ʻDevelopmental Dyslexiaʼ is translated in Japanese as developmental reading and spelling disorder, be cause children with developmental dyslexia are showing both reading and spelling difficulties. Developmen tal dyslexia is not interpreted by environmental factors but cognitive factors and show discrepancy reading/spelling attainment level from expected that from age and/or intellectual level. Namely, it is needed to con duct three kinds of tests for diagnosis; general intelligence, attainment level of reading/spelling, cognitive abilities relating with reading/spelling acquisition. The prevalence of DD is thought to be affected by the writing system whether transparent (regular orthography) or opaque (irregular orthography) . The preva lence of English as opaque writing system manifested higher than that of transparent one. It is possible that children show difficulties in one written language and not in other language. As ectopia and microgyri are observed in the adults with DD, migration disorder is one of the crucial hypothesis as the biological bases for DD. Biological bases underlying DD may produce cognitive disorders, such as phonological awareness, visual cognition, and automatization disorders. Two kinds of training method based on the scientific evi dence reported using case series study design method in Japanese children with DD.
The frontal cortex is concerned with attention, executive function, working memory, response inhibition, emotional control and self-awareness. Therefore many people who suffer frontal lobe injuries from an accident or stroke for example, may have difficulty in daily life which prevents social integration. As manage ment of attentional disorders, attention process training is effective through the use of strategies and envi ronmental supports. On the other hands, previous reports support the efficacy of goal management training in the rehabilitation of executive functioning deficits. Agitated behavior is inversely associated with engage ment in rehabilitation therapy. At the first identifying the cause of agitation is essential and secondly behav ioral modification, cognitive behavioral therapy and pharmacological treatments should be selected accord ing to individual problems. Management of unawareness include educational approaches, the prediction-performance paradigm and group therapy.
Transient epileptic amnesia (TEA) is a distinctive syndrome among the patients complaining episodic transient amnesia, and attributable to focal epileptic seizure activity. Typically, cognitive functions other than memory are intact during episodes, and interictal TEA patients frequently perform normally on standard neuropsychological tests. However, TEA is associated with marked persistent (interictal) cognitive impair ment. Memory deficits, such as anterograde amnesia called “accelerated long-term forgetting” or retro grade amnesia (remote memory deficits, especially in autobiographical memory) are often described in TEA patients. Epileptic amnesia can be mistaken for dementia, but it is important to distinguish epileptic amnesia from dementia because TEA is treated effectively with anticonvulsant. We described two cases of TEA, and discussed the clinical features of epileptic amnesia.
Aphasia United is an international umbrella organization founded in 2012 to advance aphasia services and science around the world. A key aim of Aphasia United has been to bring together international stakeholders (e.g. researchers, clinicians, consumers) to address global needs of aphasia rehabilitation. One method of promoting a common global ʻtargetʼ for aphasia rehabilitation is to have a set of agreed upon international best practice recommendations that synthesize available research evidence and expert opinions into user-friendly recommendations. A working group (WG) was tasked with developing international best practice recommendations for aphasia. This article reports on the process and the results of this WG. The development of Japanese translation and Japanese aphasia-friendly translation of Aphasia United Best Prac tice Recommendations for Aphasia is also reported.
Symposium I : Neuropsychology of autism spectrum disorder
In this article, the author reviewed studies on verbal episodic memory in autism spectrum disorder (ASD) . First, the important concepts and model on episodic memory (such as the three stages of memory (encoding, storage, retrieval) , short-and long-term memory (LTM) and the dual storage model) as well as how the free recall task contributed the advance of memory research were explained. Then the results in an early experimental study on ASD, which include theoretically contradictory findings regarding LTM, were de scribed. More recent studies on ASD without intellectual delay, using a modified paradigm of free recall or a levels-of-processing paradigm, have revealed generally unimpaired long-term memory as well as a pos sibility of an atypical semantic memory. Finally, the need of caution for the difference in the performance of LTM among ASD subtypes (such as autistic disorder and Asperger disorder in the DSM-IV) was stated.
Congenital prosopagnosia (CP) refers to lifelong and severe impairment of face recognition without vi sual dysfunction, intellectual disability or neurological disorders. Some individuals with autism spectrum disorders (ASD) also show face recognition deficits as the ability to recognize a person from their facial appearance is essential for normal social interaction. This article introduced two cases of CP and reviewed some neuropsychological studies of face recognition in developmental disorders. It is suggested that face recognition deficit in CP is qualitatively different from its deficit in ASD according to our preliminary study of face recognition and eye gaze behavior.
