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. 2009 Jan;132(Pt 1):71-86.
doi: 10.1093/brain/awn300. Epub 2008 Nov 20.

The neural basis of surface dyslexia in semantic dementia

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The neural basis of surface dyslexia in semantic dementia

Stephen M Wilson et al. Brain. 2009 Jan.

Abstract

Semantic dementia (SD) is a neurodegenerative disease characterized by atrophy of anterior temporal regions and progressive loss of semantic memory. SD patients often present with surface dyslexia, a relatively selective impairment in reading low-frequency words with exceptional or atypical spelling-to-sound correspondences. Exception words are typically 'over-regularized' in SD and pronounced as they are spelled (e.g. 'sew' is pronounced as 'sue'). This suggests that in the absence of sufficient item-specific knowledge, exception words are read by relying mainly on subword processes for regular mapping of orthography to phonology. In this study, we investigated the functional anatomy of surface dyslexia in SD using functional magnetic resonance imaging (fMRI) and studied its relationship to structural damage with voxel-based morphometry (VBM). Five SD patients and nine healthy age-matched controls were scanned while they read regular words, exception words and pseudowords in an event-related design. Vocal responses were recorded and revealed that all patients were impaired in reading low-frequency exception words, and made frequent over-regularization errors. Consistent with prior studies, fMRI data revealed that both groups activated a similar basic network of bilateral occipital, motor and premotor regions for reading single words. VBM showed that these regions were not significantly atrophied in SD. In control subjects, a region in the left intraparietal sulcus was activated for reading pseudowords and low-frequency regular words but not exception words, suggesting a role for this area in subword mapping from orthographic to phonological representations. In SD patients only, this inferior parietal region, which was not atrophied, was also activated by reading low-frequency exception words, especially on trials where over-regularization errors occurred. These results suggest that the left intraparietal sulcus is involved in subword reading processes that are differentially recruited in SD when word-specific information is lost. This loss is likely related to degeneration of the anterior temporal lobe, which was severely atrophied in SD. Consistent with this, left mid-fusiform and superior temporal regions that showed reading-related activations in controls were not activated in SD. Taken together, these results suggest that the left inferior parietal region subserves subword orthographic-to-phonological processes that are recruited for exception word reading when retrieval of exceptional, item-specific word forms is impaired by degeneration of the anterior temporal lobe.

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Figures

Fig. 1
Fig. 1
Behavioural data and VBM. (A) Accuracy in single word reading in each condition, in controls and patients with SD. See Table 2 for abbreviations of condition names. (B) Reaction time in each condition, in controls and patients with SD. (C) Regions showing significantly reduced grey matter volumes in SD patients relative to 48 normal controls, as revealed by VBM.
Fig. 2
Fig. 2
Basic networks activated by reading single words of each type in controls (A–E) and SD patients (F–J). Fixed effects analyses are shown in the yellow-to-orange colour scale, and random effects analyses in the red-to-white colour scale. Although fixed effects do not allow for inference to the general population, fixed effects results are presented to emphasize the similarities in reading networks in the two groups. The cut-out region is defined by the planes x = ±28, y = –26 and z = +18. The blue circle shows the left intraparietal sulcus.
Fig. 3
Fig. 3
Group differences in activation for reading in general. (A) The left mid-fusiform gyrus (peak –36, –48, –16) was activated by all words versus rest in controls, but was not activated in SD patients. (B) The left STG (peak –50, –26, 10) was activated by all words versus rest in controls, but was not activated in SD patients.
Fig. 4
Fig. 4
Comparison of VBM and fMRI results. (A) Regions of atrophy in SD patients (blue-to-green colour scale) and regions activated by reading pseudowords in the control group (colour scales as in Fig. 2). The pseudoword condition was selected for illustrative purposes, since this is the only condition in which all regions of interest, including the intraparietal sulcus, were activated in the control group. Overlap was observed in the left mid-fusiform gyrus, and left STG. Note that these two regions were also activated in controls in all real-word conditions of the fMRI study (Fig. 2). (B) Regions of atrophy in SD patients (blue-to-green colour scale) and regions activated by reading pseudowords in the SD group (colour scales as in Fig. 2). There was no overlap, because atrophic regions were not activated in the patient group.
Fig. 5
Fig. 5
Interaction of group by word type in the left intraparietal sulcus. (A) The left IPS was the only significant cluster in a whole-brain analysis of regions showing a significant interaction of group (control, SD) by word type (Exc LF, Pseudo). (B) Signal change in each condition in the two groups in this region. (C) Signal change in SD patients for correct responses to the five conditions, over-regularization responses to exception words, and other miscellaneous errors.
Fig. 6
Fig. 6
(A) The left posterior IFG (peak –38, 2, 24) was activated by Pseudo > Exc LF in controls, suggesting a possible role in subword processes. But this region showed a similar pattern of activation in patients. (B) The left IFG, pars triangularis (peak –44, 36, 6) was activated by Exc LF > Reg LF in controls, a contrast designed to identify regions potentially involved in whole-word processes. This region was less activated in patients, but not significantly so.

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