometry

BACKGROUND

Infantile epileptic spasms syndrome (IESS) would accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microwould accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microanatomic structure alteration.

METHODS

The IESS group had 21 males and 13 females (mean age: 17.7 ± 15.6 months), whereas the healthy controls group had 22 males and 10 females (mean age: 29.4 ± 18.7 months). High-resolution 3D T1WI was performed. Computational Anatomy Toolbox implemented in Statistical Parametric Mapping 12 was used to measure the gray matter and white matter volume, and the cortical thickness separately. Independent sample t test was used to assess between-group differences. IESS group was assessed using the Bayley Scales of Infant Development.

RESULTS

The IESS group showed a significantly decreased volume of gray matter in right middle temporal gyrus, inferior temporal gyrus, superior temporal gyrus, right fusiform, and bilateral precuneus (P < 0.001). There were no significant between-group differences with respect to white matter volume or cortical thickness (P > 0.001). The results of Bayley Scales of Infant Development showed that the Mental Development Index (MDI) and Psychomotor Development Index scores of children with IESS were almost concentrated in the range of <70. MDI score showed a positive correlation with gray matter reduction area in IESS group.

CONCLUSION

Children with IESS had impaired cognitive and delayed motor development. And the decreased gray matter in the right temporal lobe, fusiform, and bilateral precuneus could be the potential anatomic basis for impaired function, such as hearing, visual, and language.

What happens to the inhibitory control functions of the right inferior frontal cortex when this area is dominant for language?

A low number of individuals show an atypical brain control of language functions that differs from the typical lateralization in the left cerebral hemisphere. In these cases, the neural distribution of other cognitive functions is not fully understood. Although there is a bias towards a mirrored brain organization consistent with the Causal hypothesis, some individuals are found to be exceptions to this rule. However, no study has focused on what happens to the homologous language areas in the right frontal inferior cortex. Using an fMRI-adapted stop-signal task in a healthy non right-handed sample (50 typically lateralized and 36 atypically lateralized for language production), our results show that atypical lateralization is associated with a mirrored brain organization of the inhibitory control network in the left hemisphere: inferior frontal cortex, presupplementary motor area, and subthalamic nucleus. However, the individual analyses revealed a large number of cases with a noteworthy overlap in the inferior frontal gyrus, which shared both inhibitory and language functions. Further analyses showed that atypical lateralization was associated with stronger functional interhemispheric connectivity and larger corpus callosum. Importantly, we did not find task performance differences as a function of lateralization, but there was an association between atypical dominance in the inferior frontal cortex and higher scores on schizotypy and autistic spectrum traits, as well as worse performance on a reading accuracy test. Together, these results partially support the Causal hypothesis of hemispheric specialization and provide further evidence of the link between atypical hemispheric lateralization and increased interhemispheric transfer through the corpus callosum.

A voxel-based morphometry study on gray matter correlates of need for cognition and exploratory information seeking

BACKGROUND

Need for cognition (NFC) represents interindividual differences in tendencies to engage and enjoy cognitive endeavors. Exploratory information seeking (EIS) refers to individual tendencies to attain cognitive stimulation through acquiring information related to consumer products or services out of curiosity.

METHODS

The current study aims to provide an in-depth investigation of the relationship between NFC and EIS and extend this relation to determine neuroanatomical correlates of NFC and EIS. This study proposed two central hypotheses: (1) NFC and EIS scores are positively correlated and (2) the gray matter volume (GMV) of brain regions implicated in motivation, valuation, and reward systems are positively associated with both NFC and EIS. Self-report and structural MRI data of 91 Singaporean Chinese participants were utilized for the study.

RESULTS

No statistically significant correlation was revealed between NFC and EIS scores. Neuroanatomical associations of the GMV of brain regions implicated in visuospatial, attentional, and reward processing with individual constructs of interest were explored. When examining NFC and EIS scores, larger GMV in the right pallidum and left fusiform gyrus was found in participants that reported higher levels of NFC (vs. lower NFC levels), larger GMV in the left precuneus in those with greater tendencies to engage in EIS (vs. lower EIS levels), and larger GMV of the left fusiform gyrus associated with greater endorsement of both NFC and EIS. When investigating the exploratory factor analysis-generated factors of NFC and EIS, similar patterns of associations were found between self-reported levels of agreement against factors and GMV of brain regions implicated.

CONCLUSIONS

Correlational analysis and exploratory factor analysis indicated the absence of a relationship between NFC and EIS. Additionally, voxel-based morphometry whole-brain analysis revealed neuroanatomical correlates of the GMV of brain regions implicated in visuospatial, attentional, and reward processing with NFC and EIS.

