Tactile agnosia. Casuistic evidence and theoretical remarks on modality-specific meaning representations and sensorimotor integration.

Somaesthetic, motor and cognitive functions were studied in a man with impaired tactile object-recognition (TOR) in his left hand due to a right parietal convexity meningeoma which had been surgically removed. Primary motor and somatosensory functions were not impaired, and discriminative abilities for various tactile aspects and cognitive skills were preserved. Nevertheless, the patient could often not appreciate the object's nature or significance when it was placed in his left hand and was unable to name or to describe or demonstrate the use of these objects. Therefore, he can be regarded as an example of associative tactile agnosia. The view is taken and elaborated that defective modality-specific meaning representations account for associative tactile agnosia. These meaning representations are conceptualized as learned unimodal feature-entity relationships which are thought to be defective in tactile agnosia. In line with this hypothesis, tactile feature analysis and cross-modal matching of features were largely preserved in the investigated patient, while combining features to form entities was defective in the tactile domain. The alternative hypothesis of agnosia as deficit of cross-modal association of features was not supported. The presumed distributed functional network responsible for TOR is thought to involve perception of features, object recognition and related tactile motor behaviour interactively. A deficit leading primarily to impaired combining features to form entities can therefore be expected to result in additional minor impairment of related perceptual-motor processes. Unilaterality of the gnostic deficit can be explained by a lateralized organization of the functional network responsible for tactile recognition of objects.