Intact reading in patients with profound early visual dysfunction

Despite substantial neuroscientific evidence for a region of visual cortex dedicated to the processing of written words, many studies continue to reject explanations of letter-by-letter (LBL) reading in terms of impaired word form representations or parallel letter processing in favour of more general deficits of visual function. In the current paper, we demonstrate that whilst LBL reading is often associated with general visual deficits, these deficits are not necessarily sufficient to cause reading impairment and have led to accounts of LBL reading which are based largely on evidence of association rather than causation. We describe two patients with posterior cortical atrophy (PCA) who exhibit remarkably preserved whole word and letter reading despite profound visual dysfunction. Relative to controls, both patients demonstrated impaired performance on tests of early visual, visuoperceptual and visuospatial processing; visual acuity was the only skill preserved in both individuals. By contrast, both patients were able to read aloud words with perfect to near-perfect accuracy. Reading performance was also rapid with no overall significant difference in response latencies relative to age- and education-matched controls. Furthermore, the patients violated a key prediction of general visual accounts of LBL reading – that pre-lexical impairments should result in prominent word length effects; in the two reported patients, evidence for abnormal word length effects was equivocal or absent, and certainly an order of magnitude different to that reported for LBL readers. We argue that general visual accounts cannot explain the pattern of reading data reported, and attribute the preserved reading performance to preserved direct access to intact word form representations and/or parallel letter processing mechanisms. The current data emphasise the need for much clearer evidence of causality when attempting to draw connections between specific aspects of visual processing and different types of acquired peripheral dyslexia

Stages of development and injury: an epidemiological survey of young children presenting to an emergency department

<p><b>Background:</b> The aim of our study was to use a local (Glasgow, west of Scotland) version of a Canadian injury surveillance programme (CHIRPP) to investigate the relationship between the developmental stage of young (pre-school) children, using age as a proxy, and the occurrence (incidence, nature, mechanism and location) of injuries presenting to a Scottish hospital emergency department, in an attempt to replicate the findings of a recent study in Kingston, Canada.</p> <p><b>Methods:</b> We used the Glasgow CHIRPP data to perform two types of analyses. First, we calculated injury rates for that part of the hospital catchment area for which reasonably accurate population denominators were available. Second, we examined detailed injury patterns, in terms of the circumstances, mechanisms, location and types of injury. We compared our findings with those of the Kingston researchers.</p> <p><b>Results:</b> A total of 17,793 injury records for children aged up to 7 years were identified over the period 1997–99. For 1997–2001, 6,188 were used to calculate rates in the west of the city only. Average annual age specific rates per 1000 children were highest in both males and females aged 12–35 months. Apart from the higher rates in Glasgow, the pattern of injuries, in terms of breakdown factors, mechanism, location, context, and nature of injury, were similar in Glasgow and Kingston.</p> <p><b>Conclusion:</b> We replicated in Glasgow, UK, the findings of a Canadian study demonstrating a correlation between the pattern of childhood injuries and developmental stage. Future research should take account of the need to enhance statistical power and explore the interaction between age and potential confounding variables such as socio-economic deprivation. Our findings highlight the importance of designing injury prevention interventions that are appropriate for specific stages of development in children.</p&gt

Effects of adult aging on letter position coding in reading: evidence from eye movements

It is well-established that young adults encode letter position flexibly during natural reading. However, given the visual changes that occur with normal aging, it is important to establish whether letter position coding is equivalent across adulthood. In 2 experiments, young (18-25 years) and older (65 years) adults' were recorded while reading sentences with words containing transposed adjacent letters. Transpositions occurred at beginning (rpoblem), internal (porblem), or end (problme) locations in words. In Experiment 1, these transpositions were present throughout reading. By comparison, Experiment 2 used a gaze-contingent paradigm such that once the reader's gaze moved past a word containing a transposition, this word was shown correctly and did not subsequently change. Both age groups showed normal levels of comprehension for text including words with transposed letters. The pattern of letter transposition effects on eye movements was similar for the young and older adults, with greater increases in reading times when external relative to internal letters were transposed. In Experiment 1, however, effects of word beginning transpositions during rereading were larger for the older adults. In Experiment 2 there were no interactions, confirming that letter position coding is similar for both age groups at least during first-pass processing of words. These findings show that flexibility in letter position encoding during the initial processing of words is preserved across adulthood, although the interaction effect in rereading in Experiment 1 also suggests that older readers may use more stringent postlexical verification processes, for which the accuracy of word beginning letters is especially important

