24

TENNET XI

gan et al., 1984) using different measures (naming latency, gaze duration), this position appears to be located at the word center rather than to the left of the center of
the word. It would be difficult to explain this central position of OVP by either the
hypothesis in terms of a hemispheric specialization (Brysbaert & Ydewalle, 1990) or
an asymmetric perceptual span (Rayner et al., 1980). Regarding the lexical hypothesis
(O'Regan & Jacobs, 1992), the present state of research neither confirms nor rejects
it. On the one hand, visual fixation on the third letter induces better letter identification
for all kinds of stimuli; on the other hand, in terms of reading performance only
words benefit from third letter fixation. Further experiments mixing stimuli of different length and nature are still needed to thoroughly investigate OVP in reading and
to verify the proposal that only oculomotor factors could account for OVP (Nazir et
al., 1992).
This research was supported by the Rhone-Alpes Council (Arrash and Thematiques
Contracts).

ACKNOWLEDGMENT
This research was supported by the Rhone-Alpes Council (Arrash and Thematiques Contracts).

REFERENCES
Brysbaert, L., & Ydewalle, G. (1990). Collosal transmission in reading: Two new experiments. Proceed-

ings of the Fifth European Conference on Eye Movements.
Content, A., Mousty, P., & Radeau, M. (1990). Brulex. Une base de donnres lexicales informatisres
pour le franqais 6crit et pad& L'Ann~e Psychologique, 90, 551-566.
Delatollas, G., De Agostini, M., Jallon, P., Poncet, M., Rey, M., & Lellouch, J. (1988). Mesure de la
prrfrrence manuelle par auto-questionnaire dans la population franqaise adulte. Revue de Psychologie Appliqu~e, 38, 117-136.
Nazir, T. A., Heller, D., & Sussman, C. (1992). Letter visibility and word recognition: The optimal
viewing position in printed word. Perception and Psychophysics, 52, 315-328.
O'Regan, J. K., & Jacobs, A. M. (1992). Optimal viewing position effect in word recognition: A challenge
to a current theory. Journal of Experimental Psychology: Human Perception and Performance, 18,
185-197.
O'Regan, J. K., Levy-Schoen, A., Pynte, J., & Brugaillere, B. (1984). Convenient fixation location within
isolated words of different length and structure. Journal of Experimental Psychology: Human Perception and Performances, 10, 250-257.
Rayner, K., Well, A. D., & Pollatsek, A. (1980). Asymmetry of the effective visual field in reading.
Perception and Psychophysics, 31, 537-550.

Language Production and Comprehension in an Adult with ACoA Syndrome

Venu Balasubramanian, Karen Murphy, Shelly Spatafore, Rene Lopardo,
and Vanessa Dickinson
Seton Hall University
This study explored the prediction that cases with anterior communicating artery (ACoA)
syndrome will exhibit deficits in higher-level language production and comprehension. A 65year-old adult male with a history of ACoA syndrome was tested on higher-level linguistic
tasks. The patient's performance on discourse comprehension, discourse production, and linguistic ambiguity comprehension tasks was impaired. © 2001AcademicPress

