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Behavioural Neurology 25 (2012) 255–272 255DOI 10.3233/BEN-2012-119001IOS Press

Acquired dyslexia in three writing systems:Study of a Portuguese-Japanese bilingualaphasic patient

Mirna Lie Hosogi Senahaa,∗ and Maria Alice de Mattos Pimenta Parenteb

aMember of Behavioral and Cognitive Neurology Unit, Department of Neurology, University of Sao Paulo Schoolof Medicine, Sao Paulo, BrazilbInstitute of Psychology, Department of Developmental and Personality Psychology, Federal University of RioGrande do Sul, Porto Alegre, Brazil

Abstract. The Japanese language is represented by two different codes: syllabic and logographic while Portuguese employsan alphabetic writing system. Studies on bilingual Portuguese-Japanese individuals with acquired dyslexia therefore allow aninvestigation of the interaction between reading strategies and characteristics of three different writing codes. The aim of thisstudy was to examine the differential impact of an acquired brain lesion on the reading of the logographic, syllabic and alphabeticwriting systems of a bilingual Portuguese-Japanese aphasic patient (PF). Results showed impaired reading in the logographicsystem and when reading irregularly spelled Portuguese words but no effects on reading regular words and nonwords in syllabicand alphabetic writing systems. These dissociations are interpreted according to a multi-route cognitive model of readingassuming selective damage in the lexical route can result in acquired dyslexia across at least three different writing codes.

Keywords: Acquired dyslexia, written systems, surface dyslexia, kanji-kana, lexical reading, bilingualism, dissociation

1. Introduction

The Japanese language uses different writing codes:logographic and syllabic. Studies of premorbidly liter-ate Japanese speakers with acquired dyslexia thus al-low an investigation of how script has an effect on thecognitive processes used in the oral reading of differentwriting systems. In Brazil, the high number of Japanesespeakersmakes this investigationmore intriguing. Thisis because most Brazilian Japanese speakers also readand write in an alphabetic script – Portuguese – makingthese speakers tri-scriptal as well as bilingual.

Brazilian Portuguese presents, for the reading, a pre-dominantly alphabetic writing system with few irreg-

∗Corresponding author: Mirna Lie Hosogi Senaha, Ph.D., RuaMontesquieu, 371/62, Chacara Klabin, Sao Paulo, CEP 04116-190,SP, Brazil. Tel.: +55 11 5081 7363; Fax: +55 11 3288 8684; E-mail:[email protected].

ularities. This is reflected in the relationship betweennumber of phonemes (26) and letters (23). Most let-ters represent a univocal relationship between soundsand script that is independent of word context. How-ever, three letters (<x>, <e>, <o>) do present ambigu-ous relationships, with pronunciation dependent on theintraword context i.e. different sounds depending onthe word [27]. For example, the consonant <x> canbe read aloud as any one of phonemes /∫ /, /s/, /ks/ or/z/, as in the examples <faxina>, <maximo>, <sexo>and <exame>. There is also spelling to sound ambi-guity in the vowels <e> and <o> when they are in astressed position in paroxytone words. The vowel <e>can be associated to phonemes / / or /e/, as, for exam-ple, in <festa> and <vespa>, and the vowel <o> to thephonemes / / or /o/, as <cosmo> and <fosco>. Someconsonants also have context-dependent relationships.For instance: (1) if the letter <c> is preceded by thevowels <e> or <i>, it is associated with the phoneme

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256 M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems

/s/, as in the word <Cecılia>; (2) if the letter <c> ispreceded by other vowels or by a consonant, exceptthe letter <h>, it is converted to the phoneme /k/, as in<cabeca> and <pacto>; and (3) if the letter <c> is pre-ceded by the consonant <h>, both symbols constitute adigraph corresponding to the phoneme /∫ /.

The Japanese writing system is different to the Por-tuguese script in several ways. Japanese uses two typesof written code: a logographic code that is representedby kanji characters, and a syllabic code, that is repre-sented by the kana script. Kanji characters were orig-inally derived from Chinese ideograms. Kanji charac-ters represent a lexical morpheme of a spoken Japaneseword and have phonetic and semantic value (e.g. [ku-ruma] meaning car). Unlike Chinese characters, kanjihas two (or sometimes more) pronunciations: a ‘kun’reading, that is the adaptation of the Japanese meaningto Chinese writing and one (or more) ‘on’ readings, thatis the sound transcription from the Chinese language.In the Japanese syllabic system, that is represented bywritten kana script, each symbol corresponds to a syl-lable, or to a mora, without meaning (e.g. [mi],[so]). There are two forms of Japanese syllabic writing:hiragana and katakana. Both forms of kana have 46basic syllables with variations in size of the letter andsign additions leading to 102 syllables. Kana is a com-pletely transparent syllabic writing system. In otherwords, kana is regular in terms of the correspondencesbetween orthography and phonology.

Although Kanji and kana are different writing sys-tems, they are not alternative systems for communica-tion. It is possible to write a text in Japanese using onlysyllabic kana. However this happens in the first yearof education only. Also, it is not possible to write ameaningful text in Japanese using only kanji. To writea sentence in Japanese, the two writing systems aremixed and engaged simultaneously. In general, openclass words – nouns, verbs and adjectives – are writtenin kanji while the function words – inflections of verbsand adjectives, conjunctions and others – are written inhiragana whereas katakana is used for writing foreignnames and foreign words integrated into Japanese.