Eye movements during reading and topic scanning: effects of word frequency

The study examined the nature of eye movement control and word recognition during scanning for a specific topic, compared with reading for comprehension. Experimental trials included a manipulation of word frequency: the critical word was frequent (and orthographically familiar) or infrequent (2 conditions: orthographically familiar and orthographically unfamiliar). First-pass reading times showed effects of word frequency for both reading and scanning, with no interactions between word characteristics and task. Therefore, in contrast to the task of searching for a single specific word (Rayner and Fischer, 1996), there were immediate and localized influences of lexical processing when scanning for a specific topic, indicating that early word recognition processes are similar during reading and topic scanning. In contrast, there were interactions for later measures, with larger effects of word frequency during reading than scanning, indicating that reading goals can modulate later processes such as the integration of words into sentence context. Additional analyses of the distribution of first-pass single fixation durations indicated that first-pass fixations of all durations were shortened during scanning compared with reading, and reading for comprehension produced a larger subset of longer first-pass fixations compared with scanning. The implications for the nature of word recognition and eye movement control are discussed

Effects of aging, word frequency, and text stimulus quality on reading across the adult lifespan: evidence from eye movements

Reductions in stimulus quality may disrupt the reading performance of older adults more when compared with young adults because of sensory declines that begin early in middle age. However, few studies have investigated adult age differences in the effects of stimulus quality on reading, and none have examined how this affects lexical processing and eye movement control. Accordingly, we report two experiments that examine the effects of reduced stimulus quality on the eye movements of young (18-24 years), middle-aged (41-51 years), and older (65 years) adult readers. In Experiment 1, participants read sentences that contained a high-or low-frequency critical word and that were presented normally or with contrast reduced so that words appeared faint. Experiment 2 further investigated effects of reduced stimulus quality using a gaze-contingent technique to present upcoming text normally or with contrast reduced. Typical patterns of age-related reading difficulty (e.g., slower reading, more regressions) were observed in both experiments. In addition, eye movements were disrupted more for older than younger adults when all text (Experiment 1) or just upcoming text (Experiment 2) appeared faint. Moreover, there was an interaction between stimulus quality and word frequency (Experiment 1), such that readers fixated faint low-frequency words for disproportionately longer. Crucially, this effect was similar across all age groups. Thus, although older readers suffer more from reduced stimulus quality, this additional difficulty primarily affects their visual processing of text. These findings have important implications for understanding the role of stimulus quality on reading behavior across the lifespan

The Language Profile of Behavioral Variant Frontotemporal Dementia

BACKGROUND: The language profile of behavioral variant frontotemporal dementia (bvFTD) remains to be fully defined. OBJECTIVE: We aimed to quantify the extent of language deficits in this patient group. METHODS: We assessed a cohort of patients with bvFTD (n = 24) in relation to patients with semantic variant primary progressive aphasia (svPPA; n = 14), nonfluent variant primary progressive aphasia (nfvPPA; n = 18), and healthy age-matched individuals (n = 24) cross-sectionally and longitudinally using a comprehensive battery of language and general neuropsychological tests. Neuroanatomical associations of language performance were assessed using voxel-based morphometry of patients' brain magnetic resonance images. RESULTS: Relative to healthy controls, and after accounting for nonverbal executive performance, patients with bvFTD showed deficits of noun and verb naming and single word comprehension, diminished spontaneous propositional speech, and deterioration in naming performance over time. Within the bvFTD group, patients with MAPT mutations had more severe impairments of noun naming and single word comprehension than patients with C9orf72 mutations. Overall the bvFTD group had less severe language deficits than patients with PPA, but showed a language profile that was qualitatively similar to svPPA. Neuroanatomical correlates of naming and word comprehension performance in bvFTD were identified predominantly in inferior frontal and antero-inferior temporal cortices within the dominant hemispheric language network. CONCLUSIONS: bvFTD is associated with a language profile including verbal semantic impairment that warrants further evaluation as a novel biomarker

Are older adults more risky readers? Evidence from meta-analysis

According to an influential account of aging effects on reading, older adults (65+ years) employ a more “risky” reading strategy compared to young adults (18–30 years), in which they attempt to compensate for slower processing by using lexical and contextual knowledge to guess upcoming (i.e., parafoveal) words more often. Consequently, while older adults may read more slowly, they might also skip words more often (by moving their gaze past words without fixating them), especially when these are of higher lexical frequency or more predictable from context. However, this characterization of aging effects on reading has been challenged recently following several failures to replicate key aspects of the risky reading hypothesis, as well as evidence that key effects predicted by the hypothesis are not observed in Chinese reading. To resolve this controversy, we conducted a meta-analysis of 102 eye movement experiments comparing the reading performance of young and older adults. We focused on the reading of sentences displayed normally (i.e., without unusual formatting or structures, or use of gaze-contingent display change techniques), conducted using an alphabetic script or Chinese, and including experiments manipulating the frequency or predictability of a specific target word. Meta-analysis confirmed that slower reading by older compared to younger adults is accompanied by increased word-skipping, although only for alphabetic scripts. Meta-analysis additionally showed that word-skipping probabilities are unaffected by age differences in word frequency or predictability effects, casting doubt on a central component of the risky reading hypothesis. We consider implications for future research on aging effects on reading. (PsycInfo Database Record (c) 2022 APA, all rights reserved

A double-blind placebo-controlled cross-over clinical trial of DONepezil In Posterior cortical atrophy due to underlying Alzheimer's Disease: DONIPAD study.

