An early description of slowly progressive aphasia.

Slowly progressive aphasia without generalized dementia has become an important issue of present-day neuropsychological research. Historically, credit for the first description is usually given to Pick. Another German-speaking author who has published a vivid description of a pertinent cases is Pick's contemporary, Max Rosenfeld. This author has also observed a patient with slowly progressive spatial disorientation and visual recognition deficit, and he has discussed these patients in a remarkably modern way in the context of partial atrophy of the brain.

Jean-Baptiste Bouillaud, Claude-François Lallemand, and the role of the frontal lobe: location and mislocation of language in the early 19th century.

In 1825, Jean-Baptiste Bouillaud read a paper at the Royal Academy of Medicine in Paris supporting Franz Gall's theory of a relation between speech and the frontal lobes. Bouillaud argued that if the frontal lobes are crucial to speech, 2 conditions must be satisfied: when the frontal lobes are affected, speech must also be affected; conversely, when the frontal lobes are spared, speech is also spared. Following these principles, he tested and argued in support of Gall's theory by analyzing the data from 2 neuropathological casebooks (Lallemand, 1820-1823; Rostan, 1820 and 1823). We now know that Bouillaud was wrong, since the crucial dichotomy is between the left and right hemispheres and not between the anterior and posterior areas. What is interesting is that the actual data refute Bouillaud's conclusion. We replicated his experiment by reanalyzing the 147 clinical cases described by Lallemand. There were, of course, some cases with frontal lesions and speech disorders; other cases, however, had speech disorders with lesions outside the frontal lobes, and still others had frontal lesions without speech disorders. Although Bouillaud did not notice it, as we expected, almost all patients with speech disorders had a left hemisphere lesion.

Impaired retrieval of object-colour knowledge with preserved colour naming.

Two cases (G.G. and A.V.) are described of cognitive impairment resulting from herpes simplex infection. Both cases demonstrated anomic disorders and impairments in drawing but only in G.G.'s drawings was there a reliable selective impairment for items from natural categories. Both cases, however, showed an impairment for the retrieval of knowledge concerning the colours of objects. The impairment has, in the past, been ascribed to interference from colour anomia; this was not so for the present cases. For G.G. and A.V., impairments in object-colour retrieval were related to errors in picture naming. More errors were associated with items that induced circumlocutions than to those that were correctly named. The impairment was also present for some items that were named correctly. The patients' impairments are discussed within a model in which object-colour knowledge is functionally situated between an object's shape description and its output phonology but on a separate route from other associated object knowledge.

Generative associative naming in dementia of Alzheimer's type.

Forty-eight patients with mild to moderate dementia of Alzheimer's type (DAT) were tested with a generative associative naming task, a task that combines the aspects of fluency and of word association tests. The variables taken into consideration were the number of adequate and inadequate responses, conventionality, word frequency and lexical-semantic relation to the target. DAT patients' performances were compared to those of a group of control subjects matched for sex, age and educational level. As a group, the patients gave fewer adequate responses, more idiosyncratic responses and perseverations, while there was no difference in the qualitative variables. However, the analyses of the performance profiles suggest that, irrespective of the severity of the disease, two major subgroups of DAT patients may be identified: (1) a first subgroup of subjects produced words with a lower conventionality rate and these were mostly in propositional relationship to the target; they also produced a higher rate of idiosyncratic responses and perseverations. (2) A second subgroup of subjects gave more conventional responses, mostly in the hierarchical-categorical relationship. The disorders of the former subgroup seem to correspond to a disrupted access to some relatively spared semantic abilities, whereas those of the latter to a semantic breakdown.

Different basic components in the performance of Broca's and Wernicke's aphasics on the Colour-Figure Matching Test.

It is known that focal damage of the left hemisphere causes poor performances in a number of tasks devoid of overt verbal connotation, often referred to as "non-verbal intelligence", "association" or "abstract attitude" tasks. However, it is not clear whether the existence of a unitary basic functional defect to account for the faulty performances outlined above can be supposed. In this investigation we have compared the behaviour of left-hemisphere damaged patients grouped according to aphasia type and have studied the extent to which two different, widely used tests of this supposed "non-verbal basic ability" (i.e. the Weigl Sorting Test and the Raven Progressive Matrices) overlap in their predictive power of the performance of a non-verbal association task, i.e. the Colour-Figure Matching Test. Notwithstanding the identical level of performance in the three tests between groups having different aphasia types, a clear-cut dissociation was found between Broca's and Wernicke's aphasics; in the former group the Colour-Figure Matching Test was highly correlated only with Weigl Sorting Test and in the latter only with Progressive Matrices. The conclusions are that in this case the breakdown of non-verbal basic resources does not coincide in patients with different types of aphasia, and the hypothesis of the existence of a unitary basic defect caused by left hemisphere damage is not in line with our findings.

Unilateral neglect of representational space.

