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Foreign accent syndrome (FAS) refers to a disorder that involves foreign sounding speech, usually following stroke. This paper presents a case study of an English patient allegedly speaking with a Scottish English accent after right-hemisphere stroke. The results of detailed impressionistic and acoustic analyses are reported, based on a direct comparison of the patient's pre-stroke and post-stroke speech samples. The emphasis is on a comparison of the typical features of Scottish English and phonetic features actually found in the patient's post-stroke speech. The respective roles of prosodic and segmental features in the post-stroke speech sample are also discussed. Rather untypically, prosodic features seem to be affected to a much lesser extent than segmental phonetic features in the patient's post-stroke speech. They are, therefore, less likely to contribute to the perception of a foreign accent. [ABSTRACT FROM AUTHOR]

We present a case of sudden onset, acquired altered accent in the speech of NL, a 48-year-old, left-handed female. NL's typical Standard Southern British English accent was preserved in singing and reading, but altered in recitation, repetition and spontaneous speech. Neuropsychological investigation, impressionistic and acoustic analysis of accented and unaccented speech are documented. The altered accent displays a slower speech rate and longer duration of consonants and vowels. There is evidence for a shift towards syllable-timed rhythm. NL's altered accent displays atypical coordination between voicing and supra-laryngeal articulation, reduced mean and range of F0, and minor differences in vowel space. These features are broadly consistent with other documented cases of Foreign Accent Syndrome, regardless of aetiology. However, NL's profile of preserved and impaired speech does not fit any pattern typically associated with organic neurological disorder. Moreover, left-handed preference may contribute to differences between singing and reading, versus recitation, repetition and spontaneous speech.

Handedness differentiates patterns of neural asymmetry and interhemispheric connectivity in cortical systems that underpin manual and language functions. Contemporary models of cerebellar function incorporate complex motor behaviour and higher-order cognition, expanding upon earlier, traditional associations between the cerebellum and motor control. Structural MRI defined cerebellar volume asymmetries and correlations with corpus callosum (CC) size were compared in 19 pairs of adult female monozygotic twins strongly discordant for handedness (MZHd). Volume and asymmetry of cerebellar lobules were obtained using automated parcellation.CC area and regional widths were obtained from midsagittal planimetric measurements. Within the cerebellum and CC, neurofunctional distinctions were drawn between motor and higher-order cognitive systems. Relationships amongst regional cerebellar asymmetry and cortical connectivity (as indicated by CC widths) were investigated. Interactions between hemisphere and handedness in the anterior cerebellum were due to a larger right-greater-than-left hemispheric asymmetry in right-handed (RH) compared to left-handed (LH) twins. In LH twins only, anterior cerebellar lobule volumes (IV, V) for motor control were associated with CC size, particularly in callosal regions associated with motor cortex connectivity. Superior posterior cerebellar lobule volumes (VI, Crus I, Crus II, VIIb) showed no correlation with CC size in either handedness group. These novel results reflected distinct patterns of cerebellar-cortical relationships delineated by specific CC regions and an anterior-posterior cerebellar topographical mapping. Hence, anterior cerebellar asymmetry may contribute to the greater degree of bilateral cortical organisation of frontal motor function in LH individuals.

The current study investigated how the brain structure-function relationships between covert and overt verbal fluency in monozygotic handedness discordant (MzHd) twins relates to broader attentional measures. Evidence presented here shows that the structure-function correlation demonstrated between functional cerebral lateralisation and corpus callosum widths 22-39, contiguous with Broca's area and the middle frontal gyri (Gurd et al. in Brain Struct Funct 218:491-509, 2013), is not an artefact of attention. Twenty-five pairs of female MzHd twins performed a verbal switching task titrated for number of switches. The paradigm permits calculation of switch rates and costs. The switch rate and cost varied as a function of number of switches (1, 2, 3). There were no differences in any measure in relation to right-left handedness in twin pairs. This was supported by large and significant within-twin pair correlations. Atypical functional lateralisation of inferior and middle frontal lobes does not appear to be associated with better or worse performance on verbal task-switching. Discordant lateralisation for verbal fluency does not predict behavioural performance profiles in MzHd twins. This evidence is compatible with a view that attentional components of verbal fluency task performance may have significant heritable components. It does not indicate that neural correlates of frontal cerebral laterality for verbal fluency in MzHd twins are significantly accountable for by heritable components.

