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Patients with pure alexia have major difficulties in reading aloud. However, they often perform above chance level in reading tasks that do not require overt articulation of the target word - like lexical decision or semantic judgment - a phenomenon usually known as "implicit reading." There is no agreement in the literature on whether implicit reading should be attributed to relative sparing of some left hemisphere (LH) reading centers or rather to signs of compensatory endeavors by the right hemisphere (RH). We report the case of an 81-year-old patient (AA) with pure alexia due to a lesion involving the left occipital lobe and the temporal infero-mesial areas, as well as the posterior callosal pathways. Although AA's reading was severely impaired and proceeded letter by letter, she showed an above-chance-level performance for frequent concrete words in a tachistoscopic lexical decision task. A structural disconnectome analysis revealed that AA's lesion not only affected the left occipital cortex and the splenium: it also disconnected white-matter tracts meant to connect the visual word-form system to decision-related frontal areas within the LH. We suggest that the RH, rather than the LH, may be responsible for patient AA's implicit reading.

Introduction The cognitive reserve (CR) theory has been proposed to account for the mismatch between the degree of neuropathological changes and clinical outcome in dementias. Recently, it has also been applied to Parkinson's disease (PD) with promising results, but mostly just focusing on separate proxy measures of CR, such as education, working and leisure time activities, instead of adopting a more comprehensive approach. Using the Cognitive Reserve Index questionnaire (CRIq), this study examined the association of CR with motor functions and cognition in patients with medium-low (1–9 years) and medium-high (>9 years) PD duration. Methods Fifty patients with PD underwent a neurological and a neuropsychological assessment, comprised of: Unified Parkinson's Disease Rating Scale- section III, Mini-Mental State Examination, Clock-Drawing Test, Rey auditory verbal learning test (immediate and delayed recall trials), Digit Span Forward, Corsi Span Forward, Frontal Assessment Battery, Raven's Colored Progressive Matrices, WAIS similarities subtest, Phonemic Fluency, Semantic Fluency and CRIq. Results PD patients with a higher CRIq score showed a reduced motor impairment and a better global cognitive performance when compared to PD patients with a lower CRIq score, with an advantage especially observed on executive functions and short-term memory. The CR effect was even enhanced in the case of longer disease duration, as observed when considering the overall neuropsychological tests performance and non-verbal abstract reasoning in particular. The results obtained when considering education, as a single proxy measure of CR, provided no additional findings, nor did they reveal all the effects yielded by the adoption of the CRI score. Conclusion Our results support the beneficial role of CR against motor and cognitive dysfunctions in PD and suggest that its protective role may be mostly manifested at the later stages of the disease. A theoretical framework able to explain the different impact of CR on Alzheimer Disease and PD is discussed. Finally, our results stressed the importance of using a comprehensive measure of CR instead of focusing on just one of its proxies.

Background: Abnormal repetitive behaviors have been reported in Parkinson's disease (PD) during dopamine replacement therapy (DRT) and associated with individ- ual predisposing features, including impulsivity. How- ever, impulsivity and compulsive symptoms have never been explored in PD patients before initiation of DRT. We previously reported a 20% of impulse control disor- ders (ICD) in an Italian cohort. Methods: 103 consecutive newly diagnosed drug-naive PD patients (means: age 5 60.5 6 9.2 years; duration 5 15.4 6 15.3 months) were screened for compulsive sex- ual behavior, compulsive buying, intermittent explosive disorder (Minnesota Impulsive Disorders Interview, MIDI), and pathological gambling (South Oaks Gambling Screen, SOGS). Barratt Impulsiveness Scale (BIS-11) and Maudsley Obsessional-Compulsive Questionnaire (MOCQ/R) assessed impulsivity, obsessive-compulsive symptoms, respectively. Depression (GDS-15) and gen- eral cognitive status were additionally assessed. We also compared ICDs frequency with our healthy controls. Results: 17.5% of PD patients screened positive for at least one ICD at MIDI (17/103) and SOGS (1/103), though none had a disorder based on DSM-IV criteria. These frequencies were similar to healthy controls. There was a trend toward higher scores in BIS-11 attentive-impulsivity subscale (15.2 6 4.8 vs. 18.7 6 4.9; P 5 0.007) and in MOCQ/R-Doubting subscale (0.67 6 1.1 vs. 1.5 6 1.2; P 5 0.007) in PD with ICD. We also observed a positive correlation between GDS- 15 and BIS-11. Conclusions: Similar to our healthy control population, we found a significant proportion of early PD patients positive for ICDs before starting treatment. We also found a relationship between impulsivity and depression. A detailed behavioral assessment before starting dopa- minergic therapy is recommended. V C 2011 Movement Disorder Society

