Crossed aphasia in a dextral: a test of the Alexander-Annett theory of anomalous organization of brain function.

A case of crossed aphasia is presented in a strongly right-handed 77-year-old white female without history of familial sinistrality or prior neurological illness. She developed a right middle cerebral artery infarction documented by CT and accompanied by obvious clinical signs of a conduction aphasia with some resolution but continuing obvious language defect after 9 weeks in rehabilitation. Comprehensive neuropsychological and aphasia testing suggested anomalous lateralization of phonologic-output aspects of language, emotional prosody, motor planning and body schema modules with usual lateralization of lexical-semantic aspects of language and visuo-spatial functions. Experimental validation of the uncrossed lexical-semantic aspects of language using tachistoscope methods found support for the Alexander-Annett theory that different aspects of language can be dissociated in their lateralization. The subject had difficulty identifying a semantic associate of a picture presented to the left visual field (7 errors out of 10) relative to right visual field presentation (2 errors out of 10). Bilateral free naming errors (6 and 5 errors in the left and right visual fields, respectively) occurred consistent with the aphasic presentation, suggesting phonologic-output dysfunction from the right cerebral vascular accident. Implications of the results for aphasia classification are discussed.

Fractionating frontal lobe functions: factors of the Milwaukee Card Sorting Test.

The Milwaukee Card Sorting Test (MCST), a modification of the Wisconsin Card Sorting Test (WCST), was administered to 71 geriatric, orthopedic or neurologic patients. The MCST requires that participants verbalize prior to sorting, thus enabling quantification of separate, elemental executive abilities needed for card sorting performance. A preliminary factor analysis yielded three factors, corresponding to elemental executive abilities of forming, maintaining, and switching mental set. Results are discussed as they apply to understanding the cognitive structure of card sorting tasks to revealing different performances associated with behaviorally distinct executive deficits, and to suggesting anatomical substrates underlying the three factors.

Understanding symptoms of medical frontal lobe disorder: A clinical case study.

A case of anterior communicating artery aneurysm with damage to inferior medial frontal areas (Brodmann areas 25, 32, 24-inferior) is presented. Four prominent deficits are discussed: (1) anterograde amnesia, (2) inert perseverative card sorting, (3) motor stereotypies, and (4) reduplicative paramnesia. These four deficits are discussed as negative or positive symptoms, related either to damage in inferior medial frontal (Brodmann areas 25, 32, 24-inferior) regions or release phenomena of superior medial frontal (Brodmann areas 6-medial and 24-superior) regions. It is concluded that the inferior and superior medial frontal regions act as opponent processors, with the inferior (B25, 32) area functioning to switch current mental set while the superior (B24-superior, 6-medial) region functions to maintain current mental set. Testable hypotheses about the opponent processor mechanism are suggested, as applied to neuropsychiatric disorders.

A double-blind controlled study of methylphenidate treatment in closed head injury.

Closed head injuries (CHI) may produce permanent, disabling changes in cognitive functions and social behaviour. Recent clinical case reports have suggested that stimulant medications may improve neurobehavioural functioning in CHI patients. In the present study, we evaluated the effects of methylphenidate (0.3 mg/kg b.i.d.) in 12 chronic CHI patients (14 to 108 months post-injury) using a double-blind, placebo-controlled, randomized, crossover design. Outcome measures consisted of cognitive tests of attention, learning and cognitive processing speed. In addition, a rating scale was completed by a close friend or relative to assess social behaviour. No significant differences were found between drug and placebo conditions on any of the neurobehavioural measures. These data do not support the clinical use of methylphenidate in the treatment of CHI patients.

Neurobehavioral Cognitive Status Examination: its use with unilateral stroke patients in a rehabilitation setting.

The Neurobehavioral Cognitive Status Examination (NCSE) was administered to 12 patients with right unilateral stroke and 12 with left unilateral stroke and to 12 orthopedic, non-brain-dysfunctional patients who were matched in age and education, for the purpose of studying its usefulness in characterizing cognitive deficits in a stroke rehabilitation population. MANOVA demonstrated significant differences (Phillai's trace, p = .007) between the stroke groups and the controls, but not between the unilateral stroke groups. Significant univariate Fs (F[2,3], p less than .05) occurred between the stroke groups and the controls in comprehension, naming, constructions, memory, and similarities. Correlations revealed strong relationships among the scales; little relationship to age was found. Education correlated with attention, comprehension, repetition, and similarities. The number of medications patients were taking did not correlate with either individual scale scores or an overall score on the NCSE. The test was found to be sensitive to cognitive effects of stroke, although there was little discrimination between left-sided and right-sided strokes. The correlational structure of the test's scales provided general support for an attention/concentration dimension, at least one general language dimension, and a general memory dimension. Further factor analytic study was recommended to more definitively assess the test's factorial dimensions. Individual descriptive data suggested that the screen and the last item of the constructions scale were too difficult. It was suggested that the item be changed or that a clue be offered to the patient.