To further investigate brain structure and function in 26 handedness discordant monozygotic twin pairs (MzHd), MRI and behavioural assessments were carried out. These showed significant correlation between language-specific functional laterality in inferior and middle frontal gyri, and anterior corpus callosum. Previous studies of handedness discordant monozygotic twins failed to resolve the issue concerning handedness and hemispheric laterality for language due to methodological disparities. The results would be relevant to genetic theories as well as to brain structure:function explanations. MzHd twins underwent MRI and fMRI scanning as well as behavioural assessment of motor performance and cognition. There were significant differences on MRI and fMRI laterality measures, as well as a significant correlation between anterior callosal widths and functional laterality. LH twins showed higher frequencies of atypical functional laterality. There was no significant within-twin pair correlation on fMRI verbal laterality, nor did results show within-twin pair differences on verbal fluency or IQ. Implications for the field of laterality research pertain to frontal hemispheric equipotentiality for verbal processes in healthy individuals. In particular, there can be an apparent lack of cognitive 'cost' to atypical laterality. An fMRI verbal laterality index correlated significantly with corpus callosum widths near Broca's area.

Increasing evidence for a cerebellar role in human cognition has accrued with respect to anatomically and functionally distinct lobules. Questions of laterality, however, have been largely overlooked. This study therefore introduced and applied a novel measurement protocol for comparatively bias-free analysis of cerebellar asymmetries. Volumetric measurements were performed on magnetic resonance images from a single pair of monozygotic handedness-discordant twins. Against a background of functional cortical asymmetry for verbal and visuo-spatial functional magnetic resonance imaging activation, which was mirrored in the left-handed twin (Lux et al. 2008), between-twin differences in cerebellar asymmetry are described. Interestingly, asymmetry measures for the whole cerebellum did not correspond to either the direction of hand preference or to the weaker (functional magnetic resonance imaging) lateralization of the left-handed twin. The twins both showed clockwise cerebellar torques. This mirrored a counter-clockwise cerebral torque in the right-handed twin only. Selected single cerebellar lobules V and VII displayed between-twin laterality differences that partially reflected their discrepant handedness. Whole cerebellum anatomical measures appeared to be unrelated to single functional cortical asymmetries. These analyses contribute further anatomical evidence pertaining to the existence of multiple structurally and functionally distinct cortico-cerebellar networks of the healthy human brain in vivo.

To examine the nature of hemispheric lateralization for neural processes underlying verbal fluency and visuo-spatial attention, we investigated a single pair of handedness discordant monozygotic (MzHd) twins. Imaging of the brain was undertaken using magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) in combination with manual performance tasks. The twins were discordant for MRI anatomical asymmetries of the pars triangularis and planum temporale, whose asymmetry was consistent with verbal laterality on fMRI. Thus, the right-handed twin had left lateralized verbal with right lateralized visuo-spatial attention, while the left-handed twin had right lateralized verbal with left lateralized visuo-spatial activation; these data lend further support for to the conclusions of Sommer et al.

