Illiteracy and brain damage--1. Aphasia testing in culturally contrasted populations (control subjects).

One hundred neurologically healthy adults were tested for their pointing (choosing one of four or six line drawings as the match to an auditorily presented linguistic stimulus), naming (from line drawings), and repetition abilities. All subjects were unilingual adult right-handers. Fifty-seven subjects were totally unschooled illiterates and 43 were fluent readers. Statistically significant differences were found to exist between the scores of the illiterate and literate subpopulations across all tasks. With the focus being placed on these cultural differences, the discussion bears on: (a) the interaction between linguistic and iconographic factors in certain types of naming and pointing tasks currently used in clinical and research aphasiology, (b) some of the linguistic parameters which are apparently at stake in repetition behavior, and (c) the circumstances in which aphasiological research dealing with groups of patients cannot yield reliable data without reference to neurologically healthy controls. It is argued that, when testing brain-damaged patients of different cultural backgrounds, one runs the risk of over- or underestimating the frequency of aphasia if one does not refer to norms which explicitly take educational level into account.

Illiteracy and brain damage. 3: A contribution to the study of speech and language disorders in illiterates with unilateral brain damage (initial testing).

This report bears on the behavior of 188 unilateral stroke subjects when administered an aphasia screening test comprising a short interview as well as naming, repetition, word-picture matching and sentence-picture matching tasks. All subjects were unilingual lusophone adult (40 yr of age or older) right-handers. Furthermore, they were either totally unschooled illiterates or they had received school education and thereafter retained writing skills and reading habits. Subjects were tested less than 2 months after a first unilateral stroke. In all tasks, global error scores were greater among left and right brain-damaged illiterate and literate subjects than among their controls. In repetition and matching, these differences were statistically significant for the left but not for the right-stroke groups, irrespective of the literacy factor. In naming, on the other hand, significant differences were found not only for the two left-stroke groups but also for the right-stroke illiterate group although not for the right-stroke literate one. Likewise, some degree of word-finding difficulty and of reduction in speech output as well as sizeable production of phonemic paraphasias were observed in the interviews of several right-stroke illiterates, clearly less in those of right-stroke literates. These findings lead us to suggest that cerebral representation of language is more ambilateral in illiterates than it is in school educated subjects although left cerebral "dominance" remains the rule in both.

NMDA-induced lesions of the nucleus accumbens or the ventral pallidum increase the rewarding efficacy of food to deprived rats.

The role of the nucleus accumbens (NAC) and ventral pallidum (VP) in food reward modulation was investigated using Heyman's [24] curve fitting approach in food deprived rats. All rats were maintained at 80% normal body weight, and trained to lever press for food reinforcement. Each rat was tested daily with a series of four variable-interval (VI) reinforcement schedules (80, 40, 20, and 10 s) designed to approximate an exponential distribution, and randomly administered in ascending or descending order. The maximum response rate (Rmax) and the reinforcement rate required to maintain half-maximal responding (Re50) were recorded for each rat's daily test session. Following the establishment of baseline responding, the excitotoxin N-methyl-D-aspartic acid (NMDA) was bilaterally administered into the NAC (30 micrograms per side) or VP (20 micrograms per side) over a 10 min period. Both groups displayed substantial damage to the intended structure, with the lateral regions typically sustaining more damage than medial regions, and minor damage to surrounding areas. When tested at three weeks post-lesion, a suppression of motor activity was evident in all animals when compared to pre-lesion baseline. Moreover, in almost all rats, Re50 decreased, suggesting that the rewarding efficacy of food had increased. These data are surprising, given the extensive literature on the relationship between damage in the NAC and loss of reward efficacy. However, based on pharmacological and anatomical findings, both brain regions have been divided into several subregions. Behavioral studies suggest that these subregions may differentially regulate reward and motor functions. The results from the present study suggest that (1) both the NAC and VP are involved in the modulation of food reward, (2) that lateral subregions in each structure may function to dampen food reward efficacy, and (3) that medial subregions may enhance food reward.

Unexpected reading dissociation in a Brazilian "nisei" with crossed aphasia.

