Nonverbal Material Research Articles

Nonverbal selective reminding test: Efficacy in the assessment of adults with temporal lobe epilepsy

Although the relationship of verbal memory tests to left temporal lobe epilepsy (LTLE) has reportedly been well established, research on the relationship of nonverbal memory to right TLE (RTLE) has yielded mixed findings, thus bringing into question the clinical utility of nonverbal memory assessment. In the present study, we used a selective reminding procedure for nonverbal spatial material to control for procedural factors, such as verbal mediation, which may in part be the basis for these mixed findings. A sample of 39 LTLE patients and 33 RTLE patients were given both a test of verbal selective reminding (VSR) and a test of nonverbal selective reminding (NVSR) as part of a presurgical evaluation. Diagnosis of RTLE and LTLE was rendered after an extensive presurgical evaluation including magnetic resonance imaging, video-electroencephalography, the intracarotid sodium amytal procedure, and intracranial electrodes when necessary. Results obtained from the NVSR allowed better classification of patients than did VSR, yielding 40% above chance classification. More important, given impaired performance, the probability that a patient had RTLE was 0.70. VSR performance did not allow for classification significantly above chance levels. Although combining the resultsfrom the VSR and NVSR resulted in the best classification, the gain was minimal (72% vs. 70% for NVSR alone), particularly because 26 patients could not be classified. Our results support previous findings of a relationship between nonverbal memory performance and RTLE epilepsy but bring into question the unequivocal acceptance of an exclusive relationship of verbal memory to LTLE.

Intact implicit memory for novel patterns in Alzheimer's disease.

Repetition priming is a kind of implicit memory (learning without awareness) that does not depend on the medial temporal-lobe system. For example, the amnesic patient H.M., who underwent bilateral medial temporal-lobe resection, shows intact priming with novel patterns, suggesting that perceptual priming with nonverbal material does not depend on areas critical for explicit memory. A logical candidate for the neural substrate that supports this kind of priming is the peristriate cortex, an area that is relatively spared in Alzheimer's disease (AD). We therefore predicted that AD subjects would be unimpaired on pattern priming. Subjects copied each of six target figures onto dot patterns. After performing a 3-min distractor task, they were given the same dot patterns (without lines) and asked to draw the first figure that came to mind by connecting the dots with straight lines. Subsequently, in a test of recognition (explicit) memory, subjects viewed each of the six patterns of dots that they had copied previously and were asked to indicate which of four possible completions corresponded to the figure that they had copied 3 min earlier. The AD and control groups achieved comparable priming scores, but AD subjects were significantly impaired in recognizing the patterns explicitly. Our finding of intact pattern priming in AD provides, for the first time, evidence that pattern priming depends on the peristriate cortex.

Is semantic memory consistently impaired early in the course of Alzheimer's disease? Neuroanatomical and diagnostic implications

To establish whether semantic memory is consistently impaired in patients with very mild dementia of Alzheimer's type (DAT), we assessed episodic and semantic memory in 52 patients with DAT who were divided into three sub-groups according to dementia severity on the Mini-Mental State Examination (minimal > 23, mild 17–23 and moderate < 17) and 24 matched controls. The minimal group showed impairment on the following semantic memory measures: category fluency, naming of line drawings, naming to verbal description, answering semantic feature questions and a non-verbal picture-picture matching task (the Pyramids and Palm Trees Test). The mild and moderate groups showed additional deficits on picture sorting and word-picture matching tests. Within the minimal and mild groups there was, however, considerable heterogeneity. While some patients showed a consistent impairment across all of the semantic memory tests, others were impaired only on a subset of these tests and a few even performed flawlessly. In contrast, all patients showed a profound deficit in episodic memory: delayed recall of new verbal and non-verbal material appears to be a particularly sensitive marker of early DAT. These data are in keeping with recent neuropathological studies demonstrating that the transentorhinal region is consistently involved at a very early stage. Lesions in this site cause a functional disconnection of the hippocampus, and hence a profound episodic memory disorder. The fact that many, but not all, patients with early disease also show impairment of semantic memory suggests that damage to the transentorhinal region is not sufficient to produce significant disruption of semantic memory. Such disruption reliably occurs, we hypothesize, only when the pathology extends to the temporal neocortex proper.