The differences between right (RH) and left (LH) handers reported in the literature on fine motor tasks, has traditionally been interpreted relative to purported functioning of the cerebral hemispheres. However, conclusive evidence for performance differences which are intrinsic to handedness per se is difficult to obtain unless left and right handers are compared who are similar in their genetic and environmental background. The present study therefore, employed a monozygotic (MZ) twin design which minimizes differences in genetic variation between the two groups. Forty female monozygotic twins (20 pairs) were selected on the basis of discordance of writing hand. Their laterality preferences were assessed and they were tested for differences on hand performance tasks (dot filling, finger tapping, and peg moving). The results revealed that on the hand and foot preference inventories, the right-handers were more strongly lateralized than their left-handed sisters, and that the left-handers had greater variation in their laterality scores. There were substantial correlations between preference and performance scores. The analyses not only revealed the obvious strong main effects of writing hand on performance tasks, but interaction effects of handedness on the peg-moving task. The dot filling task differentiated the writing versus non-writing hand considerably better than either of the other two performance tasks. However, no evidence was found to indicate that twins who wrote with their left hands showed poorer performance than their right-handed twin sisters.

The Embedded Figures Task (EFT) involves search for a target hidden in a complex geometric pattern. Even though the EFT is designed to probe local visual search functions, not language-related processes, neuropsychological studies have demonstrated a strong association between aphasia and impairment on this task. A potential explanation for this relationship was offered by a recent functional MRI study (Manjaly et al., 2003), which demonstrated that a part of the left posterior inferior frontal gyrus (pIFG), overlapping with Broca's region, is crucially involved in the execution of the EFT. This result suggested that pIFG, an area strongly associated with language-related functions, is also part of a network subserving cognitive functions unrelated to language. In this study, we tested this conjecture by analysing the data of Manjaly et al. for context-dependent functional interactions of the pIFG during execution of the EFT. The results showed that during EFT, compared to a similar visual matching task with minimal local search components, pIFG changed its interactions with areas commonly involved in visuospatial processing: Increased contributions to neural activity in left posterior parietal cortex, cerebellar vermis, and extrastriate areas bilaterally, as well as decreased contributions to bilateral temporo-parietal cortex, posterior cingulate cortex, and left dorsal premotor cortex were found. These findings demonstrate that left pIFG can be involved in nonlanguage processes. More generally, however, they provide a concrete example of the notion that there is no general one-to-one mapping between cognitive functions and the activations of individual areas. Instead, it is the spatiotemporal pattern of functional interactions between areas that is linked to a particular cognitive context.

We investigated neural activations underlying a verbal fluency task and cytoarchitectonic probabilistic maps of Broca's speech region (Brodmann's areas 44 and 45). To do so, we reanalyzed data from a previous functional magnetic resonance imaging (fMRI) [Brain 125 (2002) 1024] and from a cytoarchitectonic study [J. Comp. Neurol. 412 (1999) 319] and developed a method to combine both data sets. In the fMRI experiment, verbal fluency was investigated in 11 healthy volunteers, who covertly produced words from predefined categories. A factorial design was used with factors verbal class (semantic vs. overlearned fluency) and switching between categories (no vs. yes). fMRI data analysis employed SPM99 (Statistical Parametric Mapping). Cytoarchitectonic maps of areas 44 and 45 were derived from histologic sections of 10 postmortem brains. Both the in vivo fMRI and postmortem MR data were warped to a common reference brain using a new elastic warping tool. Cytoarchitectonic probability maps with stereotaxic information about intersubject variability were calculated for both areas and superimposed on the functional data, which showed the involvement of left hemisphere areas with verbal fluency relative to the baseline. Semantic relative to overlearned fluency showed greater involvement of left area 45 than of 44. Thus, although both areas participate in verbal fluency, they do so differentially. Left area 45 is more involved in semantic aspects of language processing, while area 44 is probably involved in high-level aspects of programming speech production per se. The combination of functional data analysis with a new elastic warping tool and cytoarchitectonic maps opens new perspectives for analyzing the cortical networks involved in language.

