255

Behavioural Neurology 25 (2012) 255–272
DOI 10.3233/BEN-2012-119001
IOS Press

Acquired dyslexia in three writing systems:
Study of a Portuguese-Japanese bilingual
aphasic patient
Mirna Lie Hosogi Senahaa,∗ and Maria Alice de Mattos Pimenta Parenteb
a

Member of Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School
of Medicine, São Paulo, Brazil
b
Institute of Psychology, Department of Developmental and Personality Psychology, Federal University of Rio
Grande do Sul, Porto Alegre, Brazil

Abstract. The Japanese language is represented by two different codes: syllabic and logographic while Portuguese employs
an alphabetic writing system. Studies on bilingual Portuguese-Japanese individuals with acquired dyslexia therefore allow an
investigation of the interaction between reading strategies and characteristics of three different writing codes. The aim of this
study was to examine the differential impact of an acquired brain lesion on the reading of the logographic, syllabic and alphabetic
writing systems of a bilingual Portuguese-Japanese aphasic patient (PF). Results showed impaired reading in the logographic
system and when reading irregularly spelled Portuguese words but no effects on reading regular words and nonwords in syllabic
and alphabetic writing systems. These dissociations are interpreted according to a multi-route cognitive model of reading
assuming selective damage in the lexical route can result in acquired dyslexia across at least three different writing codes.
Keywords: Acquired dyslexia, written systems, surface dyslexia, kanji-kana, lexical reading, bilingualism, dissociation

1. Introduction
The Japanese language uses different writing codes:
logographic and syllabic. Studies of premorbidly literate Japanese speakers with acquired dyslexia thus allow an investigation of how script has an effect on the
cognitive processes used in the oral reading of different
writing systems. In Brazil, the high number of Japanese
speakers makes this investigation more intriguing. This
is because most Brazilian Japanese speakers also read
and write in an alphabetic script – Portuguese – making
these speakers tri-scriptal as well as bilingual.
Brazilian Portuguese presents, for the reading, a predominantly alphabetic writing system with few irreg∗ Corresponding author:

Mirna Lie Hosogi Senaha, Ph.D., Rua
Montesquieu, 371/62, Chácara Klabin, São Paulo, CEP 04116-190,
SP, Brazil. Tel.: +55 11 5081 7363; Fax: +55 11 3288 8684; E-mail:
senaha@uol.com.br.

ularities. This is reflected in the relationship between
number of phonemes (26) and letters (23). Most letters represent a univocal relationship between sounds
and script that is independent of word context. However, three letters (<x>, <e>, <o>) do present ambiguous relationships, with pronunciation dependent on the
intraword context i.e. different sounds depending on
the word [27]. For example, the consonant <x> can
be read aloud as any one of phonemes /∫ /, /s/, /ks/ or
/z/, as in the examples <faxina>, <máximo>, <sexo>
and <exame>. There is also spelling to sound ambiguity in the vowels <e> and <o> when they are in a
stressed position in paroxytone words. The vowel <e>
can be associated to phonemes / / or /e/, as, for example, in <festa> and <vespa>, and the vowel <o> to the
phonemes / / or /o/, as <cosmo> and <fosco>. Some
consonants also have context-dependent relationships.
For instance: (1) if the letter <c> is preceded by the
vowels <e> or <i>, it is associated with the phoneme

ISSN 0953-4180/12/$27.50  2012 – IOS Press and the authors. All rights reserved

256

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

/s/, as in the word <Cecı́lia>; (2) if the letter <c> is
preceded by other vowels or by a consonant, except
the letter <h>, it is converted to the phoneme /k/, as in
<cabeça> and <pacto>; and (3) if the letter <c> is preceded by the consonant <h>, both symbols constitute a
digraph corresponding to the phoneme /∫ /.
The Japanese writing system is different to the Portuguese script in several ways. Japanese uses two types
of written code: a logographic code that is represented
by kanji characters, and a syllabic code, that is represented by the kana script. Kanji characters were originally derived from Chinese ideograms. Kanji characters represent a lexical morpheme of a spoken Japanese
word and have phonetic and semantic value (e.g. [kuruma] meaning car). Unlike Chinese characters, kanji
has two (or sometimes more) pronunciations: a ‘kun’
reading, that is the adaptation of the Japanese meaning
to Chinese writing and one (or more) ‘on’ readings, that
is the sound transcription from the Chinese language.
In the Japanese syllabic system, that is represented by
written kana script, each symbol corresponds to a syl[mi],
lable, or to a mora, without meaning (e.g.
[so]). There are two forms of Japanese syllabic writing:
hiragana and katakana. Both forms of kana have 46
basic syllables with variations in size of the letter and
sign additions leading to 102 syllables. Kana is a completely transparent syllabic writing system. In other
words, kana is regular in terms of the correspondences
between orthography and phonology.
Although Kanji and kana are different writing systems, they are not alternative systems for communication. It is possible to write a text in Japanese using only
syllabic kana. However this happens in the first year
of education only. Also, it is not possible to write a
meaningful text in Japanese using only kanji. To write
a sentence in Japanese, the two writing systems are
mixed and engaged simultaneously. In general, open
class words – nouns, verbs and adjectives – are written
in kanji while the function words – inflections of verbs
and adjectives, conjunctions and others – are written in
hiragana whereas katakana is used for writing foreign
names and foreign words integrated into Japanese.
How can we understand the reading of bilingual, triscriptal speakers? Cognitive neuropsychological studies of oral reading are based on theoretical models
that are based on the observation of dissociation between reading and writing tasks as well as variability
in the relationship between orthography and phonology [3]. Since the 1970s, studies of patients with acquired dyslexia have revealed dissociations in the reading and writing of regular and irregular words in al-

phabetic and non-alphabetic writing scripts [42]. Patients may show preservation of irregular word reading
with an inability to read low frequency words and nonwords. Other patients can show the opposite pattern
i.e. impaired irregular word reading but are able to read
nonwords and low frequency regularly spelled words.
Most cognitive models or oral reading assume at least
two independent reading pathways: lexical and nonlexical routes. In the lexical route, known words are
read as a whole with or without access to the semantic system. In the nonlexical route, segmented reading
is used, in which graphemes are converted into their
respective phonemes for oral reading. These models
assume that whereas oral reading of irregular words is
achieved via a lexical reading route, nonwords must be
read via a sublexical or a nonlexical pathway. Generally, the lexical route processes familiar words and the
nonlexical route processes unfamiliar and infrequent
regular words. Such models have been applied across
scripts.
One view of the cognitive processes involved in reading holds that processes may vary according to the characteristics of each writing code [18,20,21,42]. However, most studies of acquired dyslexia have investigated
(relatively opaque) alphabetic scripts, such as English
and French. The spelling irregularities in these two
codes may induce lexical reading (e.g. yacht, boeuf).
However studies of oral reading in transparent scripts,
such as Spanish, Italian, Turkish and Welsh are now
increasingly reported [1,2,6,10,11,29–32].
Portuguese is an example of transparent script. Although rare, studies of patients with acquired dyslexia
in Portuguese tend to reflect the patterns of impaired
lexical and nonlexical reading reported in other alphabetic scripts. Portuguese speaking patients with acquired phonological, deep, surface, semantic and literal
dyslexia, are all reported [5,13,25,37–39,41]. The characteristics of these types of acquired dyslexias closely
resemble those described in English, French and Spanish readers. Thus, the multi-route model of reading has
been used to explain disturbances in Portuguese oral
reading.
Less is known about the patterns of acquired dyslexia in patients who speak more than one language (bilingual) or read in more than one type of script (bi-scritpal). Reports of brain damaged patients who present
dissociations between reading in logographic and syllabic writing systems have been published [15,22,23,
33–36,40]. Sasanuma (1980) first observed cases of
surface dyslexia (impairment to kanji reading with
preservation of processing the kana script), phonologi-

