Sugishita M, Otomo K, Kabe S, Yunoki K
Department of Rehabilitation, Tokyo Metropolitan Institute for Neuroscience, Japan.
Brain. 1992 Oct;115 ( Pt 5):1563-85. doi: 10.1093/brain/115.5.1563.
Owing to the Japanese language's unique writing system, which consists of phonograms and ideograms, reading impairments of Japanese brain-damaged patients have attracted the interest of many researchers. Past case reports as well as some widely accepted handbooks and textbooks have concluded that a specific aphasia type or lesion site is associated with a particular impairment pattern of phonograms and ideograms in reading. However, the methodology and analytical procedures in previous studies were inadequate for reliable generalizations to be made. First, the test materials were unspecified or inappropriate, or the number of test items was small. Secondly, the conclusions were presented without providing individual performance data to support them. Thirdly, in associating patterns of reading impairment with lesion sites, only single cases were reported. The present investigation was designed to overcome the omissions of previous studies, and examined the ability to read 46 single phonograms and 46 single ideograms aloud in four groups of sufficiently large numbers of patients; namely, seven pure alexics, 23 Broca aphasics, 13 Wernicke aphasics, and seven patients with alexia and agraphia. Ours are the first data to demonstrate unequivocally no consistent linkage between aphasia type and the patterns of impairment of phonogram and ideogram reading. The impairment patterns were not uniform across patients even in the same aphasia group. A majority of the cases in each group showed that phonograms and ideograms were unselectively impaired. However, ideogram reading was more difficult in three cases in the pure alexia and Broca aphasia groups, respectively, and in one case in the Wernicke aphasia group. Phonogram reading was more severely disturbed in four cases among the Broca aphasics and in one case among the patients with alexia with agraphia. An apparent variability of impairment patterns characterized the Broca aphasic group. These dyslexic patterns did not appear to correlate with the site and extent of lesions identified by computerized tomography scans. Past reports linking a particular impairment pattern of phonogram and ideogram reading and a specific lesion site were studies of single cases, and their conclusions seem oversimplified. While sensory and motor dysfunctions can usually be neuroanatomically localized in individuals, impairments of certain high cortical functions, such as the reading of phonograms and ideograms, may not be correlated with damage to definite neuroanatomical structures.
由于日语独特的书写系统，它由表音文字和表意文字组成，日本脑损伤患者的阅读障碍吸引了许多研究人员的关注。过去的病例报告以及一些广泛认可的手册和教科书都得出结论，特定的失语症类型或病变部位与阅读中表音文字和表意文字的特定损伤模式相关。然而，先前研究中的方法和分析程序不足以做出可靠的概括。首先，测试材料未明确规定或不合适，或者测试项目数量较少。其次，得出结论时没有提供个体表现数据来支持。第三，在将阅读障碍模式与病变部位联系起来时，只报告了单个病例。本研究旨在克服先前研究的遗漏，对四组数量足够多的患者进行了大声朗读46个单音节表音文字和46个单音节表意文字的能力测试；即7名纯失读症患者、23名布罗卡失语症患者、13名韦尼克失语症患者和7名失读失写症患者。我们的数据首次明确表明，失语症类型与表音文字和表意文字阅读的损伤模式之间没有一致的联系。即使在同一失语症组中，患者的损伤模式也不一致。每组中的大多数病例表明，表音文字和表意文字受到无选择性的损伤。然而，在纯失读症组和布罗卡失语症组中分别有3例，在韦尼克失语症组中有1例，表意文字阅读更困难。在布罗卡失语症患者中有4例，在失读失写症患者中有1例，表音文字阅读受到更严重的干扰。布罗卡失语症组的损伤模式具有明显的变异性。这些诵读困难模式似乎与计算机断层扫描确定的病变部位和范围无关。过去将表音文字和表意文字阅读的特定损伤模式与特定病变部位联系起来的报告都是对单个病例的研究，其结论似乎过于简单化。虽然感觉和运动功能障碍通常可以在个体中进行神经解剖定位，但某些高级皮质功能的损伤，如对表音文字和表意文字的阅读，可能与明确的神经解剖结构损伤无关。
