Left Anterior Temporal Cortex Research Articles

Changes in brain metabolism associated with remission in unipolar major depression.

Functional brain correlates of remission in patients with major depressive disorder (MDD) are measured with positron emission tomography (PET) and 18F-fluorodeoxyglucose. Glucose metabolism was measured in patients (n = 41) with moderate to severe MDD during acute depression and in the remitted state defined as a period of asymptomatic condition over 12 weeks. Data analyses used a region-of-interest (ROI) approach and statistical parametric mapping (SPM). There were significant decreases in metabolism upon remission with respect to the baseline scan in left prefrontal, anterior temporal and anterior cingulate cortex and bilateral thalamus (SPM analysis) and bilateral putamen and cerebellum (SPM and ROI analyses). There was a significant asymmetry in prefrontal and anterior cingulate cortex metabolism with lower metabolism in the left hemisphere that persisted despite clinical remission. These findings support the hypothesis that selective monoamine reuptake inhibition leads to an attenuation of a brain circuit that mediates depressive symptomatology.

Confrontation Naming and Morphometric Analyses of Structural MRI in Frontotemporal Dementia

We studied the neural basis for confrontation naming difficulty in 29 patients with frontotemporal dementia (FTD) by correlating naming with voxel-based morphometric analyses of gray matter volume in structural MRI. We found that naming is significantly impaired in FTD, including patients with semantic dementia (SD), progressive nonfluent aphasia (PNFA), and nonaphasic patients (NON-APH) with a disorder of social and executive functioning. Significant cortical atrophy was found in the left anterior temporal cortex in all three FTD subgroups relative to healthy seniors. We also found significant cortical atrophy in unique anatomic distributions in each FTD subgroup. This included: lateral, ventral, and parahippocampal regions of the left temporal lobe in SD; inferior, orbital, dorsolateral, and premotor regions of the left frontal lobe in PNFA, and bilateral frontal regions in NON-APH. Direct correlations between confrontation naming and gray matter volume revealed distinct patterns in each FTD subgroup. SD patients showed a significant correlation in the left lateral temporal cortex, PNFA patients in several left frontal regions, and NON-APH patients in the right dorsolateral prefrontal cortex. These findings suggest that confrontation naming is supported by a large-scale neural network, and that naming is compromised in FTD due to interruption of the network in several different ways.

Alzheimer’s disease and frontotemporal dementia exhibit distinct atrophy-behavior correlates: A computer-assisted imaging study 1

Rationale and Objectives. The purpose of this study was to test the hypothesis that distinct patterns of gray matter atrophy are responsible for unique interruptions of the naming process in Alzheimer’s disease (AD) and frontotemporal dementia (FTD). Materials and Methods. Voxel-based morphometry (VBM) was performed to characterize at the voxel level the neuroanatomic changes that occur in AD and FTD based on high-resolution T1-weighted three-dimensional (3D) spoiled-gradient echo images of patients (AD, n = 12; FTD, n = 29) and healthy control subjects (n = 12). The cortical atrophy measurements were correlated with performance on behavioral measures of naming and related processes to identify brain regions that may contribute to this language function. Results. Both AD and FTD have significant naming difficulty, and this difficulty in naming correlates with a measure of lexical retrieval in both patient groups as well. However, only FTD patients showed a correlation with semantic memory. Areas of cortical atrophy common to AD and FTD were found in the anterior temporal, posterolateral temporal, and dorsolateral prefrontal regions of the left hemisphere. Correlation with naming in both AD and FTD was seen in the left anterior temporal cortex, suggesting that this area may play a role in the lexical retrieval component of naming. We also observed several unique areas of cortical atrophy in temporal and frontal cortices of these patients. Right anterior temporal and left posterolateral temporal regions of atrophy correlated with naming difficulty in FTD, suggesting that these areas may contribute to the semantic memory component of naming. Cortical areas correlating with naming that are not atrophic may represent regions that play an optional role in naming. Conclusion. VBM provides an important first step in analyzing brain-behavior relations in vivo in patients with neurodegenerative diseases. More refined analyses of brain morphology via high-dimensional normalization methods that are capable of modeling local as well as global variability in neuroanatomical structure promise to be even more informative.