Two patients showing left unilateral neglect were asked to describe imagined perspectives of familiar surroundings. Left-sided details were largely omitted in the descriptions. Some theoretical implications of the occurrence of unilateral neglect in representational space are briefly considered.

Further suggestions for cerebral CT-localization.

A method of obtaining lateral diagrams of brain lesions or structures from CT-scan pictures has been described and tested for accuracy with satisfactory results. Possible sources of error are discussed.

Factors influencing type and severity of aphasia.

The influence of etiology and sex on aphasia type and the relation of age to the severity and type of language disorders have been assessed in 718 right-handed aphasic patients. Both trauma and neoplasia are associated with fluent aphasia significantly more often, while sex proved to have no influence on aphasia type. The frequency distribution of age according to type and severity of aphasia - studied in vascular patients only (N = 566) - demonstrated that fluency and severity are significantly associated with older age.

A neurological dissociation between preserved visual and impaired spatial processing in mental imagery.

Studies on primates have shown that visual and spatial perceptual analysis depends on two separate neural pathways, associated with the processing of "what" and "where" an object is (visual characteristics and spatial coordinates, respectively). Similar dichotomies have been proposed by cognitive psychologists (e.g., the contrast between visual and spatial processing in working memory) and by neuropsychologists (e.g., the distinction between topographic agnosia and amnesia). In this paper we report the case of a patient with a severe spatial disorientation whose perceptual processing of visual and spatial information was normal, but in imagery tasks she had a dissociation between preserved visual and impaired spatial processing. While her ability to represent objects visually was intact, she failed in any task requiring mental rotation, recall of spatial position or execution of spatially based imagery operations. The case clearly demonstrates that visual and spatial imagery are functionally independent processes which must rely on different underlying neural systems. This pattern of impairment also explains the associated topographical amnesia as an inability to integrate spatial information in a mental map.

Relevance of adverb distribution for the analysis of sentence representation in agrammatic patients.

In this study, it is shown that functional categories are present in agrammatic grammar. Specifically, the verb-adverb order is investigated in three agrammatic patients by means of a constituent ordering task. It is shown that when the verb is in a nonfinite form, it either precedes or follows the specifier-like adverb (both positions are correct), but when the verb is finite, the adverb always follows it (which is the only possible order). The conclusions are that (i) a functional category (namely Inflection), which is responsible for the relative order verb-adverb (of the relevant class), must exist in agrammatic grammar, and (ii) agrammatic aphasia cannot be described as a syntactic impairment involving basic sentence structure.

Morphological processing in Italian agrammatic speakers syntactic implementation of inflectional morphology.

Most current linguistic and psycholinguistic characterizations of agrammatic production start from the observation that in spontaneous speech inflectional suffixes are either dropped or substituted by default forms, depending on the morphological structure of the language. So far, little experimental evidence has entered theory construction. In this paper, elicited data of two Italian patients with agrammatic speech are presented. The tasks involved the production of a past participle suffix in different sentence contexts. In Italian, the past participle has to agree in gender and number with the grammatical features of an antecedent noun, pronoun, or empty element. It is shown that both patients mastered the general principles of the agreement rule, and that they could produce correct inflectional suffixes in several tasks. Furthermore, the point of breakdown in their performance was syntactic rather than morphological, namely, when there were no overt morphological cues for the identification of the thematic roles in the sentence. These data cannot be accounted for by theories formulated in terms of the syntactic or postsyntactic deletion of suffixes or the functional elements underlying their realization. At least for the patients in this study, morphological substitutions arose as a result of an impairment in the syntactic processing of content words rather than functors.

Lexical representation and processing of morphologically complex words: evidence from the reading performance of an Italian agrammatic patient.

The study of patients with acquired language disorders has provided crucial evidence for contemporary theories on mental lexical representation. This is particularly true for the representation of morphologically complex words. In this paper we analyzed the performance of a patient (M.B.) affected by agrammatism and dyslexia. M.B. was required to read aloud simple and morphologically complex words. The patient's pattern of errors was interpreted as the result of a predominant use of the lexical routine (phonological dyslexia). Three reading tasks were developed which allowed us to test M.B.'s ability to read morphologically complex words (reading of regular and irregular plurals; reading of high- and low-frequency singular and plural nouns; reading of evaluative suffixes). Errors were determined by frequency effect rather than by type of suffix (i.e., inflectional or derivational). High-frequency morphologically complex items seemed to meet stored representations, thus avoiding the parsing procedures that are required for less frequent items. These results are in keeping with dual route models of lexical representation of morphologically complex words.

Morphological processing in Italian agrammatic speakers: eight experiments in lexical morphology.