TENNET Xl

25

Introduction
The anterior communicating artery (ACoA) supplies septal nuclei, genu of the
corpus callosum, anterior cingulum, optic chiasm, columns of the fornix, substantia
inominato, anterior hypothalamus, and the mesial anterior commissure (DeLuca &
Diamond, 1995). Some of these structures, especially the anterior cingulum, play a
crucially important role in episodic and semantic memory as well as in attentional
mechanism (Desgranges et al., 1998; Cabeza et al., 1997; Grossman et al., 1992).
As a part of the ventromedial cortices, the anterior cingulate gyms receives projections from all sensory modalities including vision, audition, and touch and maintains
bidirectional connections with other memory related structures such as hippocampus
and amygdala (Tranel & Damasio, 1995; Frackowiak et al., 1997).
Interruption of the ACoA has the potential to affect memory, given the fact that
ACoA supplies many areas that serve memory. Persistent anterograde and/or retrograde memory deficits are frequently observed in this population. A profound deficit
of recall from long-term memory often exists, whereas recognition and short-term
memory seem tess disturbed (Irle et al., 1992; Hanley et al., 1994). The ACoA syndrome, seen in patients who survived the bursting of aneurysm in the ACoA, consists
of amnesia, confabulation, and personality change (Alexander et al., 1984). Most
studies, including a comprehensive review of literature in this area (Deluca & Diamond, 1995), have reported that language functions (expressive, receptive, naming,
repetition, reading, writing, etc.) were preserved in ACoA syndrome. Only one case
was reportedly aphasic (Steinman & Bigler, 1986).
Contrary to the assertion about the preservation of language functions in this population, there appears to be ground for impairment of higher-level language functions
in ACoA syndrome. As the recent years have witnessed, the clinical populations that
were traditionally known mostly for motor speech disorders and/or cognitive deficits
(e.g., patients with right hemisphere damage, Parkinson's disease, or Huntington's
disease), when came under closer scrutiny, revealed the existence of higher-level
language problems. (Cohen et al., 1994; Grossman et al., 1992; Murray & Stout,
1999; Sherratt & Penn, 1990). Furthermore, a few studies have reported high correlation between cognitive impairments (e.g., attention or memory deficits) and sentence/
discourse level comprehension in patients with degenerative diseases (Grossman et
al., 1992; Murray & Stout, 1990). Discourse comprehension and narrative recall require, among other things, intact cognitive resources such as short-term memory
(STM) and long-term (episodic and semantic) memory systems (Sherratt & Penn,
1990). Phonological short-term memory, a component of STM, adjudicates between
conflicting interpretation of a given sentence and allows repeated attempts to understand complex sentences (Van der Linden & Poncelet, 1998). However, not all memory researchers agree with the separation of memory from language (MacKay &
Abrams, 1996).
In ACoA syndrome, as several neuropsychological studies have reported, both
long- and short-term memory systems may be implicated to varying degrees. A striking feature of the previous research related to ACoA syndrome is the lack of studies
that looked at higher-level language performance. In light of the studies reviewed
above, the present study explores the prediction that patients with ACoA syndrome
will be impaired in comprehension of ambiguous sentences and narrative discourse
as well as in narrative production/recall.

Methods
Subject. JG, a 64-year-old male who is a resident of a long-term rehabilitation
hospital, was diagnosed with ACoA syndrome. On November 4, 1985, this case was
admitted to an emergency hospital following a sudden collapse and unresponsiveness.

26

TENNET XI

When he was brought to the emergency room, clinical examination revealed no focal
neurological signs. A C T scan performed 3 days later was indicative of diminishing
subarachnoid hemorrhage and a persistent focal subarachnoid hemorrhage in the region of the anterior communicating artery aneurysm. The CT scan also revealed lesions in the anterior inferior, medial frontal lobe, cingulate gyrus, posterior inferior
frontal gyrus, and anterior callosal margins.
Neuropsychological evaluation. JG underwent extensive neuropsychological
evaluation. The neuropsychological report indicates that JG's immediate memory for
both visual designs and stories was moderately impaired. He was unable to recall
any visual designs or story detail after a 30-min delay. JG's performance on the
Differential Verbal Learning Test suggests some ability for new learning with repetition but unfortunately a tendency to erroneously learn information that was not presented. On Weschler Adult Intelligence Scale (Revised), JG achieved a verbal IQ of
83, a performance IQ of 71, and a full-scale IQ of 78. His performance on Wechler
Memory Scale (revised) suggests moderately impaired levels of orientation to personal and current information. On the Folstein Mini-Mental State exam, he scored 20
of 30 possible points. This level of performance typically indicates mildly impaired
functioning in older adults.
Materials and procedures. The subject was tested on Boston Diagnostic Aphasia
Examination (Goodglass & Kaplan, 1983), Boston Naming Test (Kaplan, Goodglass,
Wintraub, & Segal 1983), Discourse Comprehension Test (Brookshire & Nicholas,
1993), Discourse Production Task (Wyckof, 1984), and Linguistic Ambiguity Comprehension Test (Balasubramanian, 1987). Following the standard procedures described in the test manual, the Boston Diagnostic Aphasia Examination (BDAE) and
the Boston Naming Test (BNT) were administered in the first session of testing. The
primary purpose of using BDAE and BNT with this case was to identify aphasia or
aphasia syndrome, if any. The three experimental tasks of this study are described
below.
The Discourse Comprehension Test (DCT) is a test designed to measure discourse
comprehension using stories. This test includes two sets (A and B) of stories, each
having five stories. The mean number of words included in these stories was 205.6.
The mean number of sentences in the stories was 14.0. The mean sentence length
was 14.7. Only stories from Set A were read to the subject. Following the presentation
of each story, the client answered eight questions. These questions examined stated
main idea, implied main idea, stated details, and implied details. Each correct answer
was given one point.
The Discourse Production Task (DPT) involved immediate verbal recall of three
short stories that were read to the client by the researcher. These stories contained
10 to 15 propositions. Following the presentation of each story, the client verbally recalled the story. The number of propositions recalled from each story was
counted.
The Linguistic Ambiguity Comprehension Test (LACT) is a test that includes three
sets of sentences and each set includes 10 ambiguous sentences. Three types of ambiguity, namely, lexical (LA), deep structure (DSA), and surface structure (SSA), were
represented by the three sets of sentences. This test used sentence-picture matching
task. For each of the sentence (LA, The man lifted the trunk; DSA, Flying planes
can be dangerous; and SSA, The woman told her baby stories) the client saw four
pictures. Two of these pictures represented the two meanings of an ambiguous sentence and the remaining two were foils. On hearing the ambiguous sentence, the
client had to choose two of these pictures that represented the two meanings. For
each correct response, the client was awarded one point. For all these experimental
tasks (DCT, DPT, and LACT), the subject received appropriate instructions that explained the tasks.

