Cognitive fluctuations in connection to disgraphia a comparison of Alzheimer's disease with dementia Lewy bodies

Background: The purpose of the present study was to examine the relationship between cognitive impairment and the performance of handwritten scripts presented as “letter-writing” to a close relative by patients with dementia Lewy bodies (DLB), as fluctuations of the symptoms phase, and in a matched group of patients with Alzheimer’s disease (AD). The degree of writing disability and personal, spatial, and temporal orientation was compared in these two groups. Design and methods: Fourteen simple questions, designed in a form that could be utilized by any general practitioner in order to document the level of cognitive functioning of each patient, were presented to 30 AD patients and 26 DLB patients. The initial cognition test was designated PQ1. The patients were examined on tests of letter-writing ability. Directly after the letter-writing, the list of 14 questions presented in PQ1 was presented again in a repeated procedure that was designated PQ2. The difference between these two measures (PQ1 – PQ2) was designated D∆. This test of letter-writing ability and cognitive performance was administered over 19 days. Results: Several markedly strong relationships between dysgraphia and several measures of cognitive performance in AD patients and DLB patients were observed, but the deterioration of performance from PQ1 to PQ2 over all test days were markedly significant in AD patients and not significant in DLB patients. It is possible that in graphic expression even by patients diagnosed with moderate to relatively severe AD and DLB there remains some residual capacity for understanding and intention that may be expressed. Furthermore, the deterioration in performance and the differences noted in AD and DLB patients may be due to the different speed at which the process of the protein degradation occurs for functional modification of synapses. Conclusion: Our method can be used as part of neuropsychological tests to differentiate the diagnosis between AD and DL

Dyspraxia in a patient with corticobasal degeneration: the role of visual and tactile inputs to action

Objectives-To investigate the roles of visual and tactile information in a dyspraxic patient with corticobasal degeneration (CBD) who showed dramatic facilitation in miming the use of a tool or object when he was given a tool to manipulate; and to study the nature of the praxic and neuropsychological deficits in CBD. Methods-The subject had clinically diagnosed CBD, and exhibited alien limb behaviour and striking ideomotor dyspraxia. General neuropsychological evaluation focused on constructional and visuospatial abilities, calculation, verbal fluency, episodic and semantic memory, plus spelling and writing because impairments in this domain were presenting complaints. Four experiments assessed the roles of visual and tactile information in the facilitation of motor performance by tools. Experiment I evaluated the patient's performance of six limb transitive actions under six conditions: (1) after he described the relevant tool from memory, (2) after he was shown a Line drawing of the tool, (3) after he was shown a real exemplar of the tool, (4) after he watched the experimenter perform the action, (5) while he was holding the tool, and (6) immediately after he had performed the action with the tool but with the tool removed from his grasp. Experiment 2 evaluated the use of the same six tools when the patient had tactile but no visual information (while he was blindfolded). Experiments 3 and 4 assessed performance of actions appropriate to the same six tools when the patient had either neutral or inappropriate tactile feedback-that is, while he was holding a non-tool object or a different tool. Results-Miming of tool use was not facilitated by visual input; moreover, lack of visual information in the blindfolded condition did not reduce performance. The principal positive finding was a dramatic facilitation of the patient's ability to demonstrate object use when he was holding either the appropriate tool or a neutral object. Tools inappropriate to the requested action produced involuntary performance of the stimulus relevant action. Conclusions-Tactile stimulation was paramount in the facilitation of motor performance in tool use by this patient with CBD. This outcome suggests that tactile information should be included in models which hypothesise modality specific inputs to the action production system. Significant impairments in spelling and letter production that have not previously been reported in CBD have also been documented

Legal medical consideration of alzheimer’s disease patients’ dysgraphia and cognitive dysfunction: a 6 month follow up

Background: The purpose of this study was to investigate the ability of Alzheimer’s disease (AD) patients to express intentions and desires, and their decision-making capacity. This study examines the findings from a 6-month follow-up of our previous results in which 30 patients participated. Materials and methods: The patient’s cognition was examined by conducting the tests of 14 questions and letter-writing ability over a period of 19 days, and it was repeated after 6 months. The difference between these two cognitive measures (PQ1 before–PQ2 before), tested previously and later the writing test, was designated DΔ before. The test was repeated after 6 months, and PQ1 after–PQ2 after was designated DΔ after. Results: Several markedly strong relationships between dysgraphia and other measures of cognitive performance in AD patients were observed. The most aged patients (over 86 years), despite less frequency, maintain the cognitive capacity manifested in the graphic expressions. A document, written by an AD patient presents an honest expression of the patient’s intention if that document is legible, clear, and comprehensive. Conclusion: The identification of impairment/deficits in writing and cognition during different phases of AD may facilitate the understanding of disease progression and identify the occasions during which the patient may be considered sufficiently lucid to make decisions. Keywords: cognition, intentions, unfit to plead, consen

Application of The Dual-Route Model in Exploring Dyslexia and Dysgraphia in Arabic Speaking Adults With Aphasia: Clinical and Theoretical Implications

