Dysgraphic features in motor neuron disease: a review

BackgroundMotor neuron disease (MND) patients can show oral language deficits mimicking those of frontotemporal degenerations (FTD). Although dysgraphic features have been also reported within the MND-FTD continuum, their characteristics and clinical relevance are still largely unexplored.AimsTo profile writing disorders in MND patients can help further define their cognitive semiology and thus conveys relevant clinical entailments. Therefore, this study aimed at reviewing evidence of writing impairment in MND patients. This review was implemented and reported by consulting Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Qualitative/quantitative measures of writing abilities in MND patients was the primary outcome. Both group studies and case reports/series were taken into consideration. Twenty-four contributions were included out of an initial N=83. Potential biases in generalizing results were qualitatively controlled for by extracting background, disease-related, neuropsychological and neuroanatomofunctional secondary outcomes.Main ContributionFifteen studies assessed writing abilities in Japaneses patients, whereas the remaining eight in western patients. Central dysgraphic features were reported in both neuropsychologically-impaired and –unimpaired MND patients. Phonetic/phonological paragraphias and morpho-syntactic errors were frequently reported. Although FTD was frequently co-occurent, neither cognitive nor language impairment fully accounted for writing impairment in some patients. By contrast, evidence of peripheral dysgraphia was scarce. Patients displaying writing deficits often presented with bulbar signs and perisylvian cortices involvement (including Exner’s area and the left angular gyrus). Writing deficits proved to be associated with abnormalities in executive functioning and its neural substrates. Writing-to-dictation tasks as well as writing samples assessment proved to be useful to detect writing errors.ConclusionsDysgraphic features in MND patients might be due to dysfunctions of the graphemic buffer – and possibly the phonological route. The lexico-semantic route appeared to be less involved. However, a mixed peripheral/central involvement cannot be ruled out. In this population, executive/attentive deficits are likely to contribute to writing errors as well. Writing deficits might thus be specific of MND patients’ cognitive/language impairment profile. The evaluation of writing abilities via writing-to-dictation/narrative writing tasks may be useful when assessing cognition/language in both neuropsychological-impaired and -unimpaired MND patients - especially when severe dysarthria/anarthria is present and prevents clinicians from assessing oral language.

Acquired dysgraphia in adults following right or left-hemisphere stroke

OBJECTIVE: This study aimed to assess the strengths and difficulties in word and pseudoword writing in adults with left- and right-hemisphere strokes, and discuss the profiles of acquired dysgraphia in these individuals.METHODS: The profiles of six adults with acquired dysgraphia in left- or right-hemisphere strokes were investigated by comparing their performance on word and pseudoword writing tasks against that of neurologically healthy adults. A case series analysis was performed on the patients whose impairments on the task were indicative of acquired dysgraphia.RESULTS: Two patients were diagnosed with lexical dysgraphia (one with left hemisphere damage, and the other with right hemisphere damage), one with phonological dysgraphia, another patient with peripheral dysgraphia, one patient with mixed dysgraphia and the last with dysgraphia due to damage to the graphemic buffer. The latter patients all had left-hemisphere damage (LHD). The patterns of impairment observed in each patient were discussed based on the dual-route model of writing.CONCLUSION: The fact that most patients had LHD rather than right-hemisphere damage (RHD) highlights the importance of the former structure for word processing. However, the fact that lexical dysgraphia was also diagnosed in a patient with RHD suggests that these individuals may develop writing impairments due to damage to the lexical route, leading to heavier reliance on phonological processing. Our results are of significant importance to the planning of writing interventions in neuropsychology.

Letter Position Dyslexia in Arabic: From Form to Position

This study reports the reading of 11 Arabic-speaking individuals with letter position dyslexia (LPD), and the effect of letter form on their reading errors. LPD is a peripheral dyslexia caused by a selective deficit to letter position encoding in the orthographic-visual analyzer, which results in migration of letters within words, primarily of middle letters. The Arabic orthography is especially interesting for the study of LPD because Arabic letters have different forms in different positions in the word. As a result, some letter position errors require letter form change. We compared the rate of letter migrations that change letter form with migrations that do not change letter form in 10 Arabic-speaking individuals with developmental LPD, and one bilingual Arabic and Hebrew-speaking individual with acquired LPD. The results indicated that the participants made 40% letter position errors in migratable words when the resulting word included the letters in the same form, whereas migrations that changed letter form almost never occurred. The error rate of the Arabic-Hebrew bilingual reader was smaller in Arabic than in Hebrew. However, when only words in which migrations do not change letter form were counted, the rate was similar in Arabic and Hebrew. Hence, whereas orthographies with multiple letter forms for each letter might seem more difficult in some respects, these orthographies are in fact easier to read in some forms of dyslexia. Thus, the diagnosis of LPD in Arabic should consider the effect of letter forms on migration errors, and use only migratable words that do not require letter-form change. The theoretical implications for the reading model are that letter form (of the position-dependent type found in Arabic) is part of the information encoded in the abstract letter identity, and thus affects further word recognition processes, and that there might be a pre-lexical graphemic buffer in which the checking of orthographic well-formedness takes place.