Platel H, Lambert J, Eustache F, Cadet B, Dary M, Viader F, Lechevalier B
Université de Caen, France.
Neuropsychologia. 1993 Nov;31(11):1147-58. doi: 10.1016/0028-3932(93)90064-7.
Rapcsak et al. (Archs Neurol. 46, 65-67, 1989) proposed a hypothesis describing the evolution of agraphic impairments in dementia of the Alzheimer type (DAT): lexico-semantic disturbances at the beginning of the disease, impairments becoming more and more phonological as the dementia becomes more severe. Our study was conducted in an attempt to prove this hypothesis on the basis of an analysis of the changes observed in the agraphia impairment of patients with DAT. A writing test from dictation was proposed to 22 patients twice, with an interval of 9-12 months between the tests. The results show that within 1 year there was little change in the errors made by the patients in the writing test. The changes observed however were all found to develop within the same logical progression (as demonstrated by Correspondence Analysis). These findings made it possible to develop a general hypothesis indicating that the agraphic impairment evolves through three phases in patients with DAT. The first one is a phase of mild impairment (with a few possible phonologically plausible errors). In the second phase non-phonological spelling errors predominate, phonologically plausible errors are fewer and the errors mostly involve irregular words and non-words. The last phase involves more extreme disorders that affect all types of words. We observe many alterations due to impaired graphic motor capacity. This work would tend to confirm the hypothesis proposed by Rapcsak et al. concerning the development of agraphia, and would emphasize the importance of peripheral impairments, especially grapho-motor impairments which come in addition to the lexical and phonological impairments.
拉普萨克等人（《神经病学文献》，第46卷，第65 - 67页，1989年）提出了一个假说，描述阿尔茨海默型痴呆（DAT）中失写症损害的演变过程：疾病初期存在词汇语义障碍，随着痴呆病情加重，损害越来越多地表现为语音方面的问题。我们开展这项研究，试图通过分析DAT患者失写症损害中观察到的变化来验证这一假说。我们对22名患者进行了两次听写写作测试，两次测试间隔9 - 12个月。结果显示，在1年时间内，患者写作测试中的错误变化不大。然而，观察到的变化都呈现出相同的逻辑进展（对应分析表明）。这些发现使得我们能够提出一个一般性假说，即DAT患者的失写症损害通过三个阶段演变。第一个阶段是轻度损害阶段（可能有一些语音上合理的错误）。在第二阶段，非语音拼写错误占主导，语音上合理的错误较少，且错误大多涉及不规则单词和非单词。最后一个阶段涉及更严重的障碍，影响所有类型的单词。我们观察到许多因图形运动能力受损而产生的变化。这项工作倾向于证实拉普萨克等人提出的关于失写症发展的假说，并强调外周损害的重要性，特别是除了词汇和语音损害之外出现的图形运动损害。
