BACKGROUND AND PURPOSE: Korean-speaking patients with a brain injury may show agraphia that differs from that of English-speaking patients due to the unique features of Hangul syllabic writing. Each grapheme in Hangul must be arranged from left to right and/or top to bottom within a square space to form a syllable, which requires greater visuospatial abilities than when writing the letters constituting an alphabetic writing system. Among the Hangul grapheme positions within a syllable, the position of a vowel is important because it determines the writing direction and the whole configuration in Korean syllabic writing. Due to the visuospatial characteristics of the Hangul vowel, individuals with early-onset Alzheimer's disease (EOAD) may experiences differences between the difficulties of writing Hangul vowels and consonants due to prominent visuospatial dysfunctions caused by parietal lesions. METHODS: Eighteen patients with EOAD and 18 age-and-education-matched healthy adults participated in this study. The participants were requested to listen to and write 30 monosyllabic characters that consisted of an initial consonant, medial vowel, and final consonant with a one-to-one phoneme-to-grapheme correspondence. We measured the writing time for each grapheme, the pause time between writing the initial consonant and the medial vowel (P1), and the pause time between writing the medial vowel and the final consonant (P2). RESULTS: All grapheme writing and pause times were significantly longer in the EOAD group than in the controls. P1 was also significantly longer than P2 in the EOAD group. CONCLUSIONS: Patients with EOAD might require a higher judgment ability and longer processing time for determining the visuospatial grapheme position before writing medial vowels. This finding suggests that a longer pause time before writing medial vowels is an early marker of visuospatial dysfunction in patients with EOAD.
Adult ; Agraphia ; Alzheimer Disease* ; Brain Injuries ; Humans ; Judgment ; Rabeprazole ; Writing*

Korean vocabularies are composed of ideograms (Hanja) and phonograms (Hangle) just like Kanji (ideogram) and Kana (Phonogram) in Japanese. Double dissociation between the phonogram and ideogram has been reported in both languages. According to those studies, the ideograms are localized in more selective brain areas than the phonograms. We report on a case of alexia with agraphia for Hangle and intact reading for Hanja after a left parieto-occipital lobe infarction.
Agraphia ; Asian Continental Ancestry Group ; Brain ; Dissociative Disorders ; Dyslexia ; Humans ; Vocabulary

Gerstmann syndrome that was caused by a traumatic origin was very rare. We have reported a case of typical Gerstmann syndrome which was caused by a localized head injury. The case showed finger agnosia, right-left disorientation, acalculia and dysgraphia. And also the case revealed amnesic dysphasia and autotopagnosia. The lesion was an egg-shell typed depressed fracture(4 cm in diameter) of the left inferior parietal bone associated with the intracerebral hematoma in the lower parietal lobe which seemed to be the transitional area of the angular gyrus and the second occipital convolution.
Agnosia ; Agraphia ; Aphasia ; Craniocerebral Trauma ; Dyscalculia ; Gerstmann Syndrome* ; Hematoma ; Parietal Bone ; Parietal Lobe

Gerstmann's syndrome, assigned to a lesion of the dominant parietal lobe, is a neurological disorder characterized by acalculia, agraphia, right-left disorientation and finger agnosia. Some studies report that these symptoms are also shown in other brain lesions. We report two patients who presented with this tetrad of symptoms in initial assessment. Their Brain MRI images both showed lesion of left frontal lobe. Over time, these symptoms became better but some still remained in last assessment. Accordingly, we suggest that a left frontal lesion cause Gerstmann's syndrome.
Agnosia ; Agraphia ; Brain ; Dyscalculia ; Frontal Lobe* ; Gerstmann Syndrome* ; Humans ; Magnetic Resonance Imaging ; Nervous System Diseases ; Parietal Lobe

Aged ; Agraphia ; etiology ; Amyotrophic Lateral Sclerosis ; complications ; pathology ; Female ; Frontotemporal Lobar Degeneration ; complications ; pathology ; Humans ; Magnetic Resonance Imaging

