Evidence conflicts as to whether adults with right hemisphere brain damage (RHD) generate inferences during text comprehension. M. Beeman (1993) reported that adults with RHD fail to activate the lexical-semantic bases of routine bridging inferences, which are necessary for comprehension. But other evidence indicates that adults with RHD activate multiple interpretations in various comprehension domains. In addition, the activation of contextually inappropriate interpretations is prolonged for many adults with RHD and predicts poor discourse comprehension. This study contrasted Beeman's activation failure hypothesis with the prediction that adults with RHD would generate multiple interpretations in text comprehension. The relation between activation of textually incompatible inferences and discourse comprehension was also investigated for this group. Thirty-seven adults with RHD and 34 without brain damage listened to brief narratives that required a bridging inference (BI) to integrate the text-final sentence. This final sentence, when isolated from its text, was strongly biased toward a contextually incompatible alternate interpretation (AI). Auditory phoneme strings were presented for lexical decision immediately after each text's initial and final sentence. Adults with RHD were both faster and more accurate in making lexical decisions to BI-related target words in final-sentence position than in initial-sentence position. Thus, contrary to the activation failure hypothesis, adults with RHD generated the lexical-semantic foundations of BIs where they were required by the text. AI generation was evident in accuracy data as well, but not in response time data. This result is partially consistent with the multiple activation view. Finally, greater activation for contextually incompatible interpretations was associated with poorer discourse comprehension performance by adults with RHD.
Purpose:
Cognitive impairment is a common consequence of stroke and has direct implications for poststroke functioning and quality of life, including the ability to maintain a job, live independently, sustain interpersonal relationships, and drive a vehicle. In this scientific statement, we critically appraise the literature on the prevalence, diagnosis, and management of poststroke cognitive impairment (PSCI) and provide a framework for clinical care while highlighting gaps that merit further study.
Methods:
We performed a scoping literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, clinical guidelines, review articles, and editorials on the incidence and prevalence, natural history, diagnosis, and management of PSCI. Scoping reviews determine the scope of a body of literature on a given topic to indicate the volume of literature and the studies currently available and provide an overview of its focus.
Results:
PSCI is common after stroke, especially in the first year, and ranges from mild to severe. Although cognitive impairment is reversible in some cases early after stroke, up to one-third of individuals with stroke develop dementia within 5 years. The pathophysiology is not yet fully elucidated but is likely attributable to an acute stroke precipitating a series of pathological events, often in the setting of preexisting microvascular and neurodegenerative changes. Screening for associated comorbidities and interdisciplinary management are integral components of the care of individuals with PSCI. There is a need for prospective studies evaluating the individual trajectory of PSCI and the role of the acute vascular event in the predisposition for Alzheimer disease and related dementias, as well as high-quality, randomized clinical trials focused on PSCI management.
Purpose-Comprehension deficits associated with right hemisphere brain damage (RHD) have been attributed to an inability to use context, but there is little direct evidence to support the claim. This study evaluated the effect of varying contextual bias on predictive inferencing by adults with RHD.Method-Fourteen adults with no brain damage (NBD) and 14 with RHD read stories constructed with either high predictability or low predictability of a specific outcome. Reading time for a sentence that disconfirmed the target outcome was measured and compared with a control story context.Results-Adults with RHD evidenced activation of predictive inferences only for highly predictive conditions, whereas NBD adults generated inferences in both high-and low-predictability stories. Adults with RHD were more likely than those with NBD to require additional time to integrate inferences in high-predictability conditions. The latter finding was related to working memory for the RHD group. Results are interpreted in light of previous findings obtained using the same stimuli.Conclusions-RHD does not abolish the ability to use context. Evidence of predictive inferencing is influenced by task and strength of inference activation. Treatment considerations and cautions regarding interpreting results from one methodology are discussed.
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