The utility of the warrington recognition memory test for temporal lobe epilepsy: Pre- and postoperative results

We wished to examine the ability of the Warrington Recognition Memory Test (RMT) to distinguish epilepsy of left versus right temporal lobe origin during preoperative testing and to assess pre- to postoperative changes in memory function after anterior temporal lobectomy (ATL). Seventy-seven patients were assessed preoperatively and 6–8 months postoperatively. Patients' performance for verbal (Words) and nonverbal (Faces) material was examined with raw, scaled, and discrepancy scores, as well as with more formal diagnostic efficiency statistics and receiver operating characteristics (ROC) curves. Preoperatively, no aspect of the RMT could reliably distinguish left from right temporal lobe epilepsy groups. Examination of pre- to postoperative memory change showed declines in Word recognition memory after left ATL and less consistent declines in Face recognition memory after right ATL. Diagnostic efficiency statistics demonstrated poor classification ability preoperatively and improved classification ability postoperatively. We conclude that the RMT is not insensitive to lateralized temporal lobe lesions (as demonstrated by the pre- to postoperative performance changes), but it is of extremely limited clinical utility in identifying laterality of temporal lobe seizure onset preoperatively. The reasons for this interesting pattern of results are discussed.

A deficit profile of executive, memory, and motor functions in schizophrenia

This study examined the neuropsychological deficits associated with schizophrenia and the interrelationships among multiple dissociable cognitive and motor functions. The tests were selected for their previously demonstrated sensitivity to circumscribed brain pathology and included four functional domains: executive functions, short-term memory and production, motor ability, and declarative memory. Each test composite was divided according to verbal versus nonverbal material or left- versus right-hand performance; this distinction permitted functions principally subserved by the left or right cerebral hemispheres to be tested separately. Data reduction was theoretically driven by the test selection and was achieved first by standardizing the scores of each test for age-related differences observed in the normal control group, and then by calculating test composite scores as an average of the age-corrected Z-scores of the tests comprising a functional composite. The schizophrenic group was impaired equivalently on all composites for both cerebral hemispheres; on average, the Z-scores of the patients were 1 standard deviation below those of the control group. The cognitive test composite scores were highly intercorrelated but showed only weak associations with motor ability. Multiple regression analyses suggested that symptom severity was a significant predictor of the Declarative Memory and Short-Term Memory/Production composite scores after accounting for disease duration, whereas disease duration uniquely contributed to the Executive Functions composite scores after controlling for symptom severity. Even though the schizophrenics as a group showed an equivalent level of deficit across all test composites, 1) the deficits were associated with different aspects of psychiatric symptomatology, 2) the motor deficit was independent of the cognitive deficits, and 3) each neuropsychological domain contributed independently to the deficit pattern. Thus, what appears to be a generalized functional deficit in schizophrenia may actually be, at least in part, combinations of multiple specific deficits.

Remote Memory and Lexical Retrieval in a Case of Frontal Pick's Disease

To examine the status of remote memory and lexical retrieval processes in a patient with frontal lobe-type dementia studied serially during an 18-month period. Longitudinal single-case study. University hospital. A 67-year-old man presented to the hospital with progressive frontal lobe dysfunction confirmed by neuropsychological testing and single photon emission-computed tomographic scan. Postmortem brain examination demonstrated focal atrophy of the orbitofrontal region of the frontal lobe and medial temporal structures with abundant Pick's bodies and Pick's cells. Anterograde memory was assessed on a range of free recall and recognition tests using verbal and nonverbal material. Remote memory was assessed by Famous Faces and Famous Events tests and the Crovitz test of remote personal memory. Lexical retrieval was examined using initial-letter and semantic category-based fluency tasks. Initially there was a dissociation between anterograde memory, which was severely impaired, and relatively spared remote memory. Within retrograde memory there was evidence of selective difficulty in retrieving contextually rich and time-specific personal memories and in dating personal and public memories. In contrast, retrieval of names of famous persons and recognition of famous events was relatively normal. As the disease progressed, performance on all remote memory tests worsened, but without a temporally graded pattern. Lexical retrieval was markedly impaired and affected to an equivalent degree performance on initial-letter and category fluency tasks. These findings are interpreted in the context of a general retrieval deficit resulting from the interruption of frontostriatal circuits.