Brain reactivity to specific symptom provocation indicates prospective therapeutic outcome in OCD

A pertinent question in biological psychiatry is what differentiates responders and non-responders to pharmacological treatment. One possibility is that individual differences in the symptomatic spectrum as well as in the underlying biology of the disorder lead to the known 40% failure in pharmacological treatment. Our study aimed to maximize individual brain markers of obsessive-compulsive disorder (OCD) by applying single photon emission computed tomography (SPECT) during a provoked symptomatic state prior to and following treatment. Four brain SPECT scans were obtained from 26 OCD patients prior to and at 6 months of sertraline treatment. At each time point, two SPECT scans were performed in a counterbalanced order of two specific states; one a symptom-provoking condition and the other a relaxed condition. At 6 months of treatment, patients were divided into responders and non-responders according to a predetermined clinical criterion. Prospective responders showed significantly lower brain perfusion in the dorsal–caudal anterior cingulum and higher brain perfusion in the right caudate, when compared to non-responders, only during symptom provocation. When pre- and post-treatment scans during symptom provocation were compared, only responders showed significant change in brain response: increased perfusion in the left anterior temporal cortex and prefrontal cortex at 6 months’ treatment. These findings suggest that obtaining functional brain imaging during specific symptom provocation emphasizes individual differences in brain reactivity. Thus can indicate prospective responders to symptom-related treatment in OCD and mark the relevant brain regions for effective response to treatment.

Neural Substrates of Human Facial Expression of Pleasant Emotion Induced by Comic Films: A PET Study

Laughter or smile is one of the emotional expressions of pleasantness with characteristic contraction of the facial muscles, of which the neural substrate remains to be explored. This currently described study is the first to investigate the generation of human facial expression of pleasant emotion using positron emission tomography and H 2 15O. Regional cerebral blood flow (rCBF) during laughter/smile induced by visual comics and the magnitude of laughter/smile indicated significant correlation in the bilateral supplementary motor area (SMA) and left putamen ( P < 0.05, corrected), but no correlation in the primary motor area (M1). In the voluntary facial movement, significant correlation between rCBF and the magnitude of EMG was found in the face area of bilateral M1 and the SMA ( P < 0.001, uncorrected). Laughter/smile, as opposed to voluntary movement, activated the visual association areas, left anterior temporal cortex, left uncus, and orbitofrontal and medial prefrontal cortices ( P < 0.05, corrected), whereas voluntary facial movement generated by mimicking a laughing/smiling face activated the face area of the left M1 and bilateral SMA, compared with laughter/smile ( P < 0.05, corrected). We demonstrated distinct neural substrates of emotional and volitional facial expression and defined cognitive and experiential processes of a pleasant emotion, laughter/smile.

Neural Substrates of Human Facial Expression of Pleasant Emotion Induced by Comic Films: A PET Study

Laughter or smile is one of the emotional expressions of pleasantness with characteristic contraction of the facial muscles, of which the neural substrate remains to be explored. This currently described study is the first to investigate the generation of human facial expression of pleasant emotion using positron emission tomography and H215O. Regional cerebral blood flow (rCBF) during laughter/smile induced by visual comics and the magnitude of laughter/smile indicated significant correlation in the bilateral supplementary motor area (SMA) and left putamen (P < 0.05, corrected), but no correlation in the primary motor area (M1). In the voluntary facial movement, significant correlation between rCBF and the magnitude of EMG was found in the face area of bilateral M1 and the SMA (P < 0.001, uncorrected). Laughter/smile, as opposed to voluntary movement, activated the visual association areas, left anterior temporal cortex, left uncus, and orbitofrontal and medial prefrontal cortices (P < 0.05, corrected), whereas voluntary facial movement generated by mimicking a laughing/smiling face activated the face area of the left M1 and bilateral SMA, compared with laughter/smile (P < 0.05, corrected). We demonstrated distinct neural substrates of emotional and volitional facial expression and defined cognitive and experiential processes of a pleasant emotion, laughter/smile.

