C. Caltagirone

Validity of some neuropsychological tests in the assessment of mental deterioration.

Eighty‐three control subjects and 200 patients suspected of diffuse cerebral damage were submitted to the Mental Deterioration Battery. Three independent judges evaluated each patient on the basis of all available data. Only 103 patients, unanimously classed as demented by the three judges were retained. On the basis of controls performances, the scores obtained by each demented patient in the various tests were corrected for age and educational level. Both single tests and the Battery as a whole discriminated normal controls from demented patients at a very satisfactory level.

Constructional Apraxia in Left Brain-Damaged Patients: A Planning Disorder?

The aim of the present study was to verify the hypothesis advanced by Hécaen and Assal (1970), that the presence of landmarks can improve the copying performance of left brain-damaged patients, while leaving unchanged that of right brain-damaged patients. Sixty-two control subjects and 196 brain-damaged patients with lesions restricted to the right (N = 84) or to the left (N = 112) cerebral hemisphere were given two tests of copying drawings. In the first task the patients were asked to directly copy a drawing; to perform the second test they were given guiding landmarks. On both tests no difference was found between the performance of the two hemispheric groups. Right-sided patients used a lower number of guiding landmarks, but this occurred only on the half of the drawings contralateral to the side of the lesion and was apparently due to unilateral spatial neglect.

Selective semantic-lexical impairment of language comprehension in right-brain-damaged patients

Abstract Fifty right-brain-damaged patients and thirty-nine normal controls were given two tests of semantic-lexical discrimination (auditory language comprehension and reading comprehension) and a test of phoneme discrimination. The aims of the research consisted in checking: (A) if right-brain-damaged patients are significantly more impaired than normal controls on the tasks of semantic discrimination even when the influence of associated variables (such as unilateral spatial neglect or general mental impairment) is ruled out; and (B) if semantic-lexical disorders of right-brain-damaged patients are selective or if they are associated with disorders of phoneme discrimination. Results have shown that right hemispheric lesions consistently impair semantic-lexical discrimination but do not hamper phoneme discrimination. Some implications of these results are discussed.

Focal brain lesions and intelligence: A study with a new version of Raven's colored matrices

Contrasting results have been obtained in previous investigations, which have used the standard version of Ravens Colored Progressive Matrices for studying the effects of localized brain lesion on visual-spatial intelligence. Some of these discrepancies might be due to the fact that specific factors, such as unilateral spatial neglect, could contribute to decreased performance obtained on Ravens test by patients with focal brain lesions. A new set of Colored Matrices, devised to minimize the influence of unilateral spatial neglect without changing the essential features of the original task, was therefore constructed. The test was administered to 76 normal controls, 74 right brain-damaged patients, 87 aphasics, and 61 nonaphasic left brain-damaged patients, in order to study the effect of laterality of lesions and of language impairment on Ravens scores. The results show that, if the influence of unilateral spatial neglect is minimized and Ravens scores are corrected in reference to age, educational level, and lesion size, then: no significant differences are observed between right and left brain-damaged patients; aphasics score worse than nonaphasic left brain-damaged patients; impairment is greater in patients with Wernickes and Global aphasia (i.e., in patients with severe language comprehension disorders) than in patients classified as Brocas, Anomic, or Conduction aphasia; impairment is greater in patients with semantic-lexical discrimination errors than in patients free from semantic-lexical comprehension disorders.

Influence of age, sex, literacy and pathologic lesion on incidence, severity and type of aphasia

The influence of sex, age, educational level and pathologic lesion on incidence, severity and clinical form of aphasia was investigated in 390 right‐handed, left brain‐damaged patients. Sex and educational level were not related to any parameter. Etiology of lesion and age were related to both incidence and type of aphasia. Incidence of aphasia increased with age and was higher in patients with cerebrovascular accidents than in subjects with other types of brain lesions. Non‐fluent forms of aphasia were more frequent in young patients suffering from acute cerebrovascular accidents, whereas anomia prevailed in neoplastic subjects and Wernickes aphasia increased regularly in frequency with age. Some tentative explanations of these findings are discussed.

Oral administration of chronic physostigmine does not improve cognitive or mnesic performances in Alzheimer's presenile dementia.

Physostigmine was administered orally 1 mg q.i.d. for one month to 8 patients with a clinical diagnosis of Alzheimers presenile dementia. The possible beneficial effects of the drug were evaluated by means of a neuropsychological battery administered to all patients before and after treatment. The performances obtained by demented patients on retest did not show any difference in comparison with performances obtained on the first neuropsychologic assessment. Some implications of these negative results are briefly discussed.

Immediate visual-spatial memory in hemisphere-damaged patients: Impairment of verbal coding and of perceptual processing

Abstract A test of immediate visual-spatial memory was administered to 71 normal controls, 140 right and 219 left brain-damaged patients, in order to check if immediate visual recognition is lowered chiefly by an aphasic or by a perceptual disorder. Results showed that both a visual field defect and, even more, a language disturbance impair visual recognition of brain-damaged patiens.

Neurophysiological study of normal pressure hydrocephalus

A neuropsychological Mental Deterioration Battery (MDB) was used to identify deterioration profiles of 43 patients afflicted with normal pressure hydrocephalus (NPH) (n= 18) or other forms of dementia (n= 25). The NPH patients submitted to a shunt‐intervention (n= 10) were also evaluated after surgery. A comparison of profiles, obtained from the experimental and control groups, shows that NPH patients seem to be more impaired in tests designed to detect frontal lobe involvement. Some implications of the relatively greater impairment of frontal functions in NPH dementia are discussed.

Semantic disorders of auditory language comprehension in right brain-damaged patients

A test of auditory language comprehension was given to 110 right brain-damaged patients and to 94 normal controls in order to check if patients with lesions of the right (nondominant) hemisphere make a significantly higher number of semantic errors than normals. Confirmation of the hypothesis was obtained, but the relationship between semantic errors and lesion of the right hemisphere did not seem a simple and direct one. In fact, most of the lexical-semantic errors were due to associated variables (such as unilateral spatial agnosia and general mental deterioration) and not to the lesion of the right hemisphere per se. These data do not suggest a specific semantic capacity of the nondominant hemisphere but rather stress the fragility of the lexical-semantic organization at the cortical level.

Poor performance of right brain-damaged patients on Raven's coloured matrices: Derangement of general intelligence or of specific abilities?

Abstract Two groups of 170 left and 173 right brain-damaged patients were given the Ravens Coloured Matrices, in order to study the influence of the hemispheric side of the lesion on this test of visual-spatial intelligence. A significant difference was found between the two hemispheric groups, the right brain-damaged patients scoring worse than the left hemisphere- damaged subjects. Furthermore, patients with right hemispheric lesions showed a striking tendency to neglect the responses lying on the left side of the page, whereas subjects with left hemispheric damage showed only a mild tendency to neglect the alternatives lying on the right half of the sheet. The worse performances obtained on the Coloured Matrices by right brain-damaged patients seemed due for the most part to unilateral spatial neglect. These findings suggest that the bad performances of patients affected by retro-rolandic right hemispheric lesions are not due to a general intellectual impairment, but rather to the detrimental effect of unilateral spatial neglect and of a general disorder in visual-spatial analysis.