Simultaneous verbal and affective laterality effects

By analyzing the error scores of normal participants asked to identify a specific word spoken in a specific tone of voice (for example, the word “tower” spoken in a happy tone of voice), we have been able to demonstrate concurrent verbal and affective cerebral laterality effects in a dichotic listening task. The targets comprised the 16 possible combinations of four two-syllable words spoken in four different tones of voice. There were 128 participants equally divided between left- and right-handers, with equal numbers of each sex within each handedness group. Each participant responded to 144 trials on the dichotic task, and filled in the 32-item Waterloo Handedness Questionnaire. Analysis of false positive responses on the dichotic task (responding “yes” when only the verbal or only the affective component of the target was present, or when both components were present but were at opposite ears) indicated that significantly more errors were made when the verbal aspect of the target appeared at the right ear (left hemisphere) and the emotional aspect was at the left ear (right hemisphere) than when the reverse was the case. A single task has generated both effects, so that differences in participants' strategies or the way in which attention is biased cannot account for the results. While the majority of participants showed a right-ear advantage for verbal material and a left-ear advantage for nonverbal material, these two effects were not correlated, suggesting that independent mechanisms probably underly the establishment of verbal and affective processing. We found no significant sex or handedness effects, though left-handers were much more variable than were right-handers. There were no significant correlations between degree of handedness as measured on the handedness questionnaire and extent of lateralization of verbal or affective processing on the dichotic task. We believe that this general technique may be able to provide information as to the nature and extent of interhemispheric integration of information, and is easily adaptable to other modalities, thus holds great promise for future research.

Neuropsychological Sequelae of Wernicke′s Encephalopathy in a 20-Year-Old Woman: Selective Impairment of a Frontal Memory System

This article reports the neuropsychological sequelae of Wernicke"s Encephalopathy in a 20-year-old woman. After amelioration of acute symptoms, the patient showed a range of cognitive impairments the most marked of which was a severe impairment on free recall tasks involving both verbal and nonverbal material. In contrast, recognition memory appeared remarkably well preserved. Some evidence of frontal lobe and general intellectual impairment was also noted. The case is discussed in terms of the pathophysiology of Wernicke–Korsakoff Syndrome, criteria for its diagnosis, and the multicomponent nature of memory deficits.

Selective impairment of the “central executive” component of working memory: A single case study

We report the case of a head-injured patient (AM) with a specific short-term memory impairment. He did not show any deficit in long-term memory and presented no sign of either intellectual or frontal dysfunction. His spans for verbal and nonverbal material were reduced and he showed a lack of recency effect in free recall for visually presented words. We observed word length and phonological similarity effects as well as the abolition with articulatory suppression of the visual and auditory word length effect and of the visual phonological similarity effect, indicating that both the phonological store and the articulatory rehearsal mechanism were functioning. Furthermore, our investigations did not evidence any structural defect in either the control and planning functions of the central executive, or in its storage functions. The deficit AM presented on a verbal and nonverbal Brown-Peterson task, especially when the distractor tasks were more demanding, suggests that AM's central executive disposed of fewer processing resources. This resource reduction seemed to affect only short-term storage but not processing, and was interpreted as the consequence of strategic adaptation by the patient. Finally, the resource reduction did not cause interference on those divided attention tasks not requiring storage. As such, these results call for a more accurate specification of the allocation of resources in dual tasks.

Nonverbal priming in amnesia.

In this experiment, we examined whether a group of well-characterized amnesic patients would exhibit normal priming for novel nonverbal materials after a single exposure. Both amnesic patients and normal control subjects studied line figures and were then given a priming test in which they were asked to reproduce both old (studied) and new (unstudied) figures after a brief exposure. The measure of priming was the number of old patterns drawn correctly relative to the number of new patterns drawn correctly. Both subject groups reproduced more old patterns than new patterns, and the effect was similar in the two groups. In contrast, amnesic patients were significantly impaired on a recognition memory test for the items that had been presented. This study contributes to recent evidence that implicit memory can support the rapid acquisition of novel verbal and nonverbal information. Perceptual priming for such material is independent of the structures damaged in amnesia.

