Ideational agraphia: a single case study.

Abstract

SUMMARY A case study investigates the writing, spelling and praxic skills of one patient who was found to have a selective impairment in his ability to write letters and words in the absence of difficulty in copying these same letters and words. He appeared to have difficulty accessing the correct motor programmes or sequences for writing which we term "ideational agraphia" analagous to the syndrome of ideational apraxia. These findings are related to Margolin's informationprocessing model of writing.The concept of "pure agraphia" as a unitary syndrome has long been superseded by the documentation of a number of distinct subtypes of agraphia. Inherent in an accurate classification of the agraphias is the distinction between the disorders of "spelling" and disorders of "writing". In the spelling agraphias there is a disturbance of letter choice but the actual written form of letters remains intact. The majority of these cases show little or no difference between oral and written spelling skills, unless associated deficits are also present. In contrast, patients with disorders of writing or apraxic agraphia do not have problems with letter-name selection as such. The deficit cannot be explained by peripheral weakness or clumsiness, by sensory problems or by confusion or impaired reasoning. The identification of "pure" apraxic agraphia requires a disturbance of writing in the absence of a disturbance of spelling, reading or other general language problems. More importantly, it should occur in the absence of major praxic or visuo-constructional difficulties.To our knowledge, no reports providing quantitative data fulfilling the above criteria have been published (for a review see ref 1), although there are a number of cases which include apraxic agraphia as a major feature (for example, in refs 2-5, amongst others). The following systematic investigation describes a patient with a marked disturbance of writing in the absence of any impairment of oral spelling, praxic or visuo-constructional difficulties, thus fulfilling the above requirements of a "pure" apraxic agraphic. Case report IDT, a 73-year-old retired production engineer was transferred for further investigations on 2 May 1985. He was fully right handed for writing and for all tasks involving both motor agility and motor power. Since December 1984 he had experienced increasing difficulties with memory, his conversation had become "woolly" and he had even lost his way when driving in a familiar district. His writing had deteriorated and since March he had been unable to write at all.On examination there was no evidence of papilloedema or visual field loss. His cranial nerves, motor system and reflexes were all normal. No definite sensory loss was present although two-point discrimination was a little variable on the right hand (right index finger 5mm, left 4 mm). He was, however, totally disorientated in time and place. He was unable to give a history and had forgotten his home address. Apart from his very obvious global memory impairments he had an agraphia...

Figuring out drawing-induced epilepsy

“…The occurrence of selective deficits in writing but not drawing supports the idea of separate modules involved in writing and drawing. 1 In reflex epilepsies, seizures are precipitated by specific stimuli, such as stroboscopic light, or even higher-level cognitive activity (for a historical overview, see reference 2). Several cases of epilepsy induced by reading, writing, or speaking have been reported.…”

The history of written language disorders: Reexamining Pitres’ case (1884) of pure agraphia

“…In contrast the execution of both Kanji and Kana were impaired and was associated with a haemorrhage in the left superior parietal lobe. Although Otsuki et al (1999) adopt the terminology 'pure apraxic agraphia' proposed by Baxter & Warrington (1986) it seems that the clinical picture they describe matches the description of 'pure motor agraphia' proposed by Pitres (1884) more than a century ago.…”

Writing without Graphic Motor Patterns: A Case of Dysgraphia for Letters and Digits Sparing Shorthand Writing

“…How does it relate to other cases described in the literature? In particular, is it compatible with patients IDT (Baxter & Warrington, 1986) and LCA (Kartsounis, 1992)? These patients produced mainly aborted letters, "nonletters," or letters containing additional or omitted strokes.…”

“…Finally, it should be noted that these patients' performance in copying letters and words seems to vary. In some cases, copying is significantly better than writing from memory (Baxter & Warrington, 1986;Kartsounis, 1992), whereas in others, no such dissociation is reported (Papagno, 1992). This paper focuses mainly on the following question: Is it possible to write spatially well-formed letters without accessing the GMPs?…”

“…Other patients produce mostly ill-formed letters (i.e. letters containing stroke omissions or additions) or nonrecognisable letters (Baxter & Warrington, 1986;Kartsounis, 1992). In these cases, writing production is reported as being slow and nonfluent.…”