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

cal dyslexia (impairment in kana nonword reading) and
deep dyslexia (disproportionately greater impairment
for kana than kanji reading and semantic paralexias in
kanji reading) with others subsequently reported [27,
34–36,44].
Caramelli et al. [4] was the first to report a Portuguese-Japanese bilingual aphasic patient who had acquired dyslexia. YI was a premorbidly literate reader
in three different writing systems. Japanese was the
first acquired language (L1) for YI and Portuguese was
the second acquired language (L2). After the brain lesion, YI was able to understand high frequency kanji
characters and Portuguese written words if they had a
high frequency of occurrence in the script. However, he was unable to understand words written in kana
and less familiar low frequency words written in Portuguese. Using the multi-route framework, Caramelli
et al. suggested that YI processed high frequency Portuguese words and kanji characters using an intact lexical reading pathway and also argued that YI’s inability to read Portuguese nonwords, kana written words
and nonwords was a consequence of impairment to the
nonlexical reading pathway.
One problem with the interpretation offered by Caramelli et al. is that oral reading of nonwords written in alphabetic and non-alphabetic writing systems
may simply be more difficult than reading known
words in any language. However, there is evidence
of the reverse dissociation in the pattern of oral reading in Portuguese-Japanese speakers i.e. selective impairment of the lexical route with intact nonlexical
reading in these patients. In an epidemiological study
with Japanese immigrants in Brazil (Nisei), Meguro et
al. [20] identified four Portuguese-Japanese bilingual
speakers with Alzheimer’s disease who showed dissociations between the reading of logographic, syllabic
and alphabetical scripts. In these cases, kanji (L2) and
Portu- guese (L1) irregular word reading were more
affected than both kana and Portuguese regular word
and nonword reading. Together with the case report
of Caramelli et al. [4], this suggests a “double” dissociation in tri-scriptal Portuguese-Japanese reading and
supports the assumption of a multi reading framework
available to Portuguese-Japanese speakers. However, due to possible differences in the age of acquisition and premorbid familiarity with alphabetic and nonalphabetic scripts in tri-scriptal speakers, it is not easy
to interpret the patterns of dissociation in performance.
It is therefore necessary to test the veracity of claims
made in prior studies of Portuguese-Japanese speakers
with acquired dyslexia.

257

The aim of the present study was to test the multiroute framework for tri-scriptal oral reading with a
Portuguese-Japanese speaker. Specifically, it was of interest to know if the reported dissociation between lexical reading (Kanji and irregular word reading in Portuguese) or nonlexical reading (Kana and nonwords in
Portuguese) was selectively impaired following brain
damage. A correlation between impaired lexical reading across scripts in a tri-scriptal patient would challenge the hypothesis that the cognitive processes in
reading vary according to characteristics of the writing
system [18,20,21]. However, if damage to the reading
system of a tri-scriptal patient impairs oral reading in
one script only, this would be evidence that type of
script constrains oral reading in tri-script readers [see
43 for review]. The data from patients who were premorbidly literate in contrasting writing systems: logographic, syllabic and alphabetic such as those reported
by Caramelli et al. [4] and Meguro et al. [20] are a strong
test of these alternatives [see also 43]. Also, as Nisei
patients are bilingual Portuguese and Japanese speakers and also bi-scriptal in one language (Japanese), it is
possible to examine if differences in the type of script
(syllabic versus logographic) or the status of a script
(L1 versus L2) has a greater impact on impaired reading
performance. If language status has an effect perhaps
because one language is acquired earlier or is more familiar, then we might expect to observe greater impairment to the oral reading of one language with no differences in the performance between syllabic and logographic scripts used in the Japanese language. However, if we observe dissociations in the oral reading performance of a patient between the Japanese scripts, this
would be evidence that the type of script has an effect
on bi-scriptal reading.
We report here the case of a Portuguese-Japanese
bilingual and tri-scriptal patient (PF) with acquired
dyslexia. We asked the following questions: (1) does
brain damage influence the cognitive mechanisms in
oral reading across scripts according to lexical and nonlexical processes independently of the writing system;
and (2) in each language, do the patterns of acquired
dyslexia observed depend on the unique features of the
writing system i.e. is there a dissociation in the Japanese
script that is not observed in Portuguese or vice versa? For comparison, tasks were administered to two
healthy control subjects, whose language background
and sociolinguistic characteristics were very similar to
PF.

258

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

Fig. 1. CT scan of PF showing left frontotemporal lesion after traumatic brain injury.

2. Method
2.1. Participants
2.1.1. Case report
PF is a 48 year-old, right-handed male. At the age
of 39, he suffered a traumatic brain injury to the left
frontotemporal area (Fig. 1) in a traffic accident, which
resulted in Broca’s aphasia and right hemiparesis. PF is
Brazilian and the son of Japanese parents. His mother
tongue was Japanese. During his childhood, teenage
years and adult life he used Japanese within the family environment. He acquired the Portuguese language
when he started school during early literacy learning.
His formal study was completed in the Portuguese language and he graduated with a degree in Electrical Engineering. In the academic environment and subsequently in his work activities, PF used predominately Portuguese for communication. He learned to read
and to write Japanese with parent help. He was able
to read aloud and write both syllabic and logographic
systems of Japanese writing. Prior to his accident, he
frequently read magazines and newspapers in Japanese
and in Portuguese. Reading Japanese newspapers requires very advanced knowledge of logographic writing. After graduation, PF worked in a Japanese multinational company for 15 years, in which it was necessary to have good Japanese oral and written language
proficiency. He made frequent business trips to Japan.
He also had good knowledge of a third language, English. English language was not however a focus of
this investigation.
2.1.2. Control subjects
PF’s performance on oral reading and other tasks was
compared with two healthy controls who have similar
sociolinguistic characteristics. Both control subjects

were men, right-handed and born in Brazil, and their
parents were also Japanese. Their mother tongue was
Japanese and their second language was Portuguese
acquired when starting school. Their formal study was
completed in Portuguese. Both controls were able to
read newspapers in Portuguese and Japanese. They
presented with no history of oral and written language
disturbances or neurological impairment. Control One
was a 52 year-old accounting technician (12 years of
Japanese education). Control Two was a 53 year-old
with an Economics degree who had studied Japanese
up until the age of 17 in private schools.
2.2. Experimental investigation
PF and the control subjects were given word and
nonword reading aloud tasks (Part I) and specific tasks
to examine lexical and nonlexcial oral reading mechanisms (Part II). All evaluations involved written stimuli
presented in the Portuguese alphabetic, Japanese syllabic and Japanese logographic writing systems. To
examine oral reading, tasks from the Portuguese and
Japanese Human Frontier Science Program (HFSP)
protocols [14,24] were selected and in addition other
specially formulated complementary tasks were also
designed to investigate reading disturbance across all
three scripts.
Part I – Reading aloud tasks
1. Alphabetic system
1.1. Words
The Portuguese reading aloud task from the HFSP
protocol [24] was administered. The test is composed
of 180 balanced stimuli to verify the effects of regularity, imageability, frequency, length and class of words.
Of 180 stimuli, 40 words have irregular spellings, half