Can segregation within the semantic system account for category-specific deficits?

Functional neuroimaging was used to investigate the extent to which category-specific semantic deficits in patients can be accounted for in terms of the demands placed on neural systems underlying different types of semantic knowledge. Unlike previous functional imaging studies of category specificity, we used a factorial design that crossed category (tools and fruits) with tasks requiring retrieval of either action or perceptual (real life size) knowledge. The presentation of tools relative to fruit increased activation in the same left posterior middle temporal area that was linked to the retrieval of action knowledge in general (for fruit as well as tools). However, we found no correlation between activation evoked by fruit and the size retrieval task. The left medial anterior temporal cortex was the only region to be activated for fruit relative to tools. We argue that the sensory-functional theory of category-specific effects is insufficient to account for the current neuroimaging literature. However, the data do support a more refined version of the theory: tools, relative to fruit, are more strongly linked to manipulative/motor knowledge and, for some tasks, fruit may be more reliant on integrating multiple semantic features.

The response of left temporal cortex to sentences.

The meaning of a sentence differs from the sum of the meanings of its constituents. Left anterior temporal cortex responds to sentences more strongly than to unconnected words. We hypothesized that the anterior temporal response to sentences is due to this difference in meaning (compositional semantics). Using positron emission tomography (PET), we studied four experimental conditions (2 x 2 factorial design): In one condition, subjects read normal sentences. In a second condition, they read grammatically correct sentences containing numerous semantic violations (semantically random sentences). In a third condition, we scrambled the word order within the normal sentences, and, in a fourth condition, the word order was scrambled within the semantically random sentences. The left anterior temporal pole responded strongly to sentences compared to scrambled versions of sentences. A similar although weaker response occurred in the left anterior superior temporal sulcus and the left posterior middle temporal gyrus. A subset of voxels within the left anterior temporal pole responded more to semantically random sentences and their scrambled versions than to normal sentences and the corresponding scrambled versions (main effect of semantic randomness). Finally, the grammatical and the semantic factor interacted in a subset of voxels within the anterior temporal pole: Activity was higher when subjects read normal sentences compared to their scrambled versions but not for semantically random sentences compared to their corresponding scrambled versions. The effects of grammar and meaning and, most importantly, the interaction between grammatical and semantic factors are compatible with the hypothesis that the left anterior temporal pole contributes to the composition of sentence meaning.

Identification of famous faces and buildings: a functional neuroimaging study of semantically unique items.

Several functional imaging experiments have clearly established that the fusiform gyri are preferentially responsive to faces, whereas the parahippocampal/lingual gyri are more responsive to buildings. Other studies have demonstrated that famous faces additionally activate the anterior temporal cortex relative to unfamiliar faces, animals, tools, body parts and maps. One explanation for this apparent specialization for known people could be that famous faces are 'semantically unique items'. In other words, they carry unique semantic associations that are not shared by other perceptually similar category members. If this hypothesis is correct, the anterior temporal cortex should also respond to other semantically unique items, such as famous buildings. In this PET study, we investigated the effect of fame (famous relative to non-famous) on activation elicited by famous and non-famous faces and buildings during a same-different matching task. We found that, when the task was held constant, category-specific activations in the fusiform and parahippocampal/lingual areas were not modulated by fame. In contrast, in the left anterior middle temporal gyrus there was an effect of fame that was common to faces and buildings. These results suggest that the identification of famous faces and buildings involves category-specific perceptual processing in the fusiform and parahippocampal/lingual regions, respectively, and shared analysis of unique semantic attributes in the left anterior temporal cortex.