Priming of spatial configurations in alcoholic Korsakoff's amnesia

To examine priming for novel, nonverbal patterns, a modification of the paradigm used by Gabrieli et al. (1990, Neuropsychologia, 28, 417–427) was administered to a group of Korsakoff patients, a group of alcoholic controls, and a group of normal controls. Subjects were asked to connect five-dot configurations into the first pattern that came to mind. Priming was than assessed by having the subjects copy experimenter-provided interpretations for each configuration and examining the effect of this manipulation on the subjects' subsequent interpretation of the same configurations. For the Korsakoff patients, the copied prime replaced their initial perceptual interpretation less frequently than it did for normal controls. Instead, the prime had its effect by combining with the baseline percept. These findings suggest that priming for novel, nonverbal material is weaker and less direct for Korsakoff patients than it is for controls.

Mirror phenomena in language and nonverbal activities—A case report

A case is described of a 38-year-old, left-handed female who demonstrated mirror phenomena for both language and non-motor, nonverbal material. She mirror-wrote with her left hand with normal right-hand writing. Mirror-reading as well as object and spatial reversals were revealed. These data are consistent with bilateral representation of visual engrams, with one hemisphere containing a mirror-reversed representation of the other.

DOUBLE DISSOCIATION OF SHORT-TERM AND LONG-TERM MEMORY FOR NONVERBAL MATERIAL IN PARKINSON'S DISEASE AND GLOBAL AMNESIA

The traditional concept of memory disorder is deficiency of the long-term (LTM) but not short-term (STM) component of memory. STM impairment with LTM sparing is seldom reported. The present study investigated STM and LTM for nonverbal material in three neurological conditions associated with memory impairment: bilateral medial temporal lobe lesions (patient H.M.), Parkinson's disease (PD) and Alzheimer's disease (AD). Subjects received 3 tests of nonverbal memory: forward block span, immediate and delayed recall of the Wechsler Memory Scale drawings, and immediate and delayed recognition of abstract designs. Compared with the normal control group, the patient groups displayed different patterns of sparing and loss of the two components of memory: in PD, only STM was impaired; in medial temporal lobe amnesia, only LTM was impaired; and in AD, STM and LTM were both impaired. The contrasting patterns of sparing and loss of STM and LTM in PD and global amnesia were present for both recognition and recall. These results provide evidence that STM and LTM are dissociable processes and are served by separate neurological systems: STM depends upon intact corticostriatal systems, whereas LTM depends upon intact medial temporal lobe systems.

Learning Disabilities in Epilepsy: Neurophysiological Aspects

Subclinical generalized spike-wave discharges are often accompanied by transitory cognitive impairment, demonstrable by psychological testing during EEG recording. Transitory cognitive impairment is demonstrated most readily by difficult tasks and during generalized regular spike-wave bursts lasting for more than 3 s, but can also be found during briefer and even focal discharges. That this is not simply a consequence of global inattention is shown by the fact that focal discharges exhibit some specificity: left-sided focal spiking is more likely to produce errors on verbal tasks, for instance, whereas right-sided discharges are more often accompanied by impairment in handling nonverbal material. Both learning difficulties in general and specific abnormal patterns of cognitive functioning are well documented in children with epilepsy and are most pronounced in those with frequent interictal discharges. However, there is now evidence that intermittent cognitive impairment due to the discharges themselves contributes significantly to such neurophysiological abnormalities. The significance of transitory cognitive impairment accompanying subclinical EEG discharges for everyday functioning is uncertain, but there is experimental evidence that subclinical discharges may be accompanied by disruption of educational skills in children or by impairment of driving performance in motorists. In some individuals, suppression of discharges by antiepileptic drugs has demonstrably improved psychological function, but further work is required to determine the indications for such treatment.