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

of them being composed of irregular words for reading
in Portuguese, and the other half corresponding to foreign words used frequently in Brazil, such as <pizza>.
1.2. Nonwords
A reading aloud task with 300 nonwords written
according to the characteristics of the Portuguese alphabetic system was administered to verify the influence of word length and syllabic structure on oral reading. To examine length effects, nonwords were divided into three stimuli groups (bisyllabic, trisyllabic
and polysyllabic) with 100 stimuli each. These groups
were then further divided into another five subgroups
of 20 stimuli representing the characteristics of the Portuguese writing system: consonant-vowel (CV); consonant-vowel-consonant (CVC); consonant-vowel-vowel
(CVV); consonants group and digraph.
2. Logographic system (kanji)
2.1. Words
The kanji reading aloud task from the Japanese HFSP
protocol [14] with 120 words was administered. Only
words represented by a single kanji character were selected. Stimuli were chosen according to the linguistic variables of length, imageability, frequency [17],
number of strokes (kanji characters up to seven strokes
and kanji characters with more than 10 strokes), type
(simple and compound) and verbs (conjugated verbs
and verbs in the infinitive). Twenty stimuli for each
of these variables were selected and, as for the reading
aloud task of the Portuguese HFSP protocol [24], stimuli were selected in pairs, modified only by the criteria
being tested, while keeping all the others equivalent.
Due to the logographic characteristics of kanji and the
option of using words represented by only one kanji,
it was not possible to create a list of nonwords in the
logographic system.
3. Syllabic system (hiragana and katakana)
3.1. Words
The reading aloud task of real words in hiragana presented 90 stimuli divided into four groups, designed to
exam frequency, length, imageability and word class
effects. The word reading aloud task in katakana consisted of 60 balanced items, to verify the effects of
length, imageability and familiarity. A familiarity criterion was chosen instead of frequency due to the absence of a word frequency norms in katakana at time
of testing.

259

3.2. Nonwords
The hiragana nonword reading task comprised 120
stimuli, constituting 40 bisyllabic, 40 trisyllabic and
40 polysyllabic nonwords. In each group, half (20
nonwords) were made up of simple syllables and half,
complex syllables. The katakana nonword reading task
contained 120 stimuli, testing effects of length and syllabic structure. The number and distribution of stimuli
types in this task were equal to the hiragana nonwords
reading task.
Part II – Specific tests – lexical reading mechanisms
exam
1. Input orthographic lexicon exam
1.1. Lexical decision tasks - alphabetic system
Two lexical decision tasks were used to test the alphabetic system. The first was from the HFSP protocol [24] with 10 items, with two stimuli in each. One
stimulus corresponded to an irregular real word and the
other, to a nonword with the same syllabic structure
and length as the irregular word. Each item was presented separately on a sheet of paper and subjects were
requested to indicate the real word. The second lexical
decision task was composed of regular words and nonwords presented in a tachistoscopic task. For this task,
39 regular words and 39 nonwords were selected. The
nonwords were created in pairs from each real word,
taking into consideration the length and the syllabic
structure. Each of the 78 stimuli was introduced separately in the center of a computer screen, displayed for
100 milliseconds. The subjects were instructed to hit
keys <p> or <o> to indicate if the stimuli represented a
real word or a nonword, respectively. In addition, there
was an option to hit the letter <i> if they did not know
the answer.
1.2. Lexical decision task – logographic system
To test the input orthographic lexicon for the logographic system, a similar task to the lexical decision
task for the alphabetical code was used. The task consisted of 10 items. Each item had three stimuli, comprising two real kanji characters and a third, false kanji that was derived from components of the other two
real kanji characters. The subjects were requested to
identify the false kanji.
1.3. Lexical decision task – syllabic systems
The lexical decision task from the HFSP protocol [14] in the Japanese syllabic systems had 10 items
in hiragana and 10 in katakana. Each item was composed of a real word and a nonword. The subjects were
requested to indicate the real word.

260

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

2. Access to semantic system examination
2.1. Reading and written comprehension of irregular
and foreign words – alphabetic.
To verify access to the semantic system in Portuguese, a task with 22 Portuguese irregular words and
16 foreign words was devised. The stimuli were presented individually. For each word, reading aloud was
requested after which the meaning of the read stimulus
was requested. The main objective of this task was to
examine access to the semantic system after reading
mistakes (regularizations). There are two possibilities:
first via the input orthographic lexicon i.e. through the
written form of the word; and second, via the output
phonological lexicon through the phonological representation of the read word.
2.2. Reading and written comprehension of kanji –
logographic system
This task was composed of 20 single-character kanji
words. The stimuli were presented individually. For
each kanji word, reading aloud was requested after
which the meaning of the read stimulus was requested.
As in the Portuguese version previously described, the
objective of this task was to verify access to the semantic system. Due to the transparency of the Japanese
syllabic system, tasks to verify access between the input orthographic lexicon and the semantic system with
written stimuli in hiragana and katakana were not carried out.
3. Semantic system examination
3.1. Written word comprehension – alphabetic system
A written word – picture matching task was administered, having frequency of target stimuli as a linguistic
variable. A total of 20 words were selected, 10 highfrequency and 10 low-frequency. Participants were
requested to identify the picture corresponding to the
written word. Among the five picture alternatives, there
were: a target picture, a semantic, a visual, a phonological distractor and a picture with no relationship with
the target.
3.2. Written word comprehension – logographic
system
A written word (kanji) – picture matching task was
performed. The task contained 20 items and each item
was composed of a kanji written word and four picture
alternatives: a target, a semantic, a phonological and a
visual distractor.

3.3. Written comprehension – syllabic system
Two written word – picture matching tasks were performed, one with stimuli in hiragana and another in
katakana. Each task contained 20 items and each item
had a written word and four picture alternatives, consisting of a picture target and three semantic distractors. The subjects were requested to identify the picture
corresponding to the written word.
4. Output phonological lexicon examination
4.1. Homophonic nonword – irregular word matching
– Portuguese
To test the output phonological lexicon in Portuguese, a homophonic nonword – irregular word matching task was applied. This task was composed of 10
items, each containing three stimuli. Among these
stimuli, one corresponded to an irregular word; the second to a homophonic nonword to the irregular word;
and the third to a nonword visually similar to the irregular word. For instance, one of the items had the following stimuli: <sexo>, <séquisso> and <sejo>. Participants were asked to point the two stimuli with the
same phonological representation.
4.2. Kanji – Katakana matching
The output phonological lexicon stores the phonological representations of lexical items. Therefore, this
memory is not related to the writing code, but to the
phonology of the language. Thus, to test the output
phonological lexicon in Japanese, a kanji – katakana
matching task was administered. In this task, the subjects were requested to match a kanji (Japanese word)
to a katakana “nonword” which represented the kanji
transcription (the same phonological form of the kanji). Therefore, this second stimulus was a “real oral
Japanese word” but a “written nonword” (as previously
cited in the Introduction, katakana characters are only used to write foreign words). It was assumed that
matching the phonological similarity between the two
stimuli would be accomplished by the output phonological lexicon since, (1) kanji is mandatorily processed
via the lexical route and (2) a katakana “written nonword” is processed via the nonlexical route. The task
had 10 items and each item was composed of a kanji
written word and four katakana “nonword” alternatives.
5. Semantic system and output lexical mechanisms
5.1. Picture naming – Portuguese and Japanese
Picture naming and lexical reading share some lexical-semantic mechanisms. To examine these mechanisms, picture naming tasks were administered in Portuguese and Japanese with 40 pictured objects, balancing the length and familiarity criteria.