Systematic evaluation of high-level visual deficits and lesions in posterior cerebral artery stroke

Knowledge about the consequences of stroke on high-level vision comes primarily from single case studies of patients selected based on their behavioural profiles, typically patients with specific stroke syndromes like pure alexia or prosopagnosia. There are, however, no systematic, detailed, large-scale evaluations of the more typical clinical behavioural and lesion profiles of impairments in high-level vision after posterior cerebral artery stroke. We present behavioural and lesion data from the Back of the Brain project, to date the largest (N = 64) and most detailed examination of patients with cortical posterior cerebral artery strokes selected based on lesion location. The aim of the current study was to relate behavioural performance with faces, objects and written words to lesion data through two complementary analyses: (i) a multivariate multiple regression analysis to establish the relationships between lesion volume, lesion laterality and the presence of a bilateral lesion with performance and (ii) a voxel-based correlational methodology analysis to establish whether there are distinct or separate regions within the posterior cerebral artery territory that underpin the visual processing of words, faces and objects. Behaviourally, most patients showed more general deficits in high-level vision (n = 22) or no deficits at all (n = 21). Category-selective deficits were rare (n = 6) and were only found for words. Overall, total lesion volume was most strongly related to performance across all three domains. While behavioural impairments in all domains were observed following unilateral left and right as well as bilateral lesions, the regions most strongly related to performance mainly confirmed the pattern reported in more selective cases. For words, these included a left hemisphere cluster extending from the occipital pole along the fusiform and lingual gyri; for objects, bilateral clusters which overlapped with the word cluster in the left occipital lobe. Face performance mainly correlated with a right hemisphere cluster within the white matter, partly overlapping with the object cluster. While the findings provide partial support for the relative laterality of posterior brain regions supporting reading and face processing, the results also suggest that both hemispheres are involved in the visual processing of faces, words and objects.

With childhood hemispherectomy, one hemisphere can support—but is suboptimal for—word and face recognition

The right and left cerebral hemispheres are important for face and word recognition, respectively—a specialization that emerges over human development. The question is whether this bilateral distribution is necessary or whether a single hemisphere, be it left or right, can support both face and word recognition. Here, face and word recognition accuracy in patients (median age 16.7 y) with a single hemisphere following childhood hemispherectomy was compared against matched typical controls. In experiment 1, participants viewed stimuli in central vision. Across both face and word tasks, accuracy of both left and right hemispherectomy patients, while significantly lower than controls' accuracy, averaged above 80% and did not differ from each other. To compare patients' single hemisphere more directly to one hemisphere of controls, in experiment 2, participants viewed stimuli in one visual field to constrain initial processing chiefly to a single (contralateral) hemisphere. Whereas controls had higher word accuracy when words were presented to the right than to the left visual field, there was no field/hemispheric difference for faces. In contrast, left and right hemispherectomy patients, again, showed comparable performance to one another on both face and word recognition, albeit significantly lower than controls. Altogether, the findings indicate that a single developing hemisphere, either left or right, may be sufficiently plastic for comparable representation of faces and words. However, perhaps due to increased competition or “neural crowding,” constraining cortical representations to one hemisphere may collectively hamper face and word recognition, relative to that observed in typical development with two hemispheres.

Training flexible conceptual retrieval in post-stroke aphasia

Semantic therapy in post-stroke aphasia typically focusses on strengthening links between conceptual representations and their lexical-articulatory forms to aid word retrieval. However, research has shown that semantic deficits in this group can affect both verbal and non-verbal tasks, particularly in patients with deregulated retrieval as opposed to degraded knowledge. This study, therefore, aimed to facilitate semantic cognition in a sample of such patients with post-stroke semantic aphasia (SA) by training the identification of both strong and weak semantic associations and providing explicit pictorial feedback that demonstrated both common and more unusual ways of linking concepts together. We assessed the effects of this training on (i) trained and untrained items; and (ii) trained and untrained tasks in eleven individuals with SA. In the training task, the SA group showed improvement with practice, particularly for trained items. A similar untrained task using pictorial stimuli (Camel and Cactus Test) also improved. Together, these results suggest that semantic training can be beneficial in patients with SA and may show some degree of generalization to untrained situations. Future research should seek to understand which patients are most likely to benefit from this type of training.

Shallow or deep? The impact of orthographic depth on visual processing impairments in developmental dyslexia

The extent to which impaired visual and phonological mechanisms may contribute to the manifestation of developmental dyslexia across orthographies of varying depth has yet to be fully established. By adopting a cross-linguistic approach, the current study aimed to explore the nature of visual and phonological processing in developmental dyslexic readers of shallow (Italian) and deep (English) orthographies, and specifically the characterisation of visual processing deficits in relation to orthographic depth. To achieve this aim, we administered a battery of non-reading visual and phonological tasks. Developmental dyslexics performed worse than typically developing readers on all visual and phonological tasks. Critically, readers of the shallow orthography were disproportionately impaired on visual processing tasks. Our results suggest that the impaired reading and associated deficits observed in developmental dyslexia are anchored by dual impairments to visual and phonological mechanisms that underpin reading, with the magnitude of the visual deficit varying according to orthographic depth.