BACKGROUND: The study investigated whether donepezil exerts symptomatic benefit in patients with posterior cortical atrophy (PCA), an atypical variant of Alzheimer's disease. METHODS: A single-centre, double-blind, placebo-controlled, cross-over clinical trial was performed to assess the efficacy of donepezil in patients with PCA. Each patient received either donepezil (5 mg once daily in the first 6 weeks and 10 mg once daily in the second 6 weeks) or placebo for 12 weeks. After a 2-week washout period, each patient received the other treatment arm during the following 12 weeks followed by another 2-week washout period. The primary outcome was the Mini-Mental State Examination (MMSE) at 12 weeks. Secondary outcome measures were five neuropsychological tests reflecting parieto-occipital function. Intention-to-treat analysis was used. For each outcome measure, carry-over effects were first assessed. If present, then analysis was restricted to the first 12-week period. Otherwise, the standard approach to the analysis of a 2 × 2 cross-over trial was used. RESULTS: Eighteen patients (13 females) were recruited (mean age 61.6 years). There was a protocol violation in one patient, who subsequently withdrew from the study due to gastrointestinal side effects. There was statistically significant (p 0.05). There were no statistically significant treatment effects on any of the five neuropsychological tests, except for digit span at 12 weeks (higher by 0.5 digits in favour of placebo, 95% CI 0.1 to 0.9). Gastrointestinal side effects occurred most frequently, affecting 13/18 subjects (72%), and were the cause of study discontinuation in one subject. Nightmares and vivid dreams occurred in 8/18 subjects (44%), and were statistically more frequent during treatment with donepezil. CONCLUSIONS: In this small study, there was no statistically significant treatment effect of donepezil on the primary outcome measure (MMSE score at 12 weeks) in PCA patients, who appear to be particularly susceptible to the development of nightmares and vivid dreams when treated. TRIAL REGISTRATION: Trial registration: Current Controlled Trials ISRCTN22636071 . Retrospectively registered 19 May 2010

Fractionated stereotactic radiotherapy for skull base tumors: analysis of treatment accuracy using a stereotactic mask fixation system

Background: To assess the accuracy of fractionated stereotactic radiotherapy (FSRT) using a stereotactic mask fixation system. Patients and Methods: Sixteen patients treated with FSRT were involved in the study. A commercial stereotactic mask fixation system (BrainLAB AG) was used for patient immobilization. Serial CT scans obtained before and during FSRT were used to assess the accuracy of patient immobilization by comparing the isocenter position. Daily portal imaging were acquired to establish day to day patient position variation. Displacement errors along the different directions were calculated as combination of systematic and random errors. Results: The mean isocenter displacements based on localization and verification CT imaging were 0.1 mm (SD 0.3 mm) in the lateral direction, 0.1 mm (SD 0.4 mm) in the anteroposterior, and 0.3 mm (SD 0.4 mm) in craniocaudal direction. The mean 3D displacement was 0.5 mm (SD 0.4 mm), being maximum 1.4 mm. No significant differences were found during the treatment (P = 0.4). The overall isocenter displacement as calculated by 456 anterior and lateral portal images were 0.3 mm (SD 0.9 mm) in the mediolateral direction, -0.2 mm (SD 1 mm) in the anteroposterior direction, and 0.2 mm (SD 1.1 mm) in the craniocaudal direction. The largest displacement of 2.7 mm was seen in the cranio-caudal direction, with 95% of displacements < 2 mm in any direction. Conclusions: The results indicate that the setup error of the presented mask system evaluated by CT verification scans and portal imaging are minimal. Reproducibility of the isocenter position is in the best range of positioning reproducibility reported for other stereotactic systems

Drug allergy

Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions with varying mechanisms and clinical presentations. This type of adverse drug reaction (ADR) not only affects patient quality of life, but may also lead to delayed treatment, unnecessary investigations, and even mortality. Given the myriad of symptoms associated with the condition, diagnosis is often challenging. Therefore, referral to an allergist experienced in the identification, diagnosis and management of drug allergy is recommended if a drug-induced allergic reaction is suspected. Diagnosis relies on a careful history and physical examination. In some instances, skin testing, graded challenges and induction of drug tolerance procedures may be required