How can we understand the reading of bilingual, tri-scriptal speakers? Cognitive neuropsychological stud-ies of oral reading are based on theoretical modelsthat are based on the observation of dissociation be-tween reading and writing tasks as well as variabilityin the relationship between orthography and phonolo-gy [3]. Since the 1970s, studies of patients with ac-quired dyslexia have revealed dissociations in the read-ing and writing of regular and irregular words in al-

phabetic and non-alphabetic writing scripts [42]. Pa-tients may show preservation of irregular word readingwith an inability to read low frequency words and non-words. Other patients can show the opposite patterni.e. impaired irregular word reading but are able to readnonwords and low frequency regularly spelled words.

Most cognitivemodels or oral reading assume at leasttwo independent reading pathways: lexical and non-lexical routes. In the lexical route, known words areread as a whole with or without access to the seman-tic system. In the nonlexical route, segmented readingis used, in which graphemes are converted into theirrespective phonemes for oral reading. These modelsassume that whereas oral reading of irregular words isachieved via a lexical reading route, nonwords must beread via a sublexical or a nonlexical pathway. Gener-ally, the lexical route processes familiar words and thenonlexical route processes unfamiliar and infrequentregular words. Such models have been applied acrossscripts.

One viewof the cognitive processes involved in read-ing holds that processesmay vary according to the char-acteristics of each writing code [18,20,21,42]. Howev-er, most studies of acquired dyslexia have investigated(relatively opaque) alphabetic scripts, such as Englishand French. The spelling irregularities in these twocodes may induce lexical reading (e.g. yacht, boeuf).However studies of oral reading in transparent scripts,such as Spanish, Italian, Turkish and Welsh are nowincreasingly reported [1,2,6,10,11,29–32].

Portuguese is an example of transparent script. Al-though rare, studies of patients with acquired dyslexiain Portuguese tend to reflect the patterns of impairedlexical and nonlexical reading reported in other alpha-betic scripts. Portuguese speaking patients with ac-quired phonological, deep, surface, semantic and literaldyslexia, are all reported [5,13,25,37–39,41]. The char-acteristics of these types of acquired dyslexias closelyresemble those described in English, French and Span-ish readers. Thus, the multi-route model of reading hasbeen used to explain disturbances in Portuguese oralreading.

Less is known about the patterns of acquired dyslex-ia in patients who speak more than one language (bilin-gual) or read in more than one type of script (bi-scri-tpal). Reports of brain damaged patients who presentdissociations between reading in logographic and syl-labic writing systems have been published [15,22,23,33–36,40]. Sasanuma (1980) first observed cases ofsurface dyslexia (impairment to kanji reading withpreservation of processing the kana script), phonologi-

M.L.H. Senaha and M.A. de Mattos Pimenta Parente / Acquired dyslexia in three writing systems 257

cal dyslexia (impairment in kana nonword reading) anddeep dyslexia (disproportionately greater impairmentfor kana than kanji reading and semantic paralexias inkanji reading) with others subsequently reported [27,34–36,44].

Caramelli et al. [4] was the first to report a Portu-guese-Japanese bilingual aphasic patient who had ac-quired dyslexia. YI was a premorbidly literate readerin three different writing systems. Japanese was thefirst acquired language (L1) for YI and Portuguese wasthe second acquired language (L2). After the brain le-sion, YI was able to understand high frequency kanjicharacters and Portuguese written words if they had ahigh frequency of occurrence in the script. Howev-er, he was unable to understand words written in kanaand less familiar low frequency words written in Por-tuguese. Using the multi-route framework, Caramelliet al. suggested that YI processed high frequency Por-tuguese words and kanji characters using an intact lex-ical reading pathway and also argued that YI’s inabil-ity to read Portuguese nonwords, kana written wordsand nonwords was a consequence of impairment to thenonlexical reading pathway.

One problem with the interpretation offered by Car-amelli et al. is that oral reading of nonwords writ-ten in alphabetic and non-alphabetic writing systemsmay simply be more difficult than reading knownwords in any language. However, there is evidenceof the reverse dissociation in the pattern of oral read-ing in Portuguese-Japanese speakers i.e. selective im-pairment of the lexical route with intact nonlexicalreading in these patients. In an epidemiological studywith Japanese immigrants in Brazil (Nisei), Meguro etal. [20] identified four Portuguese-Japanese bilingualspeakers with Alzheimer’s disease who showed disso-ciations between the reading of logographic, syllabicand alphabetical scripts. In these cases, kanji (L2) andPortu- guese (L1) irregular word reading were moreaffected than both kana and Portuguese regular wordand nonword reading. Together with the case reportof Caramelli et al. [4], this suggests a “double” disso-ciation in tri-scriptal Portuguese-Japanese reading andsupports the assumption of a multi reading frameworkavailable to Portuguese-Japanese speakers. Howev-er, due to possible differences in the age of acquisi-tion and premorbid familiarity with alphabetic and non-alphabetic scripts in tri-scriptal speakers, it is not easyto interpret the patterns of dissociation in performance.It is therefore necessary to test the veracity of claimsmade in prior studies of Portuguese-Japanese speakerswith acquired dyslexia.

