Acquired dysgraphia in adults following right or left-hemisphere stroke

Rodrigues, Jaqueline de Carvalho; Fontoura, Denise Ren da; Salles, Jerusa Fumagalli de

doi:10.1590/S1980-57642014DN83000007

Abstracts

OBJECTIVE:

This study aimed to assess the strengths and difficulties in word and pseudoword writing in adults with left- and right-hemisphere strokes, and discuss the profiles of acquired dysgraphia in these individuals.

METHODS:

The profiles of six adults with acquired dysgraphia in left- or right-hemisphere strokes were investigated by comparing their performance on word and pseudoword writing tasks against that of neurologically healthy adults. A case series analysis was performed on the patients whose impairments on the task were indicative of acquired dysgraphia.

RESULTS:

Two patients were diagnosed with lexical dysgraphia (one with left hemisphere damage, and the other with right hemisphere damage), one with phonological dysgraphia, another patient with peripheral dysgraphia, one patient with mixed dysgraphia and the last with dysgraphia due to damage to the graphemic buffer. The latter patients all had left-hemisphere damage (LHD). The patterns of impairment observed in each patient were discussed based on the dual-route model of writing.

CONCLUSION:

The fact that most patients had LHD rather than right-hemisphere damage (RHD) highlights the importance of the former structure for word processing. However, the fact that lexical dysgraphia was also diagnosed in a patient with RHD suggests that these individuals may develop writing impairments due to damage to the lexical route, leading to heavier reliance on phonological processing. Our results are of significant importance to the planning of writing interventions in neuropsychology.

agraphia; cognitive neuropsychology; written language; cerebral dominance

OBJETIVO:

Investigar aspectos preservados e dificuldades na escrita de palavras e pseudopalavras em adultos que sofreram acidente vascular cerebral (AVC) à esquerda e à direita e discutir os perfis de disgrafia adquirida nesses indivíduos.

MÉTODOS:

Investigaram-se perfis de disgrafia adquirida a partir da avaliação das habilidades e dificuldades na escrita de palavras e pseudopalavras de seis adultos que sofreram AVC no hemisfério direito (LHD) e no hemisfério esquerdo (LHE), comparados a adultos neurologicamente saudáveis. Realizou-se análise de séries de casos com os pacientes que apresentaram desempenho deficitário na escrita de palavras, que indicavam a presença de uma disgrafia adquirida.

RESULTADOS:

Foram identificados dois casos com disgrafia lexical (sendo um com LHE e outro com LHD), um caso com disgrafia fonológica, um com disgrafia periférica, um com disgrafia mista e um com disgrafia por déficit no buffer grafêmico, todos estes com LHE. Destacou-se nesse estudo a heterogeneidade das habilidades linguísticas dos casos clínicos, discutidas de acordo com o modelo cognitivo de dupla-rota de escrita.

CONCLUSÃO:

O maior prejuízo encontrado nos pacientes com LHE ressalta a importância desse hemisfério cerebral para o processamento da escrita de palavras. A presença de um caso com LHD com perfil de disgrafia lexical destaca a necessidade de melhor estudar o papel do hemisfério direito no processamento de palavras. Espera-se que esse estudo contribua para o planejamento de estratégias de intervenção neuropsicológica direcionadas à escrita de palavras.