Minnesota Multiphasic Personality Inventory correlates of the Luria-Nebraska Neuropsychological Battery in a psychiatric population.

To investigate the relationships between several neuropsychological deficits and personality function, 73 schizophrenic subjects with medically verified brain damage were administered the Luria-Nebraska Neuropsychological Battery (L-N) and the MMPI. Relationships between each of the 14 neuropsychological variables (the fourteen summary scales of the L-N) and each of the 10 clinical and three validity scales of the MMPI were analyzed by means of t-tests and Pearson correlations. Complex relationships between the neuropsychological variables and the MMPI scales were analyzed by means of multiple regression and discriminant analysis. With the exception of the F scale, results showed a relative lack of individual relationships between the cognitive and personality variables. As expected, however, relatively strong correlations were found between neuropsychological performance and overall patterns of personality variables for 11 of the 14 neuropsychological variables. Traditional personality differences associated with lesion laterality were replicated. Personality profiles uniquely related to specific neuropsychological deficits and personality trends which appeared across neuropsychological variables were discussed in terms of psychological reactivity and cognitive loss.

The relationship between neuropsychological deficit and MMPI profile in chronic schizophrenics.

The present study was an attempt to examine the relationship between personality variables and neuropsychological deficits in chronic schizophrenic subjects. The groups were composed of 73 chronic schizophrenic subjects with measureable cortical atrophy on CAT-Scan and 118 chronic schizophrenic subjects without identifiable brain damage. The relationship between neuropsychological deficit and personality variables was tested by means of discriminant analysis. As hypothesized, the brain-damaged group was found to have a stronger relationship between the neuropsychological deficits and the personality variables than the nonbrain-damaged group. Canonical correlation was used to demonstrate the underlying neuropsychological pattern which was found related to the personality profile of the MMPI for the entire sample of chronic schizophrenics. A frontal and anterior temporal lobe neuropsychological profile was found related to a particular personality profile.

The diagnosis of brain-damage by the MMPI: a comprehensive evaluation.

A number of research studies have proposed various methods for using the MMPI to identify brain dysfunction. This previous research has taken one of three major approaches. The present study compared the major approaches in a population consisting of 30 schizophrenic, 30 brain-damaged and 30 hospitalized normal patients. The results indicated that the most effective diagnosis device was the use of the Sc scale alone or in conjunction with the remaining clinical scales and the F scale. None of the organic scales or keys were able to match the performance of the Sc scale alone. The poor results obtained bring into question the use of these scales in any other setting without an extensive research validation. An alternate method that might be used to employ the MMPI in the diagnosis of brain dysfunction was suggested.

The use of a standardized battery of Luria's tests in the diagnosis of lateralized cerebral dysfunction.

The present study was designed to examine the capability of a standardized battery of Luria's qualitative neuropsychological techniques in discriminating between right, left and diffuse brain-injured subjects. A total of sixty medically confirmed brain-damaged subjects were equally divided among the three groups. Subjects were assigned to two groups (right, left) according to medically proven lateralized brain injury to either the right or left hemisphere in the absence of verifiable insult to the opposite hemisphere. A third group was also selected in which medical evidence confirmed damage to both hemispheres (diffuse group). All three groups were matched for age and education. All subjects were tested on a standardized version of 269 Luria's qualitative neuropsychological test items. The items were divided into 11 sections based upon Luria's theory of brain function. Each of the 11 sections plus a right and a left hemisphere scale as well as an overall impairment scale yielded 14 summary measures of performance representing several areas of neuropsychological ability and overall severity of brain dysfunction. Analysis of variance and discriminant analysis were used to compare the three groups on these 14 summary measures. Analysis of variance revealed on significant difference between the three groups on the Left scale with the left group performing poorest. Discriminant analysis predicted the status of 59 of 60 subjects correctly (98% hit rate). The implication of the lack of significant simple relationships (ANOVA) and the complex interrelationships found using the discriminant analysis were discussed in terms of the support these results provide for Luria's theory of brain function. The specific qualitative aspects of the test battery and their use in the diagnosis of lateralized brain injury were also discussed. Indications for future research were pointed out.