The aim of the present study was to test the multi-route framework for tri-scriptal oral reading with aPortuguese-Japanese speaker. Specifically, it was of in-terest to know if the reported dissociation between lex-ical reading (Kanji and irregular word reading in Por-tuguese) or nonlexical reading (Kana and nonwords inPortuguese) was selectively impaired following braindamage. A correlation between impaired lexical read-ing across scripts in a tri-scriptal patient would chal-lenge the hypothesis that the cognitive processes inreading vary according to characteristics of the writingsystem [18,20,21]. However, if damage to the readingsystem of a tri-scriptal patient impairs oral reading inone script only, this would be evidence that type ofscript constrains oral reading in tri-script readers [see43 for review]. The data from patients who were pre-morbidly literate in contrasting writing systems: logo-graphic, syllabic and alphabetic such as those reportedbyCaramelli et al. [4] andMeguro et al. [20] are a strongtest of these alternatives [see also 43]. Also, as Niseipatients are bilingual Portuguese and Japanese speak-ers and also bi-scriptal in one language (Japanese), it ispossible to examine if differences in the type of script(syllabic versus logographic) or the status of a script(L1 versusL2) has a greater impact on impaired readingperformance. If language status has an effect perhapsbecause one language is acquired earlier or is more fa-miliar, then we might expect to observe greater impair-ment to the oral reading of one language with no dif-ferences in the performance between syllabic and logo-graphic scripts used in the Japanese language. Howev-er, if we observe dissociations in the oral reading per-formance of a patient between the Japanese scripts, thiswould be evidence that the type of script has an effecton bi-scriptal reading.

We report here the case of a Portuguese-Japanesebilingual and tri-scriptal patient (PF) with acquireddyslexia. We asked the following questions: (1) doesbrain damage influence the cognitive mechanisms inoral reading across scripts according to lexical and non-lexical processes independently of the writing system;and (2) in each language, do the patterns of acquireddyslexia observed depend on the unique features of thewriting system i.e. is there a dissociation in the Japanesescript that is not observed in Portuguese or vice ver-sa? For comparison, tasks were administered to twohealthy control subjects, whose language backgroundand sociolinguistic characteristics were very similar toPF.


Fig. 1. CT scan of PF showing left frontotemporal lesion after traumatic brain injury.

2. Method

2.1. Participants

2.1.1. Case reportPF is a 48 year-old, right-handed male. At the age

of 39, he suffered a traumatic brain injury to the leftfrontotemporal area (Fig. 1) in a traffic accident, whichresulted in Broca’s aphasia and right hemiparesis. PF isBrazilian and the son of Japanese parents. His mothertongue was Japanese. During his childhood, teenageyears and adult life he used Japanese within the fami-ly environment. He acquired the Portuguese languagewhen he started school during early literacy learning.His formal study was completed in the Portuguese lan-guage and he graduated with a degree in Electrical En-gineering. In the academic environment and subse-quently in his work activities, PF used predominate-ly Portuguese for communication. He learned to readand to write Japanese with parent help. He was ableto read aloud and write both syllabic and logographicsystems of Japanese writing. Prior to his accident, hefrequently read magazines and newspapers in Japaneseand in Portuguese. Reading Japanese newspapers re-quires very advanced knowledge of logographic writ-ing. After graduation, PF worked in a Japanese multi-national company for 15 years, in which it was neces-sary to have good Japanese oral and written languageproficiency. He made frequent business trips to Japan.He also had good knowledge of a third language, En-glish. English language was not however a focus ofthis investigation.

2.1.2. Control subjectsPF’s performanceon oral reading and other tasks was

compared with two healthy controls who have similarsociolinguistic characteristics. Both control subjects

were men, right-handed and born in Brazil, and theirparents were also Japanese. Their mother tongue wasJapanese and their second language was Portugueseacquired when starting school. Their formal study wascompleted in Portuguese. Both controls were able toread newspapers in Portuguese and Japanese. Theypresented with no history of oral and written languagedisturbances or neurological impairment. Control Onewas a 52 year-old accounting technician (12 years ofJapanese education). Control Two was a 53 year-oldwith an Economics degree who had studied Japaneseup until the age of 17 in private schools.

2.2. Experimental investigation

PF and the control subjects were given word andnonword reading aloud tasks (Part I) and specific tasksto examine lexical and nonlexcial oral reading mecha-nisms (Part II). All evaluations involved written stimulipresented in the Portuguese alphabetic, Japanese syl-labic and Japanese logographic writing systems. Toexamine oral reading, tasks from the Portuguese andJapanese Human Frontier Science Program (HFSP)protocols [14,24] were selected and in addition otherspecially formulated complementary tasks were alsodesigned to investigate reading disturbance across allthree scripts.

Part I – Reading aloud tasks

1. Alphabetic system1.1. Words

The Portuguese reading aloud task from the HFSPprotocol [24] was administered. The test is composedof 180 balanced stimuli to verify the effects of regular-ity, imageability, frequency, length and class of words.Of 180 stimuli, 40 words have irregular spellings, half


of them being composed of irregular words for readingin Portuguese, and the other half corresponding to for-eign words used frequently in Brazil, such as <pizza>.