Objective: The cognitive neuropsychology is based on the “universality” assumption, which suggest that all normal people have the same cognitive systems regardless of their culture and language (Coltheart, 2001). The aim of the study is to test the universality assumption of the dual-route model (DRM) for spelling and reading in modern Arabic language. The study follow the same architecture of the DRM taking into considerations specific variables that hold certain features of the Arabic script. Methods: The study results were secured by using case series method analysis of each individual participant’s performance. The Case series method offered the ability to look into each individual’s symptoms and error types and also took into account individual variances. The profiles of fifteen adults with left-hemisphere strokes were investigated by analyzing their performance in writing to dictation and reading aloud tasks of words and non-words, and discuss the profiles of acquired dysgraphia and dyslexia in these individuals. Results: The patterns of impairment observed in each patient were discussed based on the dual-route model of spelling and reading aloud. The results yield different types of dysgraphia and dyslexia but no evidence of surface dysgraphia or surface dyslexia. The types of spelling impairments were graphemic buffer dysgraphia (46%), followed by mixed dysgraphia (27%) and lastly phonological dysgraphia (20%). Reading aloud impairment, on the other hand, showed a majority of deep dyslexia (46%), followed by phonological dyslexia (20%), mixed dyslexia (14%), and a much lower incidence of letter-by-letter dyslexia (6%). Conclusion: All of the components hypothesized by DRM were impaired to some degree in each participant. These components are cognitive functions that in Arabic skilled reader, comprise a highly practiced mechanism specialized for spelling and reading aloud. Elements of these components, such as the sub-lexical route may be involved differently and that the relative impact of both routes varies substantially. The evidence from reading and writing disorders in other languages, as reported in this study, contribute to the theoretical understanding of the cognitive models with the focus on the unique orthographic differences that serve as a basis for hypothesizing about breakdowns within a language

A comparison of errorless and errorful therapies for dysgraphia after stroke.

Despite the increasing significance of written communication, there is limited research into spelling therapy for adults with acquired dysgraphia. Existing studies have typically measured spelling accuracy as an outcome, although speed may also be important for functional writing. As spelling is relatively slow, effortful and prone to errors in people with dysgraphia, minimising errors within therapy could be a factor in therapy success. This within-participant case-series study investigated whether errorless and errorful therapies would differ in their effects on spelling speed and accuracy for four participants with acquired dysgraphia. Matched sets of words were treated with errorless or errorful therapy or left untreated. Results were collated one week and five weeks after therapy. Both therapy approaches were successful in improving spelling accuracy. For three participants, equivalent gains were demonstrated following errorless and errorful therapy. One participant made significantly greater improvements in spelling accuracy following errorless therapy. The effects were maintained five weeks later. There was no significant difference in post-therapy spelling speed between the two therapy conditions. The results of this study suggest that both errorful and errorless therapies can be effective methods with which to treat spelling in adults with acquired dysgraphia

Understanding Interest And Self-Efficacy In The Reading And Writing Of Students With Persisting Specific Learning Disabilities During Middle Childhood And Early Adolescence

Three methodological approaches were applied to understand the role of interest and self-efficacy in reading and/or writing in students without and with persisting specific learning disabilities (SLDs) in literacy. For each approach students in grades 4 to 9 completed a survey in which they rated 10 reading items and 10 writing items on a Scale 1 to 5; all items were the same but domain varied. The first approach applied Principal Component Analysis with Varimax Rotation to a sample that varied in specific kinds of literacy achievement. The second approach applied bidirectional multiple regressions in a sample of students with diagnosed SLDs-WL to (a) predict literacy achievement from ratings on interest and self-efficacy survey items; and (b) predict ratings on interest and self-efficacy survey items from literacy achievement. The third approach correlated ratings on the surveys with BOLD activation on an fMRI word reading/spelling task in a brain region associated with approach/avoidance and affect in a sample with diagnosed SLDs-WL. The first approach identified two components for the reading items (each correlated differently with reading skills) and two components for the writing items (each correlated differently with writing skills), but the components were not the same for both domains. Multiple regressions supported predicting interest and self-efficacy ratings from current reading achievement, rather than predicting reading achievement from interest and self-efficacy ratings, but also bidirectional relationships between interest or self-efficacy in writing and writing achievement. The third approach found negative correlations with amygdala connectivity for 2 reading items, but 5 positive and 2 negative correlations with amygdala connectivity for writing items; negative correlations may reflect avoidance and positive correlations approach. Collectively results show the relevance and domain-specificity of interest and self-efficacy in reading and writing for students with persisting SLDs in literacy

Comparing uni-modal and multi-modal therapies for improving writing in acquired dysgraphia after stroke.

Writing therapy studies have been predominantly uni-modal in nature; i.e., their central therapy task has typically been either writing to dictation or copying and recalling words. There has not yet been a study that has compared the effects of a uni-modal to a multi-modal writing therapy in terms of improvements to spelling accuracy. A multiple-case study with eight participants aimed to compare the effects of a uni-modal and a multi-modal therapy on the spelling accuracy of treated and untreated target words at immediate and follow-up assessment points. A cross-over design was used and within each therapy a matched set of words was targeted. These words and a matched control set were assessed before as well as immediately after each therapy and six weeks following therapy. The two approaches did not differ in their effects on spelling accuracy of treated or untreated items or degree of maintenance. All participants made significant improvements on treated and control items; however, not all improvements were maintained at follow-up. The findings suggested that multi-modal therapy did not have an advantage over uni-modal therapy for the participants in this study. Performance differences were instead driven by participant variables

DIFFERENT FORMS OF DYSGRAPHIA IN BRAIN-DAMAGED PATIENTS

Normally a neurological accident (stroke, head injury, degenerative processes, tumour) to the left hemisphere produces disor- of linguistic functions (aphasia). Among these deficits, the comprehension (reading) and production (spelling) of written lan- guage are frequently altered. In this communication will be described the different types of acquired dysgraphia following a cerebral damage. A cognitive model of the spelling system is reported to explain the different level of processing that can be impaired. The aim is to highlight the complexity of the different clinical pictures that the dysgraphic patients can to show: indeed a careful diagno- sis on damaged cognitive functions and processes can lead to an effective rehabilitative schedule