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A 36-item-version of the Token Test is described and normative data obtained from its administration to 215 normal subjects are given. Years of schooling (but not age) were found to significantly affect the performance. The scores were corrected for this factor and the lower limit of the 90% tolerance interval around the mean of the adjusted scores was determined: it was found to correspond to 29 and left below it exactly 5% of the normal sample. The test was given to 200 aphasic patients. Fourteen (7%) were found to have an adjusted score of 29 or more, namely would have been classified as non-aphasic. This is a percentage remarkably smaller than that (40%) obtained with a 10 sentence comprehension test, which supports previous studies pointing to the sensitivity of the Token Test to the presence of oral language disorders. On the basis of the aphasic patients' performance, cutting scores allowing evaluation of the severity of the comprehension deficit are provided. The 36-item-version of the test appears to be an useful and convenient device to diagnose aphasic impairment of language comprehension.

Ideational apraxia was investigated in 20 left brain-damaged patients with tests requiring the demonstration of how objects are used. On a multiple object use test the most frequent errors were those of omission, misuse and mislocation, while sequence errors were rare. Patients also failed on a single object use test, which showed a correlation of 0.85 with the multiple object use test. Neither of these tests was significantly correlated with an ideomotor apraxia test (imitation of movements). Ideational apraxia was frequently, but not exclusively, associated with damage to the left posterior temporoparietal junction. These findings support the view that ideational apraxia is an autonomous syndrome, linked to left hemisphere damage and pertaining to the area of semantic memory disorders rather than to that of defective motor control.

Short-term memory was investigated in 30 control and 125 unilaterally brain-damaged patients with a series of tests requiring the immediate reproduction of strings of items of increasing length. In three tests the items were auditorially presented digits or words: one test asked for oral repetition of digits, while the other two required the patient to point to written digits or to pictures. The fourth test aimed at measuring spatial span. On both the Digits Forward test and the two other verbal tests not requiring the use of speech, left brain-damaged patients were impaired in comparison to normals, while the right brain-damaged patients were not. Aphasics had a significantly shorter verbal span than non-aphasic patients with left hemisphere damage. Spatial span, on the other hand, was significantly affected by a lesion posteriorly located in either hemisphere, but not by aphasia. Two patients with an exceedingly poor verbal memory span were observed, one suffering from anomic aphasia and the other from conduction aphasia. There were also two right hemisphere damaged patients who showed an extreme reduction of spatial span, which could not be accounted for by space perceptual disorders and contrasted with a normal performance on a spatial long-term memory test.

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Three prosopagnosic patients were given four face tests, two perceptual (an unknown face identification test and an age estimation test) and two also implying memory (a familiarity check test and a famous face recognition test). The patients' performance was assessed with reference to the score distribution of the normal population. A patient was found to fail both perceptual and mnestic tests, without any noticeable difference between them. Also the second patient had poor scores on both kinds of tests, but his impairment was significantly greater on the perceptual ones. The third patient, on the contrary, showed no perceptual deficit and only failed the mnestic tests. His inability to recognize the individuality of an item among members of the same category was strictly confined to faces and never present for other classes of stimuli (cars, coins, personal belongings). This finding is supportive of the thesis that in a few patients the deficit underlying prosopagnosia is face specific.

This study investigated the relation of apraxia to the nature of the stimulus which is given to elicit the gesture. Patients were required to perform a movement imitation test and to demonstrate the use of the same ten objects, once on verbal command, once with the object shown but not handled, and once with the object handled but not seen. One set of comparisons concerned the performance on two tasks involving the visual modality, movement imitation and use of objects presented visually. Although the majority of left brain-damaged patients either failed or passed both tests, there were at least 13 patients who showed an exceedingly poor performance on demonstration of use as compared to imitation. We infer that the distinction between ideational and ideomotor apraxia is warranted. Another set of comparisons concerned the performance on the use of objects presented in the verbal, visual and tactile modalities. A greater percentage of patients failed on the verbal or visual modalities than on the tactile modality. Out of 64 left brain-damaged patients who were diagnosed as apraxic in at least one modality, 23 had an exceedingly poor score on one test as compared to their score on either or both other tests. Fourteen patients selectively failed on verbal presentation, 14 on visual presentation and 2 on tactile presentation. These findings are viewed as supporting the hypothesis that apraxia results from the disconnection between the areas where information is processed and the areas where the movement is programmed.

No abstract