1.2. NonwordsA reading aloud task with 300 nonwords written

according to the characteristics of the Portuguese al-phabetic system was administered to verify the influ-ence of word length and syllabic structure on oral read-ing. To examine length effects, nonwords were di-vided into three stimuli groups (bisyllabic, trisyllabicand polysyllabic) with 100 stimuli each. These groupswere then further divided into another five subgroupsof 20 stimuli representing the characteristics of the Por-tuguese writing system: consonant-vowel (CV); conso-nant-vowel-consonant (CVC); consonant-vowel-vowel(CVV); consonants group and digraph.

2. Logographic system (kanji)2.1. Words

The kanji reading aloud task from the JapaneseHFSPprotocol [14] with 120 words was administered. Onlywords represented by a single kanji character were se-lected. Stimuli were chosen according to the linguis-tic variables of length, imageability, frequency [17],number of strokes (kanji characters up to seven strokesand kanji characters with more than 10 strokes), type(simple and compound) and verbs (conjugated verbsand verbs in the infinitive). Twenty stimuli for eachof these variables were selected and, as for the readingaloud task of the Portuguese HFSP protocol [24], stim-uli were selected in pairs, modified only by the criteriabeing tested, while keeping all the others equivalent.Due to the logographic characteristics of kanji and theoption of using words represented by only one kanji,it was not possible to create a list of nonwords in thelogographic system.

3. Syllabic system (hiragana and katakana)3.1. Words

The reading aloud task of real words in hiragana pre-sented 90 stimuli divided into four groups, designed toexam frequency, length, imageability and word classeffects. The word reading aloud task in katakana con-sisted of 60 balanced items, to verify the effects oflength, imageability and familiarity. A familiarity cri-terion was chosen instead of frequency due to the ab-sence of a word frequency norms in katakana at timeof testing.

3.2. NonwordsThe hiragana nonword reading task comprised 120

stimuli, constituting 40 bisyllabic, 40 trisyllabic and40 polysyllabic nonwords. In each group, half (20nonwords) were made up of simple syllables and half,complex syllables. The katakana nonword reading taskcontained 120 stimuli, testing effects of length and syl-labic structure. The number and distribution of stimulitypes in this task were equal to the hiragana nonwordsreading task.

Part II – Specific tests – lexical reading mechanismsexam

1. Input orthographic lexicon exam1.1. Lexical decision tasks - alphabetic system

Two lexical decision tasks were used to test the al-phabetic system. The first was from the HFSP proto-col [24] with 10 items, with two stimuli in each. Onestimulus corresponded to an irregular real word and theother, to a nonword with the same syllabic structureand length as the irregular word. Each item was pre-sented separately on a sheet of paper and subjects wererequested to indicate the real word. The second lexicaldecision task was composed of regular words and non-words presented in a tachistoscopic task. For this task,39 regular words and 39 nonwords were selected. Thenonwords were created in pairs from each real word,taking into consideration the length and the syllabicstructure. Each of the 78 stimuli was introduced sepa-rately in the center of a computer screen, displayed for100 milliseconds. The subjects were instructed to hitkeys <p> or <o> to indicate if the stimuli represented areal word or a nonword, respectively. In addition, therewas an option to hit the letter <i> if they did not knowthe answer.

1.2. Lexical decision task – logographic systemTo test the input orthographic lexicon for the logo-

graphic system, a similar task to the lexical decisiontask for the alphabetical code was used. The task con-sisted of 10 items. Each item had three stimuli, com-prising two real kanji characters and a third, false kan-ji that was derived from components of the other tworeal kanji characters. The subjects were requested toidentify the false kanji.

1.3. Lexical decision task – syllabic systemsThe lexical decision task from the HFSP proto-

col [14] in the Japanese syllabic systems had 10 itemsin hiragana and 10 in katakana. Each item was com-posed of a real word and a nonword. The subjects wererequested to indicate the real word.


2. Access to semantic system examination2.1. Reading and written comprehension of irregularand foreign words – alphabetic.

To verify access to the semantic system in Por-tuguese, a task with 22 Portuguese irregular words and16 foreign words was devised. The stimuli were pre-sented individually. For each word, reading aloud wasrequested after which the meaning of the read stimuluswas requested. The main objective of this task was toexamine access to the semantic system after readingmistakes (regularizations). There are two possibilities:first via the input orthographic lexicon i.e. through thewritten form of the word; and second, via the outputphonological lexicon through the phonological repre-sentation of the read word.

2.2. Reading and written comprehension of kanji –logographic system

This task was composed of 20 single-character kanjiwords. The stimuli were presented individually. Foreach kanji word, reading aloud was requested afterwhich the meaning of the read stimulus was requested.As in the Portuguese version previously described, theobjective of this task was to verify access to the seman-tic system. Due to the transparency of the Japanesesyllabic system, tasks to verify access between the in-put orthographic lexicon and the semantic system withwritten stimuli in hiragana and katakana were not car-ried out.

3. Semantic system examination3.1. Written word comprehension – alphabetic system

A written word – picture matching task was adminis-tered, having frequency of target stimuli as a linguisticvariable. A total of 20 words were selected, 10 high-frequency and 10 low-frequency. Participants wererequested to identify the picture corresponding to thewritten word. Among the five picture alternatives, therewere: a target picture, a semantic, a visual, a phonolog-ical distractor and a picture with no relationship withthe target.

3.2. Written word comprehension – logographicsystem

A written word (kanji) – picture matching task wasperformed. The task contained 20 items and each itemwas composed of a kanji written word and four picturealternatives: a target, a semantic, a phonological and avisual distractor.