Task-switching, a term that covers a wide range of different cognitive processes, is a topic of considerable current interest. We draw particular attention to verbal within-task switching in neurological patients and healthy volunteers. The paradigm employs two types of fluency tasks: (i) semantic category verbal fluency in which subjects covertly produce words from a predefined superordinate semantic category and (ii) automatic speech tasks in which subjects produce words from overlearned sequences. In the single-category conditions, words are produced from one category at a time; in the switching conditions, words are produced alternately from three categories. For example, the semantic categories could be fruits, cars, and furniture and the automatic categories could be days of the week, letters of the alphabet, and months of the year. In a previous fMRI study of healthy volunteers, the main group effect of switching (semantic category and automatic speech) relative to single-category fluency (semantic category and automatic speech) showed significant activations (p < 0.05 corrected) only in bilateral superior posterior parietal cortex, Brain 125, 1024-1038). There was no significant prefrontal activation as a main effect of switching. In this paper we present further results from that experiment which show a surprising lack of consistent frontal lobe switch activations in single-subject analyses. These findings are discussed in relation to other neuroimaging studies of task-switching and the role of convergent neuropsychological data from patients with neurodegenerative disease.

The Embedded Figures Task involves a search for a target hidden in a more complex visual pattern. The task has been used to study local perception and visual search in a range of normal and pathological populations. After acquired brain damage, impairment on embedded figures is strongly associated with aphasia; in the context of developmental disorder, people with autism or with Asperger's syndrome are reliably found to be better than normal controls on the task. The current study employed functional MRI with healthy volunteers to elucidate the brain regions that are specifically involved in the local search aspects of the Embedded Figures Task. We did so by analyzing the neural activations that are implicated in the task over and above those involved in an easier visual search task and in a straightforward shape recognition task. Significant activations (P < 0.05, corrected) specific in the above sense to the Embedded Figures Task were found in left inferior and left superior parietal cortex and in left ventral premotor cortex (inferior frontal gyrus). By contrast, comparing the overall effect of visual search within geometric figures to pure recognition of geometric shapes revealed more widespread activations in parietal, occipital, cerebellar, and frontal areas bilaterally. The implications of these findings for some developmental and acquired pathologies of perceptual functioning are outlined. We also relate our results to studies of local/global processing in other tasks.

Background: Schizophrenic patients generate fewer words than healthy controls during verbal fluency tasks. The structure of output may explain why patients generate fewer exemplars., Methods: Twenty-four healthy controls and 24 patients with schizophrenia participated in six, 3 min semantic fluency tasks. In a subsequent session, participants were given cards, each printed with one of their own words generated from previous fluency tasks. Participants were to sort the cards into categories (e.g. subcategories of 'animals'), thus defining their own semantic subcategories of words, and thereby eliminating experimenter assumptions about word relatedness. These clusters were matched with fluency output of each participant. The time spent searching through semantic networks within clusters and switching to other clusters when locating and producing associated words were measured., Results: Patients produced fewer words and spent more time switching to words within clusters and to different clusters than controls, but otherwise response profiles were similar. Although controls returned more frequently to clusters and consequently made more switches between these clusters than patients, this group difference disappeared when the total number of words produced was covaried., Conclusions: Consistent with previous literature, patients produced fewer words and made more errors than controls. The absence of a group difference in number of different clusters or mean number of items per cluster suggests that patients are similar to controls with respect to number of ideas in their semantic network. Patients' longer between-cluster switching times indicate a general slowness that may be attributed to difficulties finding new words within a semantic field.