agrafia; neuropsicologia cognitiva; linguagem escrita; dominância cerebral

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Ardila A, Rosselli M. Agrafia. In: Ardila A, Rosselli M (eds), Neuropsicología Clínica. México: Editorial El Manual Moderno; 2007:101-113.
²
Rapcsak S, Beeson PM. Agraphia. Enciclopedia of the Human Brain 2002;1:71-86.
³
Henry ML, Beeson PM, Stark AJ, Rapcsak SZ. The role of left perisylvian cortical regions in spelling. Brain Lang 2007;100:44-52.
⁴
Rapcsak SZ, Beeson PM. The role of left posterior inferior temporal cortex in spelling. Neurology 2004;62:2221-2229.
⁵
Rapcsak SZ, Rubens AB. Disruption of semantic influence on writing following a left prefrontal lesion. Brain Lang 1990;38:334-44.
⁶
Carthery MT, Parente MAMP. Agrafias adquiridas - Introdução histórica e classificação. In: Ortiz KZ (ed), Distúrbios Neurológicos Adquiridos, 2ª ed., Barueri: Manole; 2010:176-198.
⁷
Ardila A, Rosselli M. Spatial agraphia. Brain Cogn 1993;22:137-147.
⁸
Cubelli R, Guiducci A, Consolmagno P. Afferent dysgraphia after right cerebral stroke: An autonomous syndrome? Brain Cogn 2000;44:629-644.
⁹
Seki K, Ishiai S, Koyama Y, et al. Effects of unilateral spatial neglect on spatial agraphia of Kana and Kanji letters. Brain Lang 1998;63:256-275.
¹⁰
Beeson PM, Rapcsak SZ, Plante E, et al. The neural substrates of writing: A functional magnetic resonance imaging study. Aphasiology 2003; 17:647-665.
¹¹
Coltheart M. Acquired dyslexias and the computational modeling of reading. Cogn Neuropsychol 2006;23:96-109.
¹²
Houghton G, Zorzi M. Normal and impaired spelling in a connectionist dual-route architecture. Cogn Neuropsychol 2003;20:115-162.
¹³
Plaut DC, McClelland JL, Seidenberg MS, Patterson K. Understanding normal and impaired word reading: Computational principles in quasi-regular domains. Psychol Rev 2006;103:56-115.
¹⁴
Rapcsak SZ, Henry ML, Teague SL, Carnahan SD, Beeson PM. Do dual-route models accurately predict reading and spelling performance in individuals with acquired alexia and agraphia? Neuropsychologia 2007;45:2519-2524.
¹⁵
Ellis AW. Leitura, escrita, dislexia Uma análise cognitiva. Trad. Dayse Batista. 2a ed. Porto Alegre: Artes Médicas; 1995:153p.
¹⁶
Lecours AR, Parente MAMP. Dislexia: Implicações do sistema de escrita do português. São Paulo: Artes Médicas; 1997:186.
¹⁷
Coltheart M, Rastle K, Perry C, Langdon R, Ziegler T. DRC: Dual-route cascaded model of visual word recognition and reading aloud. Psychol Rev 2001;108:204-256.
¹⁸
Henry ML, Beeson PM, Stark AJ, Rapcsak SZ. The role of left perisylvian cortical regions in spelling. Brain Lang 2007;100:44-52.
¹⁹
Rapcsak SZ, Beeson PM, Henry ML, et al. Phonological dyslexia and dysgraphia: Cognitive mechanisms and neural substrates. Cortex 2009;45:575-591.
²⁰
Luzzatti C, Laiacona M, Allamano N, De Tanti A, Inzaghi MG. Writing disorders in Italian aphasic patients: A multiple single-case study of dysgraphia in a language with shallow orthography. Brain 1998;12:1721-1734.
²¹
Laiacona M, Capitani E, Zonca G, Scola I, Saletta P, Luzzatti C. Integration of lexical and sublexical processing in the spelling of regular words: A multiple single-case study in Italian dysgraphic patients. Cortex 2009;45:804-815.
²²
Jefferies E, Sage K, Ralph MAL. Do deep dyslexia, dysphasia and dysgraphia share a common phonological impairment? Neuropsychologia 2007;45:1553-1570.
²³
Caramazza A, Miceli G, Villa G. The role of the (output) phonological buffer in reading, writing and repetition. Cogn Neuropsychol 1986;3:37-76.
²⁴
Miceli G, Capasso R. Spelling and dysgraphia. Cognitive Neuropsychol 2006;23:110-134.
²⁵
Miceli G, Benvegnù B, Capasso R, Caramazza A. The independence of phonological and orthographic lexical forms: Evidence from aphasia. Cognitive Neuropsychol 1997;14:35-70.
²⁶
Di Pietro M, Schnider A, Ptak R. Peripheral dysgraphia characterized by the co-occurrence of case substitutions in uppercase and letter substitutions in lowercase writing. Cortex 2011;47(9):1038-1051. doi: 10.1016/j.cortex.2010.10.005