3.3. Written comprehension – syllabic systemTwo written word – picture matching tasks were per-

formed, one with stimuli in hiragana and another inkatakana. Each task contained 20 items and each itemhad a written word and four picture alternatives, con-sisting of a picture target and three semantic distrac-tors. The subjects were requested to identify the picturecorresponding to the written word.

4. Output phonological lexicon examination4.1. Homophonic nonword – irregular word matching– Portuguese

To test the output phonological lexicon in Portu-guese, a homophonic nonword – irregular word match-ing task was applied. This task was composed of 10items, each containing three stimuli. Among thesestimuli, one corresponded to an irregular word; the sec-ond to a homophonic nonword to the irregular word;and the third to a nonword visually similar to the irreg-ular word. For instance, one of the items had the fol-lowing stimuli: <sexo>, <sequisso> and <sejo>. Par-ticipants were asked to point the two stimuli with thesame phonological representation.

4.2. Kanji – Katakana matchingThe output phonological lexicon stores the phono-

logical representations of lexical items. Therefore, thismemory is not related to the writing code, but to thephonology of the language. Thus, to test the outputphonological lexicon in Japanese, a kanji – katakanamatching task was administered. In this task, the sub-jects were requested to match a kanji (Japanese word)to a katakana “nonword” which represented the kanjitranscription (the same phonological form of the kan-ji). Therefore, this second stimulus was a “real oralJapanese word” but a “written nonword” (as previouslycited in the Introduction, katakana characters are on-ly used to write foreign words). It was assumed thatmatching the phonological similarity between the twostimuli would be accomplished by the output phono-logical lexicon since, (1) kanji is mandatorily processedvia the lexical route and (2) a katakana “written non-word” is processed via the nonlexical route. The taskhad 10 items and each item was composed of a kanjiwrittenword and four katakana “nonword” alternatives.

5. Semantic system and output lexical mechanisms5.1. Picture naming – Portuguese and Japanese

Picture naming and lexical reading share some lexi-cal-semantic mechanisms. To examine these mecha-nisms, picture naming tasks were administered in Por-tuguese and Japanese with 40 pictured objects, balanc-ing the length and familiarity criteria.


ProcedureThe oral responses were recorded with a tape re-

corder and the productions transcribed. Performancewas analyzed in relation to number and type of errorsand compared later with the performance of controlparticipants. Statistical analyses were conducted usingFisher’s exact and Chi-square tests to compare propor-tion of correct responses among the participants. Thesignificance value accepted was p < 0.05.

3. Results

3.1. Part I – Reading aloud tasks

3.1.1. Alphabetic system – words and nonwordsForword reading aloud in Portuguese, PF produced a

relatively high percentage of correct responses (87.8%).He made 22 errors, 18 (81.8%) being a regularizationtype. Considering the different linguistic variables,PF’s performance varied between 90.0% and 100.0%of correct answers across all variables, except for thegroup of irregular words, of which PF read only 60.0%correctly (see Table 1). Comparison of his performanceto controls in irregular word reading showed a signifi-cant difference (x2 = 14.1, p < 0.001). Sporadic slowreading was observed, chiefly in reading longer words.

On the nonword reading task with alphabetic stim-uli, PF read 78.3% correctly. Although performancewas lower than controls this was not a significant dif-ference (see Table 1). Among PF’s errors, he producedphonemic paralexias most often. Analysis of effects oflength and syllabic complexity showed no differencesbetween bisyllabic, trisyllabic and polysyllabic stimuli.Furthermore, there was no effect of syllabic structure(CV, CVC, CVV, digraphs and consonantal groups) onperformance.

3.1.2. Logographic and syllabic system – words andnonwords

PF’s performance was similar to controls in oralreading tasks using stimuli written in syllabic systems:written words and nonwords in hiragana and katakana(see Table 2). However, a significant difference wasidentified in reading written stimuli in the logographicsystem: PF read 40.0% of the items correctly whilethe controls had more than double the number of cor-rect answers compared to PF (x2 = 49.9, p < 0.001).Among errors in kanji reading, the majority (81.9%)corresponded to the absence of a response (“I don’tknow”). Visual mistakes, semantic, formal and phone-

Table 1Performance of PF and controls in word and nonword reading aloudtasks in the alphabetic system

% successStimuli n PF Controls

WordsRegular 20 100.0 100.0Regular (type 2)∗∗ 20 90.0 100.0Irregular 40 60.0∗ 95.0∗High frequency 10 100.0 100.0Low frequency 10 90.0 100.0High imageability 10 100.0 100.0Low Imageability 10 100.0 100.0Short 10 100.0 100.0Long 10 100.0 100.0Verbs in the infinitive 10 100.0 100.0Conjugated verbs 10 100.0 100.0Closed class 20 90.0 100.0Total 180 87.8 98.9NonwordsTotal 300 78.3 88.5

∗p < 0.001; ∗∗regular words for reading, but irregular for writing.

Table 2Performance of PF and controls on the reading aloud task in logo-graphic and syllabic systems

% successStimuli n PF Controls

Words – kanjiTotal 120 40.0∗ 84.2∗Words – hiraganaTotal 90 97.8 99.4Words – katakanaTotal 60 96.7 98.3Nonwords – hiraganaTotal 120 87.5 87.9Nonwords – katakanaTotal 120 74.2 82.1

∗p < 0.001.

mic paralexias and unclassifiable mistakes were alsoobserved, albeit in smaller number.