Autobiographical memory unknown: Pervasive autobiographical memory loss encompassing personality trait knowledge in an individual with medial temporal lobe amnesia

Autobiographical memory consists of distinct memory types varying from highly abstract to episodic. Self trait knowledge, which is considered one of the more abstract types of autobiographical memory, is thought to rely on regions of the autobiographical memory neural network implicated in schema representation, including the ventromedial prefrontal cortex, and critically, not the medial temporal lobes. The current case study introduces an individual who experienced bilateral posterior cerebral artery strokes resulting in extensive medial temporal lobe damage with sparing of the ventromedial prefrontal cortex. Interestingly, in addition to severe retrograde and anterograde episodic and autobiographical fact amnesia, this individual's self trait knowledge was impaired for his current and pre-morbid personality traits. Yet, further assessment revealed that this individual had preserved conceptual knowledge for personality traits, could reliably and accurately rate another person's traits, and could access his own self-concept in a variety of ways. In addition to autobiographical memory loss, he demonstrated impairment on non-personal semantic memory tests, most notably on tests requiring retrieval of unique knowledge. This rare case of amnesia suggests a previously unreported role for the medial temporal lobes in self trait knowledge, which we propose reflects the critical role of this neural region in the storage and retrieval of personal semantics that are experience-near, meaning autobiographical facts grounded in spatiotemporal contexts.

Elucidating the nature of linguistic processing in insight

The relationship between language and thinking has long been a matter of debate and a research focus in studies on thinking and problem solving, including creativity. Previous behavioral studies have found that verbalization of one's internal thoughts does not participate in or even interfere with the creative insight process, thus suggesting that insight may take place nonverbally. In contrast to this hypothesis, the present study proposes a new one. That is, given that the basic categories or fundamental functions of key concepts or objects are critically changed or expanded during insightful thinking, the linguistic processing accompanying insight can be reflected as category-related representation and recategorization processes, which can be critically mediated by the posterior middle temporal gyrus and the angular gyrus (pMTG/AG). Using constraint-relaxation insight riddles as materials in a guided-insight experimental design with external hints to trigger the insightful representational change, this preliminary neuroimaging study of 11 participants found the involvement of pMTG/AG during moments of induced insight, but did not find the activation of left ventral frontal areas which are typically involved in verbalizing of one's internal thoughts. Although this observation still cannot exclude the possibility of internal verbalization in insightful restructuring, it implies that linguistic processing in insight may take the more fundamental form of category-related processing.

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

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

From Schools to Scans: A Neuroeducational Approach to Comorbid Math and Reading Disabilities

We bridge two analogous concepts of comorbidity, dyslexia-dyscalculia and reading-mathematical disabilities, in neuroscience and education, respectively. We assessed the cognitive profiles of 360 individuals (mean age 25.79 ± 13.65) with disability in reading alone (RD group), mathematics alone (MD group) and both (comorbidity: MDRD group), with tests widely used in both psychoeducational and neuropsychological batteries. As expected, the MDRD group exhibited reading deficits like those shown by the RD group. The former group also exhibited deficits in quantitative reasoning like those shown by the MD group. However, other deficits related to verbal working memory and semantic memory were exclusive to the MDRD group. These findings were independent of gender, age, or socioeconomic and demographic factors. Through a systematic exhaustive review of clinical neuroimaging literature, we mapped the resulting cognitive profiles to correspondingly plausible neuroanatomical substrates of dyslexia and dyscalculia. In our resulting "probing" model, the complex set of domain-specific and domain-general impairments shown in the comorbidity of reading and mathematical disabilities are hypothesized as being related to atypical development of the left angular gyrus. The present neuroeducational approach bridges a long-standing transdisciplinary divide and contributes a step further toward improved early prediction, teaching and interventions for children and adults with combined reading and math disabilities.

Anatomy and white matter connections of the fusiform gyrus

The fusiform gyrus is understood to be involved in the processing of high-order visual information, particularly related to faces, bodies, and stimuli characterized by high spatial frequencies. A detailed understanding of the exact location and nature of associated white-tracts could significantly improve post-operative morbidity related to declining capacity. Through generalized q-sampling imaging (GQI) validated by gross dissection as a direct anatomical method of identifying white matter tracts, we have characterized these connections based on relationships to other well-known structures. We created the white matter tracts using GQI and confirmed the tracts using gross dissection. These dissections demonstrated connections to the occipital lobe from the fusiform gyrus along with longer association fibers that course through this gyrus. The fusiform gyrus is an important region implicated in such tasks as the visual processing of human faces and bodies, as well as the perception of stimuli with high spatial frequencies. Post-surgical outcomes related to this region may be better understood in the context of the fiber-bundle anatomy highlighted by this study.

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

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

Functional laterality of the anterior and posterior occipitotemporal cortex is affected by language experience and processing strategy, respectively

Both language experience and processing strategy have been found to affect functional lateralization of the ventral occipitotemporal cortex (vOT). In this study, we adopted a factorial design to investigate the effects of language experience and processing strategy on functional lateralization of different vOT subregions in the processing of familiar (Chinese characters) and unfamiliar characters (Korean Hangul characters) in logographic writings. The processing strategy was manipulated by using part- and whole-based judgement tasks to induce part- and whole-based processing, respectively. The results showed that language experience enhanced neural responses in the anterior and middle vOT subregions, whereas part-based processing enhanced neural activations in the middle and posterior vOT subregions. More importantly, increased neural activations in the left hemisphere induced by language experience and part-based processing resulted in left laterality of the anterior and posterior vOT subregions, respectively, in the processing of logographic characters. These results suggested that functional lateralization of the anterior and posterior vOT subregions were respectively affected by language experience and processing strategy.