» https://doi.org/10.1016/j.cortex.2010.10.005
²⁷
Rapp B, Caramazza A. From graphemes to abstract letter shapes: Levels of representation in written spelling. J Exp Psychol Hum Percept Perform 1997;23: 1130-1152.
²⁸
Sakurai Y, Onuma Y, Nakazawa G, et al. Parietal dysgraphia: Characterization of abnormal writing stroke sequences, character formation and character recall. Behav Neurol 2007;18:99-114.
²⁹
Goodglass H, Kaplan E, Barresi B. Boston Diagnostic Aphasia Examination Short Form. Philadelphia, USA: Lippincott Williams & Wilkins; 2001.
³⁰
Radanovic M, Mansur LL, Azambuja MJ, Porto CS, Scaff M. Contribution to the evaluation of language disturbances in subcortical lesions: A pilot study. Arq Neuropsiquiatr 2004;62:51-57.
³¹
Pawlowski J, Remor E, Parente MAMP, Salles JF, Fonseca RP, Bandeira DR. The influence of reading and writing habits associated with education on the neuropsychological performance of Brazilian adults. Read Writ 2012;25:2275-2289.
³²
Yesavage JA, Brink TL, Rose TL, Lurn O. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.
³³
Gorenstein C, Pang WY, Argimon IL, Werlang BSG. BDI-II - Inventário de depressão de Beck. Porto Alegre: Casa do Psicólogo; 2011.
³⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: A study of efficiency increment. Acta Neurol Scand 1992; 11:412-429.
³⁵
Moreira L, Schlottfeldt CG, Paula JJ, et al. Estudo Normativo do Token Test versão reduzida: Dados preliminares para uma população de idosos brasileiros. Rev Psiquiatr Clín 2011;38:97-101.
³⁶
Fontoura DR, Rodrigues JC, Parente MAMP, Fonseca RP, Salles JF. Adaptação do Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN para avaliar pacientes com afasia expressiva: NEUPSILIN-Af. Ciênc Cogn 2011;16:78-94.
³⁷
Fontoura DR, Rodrigues JC, Mansur L, Monção AM, Salles JF. Neuropsycholinguistic profile of patients post-stroke in the left hemisphere with expressive aphasia. Rev Neuropsic Neuropsiq Neurocien 2013;13:91-110.
³⁸
Rodrigues JC, Salles JF. Tarefa de escrita de palavras/pseudopalavras para adultos: abordagem da neuropsicologia cognitiva. Letras de Hoje 2013;48:50-58.
³⁹
Schwartz MF, Dell GS. Case series investigations in cognitive neuropsychology. Cogn Neuropsychol 2010;27:477-494.
⁴⁰
Sakurai Y, Yoshida Y, Sato K, Sugimoto I, Mannen T. Isolated thalamic agraphia with impaired grapheme formation and micrographia. J Neurol 2011;258:1528-1537.
⁴¹
Roeltgen DP, Heilman KM. Lexical agraphia: Further support for the two-strategy hypothesis of linguistic agraphia. Brain 1984;107:811-827.
⁴²
Springer JA, Binder JR, Hammeke TA. Language dominance in neurologically normal and epilepsy subjects: A functional MRI study. Brain 1999;122:2033-2045.
⁴³
Rothi LJG, Roeltgen DP, Kooistra CA. Isolated lexical agraphia in a right-handed patient with a posterior lesion of the right cerebral hemisphere. Brain Lang 1987;30:181-190.
⁴⁴
Yamadori A, Nagashima T, Tamaki N. Ideogram writing in a disconnection syndrome. Brain Lang 1983;19:346-356.
⁴⁵
Rapcsak SZ, Beeson PM, Rubens AB. Writing with the right hemisphere. Brain Lang 1991;41:510-530.
⁴⁶
Hayashi A, Nomura H, Mochizuki R, et al. Neural substrates for writing impairments in Japanese patients with mild Alzheimer's disease: A SPECT study. Neuropsychologia 2011;49:1962-1968.
⁴⁷
Helm-Estabrooks N, Albert ML. Manual of aphasia and aphasia therapy. Austin: Pro-Ed; 2003.
⁴⁸
Scarone P, Gatignol P, Guillaume S, Denvil D, Capelle L, Duffau H. Agraphia after awake surgery for brain tumor: New insights into the anatomo-functional network of writing. Surg Neurol 2009;72:223-241.
⁴⁹
Balfour S, Borthwick S, Cubelli R, Della Sala S. Mirror writing and reversing single letters in stroke patients and normal elderly. J Neurol 2007;254:436-441.
⁵⁰
Gvion A, Friedmann N. Letter position dysgraphia. Córtex 2010;46:1 100-1113.