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

Procedure
The oral responses were recorded with a tape recorder and the productions transcribed. Performance
was analyzed in relation to number and type of errors
and compared later with the performance of control
participants. Statistical analyses were conducted using
Fisher’s exact and Chi-square tests to compare proportion of correct responses among the participants. The
significance value accepted was p < 0.05.
3. Results
3.1. Part I – Reading aloud tasks
3.1.1. Alphabetic system – words and nonwords
For word reading aloud in Portuguese, PF produced a
relatively high percentage of correct responses (87.8%).
He made 22 errors, 18 (81.8%) being a regularization
type. Considering the different linguistic variables,
PF’s performance varied between 90.0% and 100.0%
of correct answers across all variables, except for the
group of irregular words, of which PF read only 60.0%
correctly (see Table 1). Comparison of his performance
to controls in irregular word reading showed a significant difference (x2 = 14.1, p < 0.001). Sporadic slow
reading was observed, chiefly in reading longer words.
On the nonword reading task with alphabetic stimuli, PF read 78.3% correctly. Although performance
was lower than controls this was not a significant difference (see Table 1). Among PF’s errors, he produced
phonemic paralexias most often. Analysis of effects of
length and syllabic complexity showed no differences
between bisyllabic, trisyllabic and polysyllabic stimuli.
Furthermore, there was no effect of syllabic structure
(CV, CVC, CVV, digraphs and consonantal groups) on
performance.
3.1.2. Logographic and syllabic system – words and
nonwords
PF’s performance was similar to controls in oral
reading tasks using stimuli written in syllabic systems:
written words and nonwords in hiragana and katakana
(see Table 2). However, a significant difference was
identified in reading written stimuli in the logographic
system: PF read 40.0% of the items correctly while
the controls had more than double the number of correct answers compared to PF (x2 = 49.9, p < 0.001).
Among errors in kanji reading, the majority (81.9%)
corresponded to the absence of a response (“I don’t
know”). Visual mistakes, semantic, formal and phone-

261

Table 1
Performance of PF and controls in word and nonword reading aloud
tasks in the alphabetic system
Stimuli
Words
Regular
Regular (type 2)∗∗
Irregular
High frequency
Low frequency
High imageability
Low Imageability
Short
Long
Verbs in the infinitive
Conjugated verbs
Closed class
Total
Nonwords
Total

n

% success
PF

Controls

20
20
40
10
10
10
10
10
10
10
10
20
180

100.0
90.0
60.0∗
100.0
90.0
100.0
100.0
100.0
100.0
100.0
100.0
90.0
87.8

100.0
100.0
95.0∗
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
98.9

300

78.3

88.5

∗ p < 0.001; ∗∗ regular words for reading, but irregular for writing.

Table 2
Performance of PF and controls on the reading aloud task in logographic and syllabic systems
Stimuli
Words – kanji
Total
Words – hiragana
Total
Words – katakana
Total
Nonwords – hiragana
Total
Nonwords – katakana
Total

n

% success
PF
Controls

120

40.0∗

84.2∗

90

97.8

99.4

60

96.7

98.3

120

87.5

87.9

120

74.2

82.1

∗ p < 0.001.

mic paralexias and unclassifiable mistakes were also
observed, albeit in smaller number.
Analyzing PF’s performance in kanji reading for
each pair of stimuli according to linguistic variables
(high frequency versus low frequency; high imageability versus low imageability; number of strokes; length;
type and verbs) no effects were found. However, in
other analyses considering all stimuli of the protocol
(120 kanji words), and comparing the linguistic variables mentioned above, the effect of frequency was significant (x2 = 9.5, p < 0.05). PF correctly read 48.9%
of high frequency kanji characters and 14.6% of low
frequency kanji characters.
In reading aloud of written words in the Japanese
syllabic systems, PF correctly read 97.8% of hiragana
words and 96.7% of katakana words. Due to the small
number of errors, differences in performance according

262

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems
Table 3
Performance of PF and controls in specific tasks examining lexical reading mechanisms
Tasks
Alphabetic system – Portuguese
• Input orthographic lexicon
Lexical decision (HFSP)
Lexical decision (taquistoscopic presentation)
• Access to semantic system
Comprehension of words read incorrectly
• Semantic system
Written comprehension
• Output phonological lexicon
Homophonic nonword – irregular word matching
• Semantic system and output lexical mechanisms
Picture naming
Logographic system
• Input orthographic lexicon
Lexical decision (HFSP)
• Access to semantic system
Comprehension of kanji characters read incorrectly
• Semantic system
Written comprehension
• Output phonological lexicon
Homophonic nonword – irregular word matching
Syllabic system
• Input orthographic lexicon
Lexical decision – hiragana (HFSP)
Lexical decision – katakana (HFSP)
• Semantic system
Written comprehension – hiragana
Written comprehension – katakana
Japanese language
• Semantic system and output lexical mechanisms
Picture naming

n

%success
PF
Controls

10
78

100.0
87.2

100.0
92.3

12

100.0

NA

20

100.0

100.0

10

90.0

100.0

40

42.5∗

98.8∗

10

80.0

100.0

16

75.0

NA

20

85.0

100.0

10

90.0

100.0

10
10

100.0
100.0

100.0
100.0

10
10

100.0
100.0

100.0
100.0

40

15.0∗

88.8∗

∗ p < 0.001; NA: not applicable.

to the linguistic variables were not evident. There was
no signifiicant difference between PF and controls in
hiragana and katakana nonword reading. For hiragana
and katakana nonword reading, no significant differences were found in performance in terms of length and
syllabic structure.
3.2. Part II – Specific tests – lexical reading
mechanisms examination
3.2.1. Specific tasks – alphabetic system/Portuguese
language
Comparison between PF and controls on alphabetic
writing system tasks revealed no significant differences
in lexical decision, written word – picture matching
and homophonic nonword – irregular word matching
tasks (Table 3). These results suggest that the input
orthographic lexicon, the semantic system and the output phonological lexicon – mechanisms that must be
involved in reading via the lexical route – were pre-

served. However, differences between PF and controls
were seen in tasks of picture naming and access to the
semantic system. PF presented low performance in
picture naming, with better results for familiar words
in comparison to unfamiliar words.
To evaluate access to the semantic system, a task
of reading and written comprehension of irregular and
foreign words was applied. The main semantic system
from printed words. Testing the written comprehension of words that PF read incorrectly allows verification of how the semantic system is accessed i.e. via
input orthographic lexical mechanisms or through output phonological lexical mechanisms. PF read 68.4%
words correctly. All of the errors were regularization
type. Most striking was the finding that PF provided the
correct meaning of all words read incorrectly (see also
Wilson and Martinez, this issue). In this task, controls
read 98.6% of the stimuli correctly and comprehension
of words was preserved.