Analyzing PF’s performance in kanji reading foreach pair of stimuli according to linguistic variables(high frequency versus low frequency; high imageabil-ity versus low imageability; number of strokes; length;type and verbs) no effects were found. However, inother analyses considering all stimuli of the protocol(120 kanji words), and comparing the linguistic vari-ables mentioned above, the effect of frequencywas sig-nificant (x2 = 9.5, p < 0.05). PF correctly read 48.9%of high frequency kanji characters and 14.6% of lowfrequency kanji characters.

In reading aloud of written words in the Japanesesyllabic systems, PF correctly read 97.8% of hiraganawords and 96.7% of katakana words. Due to the smallnumber of errors, differences in performanceaccording


Table 3Performance of PF and controls in specific tasks examining lexical reading mechanisms

%successTasks n PF Controls

Alphabetic system – Portuguese• Input orthographic lexicon

Lexical decision (HFSP) 10 100.0 100.0Lexical decision (taquistoscopic presentation) 78 87.2 92.3

• Access to semantic systemComprehension of words read incorrectly 12 100.0 NA

• Semantic systemWritten comprehension 20 100.0 100.0

• Output phonological lexiconHomophonic nonword – irregular word matching 10 90.0 100.0

• Semantic system and output lexical mechanismsPicture naming 40 42.5∗ 98.8∗

Logographic system• Input orthographic lexicon

Lexical decision (HFSP) 10 80.0 100.0• Access to semantic system

Comprehension of kanji characters read incorrectly 16 75.0 NA• Semantic system

Written comprehension 20 85.0 100.0• Output phonological lexicon

Homophonic nonword – irregular word matching 10 90.0 100.0

Syllabic system• Input orthographic lexicon

Lexical decision – hiragana (HFSP) 10 100.0 100.0Lexical decision – katakana (HFSP) 10 100.0 100.0

• Semantic systemWritten comprehension – hiragana 10 100.0 100.0Written comprehension – katakana 10 100.0 100.0

Japanese language• Semantic system and output lexical mechanisms

Picture naming 40 15.0∗ 88.8∗∗p < 0.001; NA: not applicable.

to the linguistic variables were not evident. There wasno signifiicant difference between PF and controls inhiragana and katakana nonword reading. For hiraganaand katakana nonword reading, no significant differ-ences were found in performance in terms of length andsyllabic structure.

3.2. Part II – Specific tests – lexical readingmechanisms examination

3.2.1. Specific tasks – alphabetic system/Portugueselanguage

Comparison between PF and controls on alphabeticwriting system tasks revealed no significant differencesin lexical decision, written word – picture matchingand homophonic nonword – irregular word matchingtasks (Table 3). These results suggest that the inputorthographic lexicon, the semantic system and the out-put phonological lexicon – mechanisms that must beinvolved in reading via the lexical route – were pre-

served. However, differences between PF and controlswere seen in tasks of picture naming and access to thesemantic system. PF presented low performance inpicture naming, with better results for familiar wordsin comparison to unfamiliar words.

To evaluate access to the semantic system, a taskof reading and written comprehension of irregular andforeign words was applied. The main semantic systemfrom printed words. Testing the written comprehen-sion of words that PF read incorrectly allows verifica-tion of how the semantic system is accessed i.e. viainput orthographic lexical mechanisms or through out-put phonological lexical mechanisms. PF read 68.4%words correctly. All of the errors were regularizationtype. Most strikingwas thefinding that PF provided thecorrect meaning of all words read incorrectly (see alsoWilson and Martinez, this issue). In this task, controlsread 98.6% of the stimuli correctly and comprehensionof words was preserved.


3.2.2. Specific tasks – logographic and syllabicsystems/Japanese language

To compare PF’s performance in the non-alphabeticwriting system, specific tasks were designed to inves-tigate lexical reading mechanisms of the logographicand syllabic systems. The main differences betweenPF and controls were in picture naming and access tothe semantic system. In the lexical decision tasks withreal and false kanji characters (from the HFSP proto-col) PF scored 80.0% correct a score that is consideredto be within the normal range [27]. Satisfactory re-sults were also observed on written word comprehen-sion tasks (kanji characters – picture matching) and inthe output phonological lexicon tasks (kanji – katakanamatching).

On the reading and written comprehension of kanjicharacters task to verify access to the semantic system,PF read aloud 4 out of the 20 kanji characters appro-priately yet was unable to read the other 16 stimuli,giving no response. Despite the absence of responsein these 16 kanji characters, PF was able to give thecorrect meaning of 12, corresponding to 75.0% correctperformance. With the four kanji characters for whichhe did not give the correct meaning, he gave rathervague answers that could be considered close to the tar-get meaning. Therefore, as in the tests of the alphabeticwriting system, there was a dissociation between oralreading and written comprehension in the logographiccode. Controls read 92.5% kanji characters correct-ly. PF achieved comparable performance to controlsin tasks involving the Japanese syllabic system: lexicaldecision (input orthographic lexicon) and written word– picture matching task (semantic system) and the kanji– katakana matching task. PF scored 15.0% correcton picture naming in Japanese and correct responsestended to be more familiar objects.