Olfaction is a vital sense, and makes an important role for risk cognition, reproductive activity and various activities. There has been a substantial number of studies on olfaction in neuropsychiatric disorders like Alzheimerʼs disease and schizophrenia. Sensory issues including olfaction have been explicitly included in the diagnostic criteria of the autism spectrum disorders (ASD) in recently released DSM-5. This DSM-5 inclusion implies that abnormal responses to sensory stimuli have historically been an overlooked feature of ASD. A growing body of evidence using questionaires suggest that children with ASD experience increased olfactory symptoms compared to children with typical development (TD) . In clinical settings, it is suggested that olfactory trait in children with ASD are correlated with social function. On the other hand, there are little description about concern for olfactory trait in an autobiography. Laboratory-based sensory psychophysical studies to investigate olfactory trait in children with ASD using olfactory testing have produced inconsistent results. Previous study reported atypical responsiveness to olfactory stimuli was the strongest predictor of social impairment in children with ASD. Positive support considering olfactory trait in children with ASD have the potential to improve quality of life. Research in the field of ASD and olfaction is still infancy, and future studies on the topic are needed.
In this article, I illustrate two complementary approaches using functional magnetic resonance imaging (fMRI) towards understanding of alterations in functional brain network of autism spectrum disorder (ASD) : the task-based activation and resting-state functional connectivity approaches. For the task-based activation approach, we illustrate our fMRI study of functional connectivity analysis during self-and other-referential tasks. Previous fMRI studies of self-and other-referential processing in ASD has revealed abnormal brain activation in the regions for self-representations such as cortical midline structure. However, it is known that self-and other-referential processing is significantly influenced by the factor of perspective-taking and that individuals with ASD are significantly impaired in taking of othersʼ perspectives. We designed an fMRI task in which the factor of self-and other-referential processing and that of perspective-taking are independently manipulated, and demonstrated altered modulation of functional connectivity between regions for self-representations and those in the social-brain network (e.g. right inferior frontal cortex) . For the resting-state functional connectivity study, we illustrate our study of graph-theoretic analysis. The study showed that global network measures representing the information segregation and integration (i.e., clustering coefficient and characteristic path length) were significantly reduced in ASD. Furthermore, the study also revealed significant alterations in hub structure in the functional network of the ASD brain. These results demonstrate multiple aspects of alterations in functional network in the ASD brain.
The underlying mechanisms of speech and language disorders due to the frontal lobe damage were considered, according to the three levels of verbal processing, that is motor speech disturbances, neurobehavioral and linguistic disturbances. Although error inconsistency has traditionally been considered an important characteristic of apraxia of speech (AOS) , it may be difficult to differentiate between AOS and other types of dysarthria by this criterion. Damage to white matter bundles such as the frontal aslant tract might play an important role as a major cause of the disturbance in speech initiation and spontaneity. Two cases with progressive non-fluent aphasia were presented. They were not able to construct a sentence from the given two words. Besides to word finding difficulty in running speech, and an inability to select one among many verbal expressions, the deficits of generating sentences might be one of major origins of non-fluent speech in aphasia due to frontal lobe damage.
Damages to the medial frontal lobe (MFL) often elicits disorders of speech; not only aphasias, including transcortical motor aphasia, but also disturbances of more fundamental vocalization functions, such as stuttering or the inhibition of speech, and rarely, kanji agraphia. In this symposium, we explored the involvement of the right MFL in speaking and writing by discussing a case that manifested with a transient disturbance of speech initiation and persistent kanji agraphia associated with an infarction that included the right pre-supplementary motor cortex. It could not be concluded that the right MFL was the region responsible for speech initiation, because the deficit quickly abated. According to our review of published referential cases, verbal symptoms persisted only among those with left MFL damage were transient among those with right MFL damage. This is the first documented case of agraphia associated with damage to right MFL. Furthermore, kanji agraphia persisted in this case. Kanji writing performance did not depend on the number of orthographia strokes or the frequency of each kanji character, but instead varied with the number of radicals and structural elements of each kanji character. These findings suggest that the right MFL is involved in the selection and arrangement of structural elements of kanji characters, probably occurring in the latest stages of kanji writing.
The author investigated the implication of the frontal lobe in language comprehension using so-called pointing task (referring the task to choose and point to the proper object according to the presented word) and the sentence order task (referring the task to react according to the presented order by a sentence) , and the test of syntactic processing in aphasia. The results show as followings: 1. The deficit in the pointing task has relation to the lesion in the left middle frontal gyrus. The deficit in the pointing task due to frontal lobe damage might not be stemmed from the impairment of semantic process, but from the process in the way of choosing the objects according the target word. 2. The deficit in the sentence order task is closely related to the lesion in Brocaʼs area. The patients with frontal lobe lesion has impairment in this kind of task due to deficit of switching the view point when they face an unexpected sentence patterns.