The Playground of the Peritext

The Playground of the Peritext Margaret R. Higonnet (bio) In children's literature, the brevity of the average text throws into the foreground what French critics have called the "peritext." (By peritext, they understand "peripheral" features such as the cover, titlepage, table of contents, chapter titles, epigraphs, postface, and above all illustrations. Genette, for example, in Palimpsestes, lists "titre, sous-titre, intertitres; préfaces, postfaces, avertissements, avant-pages etc; notes marginales, infrapaginales, terminales; épigraphes, illustrations; pière d'insérer, bande, jaquette" (9). Obviously, in picture-books the verbal narrative constitutes but a portion of the whole, and what surrounds it becomes a more conspicuous part of the book. The relative weight of non-verbal material in nineteenth-century children's books reflected the influence of the Arts and Crafts movement, which held that even endpapers might play a role in unifying the design of a book. If organicist theory guided many artists, so did theories of education through pleasure. An interest in play gave relief to comic articulations between picture and caption, or between title and contents. Features that in adult literature are usually taken by critics to be peripheral to the text, in children's literature are deliberately used to enhance the reader's consciousness of the material existence of the text as an object, a "toy" as well as a text. And the frequent evocation in children's literature of an oral dialogue (even more common in Victorian fiction than it is today) draws attention to the text as an ever-renewable dramatic occasion. Thus children's literature offers a particularly rich domain for the exploration of the functions and effects of peritexts. We routinely assume that the (printed) verbal text is the "body" of the book. Outside this "body" of the narrative lie elements that physically precede it, those that lie in the margin, those that cut into the text or interrupt it, and those that fall at the end. The physical order most often corresponds to the sequence in which we actually encounter them. A reading of the front cover, frontispiece, and table of contents, for example, usually precedes one's reading of the text—though French books throw the table of contents to the back. Prefaces, footnotes, and appendices are more problematic; some of us, like secret prestidigitators, delight in interrupting the text by recourse to these extra-texts and have a special penchant for books in whose bindings there are strings to help us flip back and forth. The children's book puts the hierarchy and order of encounter with these peritextual elements into question, for a child familiar with books as objects of play will often look at the last page, or check out the illustrations going from back to front, before entering into the narrative. Such subversive techniques short-circuit suspense and the tyranny of narrative concatenation; yet they are, paradoxically, valuable ways of building a normative sense of narrative form. The typical book for very young children continuously opens itself up through the functioning of devices extrinsic to the work and to narrative. The material existence of children's books has an importance that is virtually absent in serious literature for adults. We can offer various explanations for this difference. Historically, Newbery already assimilated books to "toys," by marketing some (for boys) with a top and others (for girls) with a pincushion. Eighteenth-century educational theorists stressed the coordination between muscular and mental development (the old concept of mens sana in corpore sano given a new twist). One could botanize while enjoying a walk or learn the alphabet by baking shaped cookies. Harlequinades, moveable books, and pop-ups, often accompanying a story full of surprises, dramatize the reader's role in unfolding every narrative. Even more explicitly, so does the fold-out book. The process by which every reader, in turning the page, extends and perpetuates the narrative, takes physical shape in the fold-out. Although some of these, like the art-books by Warja Lavator published by the Galerie Maeght, are completely wordless, many double the verbal sequence with a visual one. An example is Warja Lavator's Blanche Neige, une imagerie d'après le conte. This story...

A New Approach to Cerebral Asymmetry: RT Differences in Simultaneous Bimanual Finger Movement during Verbal and Nonverbal Tasks

This study was aimed at testing a new approach for examination of functional laterality based on hemispheric specialization. The subjects had to perform verbal (words/nonwords) and nonverbal (similar/different patterns) discrimination. The separation of the two hemispheres during information processing was realized by requiring a simultaneous response of both index fingers. The obtained over-all reaction times (RT) were faster for verbal than for pattern tasks. Considering the RTs for solely the particular, faster response of one or the other index finger, the right index finger turned out to be faster on verbal tasks whereas the left one dominated on pattern tasks. According to the hypothesis that the faster hand indicates the more active (contralateral) hemisphere, it can be assumed that words are responded to more quickly when processed in the left hemisphere. On the other hand, patterns are responded to more quickly when the right hemisphere is active. These results suggest that each hemisphere may be capable of processing verbal and nonverbal material; the speed of information processing, however, is faster in the more adept one.