4. Discussion

4.1. Portuguese writing system: acquired dyslexiawith impairment in the lexical route

PF had difficulty reading irregular words, producingmainly regularization errors. These data suggest an im-pairment to the lexical route and preserved use of thenonlexical reading route when reading in Portuguese.His hesitation, slow reading with longer words andperformance in nonword reading were also suggestiveof reading via the nonlexical pathway. Results fromPF’s nonword reading task may appear to contradict

this claim. However, PF and controls achieved similarlevels of performance in nonword reading (see Manari-ni [19] who reported performance from 87.0% to 95.5%correct in nonword reading by undergraduates). Low-er than expected performance in nonword reading maybe due to stimuli complexity, and unfamiliarity withthe task. PF’s performance on tests of irregular wordreading was significantly worse than controls. Thus,we contend PF is more impaired when reading via thelexical pathway than the nonlexical pathway.

Considering all words in the reading aloud task of thealphabetical system, PF’s performance was relativelyhigh for reading. This may be a consequence of the ma-jority of words containing a regular correspondence be-tween orthographyand phonology in Portuguese. Colt-heart et al. [7] proposed a list of nine symptoms in sur-face dyslexia based on anglophone readers. Of all char-acteristics, the authors considered better regular wordthan irregular word reading to be a necessary and suffi-cient symptom for a diagnosis of surface dyslexia. Ac-cording to these criteria, PF presented the necessary andsufficient symptoms for diagnosis of surface dyslexia inPortuguese. A further striking feature of performancewas that reading aloud of irregular words was accom-panied by intact comprehension of the same words. Itis therefore possible to claim that in Portuguese (as inEnglish and other alphabetic writing systems), surfacedyslexia can be observedwithout damage to the seman-tic system. We note here that the opposite pattern –damage to the semantic system without surface dyslex-ia in Portuguese – has also been reported [37,38] as inother languages (see also Wilson et al.).

4.2. Japanese: reading impairment in thelogographic and preservation of syllabic systems

PF displayed a reading impairment in the logograph-ic writing system – however, performance with the syl-labic script is no different to controls. This clear dis-sociation in reading aloud within the Japanese writ-ing system raises some issues. The first is that eventhough oral reading within a language using two dif-ferent scripts may be dissociable as shown in previ-ous studies of Japanese patients, it is not clear whetherthis is evidence of an effect of type of script, an effectof task difficulty or of a selective impairment to onepathway and not to the other. Given several studieshave shown that bilingual speakers do not necessarilymanifest the same language disorders with the sameseverity in both of their languages (non-parallel lan-guage recovery), the dissociation found in PF’s read-


ing in Japanese might shown that each written systemis represented (organized) in different neural networksin the brain. However, differences in the patterns ofrecovery in bilingual aphasia may reflect the languagestatus (L1 versus L2), age of acquisition, familiarity, ordominance. Although these confounding effects maybe reduced for bi-script readers who speak a commonlanguage such as PF, there is still a problem when inter-preting data from biscript patients as these cases mayshow patterns of recovery that reflect language status.We contend that impairment to the oral reading of kanjilikely reflects damage to a lexical reading process anddoes not reflect impaired reading of a non-lexical pro-cess. However, we do not claim dissociations in func-tional reading routes in Japanese necessarily reflect in-dependent reading systems for kanji and kana at theneural level.

A different issue is whether or not brain damage in-fluences common oral reading processes independentlyof the writing code presented for testing. Thus, char-acteristics of PF’s acquired dyslexia in the Japanesescript – selective impairment in kanji reading and pre-served performance in reading of words and nonwordswritten in the Japanese syllabic transparent code – canbe interpreted as a better preserved nonlexical pathwaycompared to the lexical pathway. Given the same in-terpretation was offered for PF’s oral reading impair-ments in written Portuguese, it seems redundant to dis-tinguish differences in script to explain PF’s impairedreading performance. In other words, if his perfor-mance reflects selective damage to the lexical pathwayin a common oral reading network, this accounts for thepatterns of reading dissociation across scripts. Thus,the co-incidence of impaired lexical reading (Kanji andirregular word reading in Portuguese) and preservednonlexical reading (Kana and nonwords in Portuguese)suggests no effect of script on PF’s reading.

4.3. Analyses of acquired dyslexia in the three writingsystems

The claim that damage to the reading system influ-ences cognitive processes acrosswriting systems is sup-ported by the analysis of PF’s impaired and preservedperformance in reading and writing: impairment of thelexical route is responsible for lowperformance in read-ing kanji and Portuguese irregular words. On the otherhand, performancewhen reading words in the transpar-ent syllabic system and regular words and nonwordsof the alphabetic Portuguese system shows nonlexicalreading is intact. Together with patients reported by

Meguro et al. [20] and Caramelli et al. [4], the presentdata support the claim that Portuguese-Japanese speak-ers enjoy multiple cognitive mechanisms for oral read-ing.

Analysis of PF’s acquired dyslexia in the three writ-ing systems is compatible with the view that type ofscript has little impact on biscriptal reading and doesnot sustain the view that different writing codes of abiscriptal reader have impact on impaired reading per-formance. Instead it seems that reading mechanisms(both lexical and nonlexical) are shared for the twodifferent scripts. Damage to the oral reading systemfor PF resulted in more impairment to shared lexicalreading mechanisms than to shared nonlexical readingmechanisms thus explaining problems reading irregu-larly spelled words in Portuguese and Japanese kanjias well as preserved ability to read kana and alphabeticnonwords.