TENNET Xl

m
m
0

e~

I,.
0

27

4035302520151050-

,jii!i!ii!iii!i!i!iJ
ii;iiiii!iii!i!iiiiii:iiiii

M II

MIS

DTI

DIS

Patients performance on Discourse
Comprehension Test

m

to

L..
o

0
e~

2
o

Dog Story Roger Story WalletStory
Patient's performance on immediate recall of
propositions in Stories

m
u)
e.

o

40

m

Iz0J

30.,"/

==
t.
O

o

20.J

ii~iiiiiii~i~i~i!ii~i!ili!i!i!i!i!i

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10
,~,;:~:~:~:~:~:~;~:~,
~,~,ti,~:

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Patient's performance on Linguistc Ambiguity
Comprehension Test
FIG. 1. JG's performance on language production and comprehension tasks.

28

TENNET XI

Results

On BDAE and BNT, the subject's performance did not indicate the presence of
aphasic syndrome. In fact, JG's performance on auditory comprehension of short
paragraphs corresponded to percentile 70.
On DCT, the subject's performance was moderately impaired. The subject's recall
of stated main idea (score, 4), implied main idea (score, 4), stated detail (score, 4),
and implied detail (score, 4) was well below the mean scores (10, 9.9, 9.3, and 8.2,
respectively) and cutoff scores (10, 9, 8, and 6, respectively) reported for 40 adult
control subjects (Brookshire & Nicholas, 1993). With a score of 4 for each component, JG's overall score on the DCT was 16. The overall scores reported for the adult
control subjects is 37.4; the cutoff overall score is 35 (Brookshire & Nicholas, 1993).
JG's performance on DCT was also found inferior to that of other clinical populations
such as the Huntington's and Parkinson's patients (Murray & Stout, 1999). Unlike
the normal controls and Parkinson's and Huntington's groups, JG's level of performance in all four areas of DCT was symmetrical.
During the DPT, JG could not recall even a single proposition from the presented
story, resulting in a score of 0. This same story had been used previously in a study
of discourse production in head trauma patients (Wyckoff, 1984). In that study, the
mean score for normal controls (N = 11) was 11.38.
On the LACT, JG's performance was well below the mean scores previously obtained for eight normal controls (Balasubramanian, 1987). For those normal controls,
mean scores for the three kinds of ambiguous sentences were as follows: LA = 10,
SSA = 7.75, and DSA = 9.50 (Balasubramanian, 1987). JG's scores were as follows:
LA = 5, SSA = 3, and DSA = 1 (see Fig. 1).

Discussion and Conclusion

JG's symmetrical pattern of performance on DCT appears to confirm the observation that ACoA syndrome is associated with a profound deficit of recall from longterm memory. On the other hand, a predominantly language processing problem
could be expected to result in asymmetrical performance, so that a subject may be
able to perform better on MIS than on MII and so on. Conscious recall of stories
also appears to be influenced by JG's impaired long-term memory. However, JG's
performance pattern on the LACT leads to the conclusion that aspects of language/
semantic representation may be impaired. This conclusion is supported by the fact
that JG's comprehension of lexical ambiguity was at 50% accuracy level. This task
allows the subject to rely the least on memory. The fact that more abstract tasks of
LACT (DSA and SSA) were performed poorly by JG can be related to impaired
language processing as well as working memory impairment. With limited data obtained from a single subject, it is difficult to clearly disentangle language processing
from memory problems. Further research is warranted. On the other hand, from a
different theoretical perspective, one can argue that "no memory-specific processes
exist independently of mechanisms and processes that have evolved for learning,
comprehending, and producing language" (MacKay & Abrams, 1996, p. 261).

