Visual problem solving in the absence of lexical semantics: evidence from dementia

A case of dissociation between visual and praxic skills and linguistic, referential, and semantic skills is described in a case of dementia. Testing revealed that her visual processing was intact and that she was capable of a wide range of visually based tasks. These included copying geometric figures and block designs; matching items on the basis of number, color, or relative size, matching upper and lower case letters, sequencing numerals, orienting pictures, coins, and letters appropriately, and solving problems based on the identification of geometric patterns or on the identification of logical sequences based on pattern alternation, number, and size increases. In contrast, she was completely incapable of matching pictures on the basis of their semantic or referential meaning; similarly she had lost all comprehension of language. It was argued that this case demonstrates the capacities of a visual system cut off from all symbolic and semantic processes. When examined with other case studies this case provides information about the nature of and interaction between modality-specific perceptual processing and semantic processing, and information about the various cognitive factors involved in visual gnosis. The CT scan indicated frontal atrophy and marked anterior temporal atrophy, a pattern that is consistent with Pick's disease. The case was discussed in terms of the correlation between the pattern of observed strengths and deficits and the neurological pattern of atrophy.