The efficacy of aphasia therapy has been demonstrated in group and single case studies. However, in group studies, treatment was underspecified and replication was impossible. In single case studies, treatment was clearly defined and experimentally controlled but its scope was generally limited, e.g. learning of a pre-determined and relatively low number of words or reading of irregular words. The purpose of this study was to investigate the effects of an intensive (4–5 h/day), clearly defined, and model-based treatment in a subject—DA—with multiple language disorders who was beyond the period of spontaneous recovery. DA underwent a general neuropsychological and language evaluation 8 months post-onset. He had moderate comprehension disorders, reading and writing were slow and severely damaged, and his speech was agrammatic. DA's spontaneous production was analysed according to the Quantitative Production Analysis (QPA) method. Treatment lasted 8 months and was directed at each functional impairment. Results at the first and the final evaluation were compared. Important differences were found in many language tasks and in spontaneous production, showing that intensive and model-based treatment can improve the patient's daily use of language, even in a chronic subject past the period of spontaneous recovery.

Background : Recovery from aphasia in the first 12 months post-onset has been extensively studied. However, far less research effort has been directed towards documenting the course of long-term aphasia. The few existing studies indicate a trend towards a decline in the long term. Aims : Aims of the present research were: (1) to investigate the long-term course of aphasia, and (2) to collect data about the occupational status of individuals with aphasia. Methods & Procedures : We present data from 52 left-hemisphere-damaged vascular aphasic individuals who underwent three aphasia examinations and had a mean post-onset time of 5 years. All subjects were treated between the first and second examination and none received treatment between the second and the final examination. At final examination the aphasic individuals and/or an important other were asked to respond to a questionnaire about the aphasic individuals' use of language, social life, and employment status. Outcomes & Results : Subjects significan...

Effectiveness of aphasia therapy, at least for some patients, is no longer under discussion but the specific effect of most of the variables influencing recovery is unknown. In this paper we address a question relative to the therapeutic regimen. Three pairs of patients with similar age, educational level, sex, aetiology, lesion site, and type and severity of aphasia are compared. Except for one of the control patients who was 2 months post-onset, all patients were at least 6 months post-onset (range: 6–22 months) and had already been rehabilitated when they entered the study. The three experimental subjects underwent a very long and intensive therapeutic programme (2/3 hours per day, 7 days per week, for many months), with the help of the family and volunteers. The control patients were rehabilitated daily (1 hour, 5 days a week) for similar periods of time. It is argued that the intensive treatment achieved higher test scores and more prolonged recovery and that the experimental patients made better use...

Acalculia is a frequent disorder in left-brain-damaged patients but nothing is known about its natural course. We report a study on 51 vascular acalculic patients examined at least twice. Our results indicate that recovery from acalculia is possible in the first months post-stroke, that initial severity does not significantly influence recovery, and that it correlates with recovery of auditory comprehension.