Double Trouble: Visual and Phonological Impairments in English Dyslexic Readers

Developmental dyslexia is a reading disorder characterized by problems in accurate or fluent reading. A deficiency in phonological processing is thought to underpin the reading difficulties of individuals with developmental dyslexia and a variety of explanations have been proposed including deficits in phonological awareness and verbal memory. Recent investigations have begun to suggest that developmental deficits in the acquisition of reading may also co-occur with visual processing deficits, which are particularly salient for visually complex stimuli, yet these deficits have received relatively little attention from researchers. To further explore the nature of phonological and visual processing in developmental dyslexia, we administered a series of non-reading tasks tapping both domains. Unsurprisingly, individuals with developmental dyslexia performed worse than typically developing readers in phonological tasks. More intriguingly, they also struggled with visual tasks, specifically when discriminating between novel visual patterns, and in visuo-spatial working memory, which requires greater attentional control. These findings highlight that individuals with developmental dyslexia present not only with phonological impairments but also difficulties in processing visual materials. This aspect has received limited attention in previous literature and represents an aspect of novelty of this study. The dual phonological and visual impairments suggest that developmental dyslexia is a complex disorder characterized by deficits in different cognitive mechanisms that underpin reading.

The visual word form area (VWFA) is part of both language and attention circuitry

While predominant models of visual word form area (VWFA) function argue for its specific role in decoding written language, other accounts propose a more general role of VWFA in complex visual processing. However, a comprehensive examination of structural and functional VWFA circuits and their relationship to behavior has been missing. Here, using high-resolution multimodal imaging data from a large Human Connectome Project cohort (N = 313), we demonstrate robust patterns of VWFA connectivity with both canonical language and attentional networks. Brain-behavior relationships revealed a striking pattern of double dissociation: structural connectivity of VWFA with lateral temporal language network predicted language, but not visuo-spatial attention abilities, while VWFA connectivity with dorsal fronto-parietal attention network predicted visuo-spatial attention, but not language abilities. Our findings support a multiplex model of VWFA function characterized by distinct circuits for integrating language and attention, and point to connectivity-constrained cognition as a key principle of human brain organization.

The Clock Counts - Length Effects in English Dyslexic Readers

In reading, length effects (LEs) are defined as an increment in the time taken to read as a function of word length and may indicate whether reading is proceeding in an efficient whole word fashion or by serial letter processing. LEs are generally considered to be a pathognomonic symptom of developmental dyslexia (DD) and predominantly have been investigated in transparent orthographies where reading impairment is characterized as slow and effortful. In the present study a sample of 18 adult participants with DD were compared to a matched sample of typical developing readers to investigate whether the LE is a critical aspect of DD in an opaque orthography, English. We expected that the DD group would present with marked LEs, in both words and non-words, compared to typical developing readers. The presence of LEs in the DD group confirmed our prediction. These effects were particularly strong in low frequency words and in non-words, as observed in reading speed. These preliminary findings may have important theoretical implications for current understanding of DD.

Are children with developmental dyslexia all the same? A cluster analysis with more than 300 cases

Reading is vital to every aspect of modern life, exacerbated by reliance of the internet, email, and social media on the written medium. Developmental dyslexia (DD) characterizes a disorder in which the core deficit involves reading. Traditionally, DD is thought to be associated with a phonological impairment. However, recent evidence has begun to suggest that the reading impairment in some individuals is provoked by a visual processing deficit. In this paper, we present WISC-IV data from more than 300 Italian children with a diagnosis of DD to investigate the manifestation of phonological and visual subtypes. Our results indicate the existence of two clusters of children with DD. In one cluster, the deficit was more pronounced in the phonological component, while both clusters were impaired in visual processing. These data indicate that DD may be an umbrella term that encompasses different profiles. From a theoretical perspective, our results demonstrate that dyslexia cannot be explained in terms of an isolated phonological deficit alone; visual impairment plays a crucial role. Moreover, general rather than specific accounts of DD are discussed.

Partial withdrawal of levothyroxine treated disease leads to brain activations and effects on performance in a working memory task: A pilot study

Hypothyroidism is associated with memory impairments. The present study aimed to evaluate the effects of partial withdrawal of levothyroxine on working memory tasks and brain function. Fifteen subjects under long-term levothyroxine substitution as a result of complete hypothyroidism participated in the present study. Functional magnetic resonance imaging (MRI) was performed using a working memory task (n-back task) and neuropsychological tests were performed before and 52-54 days after the induction of subclinical hypothyroidism by reducing the pretest levothyroxine dosage by 30%. Reaction time of subjects under partial levothyroxine withdrawal was significantly longer and less accurate with respect to solving the working memory tasks. Functional MRI revealed significant activation changes after medication withdrawal in the cerebellum, insula, parietal, frontal, temporal and occipital lobes, lingual gyrus, and the cuneus. Partial withdrawal of levothyroxine may lead to deficits in a working memory task and to an activation of brain areas associated with working memory ability.

