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Biomedical subjects

T Shallice

Publications and source records attributed to T Shallice.

At least 19 recordsLinked to original sources

Can the neuropsychological case-study approach be applied to schizophrenia?

Neuropsychological studies of schizophrenia typically apply a small number of tests to a large group of patients. This approach has at least two drawbacks. First, the heterogeneity of the condition will lead to group means which may not reflect the behaviour of any individual. Secondly, it is difficult to infer the nature of the underlying cognitive impairments from a small number of tests, since good performance on a particular test depends on many different cognitive processes. In these circumstances it is more appropriate to apply the methods of cognitive neuropsychology where a large number of tests are used on a single case. This approach has proved fruitful in the study of neurological patients. We have intensively studied 5 chronic schizophrenic patients. These patients varied greatly in terms of overall ability. However, all patients, whatever their overall ability, performed badly on tests sensitive to frontal lobe lesions. This result suggests impairment of the supervisory attentional system in these patients. In addition, one patient suffered from a visual agnosia.

Adult

Lesioning an attractor network: investigations of acquired dyslexia.

A recurrent connectionist network was trained to output semantic feature vectors when presented with letter strings. When damaged, the network exhibited characteristics that resembled several of the phenomena found in deep dyslexia and semantic-access dyslexia. Damaged networks sometimes settled to the semantic vectors for semantically similar but visually dissimilar words. With severe damage, a forced-choice decision between categories was possible even when the choice of the particular semantic vector within the category was not possible. The damaged networks typically exhibited many mixed visual and semantic errors in which the output corresponded to a word that was both visually and semantically similar. Surprisingly, damage near the output sometimes caused pure visual errors. Indeed, the characteristic error pattern of deep dyslexia occurred with damage to virtually any part of the network.

Brain

Deficits in strategy application following frontal lobe damage in man.

A quantitative investigation of the ability to carry out a variety of cognitive tasks was performed in 3 patients who had sustained traumatic injuries which involved prefrontal structures. All 3 had severe difficulties in 2 tests which required them to carry out a number of fairly simple but open-ended tasks over a 15-30 min period. They typically spent too long on individual tasks. All patients scored well on tests of perception, language and intelligence and 2 performed well on a variety of other tests of frontal lobe function. Explanations for their difficulty on the multiple subgoal tasks in terms of memory or motivational problems could be excluded. It is argued that the problem arose from an inability to reactivate after a delay previously-generated intentions when they are not directly signalled by the stimulus situation.

Accidents, Traffic

Preserved recall versus impaired recognition. A case study.

A very pure and most unusual case of memory impairment is reported in a patient operated on for an aneurysm of the anterior communicating artery. Neuropsychological investigation performed about 8 yrs after the operation revealed a dissociation between very poor performance on recognition tests (on which the patient's performance was as poor as that in classical amnesic patients) and normal performance (estimated by the number of correct responses) in recall. This pattern has not previously been reported and is the reverse of that observed both in normal subjects and in amnesic patients. In addition, the patient was able to achieve a number of difficult learning tasks, at times normally; the relearning of one of these tasks after a delay of 1 h was perfectly normal. The recognition failure is interpreted in terms of the suggestion that memory performance results from an interaction between knowledge and subjective experience of remembering.

Brain

The origins of utilization behaviour.

Utilization behaviour has previously been described clinically by Lhermitte (1983). An experimental investigation is reported of utilization behaviour in a patient with a localized inferior medial bifrontal lesion. The patient picked up and used irrelevant objects not only when place directly in front of him--the procedure developed by Lhermitte--but also when he had been instructed to carry out other tasks and his attention had not been directed to the objects. The behaviour occurred most frequently in the brief intervals between tasks, and more often when auditory-verbal rather than visuomotor tasks were being performed. The results are interpreted within an information-processing model of frontal lobe function. A differentiation is made between two forms of utilization behaviour--an 'incidental' form, as exhibited by the patient, and an 'induced' form where it occurs only when Lhermitte's procedure is adopted.

