[in Japanese]

View full abstract

    Disconnected awareness in a diagonistic dyspraxic patient and degraded awareness in a visual agnosic patient were investigated from the viewpoint of occupational therapy. The first case was a male patient with disconnection syndrome including diagonistic dyspraxia. Speech reguration of interruptive actions in left hand was introduced for the purpose of reorganization of bimanual activity. As a result of the therapy he became possible to restrain the left hand activities, and to be independent his ADL and to return to his occupation. It was thought that verbalized his own directions was fed back through Wernick's area, and integrated with his activity plans in left palietal lobe. It was thought that right hemisphere processes, which were opposed to intentional acts of left hemisphere, were necessary to be inhibited. Second case was a male patient with visual agnosia whose dominant complaint was face recognition impairement. He gaind much recovery in visual perception through activities which was planned to reorganize visual perception by intact kinethetic information. By experiments of priming picture naming, his visual perceptual disorder was thought to be in the level that extracting semantic representation from structual representation.

View full abstract

    In order to investigate impaired awareness (i. e., unawareness (UA)) of patients with amnesic symptoms, we developed a self-report “Memory Questionaire” (MQ) which consisted of two forms, that is, patient's MQ with 132 items and family member's MQ with 104 items. This study focused on two problems : whether there were UA-score differences depending on diseases and lesion lateralities; whether there was a correlation between UA-scores and neuropsychological test performances, we obtained UA-scores by subtracting patients' ratings of their own amnesic symptoms from these by their family member.
    Subjects were 54 patients, composed of 4 disorder groups, 20 patients with temporal lobe epilepsy, 14 with cerebrovascular disease, 16 with dementia of Alzheimer type (DAT) , and 4 with degenerative brain atrophy who were not diagnosed as DAT yet. By their lesion lateralities they were classified into 3 groups, 11 patients with left hemispheric lesion, 11 with right, and 32 with bilateral/diffuse/obscure (BHL).
    The results suggest that UA-scores are significantly different depending on diseases and lesion lateralities (higher UA-scores in DAT and BHL) and there is a significant correlation between UA-scores and a decline of non-verbal memory test performances and others reflecting right hemispheric damage. Consequently we conclude that unawareness is correlated with right hemispheric damage and it becomes severer if left hemispheric lesion is be involved.

View full abstract

    Relation between the right hemisphere and awareness (or consciousness) was discussed. Functions considered to be the right hemisphere dominant include control and maintenance of temporal and spatial attention, perceptual categorization, judgement of spatial relations, regulation of emotion, maintenance of motor set, maintenance and control of voluntary eye opening and control of pragmatic aspect of discourse. On the other hand functions considered to be the left hemisphere dominant include language, calculation, intentional action, use of tools and identification of objects among others.
    Many studies performed by Sperry and Gazzaniga on callosotomized patients over the past 30 years strongly suggest that only the left hemisphere is conscious of its cognitive activities. The author's clinical experience is consistent with this hypothesis. It is argued that the left hemisphere manipulates sensory as well as linguistic images, while the right hemisphere provides a system for the frame of reference to make this manipulation of images possible. Only with the emergence of this frame of reference, awareness of images, i. e. consciousness might have become possible.

View full abstract

    Both seven patients who showed leftsided neglect and three patients who showed rightsided neglect in reading single words were examined. Neglect errors typically involved omission and longer words were more susceptible to errors than short words in the left neglect dyslexics. All left neglect dyslexics showed general neglect. In contrast, in the right neglect dyslexics neglect errors typically involved substitution and longer words were no more susceptible to errors than short words. All right neglect dyslexics did not show general neglect. They continued to misread letters on the right end when asked to read words from right to left.

View full abstract

    We studied clinical features and various background factors of anosognosia (Babinski, 1914) and somatoparaphrenia (Gerstmann, 1942) resulting from cerebrovascular disease. Subjects in this study were 21 patients (11 males and 10 females ; range of age, 50 - 86 years; 19 right-sided and 2 left-sided lesions ; all right-handed ) exhibiting anosognosia and/or somatoparaphrenia, who were selected from 556 consecutive admissions to our hospitals for treatment of acute stroke between April 1991 and July 1994. They comprised 8 cases with anosognosia without somatoparaphrenia, 12 cases with anosognosia and somatoparaphrenia, and 1 case with somatoparaphrenia and hemiasomatognosia. Regarding lesion location detected by cranial CT or MRI, patients with anosognosia had a highly frequency of large right hemisphere lesions, primarily involving parietal lobe and/or thalamus, and particularly anosognosia with somatoparaphrenia was related to more widespread lesions. In left hemisphere stroke patients with slight aphasia, these symptoms were associated with lesions including thalamus, basal ganglia and posterior subcortical areas. Anosognosia was seen almost similarly in the affected upper and lower limbs, while somatoparaphrenia was usually seen in the affected upper limb or forearm alone. In particular anosognosia with somatoparaphrenia was mostly seen in older female with brain atrophy. It was frequently accompanied by severe contralateral hemiplegia, deep sensory deficit, homonymous hemianopsia, unilateral spatial neglect and disinhibition, and likely to last for long time. These findings mean poor functional prognosis.

View full abstract

    In order to assess the severity of subjective memory deficits after temporal lobe resection for epilepsy, 132-item questionnaire was developed. We surveyed in 27 patients operated on on the dominant side (group d), 29 patients operated on on the non-dominant side (group nd), and 15 control subjects (group c). The control subjects were matched with respect to age. Patients in group d, particularly male patients, had more memory deficits than those in group c. Some patients in group nd experienced memory improvements after surgery. No correlation was found between the subjective memory deficit scores and the results of objective memory tests, doses of medication, or extent of resection, However, a significant correlation was found between introspective-neurotic personality traits and the severity of subjective memory deficits after surgery. In summary, resection on the dominant side and neurotic personality traits influenced awareness of memory deficits after surgery in this cohort of temporal lobe surgery recipients.

View full abstract

[in Japanese]

View full abstract

    We reported a case of hemineglect due to cerebral vascular accident (female, 40 years old) who showed marked responses in line bisection tasks in terms of rotation of the trunk to the head. In the left hemispace and left rotation of the trunk, the line bisection point deviated 17% to the left. This result was a significant decline to the left compared to right rotation of the trunk (p < 0.05). Therefore we considered that visual space recognition of the line depends on the direction of the trunk, especially in the left hemispace.

View full abstract