REFERENCES
Alexander, M. P., & Freedman, M. (1984). Neurology, 34, 752-757.
Balasubramanian, V. (1987). Comprehension of ambiguous sentences in brain damaged patients: A study
of some aspects of modularity theory. Ann Arbor, MI: University Microfilms International.

TENNET XI

29

Brookshire, R. H., & Nicholas, L. E. (1993). Discourse comprehension Test. Tuscon, AZ: Communication Skill Builders Inc.
Cabeza, R., Kapur, S., Craik, F., & McIntosh, A. R. (1997). Journal of Cognitive Neuroscience, 9, 254265.
Cohen, H., Bouchard, S., Scherzer, P., & Whitaker, H. (1994). Neuropsychiatry, Neuropsychology, and
Behavioral Neurology, 7, 166-175.
Desgranges, B., Barron, J., de la Sayette, V., Petit-Taboue, M., Benali, K., Landeau, B., Lechevalier,
B., & Eustache, F. (1998). Brain, 121, 611-631.
Deluca, J., & Diamond, J. 1995. Journal of Clinical and Experimental Neuropsychology, 1(17), 100121.
Frackowiak, R. S. J., Friston, K. J., Frith, C. D., Dolan, R. J., & Mazziotta, J. C. (1997). Human brain
Junctions. San Diego: Academic Press.
Goodglass, H., & Kaplan, E. (1983). The assessment of aphasia and related disorders. Philadelphia:
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Grossman, M., Crino, P., Stem, M. B., Reivich, M., & Hurtig, H. I. (1992). Cerebral Cortex, 3, 551-565.
Hanley, J. R., Davies, A. D. M., Downes, J. J., & Mayes, A. R. 1994. Cognitive Neuropsychology, 11(5),
543-578.
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MacKay, D. G., & Abrams, L. (1996). Language, memory, and aging: Distributed deficits and the structure of new-versus-old connections. In J. E. Birren & W. K. Schaie (Eds.). Handbook of the psychology of aging (pp. 251-265). San Diego: Academic Press.
Murray, L. L., & Stout, J. C. (1999). American Journal qfSpeech-Language Pathology, 8, 137-146.
Sherratt, S. M., & Penn, C. (1990). Aphasiology, 4, 539-560.
Steinman, D. R., & Bigler, E. D. (1986). Neuropsychology, 8, 135-140.
Tranel, D., & Damasio, A. R. (1995). Neurobiological foundations of human memory. In A. D. Baddeley,
B. A. Wilson, & F. N. Watts (Eds.), Handbook of memory disorders (pp. 27-50). New York: Wiley.
Van der Linden, M., & Poncelet, M. (1998). The role of working memory in language and communication
disorders. In B. Stemmer & H. A. Whitaker (Eds.), Handbook of neurolinguistics (pp. 289-300).
San Diego: Academic Press.
Wyckoff, L. H. (1984). Narrative and procedural discourse Jollowing closed head injury. Ann Arbor,
MI: University Micro Films International.

Global Cognitive Decline in Schizophrenia with Remission of Symptoms?
Riccardo Barbarotto,* Giorgio Castignoli,t Carlo Pasetti,t
and Marcella Laiaconat
*Servizio di Neuropsicologia, lstitum 'Villa S. Ambrogio,' Fatebenefratelli, Cernusco s/N, Milan;
?Dipartimento di Salute Mentale Nord, ASL 13, Arona, Novara; and {Department of Neurology
(Neuropsychology Unit), S. Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, Veruno,
Novara, Italy

The relation of symptoms to cognitive dysfunction in schizophrenia is still controversial.
This study was aimed (i) at verifying if a homogeneous sample of 10 young treated outpatients
in remission from psychotic symptoms displays a characteristic pattern of cognitive dysfunction and (ii) at testing the issue of a general cognitive impairment. The neuropsychological
performance of the patients was confronted with a large control group by means of Equivalent
Scores, a normative method widely used in Italy, which allows direct, reliable comparison
between tests and between patients. We found that our patients, as a group, were affected by
a basic activation deficit in attention and by a semantic impairment. These deficits in symptomtree patients could indicate that their brains are in some ways working differently from those
of normal controls and that this pattern is not necessarily linked to psychotic symptoms: their
neuropsychological impairment might reflect a basic difference in the way of processing information that is always present and is independent of general intellectual decay. © 2001 Academic
Press