There is a general agreement in psycholinguistics that the language system has a tripartite architecture, with levels of sound, syntax and meaning as the core aspects of our language faculty. Linguistic information is processed at distinct levels from words to sentences and discourses. The left frontal regions play an im portant role in the process of constructing sentence structures by applying grammatical knowledge, that is syntactic processing. We have used functional magnetic resonance imaging (fMRI) , and shown that the left inferior frontal gyrus (L. IFG) and the left lateral premotor cortex (L. LPMC) are critically involved in syn tactic processing. Moreover, we have demonstrated that a glioma in the L. IFG or L. LPMC is sufficient to cause asyntactic comprehension. Detailed analyses of abnormal activation patterns in the patients with asyn tactic comprehension revealed three syntax-related networks. In addition, these analyses clarified that asyntactic comprehension are associated with the global reorganization of functionally distinct networks, differentially contributed to syntax-related functions. These results suggest the importance of the neural networks for syntactic processing.
Recent advances in neuropsychological and neuroimaging studies can allow us to understand more close ly about the underlying mechanisms of human emotion. Essential points for clarifying the functions of emo tion are twofold: (1) the necessity to focus on autonomic bodily responses in addition to the correlates of behavior and brain activities, (2) the fundamental needs of addressing attention to the network involved in realizing emotion rather than focusing on relevant focal brain regions. In this article, some concepts around emotion were first reconsidered and the functions of the relevant network were sorted out, and finally the functional and neural mechanisms of empathy were briefly reviewed.
Correspondence between emotions and expressive behaviors has often been assumed either implicitly or explicitly in neuropsychological research. According to this theoretical position, emotion recognition is a type of perceptual pattern recognition decoding othersʼ internal states from their expressive behaviors.However, lesion studies have highlighted the roles of “emotional brain” such as the amygdala and insula in emotion recognition, leading to the “simulation theory” that the vicarious sharing of othersʼ feelings contributes to the understanding of their emotional experience. In addition, some researchers argue strongly against the emotion-expression correspondence and emphasize the importance of inferences based on contextual information for accurate emotion recognition. In recent years, there has also been increasing interest in neural and cognitive mechanisms underlying the integration of different cues such as expressive behaviors and contexts for recognizing othersʼ emotions. In brief, emotion recognition is supported by a variety of processes at least including pattern recognition, experience sharing, contextual inference, and cue integration. This implies both fragility and robustness of emotion recognition. On one hand, dysfunction in any of the above processes could result in impairment of emotion recognition. On the other hand, dysfunction in one process could be compensated for by other intact processes, possibly preventing noticeable deficits in emotion recognition. These contradictory features of emotion recognition may require attention in a clinical assessment.
A PC-based therapeutic approach named cognitive rehabilitation was employed for two patients with memory deficits and insight loss caused by anosognosia-related basal forebrain amnesia and thalamic amnesia. In this cognitive rehabilitation, patients are shown videos taken during their rehabilitation sessions. What is shown consists of two parts. The first part provides some knowledge about cerebrovascular disease awareness and introduces images and music associated with various seasonal events. The second part shows the patients own activities during the rehabilitation. Here, in both patientʼs the cognitive rehabilitation produced a good process whereby anterograde memory improved after improvement of self-awareness, including awareness of disease. Although the two patientʼs degrees of improvement and requisite periods of rehabilitation differed, having them watch videos of their own rehabilitation (reality orientation & self-awareness video) was in both cases found to be beneficial for promoting awareness of amnesia, along with the possibility that such awareness may lead to improvement by self-recall of their disease properties.
We encountered a 69-year-old woman and 70-year-old man with left hemisphere brain damage; they exhibited marked abnormalities in a facial component recognition task. Both patients exhibited marked errors in identifying facial parts by touching their face with their hands in addition to severe aphasia, habitual dysmimia of the upper limbs and configurational dysmimia of the fingers. Errors in identifying facial parts by touching made by the two patients with left hemisphere brain damage were caused by a combination of apraxia and abnormal physical representation of the face. We examined the patients while they performed a facial component recognition task. Two women (78 and 87 years old) with right hemisphere brain damage and marked unilateral spatial neglect also performed this task for comparison. All patients were right-handed. Marked abnormalities in the spatial arrangement were observed in the two patients with left hemisphere brain damage during this task, which may have reflected dysfunction in the left hemisphere related to the relative relationship of the contours and internal parts of the face. We assume that this resulted in abnormalities in meaningful physical representation and visuospatial representation of the face.