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

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

Mapping the intersection of language and reading: the neural bases of the primary systems hypothesis

The primary systems framework has been used to relate behavioural performance across many different language activities to the status of core underpinning domain-general cognitive systems. This study provided the first quantitative investigation of this account at both behavioural and neural levels in a group of patients with chronic post-stroke aphasia. Principal components analysis was used to distil orthogonal measures of phonological and semantic processing, which were then related to reading performance and the underlying lesion distributions using voxel-based correlational methodology. Concrete word reading involved both a ventral semantic pathway, and inferior and anterior aspects of the dorsal phonological pathway. Abstract word reading overlapped with the ventral semantic pathway but also drew more extensively on the superior and posterior aspects of the dorsal phonological pathway. Nonword reading was related to phonological processing along the dorsal pathway and was also supported by a more superior set of regions previously associated with speech motor output. The use of continuous measures of behavioural performance and neural integrity allowed us to elucidate for the first time both the lesion and behavioural correlates for the semantic and phonological components of the primary systems hypothesis and to extend these by identifying the importance of an additional dorsal speech motor output system. These results provide a target for future neuroanatomically constrained computational models of reading.

Migraine with Aura: Surface-Based Analysis of the Cerebral Cortex with Magnetic Resonance Imaging

Objective

Previous migraine studies have reported gray matter alterations in various cortical regions with conflicting results. This study aimed to explore a cortical morphometric difference in migraineurs with aura (MA) compared to healthy subjects (HS) and to delineate a possible difference between the cortical morphological features and different aura phenotypes.

Materials and Methods

Forty-eight MA and 30 HS that were balanced by sex, age, and educational level were selected for this study. T2-weighted and three-dimensional T1-weighted magnetic resonance imaging (MRI) of the brain were acquired using a 1.5T MRI scanner. Surface-based morphometry from the MRI data was used to identify differences between the MA and HS group, and then between MA subgroups. The MA group was subdivided into migraineurs who experienced only visual aura (MVA) and migraineurs who had visual, somatosensory and dysphasic symptoms (MVA+).

Results

The MVA+ group had significantly reduced cortical surface area of the left rostral middle frontal cortex compared with the MVA group (p < 0.001). Migraine patients had significantly reduced volume of the left fusiform gyrus relative to HS (p < 0.001). Also, the sulcal depth increased at the level of the left temporal pole in the MVA+ group relative to the MVA group (p < 0.001). The vertex-by-vertex analysis did not exhibit any significant difference in cortical thickness between MA and HS, and between MVA+ and MVA, when corrected for multiple comparisons.

Conclusion

Migraineurs with aura demonstrates different morphometric features from HS in multiple cortical regions. MVA+ have different morphometric features in the left frontal and temporal lobe relative to MVA, which could be a source of distinct symptoms and serve as potential biomarkers of different MA subtypes.

Action and object words are differentially anchored in the sensory motor system - A perspective on cognitive embodiment

Embodied and grounded cognition theories have assumed that the sensorimotor system is causally involved in processing motor-related language content. Although a causal proof on a single-cell basis is ethically not possible today, the present fMRI study provides confirmation of this longstanding speculation, as far as it is possible with recent methods, employing a new computational approach. More specifically, we were looking for common activation of nouns and objects, and actions and verbs, representing the canonical and mirror neuron system, respectively. Using multivariate pattern analysis, a resulting linear classifier indeed successfully generalized from distinguishing actions from objects in pictures to distinguishing the respective verbs from nouns in written words. Further, these action-related pattern responses were detailed by recently introduced predictive pattern decomposition into the constituent activity atoms and their relative contributions. The findings support the concept of canonical neurons and mirror neurons implementing embodied processes with separate roles in distinguishing objects from actions, and nouns from verbs, respectively. This example of neuronal recycling processing algorithms is consistent with a multimodal brain signature of human action and object concepts. Embodied language theory is thus merged with actual neurobiological implementation.