99mTc-ECD brain perfusion SPET: variability, asymmetry and effects of age and gender in healthy adults.

Reliable and high-resolution reference data for regional cerebral blood flow measured with single-photon emission tomography (SPET) are necessary for optimal clinical and research use. Therefore, a large dataset of normal technetium-99m labelled ethylene cysteine dimer (ECD) perfusion SPET in carefully screened healthy volunteers with an age range spanning six decades was created, with correction for non-uniform attenuation and scatter and based on an anatomically standardised analysis. Eighty-nine healthy volunteers, stratified for gender (46 females, 43 males; age 20-81 years), were included. Twelve volunteers underwent repeated 99mTc-ECD SPET after 2.5+/-2.3 weeks. An automated whole-brain volume of interest analysis with MANOVA as well as voxelwise analysis using SPM99 was conducted. Average intersubject variability was 4.8% while intrasubject reproducibility was 3.0%. An age-related decline in tracer uptake was found in the anterior cingulate gyrus, bilateral basal ganglia, left prefrontal, left lateral frontal and left superior temporal and insular cortex (all P=0.001-0.02). There was an overall increase in right/left asymmetry with age, which was most pronounced in the frontal and temporal neocortex. The most significant correlations between AI and age decade were found in the prefrontal (R=0.35, P=0.001) and superior temporal neocortex (R=0.43, P<0.001). Women had significantly higher uptake in the right parietal cortex (P<0.001), while men showed higher uptake in the cerebellum and the left anterior temporal and orbitofrontal cortex (all P<0.01). This normative dataset allows age- and gender-specific patient and group assessment of 99mTc-ECD perfusion SPET under a wide variety of clinical circumstances in relation to normal variations and highlights the importance of both age- and gender-specific normal datasets for optimal analysis sensitivity.

Regional cerebral blood flow effects of nicotine in overnight abstinent smokers

Background: Most people agree that dependence to tobacco is mediated by the effects of nicotine on the central nervous system, albeit the neural pathways involved are not clearly delineated. We investigated the effect of nasal nicotine spray on regional cerebral blood flow (rCBF) in a sample of habitual smokers, with H 2 15O and positron emission tomography (PET). Methods: Eighteen volunteer smokers were studied after 12 hours of smoking deprivation. Regional cerebral blood flow measures were obtained with PET and 50 mCi H 2 15O in six consecutive scans. Nicotine spray and a placebo spray were administered in a single-blind design, preceded and followed by baseline studies. Images were coregistered and anatomically standardized. Square (9-mm side) regions of interest were placed in 10 preselected brain regions, bilaterally. The effects of the experimental condition and gender were tested with two-way repeated-measures analysis of variance in each of the regions studied. Results: Nicotine reduced rCBF in the left anterior temporal cortex and in the right amygdala. Increases were noted in the right anterior thalamus. Conclusions: In habitual smokers after overnight abstinence, nicotine induced differing effects on regional blood flow relative to whole brain blood flow. Increases were observed in the thalamus, a region rich in nicotinic receptors, and reductions in limbic and paralimbic (amygdala, anterior temporal cortex) regions.

Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease

Few studies evaluate neuropathological correlates of behavioral changes in Alzheimer disease (AD). We identified 31 autopsy patients with a diagnosis of definite AD. Behavioral changes were assessed with the Neuropsychiatric Inventory. Brain sections were collected from bilateral orbitofrontal and left anterior cingulate, superior temporal, inferior parietal, occipital, and hippocampal cortices for quantification of neurofibrillary tangles (NFTs) and diffuse and neuritic plaques. Sections from frontal, cingulate, and hippocampal cortices were reviewed for the presence of Lewy bodies (LBs). Hypothesis-driven correlational analyses were performed by the bootstrap method. Subgroup analyses contrasted a group with high scores of one specific behavior to a group with low scores after equating groups for other behaviors. NFT burden in the left orbitofrontal cortex across all 31 patients significantly correlated with agitation scores (r = 0.41, p < 0.015) and NFTs correlated significantly (r = 0.66, p = 0.004) with higher agitation scores in the subgroup analysis. Left anterior cingulate NFTs, although not within our hypotheses, also showed a significant relationship to agitation within the subgroups (r = 0.76, p = 0.0003; Bonferroni p = 0.02). Seven patients, including three in the agitation subgroup, had cortical LBs. Aberrant motor behavior and NFT density in the left orbitofrontal cortex showed a significant relationship for the entire group (r = 0.38, p < 0.03) and for subgroups (r = 0.49, p = 0.04), whereas apathy and left anterior cingulate NFTs showed a significant relationship only for the entire group (r = 0.25, p ≤ 0.01). These observations suggest that agitation and aberrant motor behavior are correlates of greater NFT pathology in the orbitofrontal cortex in AD, whereas increasing apathy may relate to greater NFT burden in the anterior cingulate. Ann Neurol 2001;49:355–361

Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease

Few studies evaluate neuropathological correlates of behavioral changes in Alzheimer disease (AD). We identified 31 autopsy patients with a diagnosis of definite AD. Behavioral changes were assessed with the Neuropsychiatric Inventory. Brain sections were collected from bilateral orbitofrontal and left anterior cingulate, superior temporal, inferior parietal, occipital, and hippocampal cortices for quantification of neurofibrillary tangles (NFTs) and diffuse and neuritic plaques. Sections from frontal, cingulate, and hippocampal cortices were reviewed for the presence of Lewy bodies (LBs). Hypothesis-driven correlational analyses were performed by the bootstrap method. Subgroup analyses contrasted a group with high scores of one specific behavior to a group with low scores after equating groups for other behaviors. NFT burden in the left orbitofrontal cortex across all 31 patients significantly correlated with agitation scores (r = 0.41, p < 0.015) and NFTs correlated significantly (r = 0.66, p = 0.004) with higher agitation scores in the subgroup analysis. Left anterior cingulate NFTs, although not within our hypotheses, also showed a significant relationship to agitation within the subgroups (r = 0.76, p = 0.0003; Bonferroni p = 0.02). Seven patients, including three in the agitation subgroup, had cortical LBs. Aberrant motor behavior and NFT density in the left orbitofrontal cortex showed a significant relationship for the entire group (r = 0.38, p < 0.03) and for subgroups (r = 0.49, p = 0.04), whereas apathy and left anterior cingulate NFTs showed a significant relationship only for the entire group (r = 0.25, p < or = 0.01). These observations suggest that agitation and aberrant motor behavior are correlates of greater NFT pathology in the orbitofrontal cortex in AD, whereas increasing apathy may relate to greater NFT burden in the anterior cingulate.

Focal enhancement of chaotic strange attractor dimension in the left semantic (Wernicke) human cortex during reading without concomitant change in vigilance level

Non-averaged scalp-recorded brain potentials were analyzed in four right-handed humans while they were either silently reading a book, or in idle alert conditions. The dimensionality of chaotic strange attractors was estimated from the EEG at each of 14 scalp electrodes, using the point correlation dimension PD2 algorithm. When the subject was fully alert but not engaged in any specific task, PD2 was between 5.2 and 5.9. When the subject was silently reading a book, PD2 bifurcated to significantly higher values (6.6–6.9) in the left lateral anterior extrasylvian temporal cortex, but did not change in the adjacent left perisylvian cortex nor over the right side of the brain. The PD2 increases occurred without any significant change in vigilance level as assessed from the unchanged mean voltage of concomitant gamma (40 Hz) EEG oscillations. A small barely significant PD2 increase was only noticed in the left lateral precentral region. The increase of chaotic dimensionality in the left lateral extrasylvian temporal cortex during reading reflects enhanced processing operations in the semantic (Wernicke) areas and is in line with recent PET imaging data. These results provide for the first time evidence of a focal chaotic fractal dimension increase that is related to specific cognitive brain processing operations.