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

3.2.2. Specific tasks – logographic and syllabic
systems/Japanese language
To compare PF’s performance in the non-alphabetic
writing system, specific tasks were designed to investigate lexical reading mechanisms of the logographic
and syllabic systems. The main differences between
PF and controls were in picture naming and access to
the semantic system. In the lexical decision tasks with
real and false kanji characters (from the HFSP protocol) PF scored 80.0% correct a score that is considered
to be within the normal range [27]. Satisfactory results were also observed on written word comprehension tasks (kanji characters – picture matching) and in
the output phonological lexicon tasks (kanji – katakana
matching).
On the reading and written comprehension of kanji
characters task to verify access to the semantic system,
PF read aloud 4 out of the 20 kanji characters appropriately yet was unable to read the other 16 stimuli,
giving no response. Despite the absence of response
in these 16 kanji characters, PF was able to give the
correct meaning of 12, corresponding to 75.0% correct
performance. With the four kanji characters for which
he did not give the correct meaning, he gave rather
vague answers that could be considered close to the target meaning. Therefore, as in the tests of the alphabetic
writing system, there was a dissociation between oral
reading and written comprehension in the logographic
code. Controls read 92.5% kanji characters correctly. PF achieved comparable performance to controls
in tasks involving the Japanese syllabic system: lexical
decision (input orthographic lexicon) and written word
– picture matching task (semantic system) and the kanji
– katakana matching task. PF scored 15.0% correct
on picture naming in Japanese and correct responses
tended to be more familiar objects.
4. Discussion
4.1. Portuguese writing system: acquired dyslexia
with impairment in the lexical route
PF had difficulty reading irregular words, producing
mainly regularization errors. These data suggest an impairment to the lexical route and preserved use of the
nonlexical reading route when reading in Portuguese.
His hesitation, slow reading with longer words and
performance in nonword reading were also suggestive
of reading via the nonlexical pathway. Results from
PF’s nonword reading task may appear to contradict

263

this claim. However, PF and controls achieved similar
levels of performance in nonword reading (see Manarini [19] who reported performance from 87.0% to 95.5%
correct in nonword reading by undergraduates). Lower than expected performance in nonword reading may
be due to stimuli complexity, and unfamiliarity with
the task. PF’s performance on tests of irregular word
reading was significantly worse than controls. Thus,
we contend PF is more impaired when reading via the
lexical pathway than the nonlexical pathway.
Considering all words in the reading aloud task of the
alphabetical system, PF’s performance was relatively
high for reading. This may be a consequence of the majority of words containing a regular correspondence between orthography and phonology in Portuguese. Coltheart et al. [7] proposed a list of nine symptoms in surface dyslexia based on anglophone readers. Of all characteristics, the authors considered better regular word
than irregular word reading to be a necessary and sufficient symptom for a diagnosis of surface dyslexia. According to these criteria, PF presented the necessary and
sufficient symptoms for diagnosis of surface dyslexia in
Portuguese. A further striking feature of performance
was that reading aloud of irregular words was accompanied by intact comprehension of the same words. It
is therefore possible to claim that in Portuguese (as in
English and other alphabetic writing systems), surface
dyslexia can be observed without damage to the semantic system. We note here that the opposite pattern –
damage to the semantic system without surface dyslexia in Portuguese – has also been reported [37,38] as in
other languages (see also Wilson et al.).
4.2. Japanese: reading impairment in the
logographic and preservation of syllabic systems
PF displayed a reading impairment in the logographic writing system – however, performance with the syllabic script is no different to controls. This clear dissociation in reading aloud within the Japanese writing system raises some issues. The first is that even
though oral reading within a language using two different scripts may be dissociable as shown in previous studies of Japanese patients, it is not clear whether
this is evidence of an effect of type of script, an effect
of task difficulty or of a selective impairment to one
pathway and not to the other. Given several studies
have shown that bilingual speakers do not necessarily
manifest the same language disorders with the same
severity in both of their languages (non-parallel language recovery), the dissociation found in PF’s read-

264

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

ing in Japanese might shown that each written system
is represented (organized) in different neural networks
in the brain. However, differences in the patterns of
recovery in bilingual aphasia may reflect the language
status (L1 versus L2), age of acquisition, familiarity, or
dominance. Although these confounding effects may
be reduced for bi-script readers who speak a common
language such as PF, there is still a problem when interpreting data from biscript patients as these cases may
show patterns of recovery that reflect language status.
We contend that impairment to the oral reading of kanji
likely reflects damage to a lexical reading process and
does not reflect impaired reading of a non-lexical process. However, we do not claim dissociations in functional reading routes in Japanese necessarily reflect independent reading systems for kanji and kana at the
neural level.
A different issue is whether or not brain damage influences common oral reading processes independently
of the writing code presented for testing. Thus, characteristics of PF’s acquired dyslexia in the Japanese
script – selective impairment in kanji reading and preserved performance in reading of words and nonwords
written in the Japanese syllabic transparent code – can
be interpreted as a better preserved nonlexical pathway
compared to the lexical pathway. Given the same interpretation was offered for PF’s oral reading impairments in written Portuguese, it seems redundant to distinguish differences in script to explain PF’s impaired
reading performance. In other words, if his performance reflects selective damage to the lexical pathway
in a common oral reading network, this accounts for the
patterns of reading dissociation across scripts. Thus,
the co-incidence of impaired lexical reading (Kanji and
irregular word reading in Portuguese) and preserved
nonlexical reading (Kana and nonwords in Portuguese)
suggests no effect of script on PF’s reading.
4.3. Analyses of acquired dyslexia in the three writing
systems
The claim that damage to the reading system influences cognitive processes across writing systems is supported by the analysis of PF’s impaired and preserved
performance in reading and writing: impairment of the
lexical route is responsible for low performance in reading kanji and Portuguese irregular words. On the other
hand, performance when reading words in the transparent syllabic system and regular words and nonwords
of the alphabetic Portuguese system shows nonlexical
reading is intact. Together with patients reported by

Meguro et al. [20] and Caramelli et al. [4], the present
data support the claim that Portuguese-Japanese speakers enjoy multiple cognitive mechanisms for oral reading.
Analysis of PF’s acquired dyslexia in the three writing systems is compatible with the view that type of
script has little impact on biscriptal reading and does
not sustain the view that different writing codes of a
biscriptal reader have impact on impaired reading performance. Instead it seems that reading mechanisms
(both lexical and nonlexical) are shared for the two
different scripts. Damage to the oral reading system
for PF resulted in more impairment to shared lexical
reading mechanisms than to shared nonlexical reading
mechanisms thus explaining problems reading irregularly spelled words in Portuguese and Japanese kanji
as well as preserved ability to read kana and alphabetic
nonwords.
The reverse analysis can be made of the case YI
reported by Caramelli et al. [4] who had good performance in written comprehension of the logographic system and high frequency words in the Portuguese
writing system, but was unable to process words and
nonwords in the syllabic system and nonwords alphabetic system. Caramelli et al. [4] interpreted YI’s data
according to a multi route reading model proposed for
reading in English. According to them, YI was capable
of processing kanji and frequent words of Portuguese
lexically, but was unable to process stimuli through
print-sound conversion. We would interpret PF’s data
in the opposite way i.e. PF was not capable of processing kanji and irregularly spelled words of Portuguese
lexically, but he was able to process kana and nonwords
via print-sound conversion. Therefore manifestations
of YI’s and PF’s acquired dyslexias (both tri-scriptal
readers) supports a double dissociation in Portuguese Japanese oral reading. YI presented better lexical reading than nonlexical reading while PF presented the opposite pattern of reading impairment. Crucially the
same pattern of performance was observed across written codes for both cases, with no effect of script.
No regularization errors were observed in PF’s
Japanese reading. Legitimate Alternative Reading of
Components (LARC) errors are a type of regularization
error and are observed in patients with acquired surface
dyslexia in Japanese [12,26]. These errors correspond
to incorrect selection of phonological representations
of one or more character components. When reading kanji, LARC errors correspond to the selection of
possible pronunciations (on/kun readings). Determining which pronunciation must be used will depend on