From percept to concept in the ventral temporal lobes: Graded hemispheric specialisation based on stimulus and task

The left and right ventral anterior temporal lobes (vATL) have been implicated as key regions for the representation of conceptual knowledge. However, the nature and degree of hemispheric specialisation in their function is unclear. To address this issue, we investigated hemispheric specialisation in the ventral temporal lobes using a distortion-corrected spin-echo fMRI protocol that enhanced signal in vATL. We employed an orthogonal manipulation of stimulus (written words vs pictured objects) and task (naming vs recognition). Words elicited left-lateralised vATL activation while objects elicited bilateral activation with no hemispheric bias. In contrast, posterior ventral temporal cortex exhibited a rightward bias for objects as well as a leftward bias for words. Naming tasks produced left-lateralised activation in vATL while activity for recognition was equal in left and right vATLs. These findings are incompatible with proposals that left and right ATLs are strongly modular in function, since these predict rightward as well as leftward biases. Instead, they support an alternative model in which (a) left and right ATL together form a bilateral, integrated system for the representation of concepts and (b) within this system, graded hemispheric specialisation emerges as a consequence of differential connectivity with other neural systems. On this view, greater left vATL activation for written word processing develops as a consequence of the inputs this region receives from left-lateralised visual word processing system in posterior temporal cortex. Greater left vATL activation during naming tasks is most likely due to connectivity with left-lateralised speech output systems in prefrontal and motor cortices.

Face perception in pure alexia: Complementary contributions of the left fusiform gyrus to facial identity and facial speech processing

Recent concepts of cerebral visual processing predict from overlapping patterns of face and word activation in cortex that left fusiform lesions will not only cause pure alexia but also lead to mild impairments of face processing. Our goal was to determine if alexic subjects had deficits in facial identity processing similar to those seen after right fusiform lesions, or complementary deficits affecting different aspects of face processing. We studied four alexic patients whose lesions involved the left fusiform gyrus and one prosopagnosic subject with a right fusiform lesion, on standard tests of face perception and recognition. We evaluated their ability first to process faces in linear contour images, and second to detect, discriminate, identify and integrate facial speech patterns into perception. We found that all five patients were impaired in face matching across viewpoint, but the alexic subjects performed worse with line-drawn faces, while the prosopagnosic subject did not. Alexic subjects could detect facial speech patterns but had trouble identifying them and did not integrate facial speech patterns with speech sounds, whereas identification and integration was intact in the prosopagnosic subject. We conclude that, in addition to their role in reading, the left-sided regions damaged in alexic subjects participate in the perception of facial identity but in a non-redundant fashion, focusing on the information in linear contours at higher spatial frequencies. In addition they have a dominant role in processing facial speech patterns, another visual aspect of language processing.

Evidence for Separate Contributions of High and Low Spatial Frequencies during Visual Word Recognition

Previous studies have shown that different spatial frequency information processing streams interact during the recognition of visual stimuli. However, it is a matter of debate as to the contributions of high and low spatial frequency (HSF and LSF) information for visual word recognition. This study examined the role of different spatial frequencies in visual word recognition using event-related potential (ERP) masked priming. EEG was recorded from 32 scalp sites in 30 English-speaking adults in a go/no-go semantic categorization task. Stimuli were white characters on a neutral gray background. Targets were uppercase five letter words preceded by a forward-mask (#######) and a 50 ms lowercase prime. Primes were either the same word (repeated) or a different word (un-repeated) than the subsequent target and either contained only high, only low, or full spatial frequency information. Additionally within each condition, half of the prime-target pairs were high lexical frequency, and half were low. In the full spatial frequency condition, typical ERP masked priming effects were found with an attenuated N250 (sub-lexical) and N400 (lexical-semantic) for repeated compared to un-repeated primes. For HSF primes there was a weaker N250 effect which interacted with lexical frequency, a significant reversal of the effect around 300 ms, and an N400-like effect for only high lexical frequency word pairs. LSF primes did not produce any of the classic ERP repetition priming effects, however they did elicit a distinct early effect around 200 ms in the opposite direction of typical repetition effects. HSF information accounted for many of the masked repetition priming ERP effects and therefore suggests that HSFs are more crucial for word recognition. However, LSFs did produce their own pattern of priming effects indicating that larger scale information may still play a role in word recognition.

Word and text processing in developmental prosopagnosia

The "many-to-many" hypothesis proposes that visual object processing is supported by distributed circuits that overlap for different object categories. For faces and words the hypothesis posits that both posterior fusiform regions contribute to both face and visual word perception and predicts that unilateral lesions impairing one will affect the other. However, studies testing this hypothesis have produced mixed results. We evaluated visual word processing in subjects with developmental prosopagnosia, a condition linked to right posterior fusiform abnormalities. Ten developmental prosopagnosic subjects performed a word-length effect task and a task evaluating the recognition of word content across variations in text style, and the recognition of style across variations in word content. All subjects had normal word-length effects. One had prolonged sorting time for word recognition in handwritten stimuli. These results suggest that the deficit in developmental prosopagnosia is unlikely to affect visual word processing, contrary to predictions of the many-to-many hypothesis.