212 Information processing speed is faster for highly hypnotizable than low hypnotizable persons: Evidence from behavioral reaction time and event-related potential studies

The present study examined neurophysiological correlates of pain and pain control by recording intracranial somatosensory event-related potentials (SERPs) to painful cutaneous stimuli in two female patients with obsessive–compulsive disorder bearing multiple intracranial electrodes during conditions of (a) attention and (b) hypnotically suggested analgesia. Intracranial electrodes were located in the anterior cingulate cortex, amygdala, temporal cortex, and parietal cortex. No changes were observed in the SERPs of the hypnotically unresponsive patient. In the hypnotically responsive patient, reduced pain perception during suggested hypnotic analgesia was accompanied by (a) a significant reduction of the positive SERP component within the range of 140–160 ms post-stimulus in the left anterior cingulate cortex (Shaltenbrandt atlas: 29.12/ −7.42/32.41), and (b) a significant enhancement of the negative SERP component within the range of 200–260 ms in the left anterior temporal cortex (Brodmann area 21). No significant changes were observed in the amygdala or the scalp-recorded Fz. The present study is the first to demonstrate the involvement of the anterior cingulate cortex and the anterior temporal cortex in the control of pain with hypnotically suggested analgesia. © 1997 Elsevier Science B.V.

A functional neuroimaging description of two deep dyslexic patients.

Deep dyslexia is a striking reading disorder that results from left-hemisphere brain damage and is characterized by semantic errors in reading single words aloud (e.g., reading 'spirit' as 'whisky'). Two types of explanation for this syndrome have been advanced. One is that deep dyslexia results from a residual left-hemisphere reading system that has lost the ability to pronounce a printed word without reference to meaning. The second is that deep dyslexia reflects right-hemisphere word processing. Although previous attempts to adjudicate between these hypotheses have been inconclusive, the controversy can now be addressed by mapping functional anatomy. In this study, we demonstrate that reading by two deep dyslexic patients (CJ and JG) involves normal or enhanced activity in spared left-hemisphere regions associated with naming (Broca's area and the left posterior inferior temporal cortex) and with the meanings of words (the left posterior temporo-parietal cortex and the left anterior temporal cortex). In the right-hemisphere homologues of these regions, there was inconsistent activation within the normal group and between the deep dyslexic patients. One (CJ) showed enhanced activity (relative to the normals) in the right anterior inferior temporal cortex, the other (JG) in the right Broca's area, and both in the right frontal operculum. Although these differential right-hemisphere activations may have influenced the reading behavior of the patients, their activation patterns primarily reflect semantic and phonological systems in spared regions of the left hemisphere. These results preclude an explanation of deep dyslexia in terms of purely right-hemisphere word processing.

Regional Cerebral Blood Flow Differences During High-Caloric Food Challenge in Patients with Anorexia Nervosa Versus Normal Controls • 9

Previous neuroimaging studies have employed symptom provocation paradigms to examine the functional neuroanatomic correlates of emotions or behaviors that characterize particular psychiatric disorders. This study was designed to determine areas of differential brain activity associated with the hallmark food aversion of anorexia nervosa (AN). We hypothesized that this feature of AN would be associated with dysfunction within the paralimbic system. The tracer, oxygen 15-labeled carbon dioxide, was used to make positron emission tomographic measurements of regional cerebral blood flow (rCBF). We compared 8 young women with AN to 8 medically/psychiatrically healthy female control subjects during both a neutral and provoked state. Presentation of standardized neutral, low-caloric food stimuli (apple, lettuce) was followed by viewing of provocative, high-caloric food stimuli (cake, bagel + cream cheese). Heart rate was monitored by pulse oximetry and subjects completed emotional state analog scales after each scan. Stereotactic transformation and statistical parametric mapping techniques were used to determine locations of significant activation; a statistical threshold of p=0.001 (z=3.09) was used for analysis of imaging data. Provocative food stimuli produced a significant desire to eat in controls (p=0.01), whereas in the AN group, identical stimuli produced significant disgust (p=0.008) and other negative emotions. A significant heart rate increase (p=0.023) was noted after exposure to provocative stimuli in AN subjects, but not in controls. Planned contrasts(rCBF for provoked vs. neutral conditions) demonstrated a significant decrease in rCBF within the left anterior temporal cortex in controls only. Within the AN group alone, significantly decreased rCBF was seen in the right somatosensory cortex in an area controlling sensory function of the mouth. These results implicate left anterior temporal cortex, a component of the paralimbic system, in the mediation of normal appetitive function and as an area that appears to be differentially activated in AN. Interestingly, subjects with AN had decreased activity in a brain region mediating oral sensation, accompanying their reported experience of high-caloric food aversion.

