Biomedical subjects
Publications and source records attributed to M C Silveri.
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An Italian patient with a pure dysgraphia who incorrectly spelled words and nonwords is described. The spelling errors made by the patient were not affected by lexical factors (e.g., frequency, form class) and were qualitatively the same for words and nonwords. The pattern of writing performance is discussed in relation to current models of writing and, specifically, in relation to the role of the Output Grapheme Buffer and Phoneme-Grapheme Conversion in writing.
Current theories of agrammatism do not provide a clear explanation for the co-occurrence of omission of grammatical markers and main verbs in this disorder. This study tested the hypothesis that the two symptom features have distinct underlying causes. Specifically, that the omission of main verbs in agrammatic speech is caused, at least in part, by a lexical (as opposed to a syntactic) deficit. Agrammatic and anomic aphasics and normal controls were given an object and action naming test. Agrammatic patients showed a marked impairment in naming actions in contrast to anomic aphasics and normal controls who named actions better than objects. The action naming impairment in agrammatic patients was interpreted as evidence for the lexical deficit hypothesis of verb omission in the speech of these patients and as a demonstration that agrammatism is a heterogeneous disorder that implicates damage to both lexical and syntactic mechanisms.
Four unselected groups of Broca's, Wernicke's, conduction, amnesic aphasic patients and a group of normal controls were asked to produce the best opposite of 60 adjectives. For half of the stimuli the expected opposite was morphologically related to the stimulus word (e.g. "formal"/"informal"), for the other half it could be obtained only by selecting a new base-form within the lexicon (e.g. "good"/"bad"). Following some neurolinguistic observations by Hécaen et al., it was predicted that amnesic patients should produce mainly morphological opposites, whereas conduction aphasics should produce mainly lexical antonyms. Results confirmed the predictions, since amnesic aphasics showed a prevalent impairment in the selection lexical opposites, whereas conduction aphasics showed a selective impairment in the production of morphological antonyms.
The ability of aphasic patients to draw from memory objects with a characteristic shape has been investigated. Their capacity to reproduce the form of real objects was studied by showing them for a short time line drawings of simple objects. When the patient had analysed and recognized the figure, the model was hidden from view and the subject was asked to draw the same object from memory. This Drawing from Memory task was administered to 54 aphasics, 67 patients with right hemisphere lesions, 44 nonaphasic left brain-damaged patients and 23 normal controls. The influence of visuoconstructive disabilities was controlled by administering to the same patients a standard test for constructional apraxia (copying 10 geometrical figures). The severity and clinical form of the aphasia and the presence of semantic-lexical impairment at the receptive level were also examined in the aphasic patients. The following results were obtained. (1) Aphasic patients scored significantly less well than the control groups on the Drawing from Memory task and the intergroup differences became greater when the scores from the test for constructional apraxia were included by an analysis of covariance. (2) No significant correlation was detected between the severity and clinical form of the aphasia and the scores obtained on the Drawing from Memory task. (3) There was a significant correlation between impaired drawing from memory and disruption at the semantic-lexical level of language integration.
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When submitted to confrontation naming tasks, aphasic patients show different types of naming errors: phonetic, phonemic and verbal-semantic paraphasias, neologisms and anomia, but it is generally difficult to decide whether these errors are mainly due to a breakdown of the semantic systems or to post-lexical phonological disorders. In order to clarify this issue, 118 aphasic patients were given 3 tests of confrontation naming and 3 tests of semantic-lexical discrimination. Naming errors on confrontation were used to classify aphasic patients in various subgroups (according to the prevalence of a given type of naming error), whereas performances obtained on tests of semantic-lexical discrimination were taken as an index of disorganization of the semantic systems. The performances on semantic discrimination tests of patients showing a prevalence of phonetic, phonemic and verbal-semantic paraphasias, neologisms and anomia on confrontation naming tasks were compared. A very small number of semantic discrimination errors was obtained by patients showing a prevalence of phonetic and phonemic transformations on confrontation, whereas a much larger number of semantic discrimination errors was obtained by patients showing a prevalence of verbal-semantic paraphasias, neologisms and anomia.