Comparing and validating methods of reading instruction using behavioural and neural findings in an artificial orthography

There is strong scientific consensus that emphasizing print-to-sound relationships is critical when learning to read alphabetic languages. Nevertheless, reading instruction varies across English-speaking countries, from intensive phonic training to multicuing environments that teach sound- and meaning-based strategies. We sought to understand the behavioral and neural consequences of these differences in relative emphasis. We taught 24 English-speaking adults to read 2 sets of 24 novel words (e.g., /buv/, /sig/), written in 2 different unfamiliar orthographies. Following pretraining on oral vocabulary, participants learned to read the novel words over 8 days. Training in 1 language was biased toward print-to-sound mappings while training in the other language was biased toward print-to-meaning mappings. Results showed striking benefits of print–sound training on reading aloud, generalization, and comprehension of single words. Univariate analyses of fMRI data collected at the end of training showed that print–meaning relative to print–sound relative training increased neural effort in dorsal pathway regions involved in reading aloud. Conversely, activity in ventral pathway brain regions involved in reading comprehension was no different following print–meaning versus print–sound training. Multivariate analyses validated our artificial language approach, showing high similarity between the spatial distribution of fMRI activity during artificial and English word reading. Our results suggest that early literacy education should focus on the systematicities present in print-to-sound relationships in alphabetic languages, rather than teaching meaning-based strategies, in order to enhance both reading aloud and comprehension of written words.

An fMRI study of visual hemifield integration and cerebral lateralization

The human brain integrates hemifield-split visual information via interhemispheric transfer. The degree to which neural circuits involved in this process behave differently during word recognition as compared to object recognition is not known. Evidence from neuroimaging (fMRI) suggests that interhemispheric transfer during word viewing converges in the left hemisphere, in two distinct brain areas, an "occipital word form area" (OWFA) and a more anterior occipitotemporal "visual word form area" (VWFA). We used a novel fMRI half-field repetition technique to test whether or not these areas also integrate nonverbal hemifield-split string stimuli of similar visual complexity. We found that the fMRI responses of both the OWFA and VWFA while viewing nonverbal stimuli were strikingly different than those measured during word viewing, especially with respect to half-stimulus changes restricted to a single hemifield. We conclude that normal reading relies on left-lateralized neural mechanisms, which integrate hemifield-split visual information for words but not for nonverbal stimuli.

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

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

A longitudinal investigation of the relationship between crowding and reading: A neurodegenerative approach

We have previously documented two patients (FOL and CLA) with posterior cortical atrophy who achieved accurate and rapid reading despite deficits in ten measures of visual processing, with two notable exceptions: (1) a measure of visual acuity, (2) a measure of visual crowding. Subsequent longitudinal investigation of these patients was carried out, involving annual tests of early visual, visuoperceptual and visuospatial processing and assessment of reading ability. Follow-up assessments identified the evolution of a particular early visual processing deficit, excessive visual crowding; this deficit has been previously implicated in forms of dyslexia. Consistent with the link between crowding and reading dysfunction, follow-up assessments also revealed deterioration in both patients' reading ability. The current findings demonstrate a neurodegenerative approach towards understanding the relationship between visual crowding and the reading system, and suggest possible mechanisms for how excessive crowding may disrupt word recognition.

Graded specialization within and between the anterior temporal lobes

Considerable evidence from different methodologies has identified the anterior temporal lobes (ATLs) as key regions for the representation of semantic knowledge. Research interest is now shifting to investigate the roles of different ATL subregions in semantic representation, with particular emphasis on the functions of the left versus right ATLs. In this review, we provide evidence for graded specializations both between and within the ATLs. We argue (1) that multimodal, pan-category semantic representations are supported jointly by both left and right ATLs, yet (2) that the ATLs are not homogeneous in their function. Instead, subtle functional gradations both between and within the ATLs emerge as a consequence of differential connectivity with primary sensory/motor/limbic regions. This graded specialization account of semantic representation provides a compromise between theories that posit no differences between the functions of the left and right ATLs and those that posit that the left and right ATLs are entirely segregated in function. Evidence for this graded account comes from converging sources, and its benefits have been exemplified in formal computational models. We propose that this graded principle is not only a defining feature of the ATLs but is also a more general neurocomputational principle found throughout the temporal lobes.

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

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

Treatment for Alexia With Agraphia Following Left Ventral Occipito-Temporal Damage: Strengthening Orthographic Representations Common to Reading and Spelling

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.

A vision of graded hemispheric specialization

Understanding the process by which the cerebral hemispheres reach their mature functional organization remains challenging. We propose a theoretical account in which, in the domain of vision, faces and words come to be represented adjacent to retinotopic cortex by virtue of the need to discriminate among homogeneous exemplars. Orthographic representations are further constrained to be proximal to typically left-lateralized language-related information to minimize connectivity length between visual and language areas. As reading is acquired, orthography comes to rely more heavily (albeit not exclusively) on the left fusiform region to bridge vision and language. Consequently, due to competition from emerging word representations, face representations that were initially bilateral become lateralized to the right fusiform region (albeit, again, not exclusively). We review recent research that describes constraints that give rise to this graded hemispheric arrangement. We then summarize empirical evidence from a variety of studies (behavioral, evoked response potential, functional imaging) across different populations (children, adolescents, and adults; left handers and individuals with developmental dyslexia) that supports the claims that hemispheric lateralization is graded rather than binary and that this graded organization emerges dynamically over the course of development. Perturbations of this system either during development or in adulthood provide further insights into the principles governing hemispheric organization.