Behavior

Frontal lesions and sustained attention.

Neurological patients were presented with a succession of 2-11 stimuli which they were required to count, reporting the number in the series when it finished. The stimuli were binaural clicks, or pulses on the right or on the left index finger. Regardless of stimulus modality or lateralization, patients with lesions involving the right frontal lobe were impaired when the presentation rate was 1/sec. There was no corresponding impairment when the presentation rate was increased to 7/sec. It is argued that at slow rates when the task was monotonous patients with right-frontal lesions were less able than others to sustain attention voluntarily.

Adult

Category specific semantic impairments.

We report a quantitative investigation of the visual identification and auditory comprehension deficits of 4 patients who had made a partial recovery from herpes simplex encephalitis. Clinical observations had suggested the selective impairment and selective preservation of certain categories of visual stimuli. In all 4 patients a significant discrepancy between their ability to identify inanimate objects and inability to identify living things and foods was demonstrated. In 2 patients it was possible to compare visual and verbal modalities and the same pattern of dissociation was observed in both. For 1 patient, comprehension of abstract words was significantly superior to comprehension of concrete words. Consistency of responses was recorded within a modality in contrast to a much lesser degree of consistency between modalities. We interpret our findings in terms of category specificity in the organization of meaning systems that are also modality specific semantic systems.

Adult

Specific impairments of planning.

An information-processing model is outlined that predicts that performance on non-routine tasks can be impaired independently of performance on routine tasks. The model is related to views on frontal lobe functions, particularly those of Luria. Two methods of obtaining more rigorous tests of the model are discussed. One makes use of ideas from artificial intelligence to derive a task heavily loaded on planning abilities. A group of patients with left anterior lesions has a specific deficit on the task. Subsidiary investigations support the inference that this is a planning impairment.

Attention

Word-form dyslexia.

In this study we have reported our investigation of two patients with an acquired dyslexia characterized by letter-by-letter reading, whole word reading being apparently impossible. It has been shown that this phenomenon of letter-by-letter reading cannot be accounted for by visual or perceptual factors nor by impairment of visual span of apprehension. The exceptionally slow speed of reading was documented and a clear relationship between word length and reading speed established. Performance on tasks considered to maximize whole word reading which at the same time prevent the possibility of letter-by-letter reading, namely, reading script and reading with tachistoscopic presentation, was impaired. The satisfactory performance of these two patients on tasks of picture interpretation suggests that the two components of the syndrome simultanagnosia, letter-by-letter reading and piecemeal perception of complex scenes, are dissociable. Three alternative explanations of letter-by-letter reading are considered and we conclude that in this type of acquired dyslexia there is damage to the system through which a visual word-form is attained.

Adult

Semantic access dyslexia.

An analytical investigation of the residual reading capacities of a single patient with dyslexia without dysgraphia is reported. Both his ability to name and to comprehend letters and words were severely impaired. The major finding of this investigation was AR's striking capacity for categorizing words he could not read. In addition there was evidence of semantic priming effects. Thus AR was frequently able to achieve partial comprehension of words he could not read. The orthodox interpretation of the dyslexia without dysgraphia in terms of a disconnection syndrome is shown to be inappropriate, at least for the present case, where the deficit appears to be within the semantic domain; it is argued that this type of dyslexia is due to an impairment in accessing semantic information.

Auditory Perception

The involvement of the frontal lobes in cognitive estimation.

Ninety-six patients with localised cerebral lesions were tested on a task of providing reasonable answers to Cognitive Estimate questions. These questions are ones that can be answered using general knowledge available to almost all subjects, but for which no immediately obvious strategy is available. It was found that patients with frontal lesions gave significantly more bizarre answers than patients with more posterior lesions. This effect is interpreted in terms of Luria's (1966) theory of the planning functions of the frontal lobes.

Adult