We developed the Virtual Shopping Test-easy version (VST-e) , a new virtual reality based shopping task, to assess the comprehensive cognitive status of various aphasic patients. The purposes of this study were to examine the application of VST-e to aphasic patients, and to examine the validity and reliability of VST-e. Twenty left hemisphere-damaged stroke patients with aphasia and twenty age and education-matched healthy adults with no brain damage performed VST-e. In this test, after a demonstration with visual information and practice session, the participants were asked to buy two specific items in the virtual shopping mall by touching the PC screen as quickly and correctly as possible. They memorized the content of the shopping list in advance, and used hints on the screen when needed during the performance. The application of VST-e to aphasic patients was examined by comparing VST-e performance between the two groups and by analyzing correlations between VST-e variables and a verbal function test. The criterion-validity of VST-e was examined by analyzing correlations between VST-e variables and conventional neuropsychological tests (RCPM, SDMT, SRT, Symbol Cancellation, Symbol Trails, Design Memory, and Mazes) in the aphasia group. The reliability of VST-e was examined by calculating Cronbachʼs α. The results showed that VST-e performance was lower in the aphasic group than in the healthy group regarding the number of times using hints, the number of times making a turn on the shopping street, and the required time to accomplish one task. VST-e variables correlated significantly with verbal function, intelligence, attention, and executive function. Cronbachʼs α was 0.62. Although VST-e is affected by verbal ability, VST-e has criterionrelated validity and reliability. These results suggest that VST-e can be a useful tool to evaluate general cognitive functions in aphasic patients.
An 83-year-old, right-handed male developed visual agnosia, cerebral dyschromatopsia, aphasia, and anterograde amnesia following a stroke attack. MRI revealed a hemorrhagic infarction in the left inferior ventral occipito-temporal region including the lingual and fusiform gyri, and also showed infarctions in the left thalamus and medial inferior part of the right occipital lobe. Generally, visual recognition of line drawings is more difficult than that of objects or photographs. However, this case showed better recognition of line drawings than of real objects and photographs. Further examinations on the patientʼs visual cognitive functions suggested that recognition of objects based on contour information was comparatively preserved, while he had difficulty recognizing objects as three-dimensional based on depth and shade information.
In the present study, we report two cases of somatoparaphrenia accompanying Fregoli delusion after ce rebral hemorrhage or right hemispheric cerebral infarction. Few case reports have documented the mani festation of person misidentification symptoms such as Capgras syndrome and Fregoli delusion after cere brovascular accident. Feinberg et al. (1997) indicated that somatoparaphrenia has a similar psychopathological structure to that of Capgras syndrome; however, we did not identify any case reports where somatopara phrenia manifested with Capgras syndrome. Alternatively, a few reports described somatoparaphrenia that manifested with delusional symptoms like Fregoli syndrome. In somatoparaphrenia, the attitude of the pa tient towards the paralyzed limb demonstrates more similarity to Fregoli delusion than Capgras syndrome because the patient shows feelings of acquaintance with the affected limb. Additionally, somatoparaphrenia and Fregoli delusion are thought to result from similar lesions of the right hemisphere, especially in the frontal lobe. The frequency of somatoparaphrenia accompanying Fregoli delusion may be underestimated in previous reports where it was overlooked.
We encountered the case of a patient who exhibited timetable-like behavior and aphasia and who repeat edly shoplifted as a form of social behavioral impairment due to cognitive disorder following a cerebral in farction caused by left internal carotid artery occlusion. We assessed the shoplifted items and shoplifting factors by behavioral observation, by comparing and examining the responsible lesion with those in earlier studies. The shoplifting habit was eliminated by interventions including a system of multidisciplinary coop eration to (1) manage finances based on the specific grocery items that the patient shoplifted, store these grocery items, and create a checklist and (2) schedule the patientʼs shopping and eating behaviors by per ceiving his/her timetable-like behavior as a positive aspect. Our results demonstrated the potential of envi ronmental structuring to eliminate inappropriate behavior early in the case of a shoplifter who exhibited a stereotypical eating disorder due to a unilateral lesion without damage to the frontal lobe. This suggests that evaluating the cause of inappropriate behavior based on the lesion and behavioral observation of the patient and providing multidisciplinary intervention covering community life are effective against social behavioral impairment associated with antisocial behavior such as shoplifting.
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