C.M. is an agrammatic patient who on assessment tests shows a disproportionate difficulty when pro- ducing verbs compared with nouns. In three experiments, we investigated whether C.M. also has dif- ficulties with nouns referring to events and whether event nouns and verbs show similar patterns of disruption. Experiment 1 suggested that she is sensitive to argument structure complexity and has a greater impairment in the production of event nouns and verbs than object nouns. Experiment 2 revealed that C.M. finds derivationally complex words, such as event nouns, difficult to produce. However, morphological complexity does not completely explain C.M.’s problems with event nouns. In Experiment 3, an assessment of C.M.’s ability to use different aspects of semantic and syntactic knowledge relative to event nouns and verbs showed an almost identical performance with the two types of words. The relevance of the findings with respect to models of word production is considered.

Abnormal repetitive behaviors have been reported in Parkinson's disease (PD) during dopamine replacement therapy (DRT) and associated with individual predisposing features, including impulsivity. However, impulsivity and compulsive symptoms have never been explored in PD patients before initiation of DRT. We previously reported a 20% of impulse control disorders (ICD) in an Italian cohort.103 consecutive newly diagnosed drug-naïve PD patients (means: age = 60.5 ± 9.2 years; duration = 15.4 ± 15.3 months) were screened for compulsive sexual behavior, compulsive buying, intermittent explosive disorder (Minnesota Impulsive Disorders Interview, MIDI), and pathological gambling (South Oaks Gambling Screen, SOGS). Barratt Impulsiveness Scale (BIS-11) and Maudsley Obsessional-Compulsive Questionnaire (MOCQ/R) assessed impulsivity, obsessive-compulsive symptoms, respectively. Depression (GDS-15) and general cognitive status were additionally assessed. We also compared ICDs frequency with our healthy controls.17.5% of PD patients screened positive for at least one ICD at MIDI (17/103) and SOGS (1/103), though none had a disorder based on DSM-IV criteria. These frequencies were similar to healthy controls. There was a trend toward higher scores in BIS-11 attentive-impulsivity subscale (15.2 ± 4.8 vs. 18.7 ± 4.9; P = 0.007) and in MOCQ/R-Doubting subscale (0.67 ± 1.1 vs. 1.5 ± 1.2; P = 0.007) in PD with ICD. We also observed a positive correlation between GDS-15 and BIS-11.Similar to our healthy control population, we found a significant proportion of early PD patients positive for ICDs before starting treatment. We also found a relationship between impulsivity and depression. A detailed behavioral assessment before starting dopaminergic therapy is recommended.

A topic much considered in research on acalculia was its relationship with aphasia. Far less attention has been given to the natural course of acalculia. In this retrospective study, we examined the relationship between aphasia and acalculia in an unselected series of 98 left-brain-damaged patients and the spontaneous recovery from acalculia in 92 acalculic patients with follow-up. There was a significant association between aphasia and acalculia although 19 participants exhibited aphasia with no acalculia and six acalculia with no aphasia. We observed significant improvement between a first examination carried out between 1 and 5 months post-onset and a second examination carried out between 3 and 11 months later (mean: 5 months). The mechanisms of spontaneous recovery are discussed. (JINS, 2005, 11, 99–107.)

The paper reports the performance of 50 left- and 26 vascular right-brain-damaged (LBD, RBD) patients in the EC301 Calculation Battery, which explores different aspects of number and calculation processing. All patients underwent a comprehensive neuropsychological testing that also included evaluation for the presence and type of aphasia in LBD patients, and of spatial disorders in RBD patients. LBD were subdivided in three groups: non-aphasic (NA), Broca and Wernicke aphasics. Results indicate that language and calculation disorders can dissociate. The relationship between spatial and calculation disorders in RBD patients is less clear. No significant difference was found between Broca and Wernicke aphasics, nor between NA and RBD patients. In the transcoding tasks (reading or writing to dictation numbers and number words, for instance) syntactic errors were the most frequent type of errors in all groups. They were also present when neither the input nor the required response was in the Arabic code, and a word-by-word strategy could have been used to read the number word or write a spoken number in the orthographic code.