Normal and pathological reading: converging data from lesion and imaging studies

In this paper we discuss cognitive and anatomical models of reading that have emerged from behavioral and lesion studies of dyslexia and functional neuroimaging studies of normal subjects. We then suggest that discrepancies in their findings can partly be overcome by functional neuroimaging studies of patients with acquired dyslexia. We present two such studies. One patient had a large left temporoparietal lesion which limited his reading to words with high semantic associations. When he read these words aloud, activation was observed in all areas of the normal reading system with the exception of the damaged left superior temporal lobe. The second patient had anterior temporal lobe atrophy with semantic dementia and a deficit in reading words that rely on lexical or semantic mediation. When asked to read aloud words on which she was likely to succeed, she activated all the normal areas, with increased activation in a left sensorimotor area associated with phonological processing and decreased activation in several areas associated with semantic processing. By relating these findings to those from lesion studies and imaging studies of normals, we propose that the translation of orthography to phonology is mediated semantically by the anterior part of the left midfusiform gyrus. In contrast, when semantic processing is compromised, the translation of orthography to phonology will be more reliant on the posterior part of the left midfusiform and the left frontal areas associated with phonology. Future studies are required to examine the connectivity between these areas during normal and abnormal reading.