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

the context that a kanji is used in two-character kanji
words. LARC errors could not observed here because
only single-character kanji words are tested with the
HFSP protocol [14].1 And in this case, all the possible
kanji pronunciations can be accepted as correct.
It is important to note that if we were to consider
PF’s performance on the reading of syllabic system only, we might conclude that PF did not have any disturbances in the reading of syllabic code. Hiragana and
katakana word reading aloud was satisfactory and few
errors were found. Also, performance when reading
nonwords written in a syllabic system was similar to
controls. Drawing on these data, it may be possible to
follow Ardila’s [1] and Karanth’s [16] arguments that
reading in a script with a transparent code requires only
a nonlexical route. However, Ruiz et al. [32] reported
two cases of Spanish readers with deep dyslexia. This
conflicts with Ardila‘s [1] position that Spanish readers would not present deep or surface dyslexia. Other
hispanophonic case reports confirm the possibility that
readers of a transparent orthographic code seem to read
via a lexical pathway [9–11].
The transparent nature of the script, in either syllabic or alphabetic scripts, does not seem to mandate
that readers will only read using a nonlexical pathway.
Many studies [6,10,11,32] show evidence of lexical
reading in transparent orthographies suggesting multiroute reading models are appropriate for interpreting
patterns of acquired reading impairments. Chiacchio et
al. [6] reported acquired reading impairments in an Italian speaker [see also other papers in this Special Issue].
They described a case of primary progressive aphasia
with surface dyslexia. Instead of regularization errors
when reading irregular words, the authors found accent
mistakes and proposed this is an aspect of Italian word
reading that cannot be based on grapheme-phoneme
conversion rules.
The high number of correct responses in PF’s reading of words written in the syllabic system (136/140)
as well as by Sasanuma’s [35] patient, SU, (169/170),
with surface dyslexia, may appear as absence of reading disturbance in the syllabic system. A lexical route
dysfunction does not cause much impact in transparent
code readers, since it is possible to read transparent
writing codes appropriately through a nonlexical pathway, but this does not necessarily mean that there is
1 Sasanuma [34,35] described patients MU and SU with impairment in lexical reading. These patients produced semantic errors in
kanji reading.

265

no failure in the lexical route or that transparent code
readers can only read via a single route.
Dysfunction in patterns of lexical reading in patients
who read with a transparent script is different to readers
of deep orthographies. Readers of transparent scripts
might not produce classic regularization errors and can
read words and nonwords appropriately. But mistakes
in accent and hence stress and slow reading speed are
additional symptoms. A dysfunction in the semantic
system impairs written word comprehension. Therefore, other abilities besides reading aloud should be
investigated to examine the presence of failures in the
lexical route as demonstrated in the study of Ferreres
et al. [10].
4.4. Characterization of lexical reading dysfunction
In the experimental test – Part II of this study specific tasks were performed to evaluate cognitive mechanisms involved in PF’s lexical reading. The investigation showed that the cognitive dysfunction is localized
on the output lexical mechanisms of the lexical route,
more specifically in access to the output phonological
lexicon from the semantic system and from the input
orthographic lexicon for alphabetic, syllabic and logographic codes. The investigations demonstrate intact
input lexical mechanisms to the semantic system. PF
had satisfactory performance in lexical decision (which
investigates the input orthographic lexicon) and written
word comprehension (which investigates the semantic
system). In addition, data from tasks examining access
to the semantic system corroborat the hypothesis of the
integrity of the input lexical mechanisms to the semantic system. In the alphabetic system, concerning the
task to verify access to the semantic system, PF was
able to define irregular and foreign word meanings for
words that he had read aloud incorrectly. This behavior
suggests that the patient read irregular words using the
nonlexical route, but accessed word meaning via the
input orthographic lexicon and the semantic system.
This interpretation can be maintained, as if the patient
accessed the semantic system through output lexical
mechanisms, he would access the word meaning by the
phonological representation of the irregular word read
incorrectly. For instance, PF read the foreign word
<pizza> incorrectly. He performed regularization and
evoked aloud the word [piza], however he explained
the meaning of the word <pizza> correctly. In this example, if PF had accessed the semantic system by the
output phonological lexicon, he would state that the

266

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

Fig. 2. Dual-route cognitive model of reading showing PF’s functional disturbances (∗ ) in access to the output logophonic lexicon from the
semantic system and from the input orthographic lexicon (adapted and complemented from Rapcsak et al. [31].)

word [piza] refers to the verb “step” (<pisa>/[piza] in
Portuguese) or to the leaning tower in Italy.
On the same task in the logographic system, PF was
able to provide meaning for incorrectly read words
showing preserved written comprehension of kanji
characters. The data suggest the input lexical processes
to the semantic system are relatively preserved, and the
deficits in lexical reading in both alphabetic and logographic systems are due to impairment in post-semantic
lexical processing.
Post-semantic lexical processing involves phonological representations of stimuli. Therefore post-semantic
lexical processes do not depend on the orthographic,
logographic or syllabic or alphabetic nature of stimuli.
Thus, tasks that test the phonological lexicon and the
output lexical mechanisms suit the oral language, independently of written code. Regarding output lexical
mechanisms, PF performed well on tasks to verify the
output phonological lexicon in Portuguese (homophonic nonword – irregular word matching) and in Japanese
(kanji – katakana matching). The output lexical mechanisms were also tested through picture naming tasks.
PF’s low performance in Japanese and Portuguese in
these tasks can neither be attributed to failures in perceptual mechanisms nor to the semantic system, given the absence of failures in visual picture recognition
along with preservation of the semantic system examined in the written comprehension tasks. Therefore, we
propose the hypothesis that PF’s naming impairment
is correlated with damage to the lexical reading route
and is post-semantic and prior to the phonological lexicon. The characteristics of PF’s spontaneous speech in

Portuguese and in Japanese (non-fluent) and the type
of mistakes in some of the formal tests (absence of responses in kanji reading and Portuguese and Japanese
picture naming) point to a locus in lexical reading due
to dysfunction in access to the phonological output lexicon from the semantic and the orthographic input lexicon (see Fig. 2).
To support this claim we compared the results from
PF in some tasks with those obtained by the patient
SU, described by Sasanuma [35] who presented surface
dyslexia in Japanese (Table 4). Patient SU had Wernicke’s aphasia, fluent speech and preserved word comprehension. Similar to PF, SU presented difficulties in
the picture naming tasks and in kanji reading. However, after a qualitative analysis of errors in the tasks,
it seems errors differed between SU and PF. Whereas
PF presented a high number of no responses in picture
naming and kanji reading, SU showed a high incidence
of circumlocutions in naming and irrelevant errors (substitution of the target word by another word with no
semantic or formal relationship to the target), circumlocutions and semantic paralexias in kanji reading. SU
presented only 2.9% of no responses in kanji reading
while in picture naming, irrelevant errors together with
the absence of response comprised 19.6% errors.
Sasanuma [35] claimed SU had impairment in the
output phonological lexicon. Errors showed the patient had no difficulty in accessing the phonological
representations stored in the output phonological lexicon. However, a functional disturbance in the output phonological lexicon itself, explained failures including circumlocutions and semantic mistakes. The