We investigated whether posterior parietal cortex controls attentional switching when the tasks involve neither spatial nor visual cognition. Normal volunteers were scanned using functional MRI (fMRI). In all conditions, subjects were required to covertly produce words in verbal fluency tasks. They did so at a rate of one every 2 s (with eyes closed) in response to an auditory beep. In the non-switching (NS) trials, subjects responded with a series of items from a prespecified semantic category (SC) (e.g. fruits or cars) and from overlearned sequences (OSs) (days of the week, months of the year or letters of the alphabet). Instructions as to which category items should be drawn from on a given run of trials were presented over fMRI-compatible earphones prior to each run. In the switching (S) trials, subjects produced a series of word triads from three SCs: for example, fruits, cars and furniture (e.g. pear, Mercedes, table.); and from three OSs: days of the week, months of the year and letters of the alphabet (e.g. Monday, January, A.). This design is factorial, with the factors verbal class (SC or OSs) and switching conditions (S or NS). Increases in neural activity (P < 0.05, corrected for multiple comparisons) were observed only in superior posterior parietal cortex bilaterally as a main effect of the S conditions compared with the NS conditions. When SC fluency was compared with OS fluency, significant activations were found in anterior cingulate cortex bilaterally, the left inferior frontal gyrus, the middle frontal gyrus bilaterally, frontal operculum bilaterally and in the cerebellar vermis. These results support the hypothesis that superior posterior parietal cortex is a supramodal area implicated in task switching, even when no visual or spatial component is implicated in the tasks. Task switching, frequently used to examine 'frontal' executive functions, may also be clinically relevant to the assessment of patients with superior posterior parietal lesions.

A pure case of autopsy-confirmed dementia with Lewy bodies (DLB) is described. The patient presented with distinctive verbal fluency deficits in the context of mild language impairment, intact recognition memory, and impaired paragraph recall. Neuroimaging (CT and SPECT) showed progressive medial temporal lobe atrophy. Neuropathology revealed Lewy bodies, degeneration in the substantia nigra, nucleus basalis of Meynert (Nakano & Hirano, 1984), and locus ceruleus, but no pathology characteristic of Alzheimer's disease. It is in this sense that the case is "pure" DLB. Early neuropsychological diagnosis of DLB is essential (Salmon et al., 1996) given the potentially fatal hazard of neuroleptics (McKeith et al., 1992) and the difficulties associated with clinical neurological diagnoses (Litvan et al., 1998)., (Copyright 2000 Academic Press.)

Objectives: The aim was to investigate whether patients with Parkinson's disease (PD) make movements that are of smaller amplitude when required to attend to a secondary task at the same time as performing a motor task., Methods: Thirteen patients with idiopathic Parkinson's disease (mean age, 67.1 yrs) and 14 healthy control subjects (mean age, 66.2 yrs) were tested. The motor task was repeated opposition of the thumb and forefinger and the secondary task was a lexical decision task., Results: The PD patients made hypometric movements, and the amplitude was further decreased when they performed the secondary task at the same time. There was no significant change for the control subjects., Conclusion: The unpaced motor task was less automatic for the PD patients than for the control subjects, and hence more subject to interference from a secondary task. We relate this to the underactivation of the supplementary motor cortex (SMA).

Mechanisms of lexical retrieval within natural semantic categories are investigated in patients with schizophrenia. We predicted and found that schizophrenics show lexical retrieval impairments on word search tasks. Experiments are described in which subjects either scan through word lists for single target items (simple search), or search for members of a semantic category (semantic search). Two groups of subjects are employed: medicated schizophrenics, and a comparison group with similar age and premorbid intelligence. A significant between-group difference is reported (for both speed and accuracy) in semantic category search but not in simple search. It is known that many schizophrenic patients have word finding difficulties (Frith, 1992; Frith et al., 1991). Our results support the claim that in some schizophrenics at least, selective lexical-semantic parallel processing deficits may underlie word finding aberrations. It is possible that such dysfunctions reflect weakened connection strengths between units making up a lexical-semantic field (as characterised by proximity to a prototype).

Objective: To investigate whether micrographia in patients with Parkinson's disease is lessened either by giving visual targets or by continually reminding them that they should write with a normal amplitude., Methods: Eleven patients with Parkinson's disease (mean age 65.4 years) were compared with 14 control subjects (mean age 67.1 years). The subjects wrote with a stylus on a graphics tablet. There were three conditions: free writing, writing with dots to indicate the required size, and writing with continuous verbal reminders ("big"). Each condition was performed twice., Results: The patients wrote with a more normal amplitude when given either the visual cues or the auditory reminders. This improvement persisted when, shortly afterwards, the patients wrote freely without external cues. The increase in amplitude was achieved mainly by an increase in movement time rather than in peak velocity., Conclusion: Whereas the visual cues directly specified the required amplitude the auditory reminders did not. One effect of external cues is that they draw attention to the goal, and thus encourage the patients to write less automatically.