A neuropsychological test battery made up of verbal, visual-spatial, and intelligence tests was administered to 82 right and 67 on-aphasic left brain-damaged patients with localized cerebral lesions, in order to draw impairment profiles of the various subgroups. Separate analyses were undertaken on patients with unilobar and multilobar lesions. As for hemisphere effects, LH patients performed worse than RH subjects on verbal tests, while the reverse was true for visual-spatial tasks. As for lobe effects, patients with frontal lobe damage fared worse than other subgroups on word fluency, independent of the side of the lesion. RH patients with multilobar posterior lesions were significantly more impaired than other RH subgroups on the test of Copying Drawings with Landmarks, probably owing to the detrimental effect of unilateral spatial neglect on tasks requiring an accurate visual-spatial analysis.
The influence of sex, age, educational level and pathologic lesion on incidence, severity and clinical form of aphasia was investigated in 390 right-handed, left brain-damaged patients. Sex and educational level were not related to any parameter. Etiology of lesion and age were related to both incidence and type of aphasia. Incidence of aphasia increased with age and was higher in patients with cerebrovascular accidents than in subjects with other types of brain lesions. Non-fluent forms of aphasia were more frequent in young patients suffering from acute cerebrovascular accidents, whereas anomia prevailed in neoplastic subjects and Wernicke's aphasia increased regularly in frequency with age. Some tentative explanations of these findings are discussed.
Previous studies of category-specific semantic disturbances have focused their attention on the intrinsic cognitive structure of these disorders. The present survey aims to evaluate the relationships between disrupted semantic category and localisation of the underlying brain damage, in order to establish whether the injured brain areas house just those neurophysiological mechanisms that should have critically contributed to the acquisition of the disrupted semantic categories. We took into account in our review two double dissociations concerning respectively: (1) the impairment of a specific linguistic category--we contrast those disorders selectively affecting verbs (action names) with those selectively affecting nouns (object names); (2) the impairment of a specific conceptual/semantic domain--we contrast disorders selectively affecting living beings with those preferentially affecting man-made artefacts. The hypothesis that different categories of knowledge may be closely intertwined with different sources of sensory-motor information, was substantially confirmed. The lesion preferentially encroached on the left frontal lobe when the category "verbs" was selectively affected; it involved the left temporal lobe and the posterior association areas when the category "nouns" was preferentially disrupted; it involved bilateral temporo-limbic structures and inferior temporal lobes when the category "living beings" was selectively disrupted; it usually encroached on the left fronto-parietal areas when man-made artefacts and body parts were preferentially affected. These data support the hypothesis that: (a) action schemata may critically contribute to the development of the semantic representation of verbs, (b) mechanisms of sensory integration may play an important role in establishing the semantic representation of nouns; (c) high-level visual processing and multi-modal sensory convergency may critically contribute to organising the semantic representation of living beings; (d) motor-kinaesthetic integration may play a leading role in developing the semantic representation of man-made artefacts.
Several papers have attempted to find neurological and neuropsychological predictors of progression in Alzheimer's disease (AD) till now. Despite this quite large amount of works, different and not univocal conclusions have been reported in this field. Different study samples, different end-points and differences in statistical methods can explain much of the inconsistency in the results obtained. In our study, AD patients were examined in a very early stage of the disease to avoid any possible risk to examine subjects at different times of evolution. All the patients underwent an extensive neuropsychological test battery twice (baseline and follow-up) spaced out over about 1 year and were divided into two groups of fast decliners (FD) and slow decliners (SD) on the basis of their rate of decay at the MMSE score. Verbal memory tests, mental control abilities and attention-demanding tasks seem to play a pivotal role in distinguishing the two groups of subjects in the early stage of the disease. Moreover, FD patients show a worse performance than SD at the baseline in most of the cognitive domains explored. In conclusion, different subtypes of AD do exist and an important predictor of progression is represented by the severity of the cognitive impairment at the onset.