Somatosensory event-related potential changes to painful stimuli during hypnotic analgesia: anterior cingulate cortex and anterior temporal cortex intracranial recordings

The present study examined neurophysiological correlates of pain and pain control by recording intracranial somatosensory event-related potentials (SERPs) to painful cutaneous stimuli in two female patients with obsessive–compulsive disorder bearing multiple intracranial electrodes during conditions of (a) attention and (b) hypnotically suggested analgesia. Intracranial electrodes were located in the anterior cingulate cortex, amygdala, temporal cortex, and parietal cortex. No changes were observed in the SERPs of the hypnotically unresponsive patient. In the hypnotically responsive patient, reduced pain perception during suggested hypnotic analgesia was accompanied by (a) a significant reduction of the positive SERP component within the range of 140–160 ms post-stimulus in the left anterior cingulate cortex (Shaltenbrandt atlas: 29.12/ −7.42/32.41), and (b) a significant enhancement of the negative SERP component within the range of 200–260 ms in the left anterior temporal cortex (Brodmann area 21). No significant changes were observed in the amygdala or the scalp-recorded Fz. The present study is the first to demonstrate the involvement of the anterior cingulate cortex and the anterior temporal cortex in the control of pain with hypnotically suggested analgesia. © 1997 Elsevier Science B.V.

Acquisition of signs from American sign language in hearing individuals following left hemisphere damage and aphasia

Three severely aphasic hearing patients with no prior knowledge of sign language were able to acquire competency in aspects of American Sign Language (ASL) lexicon and finger spelling, in contrast to a near complete inability to speak the English counterparts of these visuo-gestural signs. Two patients with damage in left postero-lateral temporal and inferior parietal cortices mastered production and comprehension of single signs and short meaningful sign sequences, but the one patient with damage to virtually all left temporal cortices was less accurate in single sign processing and was unable to produce sequences of signs at all. These findings suggest that conceptual knowledge is represented independently of the auditory-vocal records for the corresponding lexical entries, and that left anterior temporal cortices outside of traditional “language areas” are part of the neural network which supports the linkage between conceptual knowledge and linguistic signs, especially as they are used in the sequenced activations required for production or comprehension of meaningful sentences.

Progressive aphasia in a patient with Pick's disease

Although Pick's disease is generally considered as a dementia characterized by signs of frontal lobe dysfunction, it can present with selective language defects rather than with cognitive decline. In this study, we report prospective and serial clinical, neuropsychological, and neuroradiologic observations in a 59-year-old man whose prominent disturbance was in the retrieval and learning of names denoting concrete entities and actions. Postmortem study confirmed the diagnosis of Pick's disease and revealed that neuronal loss and gliosis were most prominent in left anterior temporal cortices. The findings are in keeping with evidence that the left anterior temporal cortices and interconnected hippocampal system are critically involved in the learning and retrieval of verbal lexical items. The evidence from this patient, along with similar evidence from the literature we reviewed, suggests that when patients present with a progressive aphasia characterized by anomia, Pick's disease should be considered as the probable diagnosis.