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

267

Table 4
Data comparison for PF and SU (described by Sasanuma [35]) in linguistic abilities
PF (Portuguese data)
Broca
Non-fluent
9/9 (100.0%)

PF (Japanese data)
Broca
Non-fluent
8/9 (88.9%)

SU (Japanese data)
Wernicke
Fluent
20/20 (100.0%)

17/40 (42.5%)

6/40 (15.0%)

49/100 (49.0%)

Absence of response –
21/23
Semantic paraphasia –
1/23
Verbal paraphasia – 1/23

Absence of response –
33/34
Categorization – 1/34

Kanji reading

−

48/120 (40.0%)

Circumlocution – 31/51
Semantic paraphasia –
7/51
Irrelevant/Absence – 10/51
Phonemic paraphasia –
2/51
26/130 (20.0%)

Types of errors in kanji
reading

−

Absence of response –
57/72
Unclassifiable – 5/72
Visual – 5/72
Semantic paralexia – 2/72
Formal paralexia – 1/72
Phonemic paralexia – 1/72

Aphasia type
Fluency
Word oral comprehension
(number and percentage
correct)
Picture naming (number
and percentage correct)
Types of erros in naming
task

comparison between SU and PF corroborates our hypothesis that PF’s functional disorder is localized in
access to the output phonological lexicon. As PF had
an access dysfunction, he did not retrieve phonological
representations stored in the output phonological lexicon, presenting as poor kanji reading and picture naming, and absent responses. In contrast, SU presented
with preserved access between the semantic system and
the output phonological lexicon, therefore SU was able
to retrieve the phonological representations of lexical
items stored in the output phonological lexicon. However, as SU presented a cognitive dysfunction in the
output phonological lexicon, she produced inadequate
oral answers in kanji reading and picture naming.
The present case study allowed us to test the multi
route reading model to explain disturbance of a bilingual patient tri-scriptal reader across three different
writing systems. Impairment in lexical reading was
verified in the reading the written codes in Portuguese
and Japanese. Critically in both languages reading impairment was impaired in a similar way. Moreover,
there was evidence that the same functional disturbance
in access to the phonological output lexicon from the
semantic system and from the orthographic input lexicon was responsible for the acquired dyslexia in three
writing systems. Some multiple route reading models
assume a third non-semantic lexical pathway available
to support the oral reading of irregularly spelled words
and logographic characters without access to the mean-

Irrelevant – 47/104
Circumlocution – 22/104
Semantic paralexia –
15/104
Neologism – 14/104
On/Kun – 3/104
Absence of response –
3/104

ing of those characters. PF was able to read via meaning albeit at an impaired level. To test the veracity of
the lexical non-semantic pathway in biscriptal reading
in a Japanese-Portuguese speaker it will be necessary to
find a patient who can read aloud words without access
to meaning in both languages. No such case has yet
been reported.
In sum, the impact of reading disturbance in bilingual speakers who are tri-scriptal readers varies according to the division of labour between the use of
the lexical reading and non-lexical reading pathways.
We found evidence of a correlated reading impairment
to kanji reading and written words that are irregularly
spelled in Portuguese in addition to an impairment to
access to phonological output in both languages. We
locate the damage to impairment in a common lexical
reading pathway. There was no evidence of an effect
of language status (L1 versus L2) or an effect of type
of script on PF’s impaired reading performance (for a
similar conclusion see Tainturier et al. and Druks et al.
this volume).
Acknowledgments
We are grateful to PF and his wife for their time and
collaboration.

268

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

Appendix
List of kanji stimuli in the reading aloud task

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

269

270

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

References
[1]

A. Ardila, Errors resembling semantic paralexias in Spanishspeaking aphasics, Brain and Language 41 (1991), 437–445.
[2] A.A. Beaton and N.W. Davies, Semantic errors in deep dyslexia: Does orthography depth matter? Cognitive Neuropsychology 24(3) (2007), 312–323.
[3] A. Caramazza, On drawing inferences about the structure from
the analysis of patterns of impaired performance: the case for
single-patients studies, Brain and Language 5 (1986), 41–66.
[4] P. Caramelli, M.A.M.P. Parente, M.L. Hosogi, M. Bois and
A.R. Lecours, Unexpected reading dissociation in a Brazilian
“nisei” with crossed aphasia, Behavioural Neurology 7 (1994),
165–170.
[5] M.T. Carthery-Goulart and M.L.H. Senaha, Diagnosis and rehabilitation attempt of a patient with acquired dyslexia, Dementia and Neuropsychologia 1 (2007), 89–96.
[6] L. Chiacchio, D. Grossi, M. Stanzione and L. Trojano, Slowly
progressive aphasia associated with surface dyslexia, Cortex
29 (1993), 145–152.
[7] M. Coltherart, J. Masterson, S. Byng, M. Prior and J. Riddoch, Surface dyslexia, Quarterly Journal of Experimental
Psychology 35A (1983), 469–495.
[8] M. Coltheart, K. Patterson and J.C. Marshall, eds, Deep
Dyslexia, Routledge, London, 1980.
[9] F. Cuetos, F. Valle-Arroyo and M.P. Suarez, A case of phonological dislexia in Spanish, Cognitive Neuropsychology 13
(1996), 1–24.
[10] A.R. Ferreres, M.M. Cuitiño and A. Olmedo, Acquired surface
dyslexia in Spanish: a case report, Behavioural Neurology 16
(2005), 71–84.
[11] A.R. Ferreres and G. Miravalles, The production of semantic
paralexias in a Spanish-speaking aphasic, Brain and Language
49 (1995), 153–172.
[12] T. Fushimi, K. Komori, M. Ikeda, K. Patterson, M. Ijuin and
H. Tanabe, Surface dyslexia in a Japanese patient with semantic dementia: evidence for similarity-based orthographyto-phonology translation, Neuropsychologia 41 (2003), 1644–
1658.
[13] M.L. Hosogi and M.A.M.P. Parente, As dislexias adquiridas
com utilização da via perilexical: manifestação das dislexias de superfı́cie, in: Temas em neuropsicologia e neurolingüı́stica, B.P. Damasceno and M.I.H. Coudry, eds, Tec Art,
São Paulo, 1995, pp. 174–179.
[14] M.L. Hosogi, M.A.M.P. Parente, A. Yamadori, A.R. Lecours
and T. Suzuki, Protocolo de leitura das escritas japonesas
para o projeto Human Frontier Science Program (H.F.S.P.),
in: M.L.H. Senaha, Dislexia adquirida em um paciente nisei:
repercussão da lesão cerebral em diferentes sistemas de escrita, Unpublished Master’s degree thesis, University of São
Paulo, 1997.
[15] I. Jibiki and N. Yamaguchi, The Gogi (word-meaning) syndrome with impaired kanji processing: alexia with agraphia,
Brain and Language 45 (1993), 61–69.
[16] P. Karanth, The search for deep dyslexia in syllabic writing
systems, Journal of Neurolinguistics 15 (2002), 143–155.
[17] N. Kuratani, A. Kobayashi and S. Okunishi, A new dictionary
of kanji usage, Gakken, Tokyo, 1990.
[18] A.R. Lecours, L. Melançon and M.A.M.P. Parente, Os ares
da linguagem escrita, in: Dislexia: implicaç ões do sistema
de escrita do português, A.R. Lecours and M.A.M.P. Parente,
eds, Artes Médicas, Porto Alegre, 1997, pp. 153–162.
[19] A.S. Manarini, Influência do sistema de escrita do português