Triangulation of the neurocomputational architecture underpinning reading aloud

The goal of cognitive neuroscience is to integrate cognitive models with knowledge about underlying neural machinery. This significant challenge was explored in relation to word reading, where sophisticated computational-cognitive models exist but have made limited contact with neural data. Using distortion-corrected functional MRI and dynamic causal modeling, we investigated the interactions between brain regions dedicated to orthographic, semantic, and phonological processing while participants read words aloud. We found that the lateral anterior temporal lobe exhibited increased activation when participants read words with irregular spellings. This area is implicated in semantic processing but has not previously been considered part of the reading network. We also found meaningful individual differences in the activation of this region: Activity was predicted by an independent measure of the degree to which participants use semantic knowledge to read. These characteristics are predicted by the connectionist Triangle Model of reading and indicate a key role for semantic knowledge in reading aloud. Premotor regions associated with phonological processing displayed the reverse characteristics. Changes in the functional connectivity of the reading network during irregular word reading also were consistent with semantic recruitment. These data support the view that reading aloud is underpinned by the joint operation of two neural pathways. They reveal that (i) the ATL is an important element of the ventral semantic pathway and (ii) the division of labor between the two routes varies according to both the properties of the words being read and individual differences in the degree to which participants rely on each route.

Lexical is as lexical does: computational approaches to lexical representation

In much of neuroimaging and neuropsychology, regions of the brain have been associated with 'lexical representation', with little consideration as to what this cognitive construct actually denotes. Within current computational models of word recognition, there are a number of different approaches to the representation of lexical knowledge. Structural lexical representations, found in original theories of word recognition, have been instantiated in modern localist models. However, such a representational scheme lacks neural plausibility in terms of economy and flexibility. Connectionist models have therefore adopted distributed representations of form and meaning. Semantic representations in connectionist models necessarily encode lexical knowledge. Yet when equipped with recurrent connections, connectionist models can also develop attractors for familiar forms that function as lexical representations. Current behavioural, neuropsychological and neuroimaging evidence shows a clear role for semantic information, but also suggests some modality- and task-specific lexical representations. A variety of connectionist architectures could implement these distributed functional representations, and further experimental and simulation work is required to discriminate between these alternatives. Future conceptualisations of lexical representations will therefore emerge from a synergy between modelling and neuroscience.

Visuospatial complexity modulates reading in the brain

Neurocognitive processing of orthographic visuospatial complexity was examined through fMRI-based overt naming (n=16) of phonologically transparent, high and low frequency Hindi/Devanagari words that were visually simple (पालक, चातक) or complex (, चकली). Participants' overt behavior was modestly influenced by visuospatial complexity (accuracy: main effect p=.01, complexity×frequency interaction p<.07), while neuroimaging data revealed a robust effect of complexity (main effect FWE p<10(-4), complexity×frequency interaction FWE p<7×10(-8)). Interaction-based RoIs showed higher BOLD response in the VWFA to complex and left posterior temporal cortex to simple words, with greater right lingual de-activation to complex than simple words. Subtractions confirmed additional recruitment of VWFA, right frontal, inferior orbitofrontal, mid-temporal pole and left cerebellum by visuospatially complex over simple words. Finally, low frequency words activated bilateral occipital and putamen areas, left IPL, SPL, IFG and VWFA, suggesting that effortful phonological processing in alphasyllabic Hindi/Devanagari requires neural resources specialized for both visuospatially simple and complex orthographies.

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.

(Con)text-specific effects of visual dysfunction on reading in posterior cortical atrophy

Reading deficits are a common early feature of the degenerative syndrome posterior cortical atrophy (PCA) but are poorly understood even at the single word level. The current study evaluated the reading accuracy and speed of 26 PCA patients, 17 typical Alzheimer's disease (tAD) patients and 14 healthy controls on a corpus of 192 single words in which the following perceptual properties were manipulated systematically: inter-letter spacing, font size, length, font type, case and confusability. PCA reading was significantly less accurate and slower than tAD patients and controls, with performance significantly adversely affected by increased letter spacing, size, length and font (cursive < non-cursive), and characterised by visual errors (69% of all error responses). By contrast, tAD and control accuracy rates were at or near ceiling, letter spacing was the only perceptual factor to influence reading speed in the same direction as controls, and, in contrast to PCA patients, control reading was faster for larger font sizes. The inverse size effect in PCA (less accurate reading of large than small font size print) was associated with lower grey matter volume in the right superior parietal lobule. Reading accuracy was associated with impairments of early visual (especially crowding), visuoperceptual and visuospatial processes. However, these deficits were not causally related to a universal impairment of reading as some patients showed preserved reading for small, unspaced words despite grave visual deficits. Rather, the impact of specific types of visual dysfunction on reading was found to be (con)text specific, being particularly evident for large, spaced, lengthy words. These findings improve the characterisation of dyslexia in PCA, shed light on the causative and associative factors, and provide clear direction for the development of reading aids and strategies to maximise and sustain reading ability in the early stages of disease.

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.