Publication Dates

Publication in this collection
Sept 2014

History

Received
20 May 2014
Accepted
20 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Ardila A, Rosselli M. Agrafia. In: Ardila A, Rosselli M (eds), Neuropsicología Clínica. México: Editorial El Manual Moderno; 2007:101-113.

[2] ²
Rapcsak S, Beeson PM. Agraphia. Enciclopedia of the Human Brain 2002;1:71-86.

[3] ³
Henry ML, Beeson PM, Stark AJ, Rapcsak SZ. The role of left perisylvian cortical regions in spelling. Brain Lang 2007;100:44-52.

[4] ⁴
Rapcsak SZ, Beeson PM. The role of left posterior inferior temporal cortex in spelling. Neurology 2004;62:2221-2229.

[5] ⁵
Rapcsak SZ, Rubens AB. Disruption of semantic influence on writing following a left prefrontal lesion. Brain Lang 1990;38:334-44.

[6] ⁶
Carthery MT, Parente MAMP. Agrafias adquiridas - Introdução histórica e classificação. In: Ortiz KZ (ed), Distúrbios Neurológicos Adquiridos, 2ª ed., Barueri: Manole; 2010:176-198.

[7] ⁷
Ardila A, Rosselli M. Spatial agraphia. Brain Cogn 1993;22:137-147.

[8] ⁸
Cubelli R, Guiducci A, Consolmagno P. Afferent dysgraphia after right cerebral stroke: An autonomous syndrome? Brain Cogn 2000;44:629-644.

[9] ⁹
Seki K, Ishiai S, Koyama Y, et al. Effects of unilateral spatial neglect on spatial agraphia of Kana and Kanji letters. Brain Lang 1998;63:256-275.

[10] ¹⁰
Beeson PM, Rapcsak SZ, Plante E, et al. The neural substrates of writing: A functional magnetic resonance imaging study. Aphasiology 2003; 17:647-665.

[11] ¹¹
Coltheart M. Acquired dyslexias and the computational modeling of reading. Cogn Neuropsychol 2006;23:96-109.

[12] ¹²
Houghton G, Zorzi M. Normal and impaired spelling in a connectionist dual-route architecture. Cogn Neuropsychol 2003;20:115-162.

[13] ¹³
Plaut DC, McClelland JL, Seidenberg MS, Patterson K. Understanding normal and impaired word reading: Computational principles in quasi-regular domains. Psychol Rev 2006;103:56-115.

[14] ¹⁴
Rapcsak SZ, Henry ML, Teague SL, Carnahan SD, Beeson PM. Do dual-route models accurately predict reading and spelling performance in individuals with acquired alexia and agraphia? Neuropsychologia 2007;45:2519-2524.

[15] ¹⁵
Ellis AW. Leitura, escrita, dislexia Uma análise cognitiva. Trad. Dayse Batista. 2a ed. Porto Alegre: Artes Médicas; 1995:153p.

[16] ¹⁶
Lecours AR, Parente MAMP. Dislexia: Implicações do sistema de escrita do português. São Paulo: Artes Médicas; 1997:186.

[17] ¹⁷
Coltheart M, Rastle K, Perry C, Langdon R, Ziegler T. DRC: Dual-route cascaded model of visual word recognition and reading aloud. Psychol Rev 2001;108:204-256.

[18] ¹⁸
Henry ML, Beeson PM, Stark AJ, Rapcsak SZ. The role of left perisylvian cortical regions in spelling. Brain Lang 2007;100:44-52.

[19] ¹⁹
Rapcsak SZ, Beeson PM, Henry ML, et al. Phonological dyslexia and dysgraphia: Cognitive mechanisms and neural substrates. Cortex 2009;45:575-591.

[20] ²⁰
Luzzatti C, Laiacona M, Allamano N, De Tanti A, Inzaghi MG. Writing disorders in Italian aphasic patients: A multiple single-case study of dysgraphia in a language with shallow orthography. Brain 1998;12:1721-1734.

[21] ²¹
Laiacona M, Capitani E, Zonca G, Scola I, Saletta P, Luzzatti C. Integration of lexical and sublexical processing in the spelling of regular words: A multiple single-case study in Italian dysgraphic patients. Cortex 2009;45:804-815.

[22] ²²
Jefferies E, Sage K, Ralph MAL. Do deep dyslexia, dysphasia and dysgraphia share a common phonological impairment? Neuropsychologia 2007;45:1553-1570.

[23] ²³
Caramazza A, Miceli G, Villa G. The role of the (output) phonological buffer in reading, writing and repetition. Cogn Neuropsychol 1986;3:37-76.

[24] ²⁴
Miceli G, Capasso R. Spelling and dysgraphia. Cognitive Neuropsychol 2006;23:110-134.

[25] ²⁵
Miceli G, Benvegnù B, Capasso R, Caramazza A. The independence of phonological and orthographic lexical forms: Evidence from aphasia. Cognitive Neuropsychol 1997;14:35-70.

[26] ²⁶
Di Pietro M, Schnider A, Ptak R. Peripheral dysgraphia characterized by the co-occurrence of case substitutions in uppercase and letter substitutions in lowercase writing. Cortex 2011;47(9):1038-1051. doi: 10.1016/j.cortex.2010.10.005
» https://doi.org/10.1016/j.cortex.2010.10.005

[27] ²⁷
Rapp B, Caramazza A. From graphemes to abstract letter shapes: Levels of representation in written spelling. J Exp Psychol Hum Percept Perform 1997;23: 1130-1152.