Crossed aphasia refers to language disturbance induced by unilateral right hemisphere (non-language dominant) injury in right-handed people who had no previous history of brain damage. Crossed aphasia occurs in less than 2 percent who developed a aphasia. We report a case of a 49-year-old right handed man with language disturbance after right middle cerebral infarction. He showed nonfluent crossed aphasia with Gerstman syndrome such as right-left disorientation, finger agnosia, acalculia and agraphia, but not with apraxia and neglect. At 7 weeks after onset, language function indicated improvement in spontaneous speech and at 19 weeks after onset, improvement in spontaneous speech, comprehension, repetition, naming and reading.
Agnosia ; Agraphia ; Aphasia* ; Apraxias ; Brain ; Cerebral Infarction ; Comprehension ; Dyscalculia ; Hand ; Humans ; Infarction, Middle Cerebral Artery* ; Middle Aged

We report a man who exhibited pure agraphia after suffering a left subcortical infarction involving part of the thalamus and the basal ganglia. His writing difficulty was characterized by stopping, letter omission, and substitution in spontaneous writing and writing to dictation, but he was able to copy normally. Decreased perfusion in the left frontal lobe and temporal cortex was noted on brain single-photon-emission computed tomography . This patient's agraphia persisted at follow-up 52 days later. We suggest that the subcortical lesion in this patient caused pure agraphia secondary to diaschisis of the interconnected cortical area.
Agraphia ; Basal Ganglia ; Brain ; Cerebral Infarction ; Coat Protein Complex I ; Follow-Up Studies ; Frontal Lobe ; Humans ; Infarction ; Perfusion ; Stress, Psychological ; Thalamus ; Writing

BACKGROUNDPatients with Alzheimer's disease (AD) manifest progressive decline in writing abilities. Most studies on agraphia in AD have been performed in the alphabetic system, such as English. However, these findings may not be applicable to other written language systems. The unique features of the Chinese written script could affect the patterns of agraphia in Chinese AD patients. The aim of this study was to explore the features of writing errors in Chinese patients with AD and amnestic mild cognitive impairment (a-MCI), as well as to study the relationship between their writing errors and neuropsychological functions.

METHODSIn this study, we performed an observational study in a group of subjects including 17 AD patients, 14 patients with a-MCI, and 16 elderly healthy controls. We analyzed the writing errors in these subjects and also studied the relationship between their writing errors and neuropsychological functions.

RESULTSOur study showed that in patients whose mother tongue is Chinese, writing ability was comparatively well preserved in the MCI phase but significantly impaired when the disease progressed to the stage of AD. The writing errors showed corresponding increase with the severity of cognition decline, both in the types of errors and rate of occurrence. Analysis of the writing errors showed that word substitution and unintelligible words were the most frequent error types that occurred in all the three study groups. The occurrence rate of unintelligible words was significantly higher in the AD group compared with the a-MCI group (P = 0.024) and control group (P = 0.018). In addition, the occurrence rates of word substitution were also significantly higher in AD (P = 0.013) and a-MCI groups (P = 0.037) than that of control group. However, errors such as totally no response, visuospatial impairment, paragraph agraphia, ideograph, and perseverative writing errors were only seen in AD group. Besides, we also found a high occurrence rate of visuoconstructional errors (13.3%) in our AD group.

CONCLUSIONSOur study confirmed that agraphia is an important feature in patients with AD. The writing error profile in patients whose native language is Chinese was unique compared to patients using the alphabetic language system.

Aged ; Agraphia ; diagnosis ; physiopathology ; Alzheimer Disease ; complications ; physiopathology ; Asian Continental Ancestry Group ; Cognition Disorders ; diagnosis ; physiopathology ; Cognitive Dysfunction ; diagnosis ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Neuropsychological Tests

The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Agraphia/*pathology ; Brain/pathology ; Brain Injuries/*pathology ; Female ; Humans ; Language ; Male ; Middle Aged ; Neuropsychological Tests ; Perceptual Disorders/*pathology ; Republic of Korea ; Spatial Processing/*physiology ; Stroke/*pathology ; Writing ; Young Adult

The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Agraphia/*pathology ; Brain/pathology ; Brain Injuries/*pathology ; Female ; Humans ; Language ; Male ; Middle Aged ; Neuropsychological Tests ; Perceptual Disorders/*pathology ; Republic of Korea ; Spatial Processing/*physiology ; Stroke/*pathology ; Writing ; Young Adult