| Name | Dario |
| Surname | Grossi |
| Institution | Università degli Studi della Campania Luigi Vanvitelli |
| dario.grossi@unicampania.it | |
| Address | Villa Camaldoli Foundation Clinic, Naples, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Napoli, Italy |
Mirror writing (MW) is a rare disorder in which a script runs in direction opposite to normal and individual letters are reversed. The disorder generally occurs after left-hemisphere lesions, is transient and is observed on the left hand, whereas usually motor impairments prevent assessment of direction of right handwriting. We describe a left-handed patient with complete left hand mirror writing, still evident 2 years after a hemorrhagic stroke in left nucleo-capsular region. Since the patient could write with his right hand he underwent several writing tasks with either hand, and a thorough assessment to clarify the nature of MW. MW was evident in writing to dictation with left hand only, both in right and left hemispace, but the patient could modify his behavior when a verbal instruction was provided. No mirror errors were found in reading words, in copying geometric figures and in spatial orientation tasks. MW in our patient could be accounted for by a failure in automatic transformation of grapho-motor programs to write with the left hand. A lack of concern (a sort of anosodiaphoria) and a poor cognitive flexibility could contribute to long-term persistence of MW.
Several lines of evidence demonstrate that the motor system is involved in motor simulation of actions, but some uncertainty exists about the consequences of lesions of descending motor pathways on mental imagery tasks. Moreover, recent findings suggest that the motor system could also have a role in recognition of body parts. To address these issues in the present study we assessed patients with a complete damage of descending motor pathways (locked-in syndrome, LIS) on the hand laterality task, requiring subjects to decide whether a hand stimulus in a given spatial orientation represents a left or a right hand. LIS patients were less accurate than healthy controls in judging hand laterality; more importantly, LIS patients' performance was modulated by spatial orientation of hand stimuli whereas it was not affected by biomechanical constraints. These findings demonstrate a dissociation between spared hand recognition and impaired access to action simulation processes in LIS patients.
The involvement of facial mimicry in different aspects of human emotional processing is widely debated. However, little is known about relationships between voluntary activation of facial musculature and conscious recognition of facial expressions. To address this issue, we assessed severely motor-disabled patients with complete paralysis of voluntary facial movements due to lesions of the ventral pons [locked-in syndrome (LIS)]. Patients were required to recognize others' facial expressions and to rate their own emotional responses to presentation of affective scenes. LIS patients were selectively impaired in recognition of negative facial expressions, thus demonstrating that the voluntary activation of mimicry represents a high-level simulation mechanism crucially involved in explicit attribution of emotions.
The purpose of this study was to investigate the neuropsychological correlates of pathological gambling (PG) in Parkinson's disease (PD). Fifteen patients with PD affected by PG (identified based on DSM-IV criteria; PD+PG) without clinically evident dementia were compared with 15 nondemented patients with PD not affected by PG (PD-PG). Two groups of patients with PD were matched for age, length of education, and gender. Clinical and neuropsychiatric features were assessed; several cognitive domains, mainly related to executive functions, were explored by means of standardized neuropsychological tasks. PD+PG and PD-PG did not differ on clinical and neuropsychiatric aspects. PD+PG patients performed significantly worse than PD-PG patients on cognitive tasks that evaluated visuo-spatial long-term memory and several frontal lobe functions. After Bonferroni correction, differences remained significant on the Frontal Assessment Battery (FAB) (P = 0.001), on phonological fluency task (P = 0.003), and on the Trail Making Test, part B minus part A (P = 0.002). Logistic regression analysis demonstrated that low scores on the FAB were the only independent predictor of PG (odds ratio, 27.9; 95% CI: 2.82-277.95, P = 0.004). The results indicate an association between PG and frontal lobe dysfunctions in nondemented patients with PD. Low scores on the FAB indicate patients with PD at high risk for PG.
To explore the relationship between depression and cognitive impairment in non-demented PD patients, we evaluated neurological and neuropsychological asset in 65 patients with a diagnosis of major depressive disorder (dPD) according to DSM-IV criteria and 60 patients without depression (nPD). Compared with nPD patients, dPD patients had significantly higher scores on behavioral rating scales and performed worse on the Frontal Assessment Battery (FAB), Semantic Fluency Task, Copying Task (CT), and Stroop Test. Three dPD subgroups were identified based on the first two DSM-IV criteria: patients fulfilling criterion 1 (depressed mood; group 1); patients fulfilling criterion 2 (apathy/anhedonia; group 2); patients fulfilling criteria 1 and 2 (group 3). Patients of group 2 scored significantly lower than patients of group 1 on the CT, FAB and phonological fluency task. Patients of groups 2 and 3 scored significantly lower than nPD patients on visuoconstructional and frontal tasks. Similar results were obtained in dPD patients stratified in four subgroups based on cut-off scores of the Apathy Evaluation Scale and the Snaith Hamilton Pleasure Scale. In summary, PD patients with concomitant apathy and anhedonia may show more severe cognitive impairments. Since such patients are diagnosed to be affected by depression according to clinical DSM-IV criteria, we suggest that DSM-IV criteria may not distinguish an affective from a cognitive disorder in PD.
We describe the case of a patient with right hemisphere damage and left unilateral neglect. The patient was asked to draw from memory common objects, either with or without visual feedback. In the conditions without visual feedback the patient was either blindfolded or he made "invisible" drawings using a pen with the cap on, the drawings being recorded with carbon paper underneath. Results showed more neglect without than with visual feedback, contrary to previously published cases. This patient's pattern of performance may result from the contribution of a deficit of spatial working memory. Alternatively or in addition, the patient, who was undergoing cognitive rehabilitation for neglect, may have found easier to compensate for his neglect with visual feedback, which allowed him to visually explore the left part of his drawings.
The closing-in phenomenon (CIP) is often observed in patients with severe drawing disorders, but its cognitive bases are not well understood. We describe an experimental investigation aimed to clarify the nature of closing-in and its relationships with drawing disorders in a patient with corticobasal degeneration. In copying simple or complex stimuli (Experiment 1), the patient showed adherent and near types of closing-in, not affected by stimulus complexity, and produced distorted and often unrecognisable drawings. On the contrary, in drawing to dictation (without any available model), patients' performances significantly improved with respect to copying (Experiment 2). These data were consistent with the hypothesis that in some patients closing-in may develop from frontal-related release of approach behaviour even in the absence of relevant visuoperceptual impairments. By asking the patient to reproduce given spatial locations within circular frames (Experiment 3), we could further demonstrate the sparing of visuospatial processing and the frontal genesis of closing-in. These findings allowed us to speculate on the heterogeneous nature of closing-in.
We describe a patient who suddenly developed prosopometamorphopsia after a childbirth; she claimed that the left half of well-known and unfamiliar faces looked distorted. Brain MR was normal, whereas SPECT showed hypoperfusion of the left infero-lateral occipital cortex. No visual recognition defects for objects or faces were present. In three matching tasks with half-faces (Experiment 1), chimeric faces (Experiment 2), or chimeric objects (Experiment 3), the patient was impaired only when she matched pairs of chimeric faces differing in their left half; the same results were obtained after 1 year. This is the first behavioural demonstration of selective chronic metamorphopsia for the left side of faces, and provides new insights for models of face processing.