Touch-screen system for assessing visuo-motor exploratory skills in neuropsychological disorders of spatial cognition.

A new computerised test adopting touch-screen technology has been developed to assess the visuo-motor exploration of extra-personal space. The test was derived from well-known paper-and-pencil cancellation tasks used widely in the diagnosis and quantitative assessment of unilateral spatial neglect (USN), a neuropsychological syndrome that is more frequent and severe after damage to the right cerebral hemisphere. A main component deficit of USN is the defective visuo-motor exploration of the side of space contralateral to the side of the lesion (contralesional), namely, in right-sided brain-damaged patients it occurs on the left side and vice versa. The computer-based paradigm consisted of a visuo-motor spatial exploratory task: the subjects were instructed to touch, in any order they wished, all the targets they detected on a computer touch-screen. This measured the time of occurrence and the spatial co-ordinates of each touch event and forwarded the data to the computer for storage; the computer provided feedback to the subject by 'tagging' the touched target. The paradigm allowed the calculation of accuracy and latency indexes and recorded the exploratory pathway taken by each subject. A pilot study was performed in ten normal subjects and 15 brain-damaged patients, with and without psychometric evidence of USN; the results showed that the equipment was able to provide quantitative indexes related to the spatial-temporal aspects of exploratory ability, which are useful for diagnostic purposes, and revealed significant differences between the controls and patients with USN: the overall average values of latency and crossing indexes increased in patients with USN, compared with the controls (latency from 0.77 to 1.90s; path crossing index from 7.0% to 59.5%), and the significantly negative USN patient latency gradient (-2.79 against a null control value) evidenced a worsening of performance towards the left side.

C rossmodal agnosia for familiar people as a consequence of right infero polar temporal atrophy.

A 60-year-old, right-handed woman, with no focal brain lesions, suffered from a progressive impairment in recognising people of personal relevance and public figures familiar to her in the premorbid period. The patient did not suffer from general cognitive deterioration. There was no ecological or clear psychometric evidence of visuoperceptual or visuospatial deficits. Her defective person recognition was not overcome by extra-facial (e.g., observing animated people in their usual surroundings) or extra-visual information (e.g., listening to the voice). Moreover, presenting the correct name in the presence of an unrecognised familiar person failed to prompt her familiarity judgement, or retrieval of the relevant biographical knowledge. The patient also had some recognition difficulties with famous buildings and songs as well as with some common objects. It is argued that the patient's difficulty in identifying familiar people was the consequence of progressive loss of stored exemplars of familiar persons and perhaps also of some other "unique items" (famous songs and monuments) in an independent subsystem of semantics that we term "exemplar semantics." We discuss the associative (semantic) nature and specificity of the deficit in person knowledge, the possible top-down negative influences of the loss of exemplars in the person recognition system, and the link between the disorders and the right/left temporal lobe.

Intrusion errors in numerical transcoding by Alzheimer patients.

The errors made by brain-damaged patients when they attempt numerical transcoding tasks have recently been considered as a possible aid to early diagnosis of the disease. The transcoding errors of 20 Alzheimer's disease patients are described, and the incidence of each kind of error compared with norms from healthy subjects. Tegnér and Nybäck (Tegnér R, Nybäck H. "To hundred and twenty4our": a study of transcoding in dementia. Acta Neurologica Scandinavia 1990; 81: 177-178) reported that Alzheimer patients often express numerical information in a mixture of verbal and digital codes and Kessler and Kalbe (Kessler J, Kalbe E. Written numerical transcoding in patients with Alzheimer's disease. Cortex 1996; 32: 755-761) suggested that such intrusions of the source code into the target code may not only be largely absent from the responses of the healthy population, but also from the transcoding operations of patients with other kinds of brain damage, such as aphasia. It was found that intrusion errors occurred much more frequently in the transcoding protocols of some of the Alzheimer patients than they do in those of healthy subjects. On the other hand, they were entirely absent from the protocols of other Alzheimer patients. The implications of the findings for the early diagnosis of Alzheimer's disease are discussed, and the phenomenon of intrusion errors is considered in terms of some of the models of arithmetical processing that have been proposed.

Fronto-temporal dementia and motor neuron disease: a neuropsychological study.

The neuropsychological follow-up study of a 58-year-old man suffering from Motor Neuron Disease (ALS/MND) and Fronto-Temporal Dementia (FTD) is reported. Neuromuscular signs first appeared at the age of 51 and slowly progressed to late bulbar involvement; behavioural symptoms of the frontal type first appeared around age 53; lastly, several neuropsychological symptoms suggestive of worsening temporal involvement supervened at age 57. Our patient died at 59 of respiratory failure with the classic clinical and neuroradiological picture of FTD. A short discussion addresses the controversial issue of the coupling of ALS/MND with Dementia and its possible interpretation as the expression of a chance association of relatively common diseases, versus that of a single multifaceted disease. The role of a detailed neuropsychological assessment is highlighted, within the context of increasingly specific diagnostic criteria for FTD.

Seeing objects smaller than they are: micropsia following right temporo-parietal infarction.

We report the case of an 84-year-old lady who, after a right temporo-parietal infarction, complained of seeing things smaller than she expected. She also related that straight lines appeared distorted and described seeing colours as if they were a badly mixed assemblage of hues. Her visual field was normal except for a transient left field extinction. No spatial neglect emerged. The patient's micropsia remained unchanged during the course of the six month follow-up.