There is an increased interest in reading impairments in the Japanese language, due to its particular writing system which includes two different scripts, Kanji (logograms) and Kana (phonograms). Reading dissociations between Kanji and Kana have been described, showing that each system is processed differently by the cerebral hemispheres. We describe the case of a 68 year old Brazilian "nisei" (i.e. born from Japanese parents) who had knowledge of both Japanese and Portuguese. He presented an ischemic stroke affecting the right hemisphere and subsequently developed a Broca's aphasia and an unexpected reading dissociation, with an impairment in Kana reading comprehension and a good performance in Kanji and in Portuguese. These findings suggest that the patient's right and left hemispheres have assumed opposite roles not only for oral but also for written language decodification.

The acute effect of methylphenidate in Brazilian male children and adolescents with ADHD: a randomized clinical trial.

OBJECTIVE: To evaluate the acute efficacy of methylphenidate (MPH) in Brazilian male children and adolescents with ADHD. METHOD: In a 4-day, double-blind, placebo-controlled, randomized, fix dose escalating, parallel-group trial, 36 ADHD children and adolescents were allocated to two groups: MPH (n = 19) and placebo (n = 17). Participants were evaluated pre- and posttreatment using the 10-item Conners Abbreviated Rating Scale (ABRS), the Children's Global Assessment Scale (CGAS), and a simplified version of the Continuous Performance Test (CPT). RESULTS: The MPH group had a significantly greater decrease in ABRS scores and a significantly higher increase in CGAS scores than the placebo group (p < 0.01). The MPH group showed also a significantly higher proportion of patients with a robust improvement (decrement of at least 50% in the ABRS score after the intervention) than the placebo group (p < 0.01). The MPH effect size for the ABRS was 1.05 (95% CI = 0.73-1.37). CONCLUSION: Our results extend the efficacy of MPH on the ADHD core symptoms extensively demonstrated in clinical trials with samples from some developed countries to a sample from a developing country where a diverse culture may modulate the clinical presentation of the disorder.

[Evaluation of intelligence with non-verbal tests in aphasic patients]. / Avaliação da inteligência com testes não-verbais em afásicos.

Eight patients with cerebral vascular disease and aphasia were studied just after the stroke. The clinical, neuropsychiatric, EEG and neuro-radiological aspects were evaluated. The patients were submitted to the psychological and phonoaudiological studies. The authors correlated the neurological lesions to the structural alteration of the intelligence, to the praxic and estheognostic alterations and also to the language disturbances. The criterions adopted by the World Health Organization and the genetics classification of Jean Piaget were used for the intellectual level classification. The results suggest that the intelligence evaluated through Leither's non-verbal test is better preserved in some asphasics.

Spelling tasks and Alzheimer's disease staging.

Reading, writing and oral spelling were evaluated in 30 normal elderly individuals and 28 patients with probable Alzheimer's disease (AD). Significant differences between control and AD groups were found in all tasks. Oral spelling was the most impaired function in AD and the only one which differentiated mild and moderate dementia cases. This task is very sensitive to the disease's effects on working memory and may be included in batteries aimed at staging AD.

Illiteracy and brain damage. 2. Manifestations of unilateral neglect in testing "auditory comprehension" with iconographic materials.

This report concerns the sentence-picture matching behavior of 100 neurologically healthy and 169 brain-damaged subjects, all of whom were unilingual adult right-handers. Within this population, 144 subjects were totally unschooled illiterates and the remaining 125 had received school education and thereafter had retained writing skills and reading habits. Brain-damaged subjects were tested less than 2 months after a first left- or right-hemisphere stroke. All subjects were administered an aphasia screening battery including, among other subtests, a set of six sentence-picture matching stimuli. For each of these six stimuli, subjects heard a sentence uttered by the examiner and were then requested to match this sentence with one of four drawings presented within a single display divided into four quadrants of equal surface. Three sentences were syntactically "simple" (noun subject + verb) and three were relatively more "complex" (noun subject + verb + one or two noun complements). Evidence of unilateral neglect was found in both left- and right-brain-damaged illiterates and literates. Moreover, the right neglect of left-brain-damaged subjects was manifest mostly when target sentences were relatively "complex" whereas the left neglect of right-brain-damaged subjects was manifest irrespective of the syntactic complexity of target sentences. Our data are interpreted as indicative of an interaction between two cognitive disorders resulting from dysfunctions of asymmetrically represented cognitive mechanisms. The implications of these findings with respect to clinical and research aphasia testing are discussed.