Bitemporal hypoperfusion in transient global amnesia: 99m-Tc-HM-PAO SPECT and neuropsychological findings during and after an attack.

We report a patient who was evaluated neuropsychologically and with single photon emission computed tomography (SPECT) during and after an episode of transient global amnesia. During the attack, there was patchy retrograde amnesia and an inability to learn both verbal and non-verbal material. SPECT showed severe bitemporal hypoperfusion. Serial neuro-psychological testing documented a rapid recovery of recognition, but delayed recovery in reproduction of learned information. Recovery of spontaneous verbal and figural fluency was even further delayed. Follow up SPECT examination showed a recovered cerebral perfusion. This case supports the hypothesis that TGA is associated with transient hypoperfusion of bilateral medial-temporal brain structures and suggests an additional involvement of structures responsible for drive and initiation.

Normal aging and forgetting rates on the Wechsler Memory Scale-Revised.

The deleterious effects of aging on various cognitive abilities are widely recognized, yet little is known regarding what constitutes "normal" memory test performance in individuals over the age of 74. In this study, forgetting rates for verbal and nonverbal material from the Wechsler Memory Scale-Revised (WMS-R) were examined in groups of older healthy individuals, age 50-70 and 75-95. Despite equivalent scores on measures of global cognitive status and attention/ concentration, the older group demonstrated significantly more rapid forgetting rates on the Visual Reproduction, Verbal Paired Associates, and Visual Paired Associates subtests of the WMS-R. Although patients with Alzheimer's disease also evidence very rapid forgetting on some subtests, the severity and pattern of losses appears useful in differentiating "abnormal" forgetting from that exhibited by normal elderly subjects. Preliminary normative data for normal elderly subjects on the WMS-R are presented, and the need for appropriate norms for elderly individuals is discussed.

Normal aging and forgetting rates on the wechsler memory scale-revised

The deleterious effects of aging on various cognitive abilities are widely recognized, yet little is known regarding what constitutes “normal” memory test performance in individuals over the age of 74. In this study, forgetting rates for verbal and nonverbal material from the Wechsler Memory Scale-Revised (WMS-R) were examined in groups of older healthy individuals, age 50–70 and 75–95. Despite equivalent scores on measures of global cognitive status and attention/ concentration, the older group demonstrated significantly more rapid forgetting rates on the Visual Reproduction, Verbal Paired Associates, and Visual Paired Associates subtests of the WMS-R. Although patients with Alzheimer's disease also evidence very rapid forgetting on some subtests, the severity and pattern of losses appears useful in differentiating “abnormal” forgetting from that exhibited by normal elderly subjects. Preliminary normative data for normal elderly subjects on the WMS-R are presented, and the need for appropriate norms for elderly individuals is discussed.

A NEW APPROACH TO CEREBRAL ASYMMETRY:RT DIFFERENCES IN SIMULTANEOUS BIMANUAL FINGER MOVEMENT DURING VERBAL AND NONVERBAL TASKS

This study was aimed at testing a new approach for examination of functional laterality based on hemispheric specialization. The subjects had to perform verbal (words/nonwords) and nonverbal (similar/different patterns) discrimination. The separation of the two hemispheres during information processing was realized by requiring a simultaneous response of both index fingers. The obtained over-all reaction times (RT) were faster for verbal than for pattern tasks. Considering the RTs for solely the particular, faster response of one or the other index finger, the right index finger turned out to be faster on verbal tasks whereas the left one dominated on pattern tasks. According to the hypothesis that the faster hand indicates the more active (contralateral) hemisphere, it can be assumed that words are responded to more quickly when processed in the left hemisphere. On the other hand, patterns are responded to more quickly when the right hemisphere is active. These results suggest that each hemisphere may be capable of processing verbal and nonverbal material; the speed of information processing, however, is faster in the more adept one.