Agrammatic speech production has often been characterized as amorphology. This study of two Italian agrammatic patients shows that, with respect to inflectional morphology of simple and derived nouns, the morphological features of gender and number are almost fully preserved for one patient (MG) and only mildly disturbed in the other patient (DR). Like inflection, the use of derivational suffixation as a means of word-building is only mildly disturbed in both patients. However, they show a severe disturbance with respect to inflectional morphology of lexical compounds, which requires syntactic analysis at the word level. Moreover, they are severely impaired in the choice of the function word for the construction of prepositional compounds, syntactically generated phrases which have the status of a word. Apart from such syntax-dependent morphological and word-building operations, neither inflectional nor derivational morphology are seriously disturbed in our patients. The apparent amorphology in their spontaneous speech can thus not be explained by a disorder of morphological representations in the lexicon system perse. In another study (De Bleser and Luzzatti, 1994) we were able to show that the patients had severe problems with the implementation of morphology in specific syntactic contexts, thus pointing to a problem in morphosyntactic rather than morpholexical processing as a factor contributing to agrammatic speech production.

A perplexing document in the early history of Gilles de la Tourette Syndrome: Melotti's rendition of a "Lecture of Charcot" (including a complete translation from the Italian with commentary).

In 1885, Dr. Guilio Melotti published an Italian translation of a lecture on "Convulsive Tics with Coprolalia and Echolalia" given by Jean-Martin Charcot. Although this lecture often has been cited as an authoritative statement of Charcot's view, until now it has not been translated into English. The lecture presents a number of statements that appear nowhere else in Charcot's published corpus, including some that seem to contradict Charcot's other pronouncements on maladie des tics. Although the Melotti-Charcot lecture may portray Charcot's position accurately in many passages, the article most likely is a compilation from a variety of sources.

[The evaluation of aphasic deficits for the definition of a targetted logotherapeutic treatment]. / Valutazione dei deficit afasici per la definizione di un trattamento logoterapico mirato.

The Aachener Aphasie Test (AAT) is the major German test for the diagnosis of aphasic disorders. The test is easy to use and is valid and reliable for the diagnosis of aphasia and its severity and to evaluate the recovery of the aphasic disorder after language rehabilitation. The AAT is, however, not sufficient to define cognitively sound logotherapeutic treatment. The use of tasks which are based on cognitive functional models allows the identification of specific processing levels that have been damaged by a cerebral lesion, and the definition of a focussed rehabilitation plan. In this paper, we will discuss the results of a cognitive neurolinguistic treatment in a patient who suffered of Broca's aphasia with agrammatism and phonological dyslexia.

The anatomical foundations of acquired reading disorders: a neuropsychological verification of the dual-route model of reading.

In this study we investigated the neural correlates of acquired reading disorders through an anatomo-correlative procedure of the lesions of 59 focal brain damaged patients suffering from acquired surface, phonological, deep, undifferentiated dyslexia and pure alexia. Two reading tasks, one of words and nonwords and one of words with unpredictable stress position, were used for this study. We found that surface dyslexia was predominantly associated with left temporal lesions, while in phonological dyslexia the lesions overlapped in the left insula and the left inferior frontal gyrus (pars opercularis) and that pure alexia was associated with lesions in the left fusiform gyrus. A number of areas and white matter tracts, which seemed to involve processing along both the lexical and the sublexical routes, were identified for undifferentiated dyslexia. Two cases of deep dyslexia with relatively dissimilar anatomical correlates were studied, one compatible with Coltheart's right-hemisphere hypothesis (1980) whereas the other could be interpreted in the context of Morton and Patterson's (1980), multiply-damaged left-hemisphere hypothesis. In brief, the results of this study are only partially consistent with the current state of the art, and propose new and stimulating challenges; indeed, based on these results we suggest that different types of acquired dyslexia may ensue after different cortical damage, but white matter disconnection may play a crucial role in some cases.

Treatment efficacy of language and calculation disorders and speech apraxia: a review of the literature.

The aim of the study was to evaluate the efficacy of the treatment for language and calculation disorders and for speech apraxia in vascular subjects. Only therapeutic methods that could be qualified as neuropsychological were taken into account. For language disorders, we searched the pertinent literature published from 1950 to August 31, 2007 by means of electronic data banks and we took into consideration the Cochrane review, and papers in Cicerone et al. and Cappa et al. systematic reviews. For acalculia we examined the literature from 1980 by carrying out research on electronic data banks; for speech apraxia, studies emerged from a search of PUBMED. Aphasia therapy has been clearly demonstrated efficacious in groups of subjects if sufficiently prolonged/intensive. Treatment for specific disorders (words and sentences processing, reading, writing) studied in series of single patients, though always efficacious, reaches a lower level of recommendation due to the lack of RCT. Only a few studies tackled the problem of efficacy in case of speech apraxia and calculation disorders. Results are positive but data are scanty. Efficacy of aphasia therapy seems well established in group of subjects and well-promising for speech apraxia and calculation disorders. It is suggested, however, that the term "aphasia" covers widely different impairments and that RCT are not the best instrument to evaluate efficacy; the importance of chronicity is underlined.