[28] ²⁸
Sakurai Y, Onuma Y, Nakazawa G, et al. Parietal dysgraphia: Characterization of abnormal writing stroke sequences, character formation and character recall. Behav Neurol 2007;18:99-114.

[29] ²⁹
Goodglass H, Kaplan E, Barresi B. Boston Diagnostic Aphasia Examination Short Form. Philadelphia, USA: Lippincott Williams & Wilkins; 2001.

[30] ³⁰
Radanovic M, Mansur LL, Azambuja MJ, Porto CS, Scaff M. Contribution to the evaluation of language disturbances in subcortical lesions: A pilot study. Arq Neuropsiquiatr 2004;62:51-57.

[31] ³¹
Pawlowski J, Remor E, Parente MAMP, Salles JF, Fonseca RP, Bandeira DR. The influence of reading and writing habits associated with education on the neuropsychological performance of Brazilian adults. Read Writ 2012;25:2275-2289.

[32] ³²
Yesavage JA, Brink TL, Rose TL, Lurn O. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.

[33] ³³
Gorenstein C, Pang WY, Argimon IL, Werlang BSG. BDI-II - Inventário de depressão de Beck. Porto Alegre: Casa do Psicólogo; 2011.

[34] ³⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: A study of efficiency increment. Acta Neurol Scand 1992; 11:412-429.

[35] ³⁵
Moreira L, Schlottfeldt CG, Paula JJ, et al. Estudo Normativo do Token Test versão reduzida: Dados preliminares para uma população de idosos brasileiros. Rev Psiquiatr Clín 2011;38:97-101.

[36] ³⁶
Fontoura DR, Rodrigues JC, Parente MAMP, Fonseca RP, Salles JF. Adaptação do Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN para avaliar pacientes com afasia expressiva: NEUPSILIN-Af. Ciênc Cogn 2011;16:78-94.

[37] ³⁷
Fontoura DR, Rodrigues JC, Mansur L, Monção AM, Salles JF. Neuropsycholinguistic profile of patients post-stroke in the left hemisphere with expressive aphasia. Rev Neuropsic Neuropsiq Neurocien 2013;13:91-110.

[38] ³⁸
Rodrigues JC, Salles JF. Tarefa de escrita de palavras/pseudopalavras para adultos: abordagem da neuropsicologia cognitiva. Letras de Hoje 2013;48:50-58.

[39] ³⁹
Schwartz MF, Dell GS. Case series investigations in cognitive neuropsychology. Cogn Neuropsychol 2010;27:477-494.

[40] ⁴⁰
Sakurai Y, Yoshida Y, Sato K, Sugimoto I, Mannen T. Isolated thalamic agraphia with impaired grapheme formation and micrographia. J Neurol 2011;258:1528-1537.

[41] ⁴¹
Roeltgen DP, Heilman KM. Lexical agraphia: Further support for the two-strategy hypothesis of linguistic agraphia. Brain 1984;107:811-827.

[42] ⁴²
Springer JA, Binder JR, Hammeke TA. Language dominance in neurologically normal and epilepsy subjects: A functional MRI study. Brain 1999;122:2033-2045.

[43] ⁴³
Rothi LJG, Roeltgen DP, Kooistra CA. Isolated lexical agraphia in a right-handed patient with a posterior lesion of the right cerebral hemisphere. Brain Lang 1987;30:181-190.

[44] ⁴⁴
Yamadori A, Nagashima T, Tamaki N. Ideogram writing in a disconnection syndrome. Brain Lang 1983;19:346-356.

[45] ⁴⁵
Rapcsak SZ, Beeson PM, Rubens AB. Writing with the right hemisphere. Brain Lang 1991;41:510-530.

[46] ⁴⁶
Hayashi A, Nomura H, Mochizuki R, et al. Neural substrates for writing impairments in Japanese patients with mild Alzheimer's disease: A SPECT study. Neuropsychologia 2011;49:1962-1968.

[47] ⁴⁷
Helm-Estabrooks N, Albert ML. Manual of aphasia and aphasia therapy. Austin: Pro-Ed; 2003.

[48] ⁴⁸
Scarone P, Gatignol P, Guillaume S, Denvil D, Capelle L, Duffau H. Agraphia after awake surgery for brain tumor: New insights into the anatomo-functional network of writing. Surg Neurol 2009;72:223-241.

[49] ⁴⁹
Balfour S, Borthwick S, Cubelli R, Della Sala S. Mirror writing and reversing single letters in stroke patients and normal elderly. J Neurol 2007;254:436-441.

[50] ⁵⁰
Gvion A, Friedmann N. Letter position dysgraphia. Córtex 2010;46:1 100-1113.

Brasil