In this paper, we describe the detailed neuropsychological investigation of two cases of progressive supranuclear palsy (PSP) and demonstrate word-finding difficulties associated with pervasive problems in word-retrieval. The pattern of deficits resembles that seen in Parkinson's Disease (PD) but is more severe, even in very mild PSP, and appears less amenable to cue facilitation. Performance on a variety of word-production tasks is compared, and experimental controls for motor effects on performance are included. The role of stimulus cues in speeded word-finding is addressed experimentally, as are central executive influences on task performance. This combines with functional brain-scan data from single photon emission computed tomography (SPECT) which shows reduced frontal perfusion in one of the two cases.

A modified Neisser word-search (search II) was administered to patients with Parkinson's disease (PD), and significant deficits were found. Given the assumption that the processes are lexical, we interpret the results as support for the claim that there is competition between semantically related words in speech production (Wheeldon, 1989). A related verbal task-switching experiment (continuous series II) is also presented. Although PDs are impaired on task switching, there are double dissociations between verbal task switching (continuous series II) and lexical retrieval (search II). The relationship between performance on these tasks and on verbal fluency is also addressed.

Objective: To examine the status of remote memory and lexical retrieval processes in a patient with frontal lobe-type dementia studied serially during an 18-month period., Design: Longitudinal single-case study., Setting: University hospital., Patient: A 67-year-old man presented to the hospital with progressive frontal lobe dysfunction confirmed by neuropsychological testing and single photon emission-computed tomographic scan. Postmortem brain examination demonstrated focal atrophy of the orbitofrontal region of the frontal lobe and medial temporal structures with abundant Pick's bodies and Pick's cells., Main Outcome Measures: Anterograde memory was assessed on a range of free recall and recognition tests using verbal and nonverbal material. Remote memory was assessed by Famous Faces and Famous Events tests and the Crovitz test of remote personal memory. Lexical retrieval was examined using initial-letter and semantic category-based fluency tasks., Results: Initially there was a dissociation between anterograde memory, which was severely impaired, and relatively spared remote memory. Within retrograde memory there was evidence of selective difficulty in retrieving contextually rich and time-specific personal memories and in dating personal and public memories. In contrast, retrieval of names of famous persons and recognition of famous events was relatively normal. As the disease progressed, performance on all remote memory tests worsened, but without a temporally graded pattern. Lexical retrieval was markedly impaired and affected to an equivalent degree performance on initial-letter and category fluency tasks., Conclusion: These findings are interpreted in the context of a general retrieval deficit resulting from the interruption of frontostriatal circuits.

We report the impaired performance by a group of 27 patients with Parkinson's disease (vs matched controls) on semantic and letter-initial verbal fluency tasks, carried out in both single and alternating category conditions. Individual differences in fluency were significantly correlated with confrontation picture naming scores in the patient group, but not in control subjects. However, the PD patients showed no significant correlation between verbal fluency scores, and rate of reciting days of the week as rapidly as possible. Both controls and patients produced more items when retrieving words from a single category than when alternately retrieving words from two categories. The magnitude of the decrement was nonetheless no greater in the patient than in the control population. This finding shows that "task switching" per se is not impaired in PD. We suggest that the verbal fluency deficit, while it may in part be attributed to motor-speech factors, primarily reflects an underlying cognitive disorder.

We report a comparatively 'pure' case of 'foreign accent syndrome' (FAS) in a right-handed patient who sustained a small, isolated, left basal ganglia infarct. At 3 weeks post-onset FAS persisted in the absence of aphasic disorder. Phonetic analysis of the patient's speech was undertaken at that time and a further, more detailed acoustic and phonetic investigation, was undertaken at 8 months. The validity and significance of the term 'FAS' is discussed.