271

nos processamentos perilexicais da leitura, Unpublished Master’s degree thesis, University of São Paulo, 1996.
[20] K. Meguro, M.L.H. Senaha, P. Caramelli, J. Ishizaki, R.Y.S.
Chubacci, M. Meguro, H. Ambo, R. Nitrini, A. Yamadori,
Language deterioration in four Japanese-Portuguese bilingual
patients with Alzheimer’s disease: a trans-cultural study of
Japanese elderly immigrants in Brazil, Psychogeriatrics 3(2)
(2003), 63–68.
[21] E. Miles, Dyslexia may show a different face in different
languages, Dyslexia 6(3) (2000), 193–201.
[22] K. Nakamura, K. Meguro, H. Yamazaki, J. Ishizaki, H. Saito,
N. Saito, M. Shimada, S. Yamaguchi, Y. Shimada and A.
Yamadori, Kanji-predominant alexia in advanced Alzheimer’s
disease, Acta Neurológica Scandinavica 97 (1998), 237–243.
[23] M. Paradis, H. Hagiwara and N. Hildebrant, Neurolinguistic
Aspects of the Japanese Writing System, Academic Press,
Florida, 1985.
[24] M.A.M.P. Parente, M.L. Hosogi, A.P. Delgado and A.R.
Lecours, Conduta clı́nica, in: Dislexia: Implicações do Sistema de Escrita do Português, A.R. Lecours and M.A.M.P.
Parente, eds, Artes Médicas, Porto Alegre, 1997, pp. 85–105.
[25] M.A.M.P. Parente and A. Nakamura, A influência do nı́vel de
aprendizagem no protocolo de leitura em japonês, Relatório
do projeto: Influência dos códigos alfabético, silábico e morfológico nos processamentos da leitura, 1994.
[26] K. Patterson, T. Suzuki, T. Wydell and S. Sasanuma, Progressive aphasia and surface alexia in Japanese, Neurocase 1(2)
(1995), 155–165.
[27] K. Patterson, T. Suzuki and T.N. Wydell, Interpreting a case
of Japanese phonological alexia: the key is in phonology,
Cognitive Neuropsychology 13(6) (1996), 803–822.
[28] M.A.M. Pimenta, Dissociaç ões nos diferentes sistemas de escrita: hipóteses sobre as manifestaç ões de dislexia adquirida
em leitores do sistema alfabético português e em bilı́nguês
nipo-brasileiros, in: Temas em Neurolingüı́stica, L.L. Mansur
and N. Rodrigues, eds, Tec Art, São Paulo, 1993, pp. 45–62.
[29] I. Raman and B.S. Weekes, Acquired dyslexia in a TurkishEnglish speaker, Annals of Dyslexia 55(1) (2005), 79–104.
[30] I. Raman and B.S. Weekes, Deep dysgraphia in Turkish, Behavioural Neurology 16 (2005), 59–69.
[31] S.Z. Rapcsak isn’t in document (http://www.sciencedirect.
com/scidirimg/entities/REemail.gif) isn’t in document, M.L.
Henry, S.L. Teague, S.D. Carnahan and P.M. Beeson, Do dualroute models accurately predict reading and spelling performance in individuals with acquired alexia and agraphia? Neuropsychologia 45(11) (2007), 2519–2524.
[32] A. Ruiz, A.I. Ansaldo and A.R. Lecours, Two cases of deep
dyslexia in unilingual hispanophone aphasics, Brain and Language 46 (1994), 245–256.
[33] Y. Sakurai, K. Sakai, M. Sakuta and M. Iwata, Naming difficulties in alexia with agraphia for kanji after a left posterior
inferior temporal lesion, Journal of Neurology, Neurosurgery,
and Psychiatry 57 (1994), 609–613.
[34] S. Sasanuma, Acquired dyslexia in Japanese: clinical features
and underlying mechanisms, in: Deep Dyslexia, M. Coltheart,
K. Patterson and J.C. Marshall, eds, Routledge, London, 1980,
pp. 48–89.
[35] S. Sasanuma, Surface dyslexia and dysgraphia: how are they
manifested in Japanese? in: Surface dyslexia: Neuropsychological and Cognitive studies of phonological reading, K.E.
Patterson, J.C. Marshall and M. Coltheart, eds, Lawrence Erlbaum, London, 1985, pp. 225–249.
[36] S. Sasanuma, H. Ito, K. Patterson and T. Ito, Phonological

272

[37]
[38]
[39]

[40]

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems
alexia in Japanese: a case study, Cognitive Neuropsychology
13(6) (1996), 803–822.
M.L.H. Senaha, P. Caramelli, R. Nitrini, H. Charchat-Fichman
and B.S. Weekes, Semantic dementia without surface dyslexia,
Brain and Language 99(1–2) (2006), 33–34.
M.L.H. Senaha, P. Caramelli, C.S. Porto and R. Nitrini, Semantic dementia: Brazilian study of 19 cases, Dementia e
Neuropsychologia 4 (2007), 366–373.
A. Silveira and M.A.M.P. Parente, Leitura letra-por-letra: uma
dislexia periférica? in: Temas em Neuropsicologia e Neurolingüı́stica, B.P. Damasceno and M.I.H. Coudry, eds, Tec Art,
São Paulo, 1995, pp. 185–189.
M. Sugishita, K. Otomo, S. Kabe and K. Yunoki, A critical appraisal of neuropsychological correlates of Japanese
ideogram (kanji) and phonogram (kana) reading, Brain 115
(1992), 1563–1585.

[41]

[42]
[43]

[44]

B. Vidigal and M.A.M.P. Parente, As dislexias adquiridas com
utilização da via lexical: manifestaç ões das dislexias profunda
e fonológica no português, in: Temas em Neuropsicologia e
Neurolingüı́stica, B.P. Damasceno and M.I.H. Coudry, eds,
Tec Art, São Paulo, 1995, pp. 180–184.
B.S. Weekes, Acquired disorders of reading and writing:
Cross-script comparisons, Behavioural Neurology 16 (2005),
51–57.
B.S. Weekes, I.F. Su, W.G. Yin and X.H. Zhang, Oral reading
in bilingual aphasia: evidence from Mongolian and Chinese,
Bilingualism: Language and Cognition 10(2) (2007), 201–
210.
J. Yamada, Developmental deep dyslexia in Japanese: a case
study, Brain and Language 51 (1995), 444–457.

MEDIATORS
of

INFLAMMATION

The Scientific
World Journal
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Gastroenterology
Research and Practice
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Journal of

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Diabetes Research

Disease Markers

Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Volume 2014

International Journal of

Journal of

Immunology Research

Endocrinology

Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Volume 2014

Submit your manuscripts at
http://www.hindawi.com
BioMed
Research International

PPAR Research
Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Volume 2014

Journal of

Obesity

Ophthalmology

Stem Cells
International

Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com

Journal of

Volume 2014

Evidence-Based
Complementary and
Alternative Medicine
Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Journal of

Oncology
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Parkinson’s
Disease

Computational and
Mathematical Methods
in Medicine
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

AIDS

Behavioural
Neurology
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Research and Treatment

Oxidative Medicine and
Cellular Longevity

Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Volume 2014