The reverse analysis can be made of the case YIreported by Caramelli et al. [4] who had good per-formance in written comprehension of the logograph-ic system and high frequency words in the Portuguesewriting system, but was unable to process words andnonwords in the syllabic system and nonwords alpha-betic system. Caramelli et al. [4] interpreted YI’s dataaccording to a multi route reading model proposed forreading in English. According to them, YI was capableof processing kanji and frequent words of Portugueselexically, but was unable to process stimuli throughprint-sound conversion. We would interpret PF’s datain the opposite way i.e. PF was not capable of process-ing kanji and irregularly spelled words of Portugueselexically, but he was able to process kana and nonwordsvia print-sound conversion. Therefore manifestationsof YI’s and PF’s acquired dyslexias (both tri-scriptalreaders) supports a double dissociation in Portuguese -Japanese oral reading. YI presented better lexical read-ing than nonlexical reading while PF presented the op-posite pattern of reading impairment. Crucially thesame pattern of performance was observed across writ-ten codes for both cases, with no effect of script.

No regularization errors were observed in PF’sJapanese reading. Legitimate Alternative Reading ofComponents (LARC) errors are a type of regularizationerror and are observed in patients with acquired surfacedyslexia in Japanese [12,26]. These errors correspondto incorrect selection of phonological representationsof one or more character components. When read-ing kanji, LARC errors correspond to the selection ofpossible pronunciations (on/kun readings). Determin-ing which pronunciation must be used will depend on


the context that a kanji is used in two-character kanjiwords. LARC errors could not observed here becauseonly single-character kanji words are tested with theHFSP protocol [14].1 And in this case, all the possiblekanji pronunciations can be accepted as correct.

It is important to note that if we were to considerPF’s performance on the reading of syllabic system on-ly, we might conclude that PF did not have any distur-bances in the reading of syllabic code. Hiragana andkatakana word reading aloud was satisfactory and fewerrors were found. Also, performance when readingnonwords written in a syllabic system was similar tocontrols. Drawing on these data, it may be possible tofollow Ardila’s [1] and Karanth’s [16] arguments thatreading in a script with a transparent code requires onlya nonlexical route. However, Ruiz et al. [32] reportedtwo cases of Spanish readers with deep dyslexia. Thisconflicts with Ardila‘s [1] position that Spanish read-ers would not present deep or surface dyslexia. Otherhispanophonic case reports confirm the possibility thatreaders of a transparent orthographic code seem to readvia a lexical pathway [9–11].

The transparent nature of the script, in either syl-labic or alphabetic scripts, does not seem to mandatethat readers will only read using a nonlexical pathway.Many studies [6,10,11,32] show evidence of lexicalreading in transparent orthographies suggesting multi-route reading models are appropriate for interpretingpatterns of acquired reading impairments. Chiacchio etal. [6] reported acquired reading impairments in an Ital-ian speaker [see also other papers in this Special Issue].They described a case of primary progressive aphasiawith surface dyslexia. Instead of regularization errorswhen reading irregular words, the authors found accentmistakes and proposed this is an aspect of Italian wordreading that cannot be based on grapheme-phonemeconversion rules.

The high number of correct responses in PF’s read-ing of words written in the syllabic system (136/140)as well as by Sasanuma’s [35] patient, SU, (169/170),with surface dyslexia, may appear as absence of read-ing disturbance in the syllabic system. A lexical routedysfunction does not cause much impact in transparentcode readers, since it is possible to read transparentwriting codes appropriately through a nonlexical path-way, but this does not necessarily mean that there is

1Sasanuma [34,35] described patients MU and SU with impair-ment in lexical reading. These patients produced semantic errors inkanji reading.

no failure in the lexical route or that transparent codereaders can only read via a single route.

Dysfunction in patterns of lexical reading in patientswho read with a transparent script is different to readersof deep orthographies. Readers of transparent scriptsmight not produce classic regularization errors and canread words and nonwords appropriately. But mistakesin accent and hence stress and slow reading speed areadditional symptoms. A dysfunction in the semanticsystem impairs written word comprehension. There-fore, other abilities besides reading aloud should beinvestigated to examine the presence of failures in thelexical route as demonstrated in the study of Ferrereset al. [10].

4.4. Characterization of lexical reading dysfunction

In the experimental test – Part II of this study specif-ic tasks were performed to evaluate cognitive mecha-nisms involved in PF’s lexical reading. The investiga-tion showed that the cognitive dysfunction is localizedon the output lexical mechanisms of the lexical route,more specifically in access to the output phonologicallexicon from the semantic system and from the inputorthographic lexicon for alphabetic, syllabic and logo-graphic codes. The investigations demonstrate intactinput lexical mechanisms to the semantic system. PFhad satisfactory performance in lexical decision (whichinvestigates the input orthographic lexicon) and writtenword comprehension (which investigates the semanticsystem). In addition, data from tasks examining accessto the semantic system corroborat the hypothesis of theintegrity of the input lexical mechanisms to the seman-tic system. In the alphabetic system, concerning thetask to verify access to the semantic system, PF wasable to define irregular and foreign word meanings forwords that he had read aloud incorrectly. This behaviorsuggests that the patient read irregular words using thenonlexical route, but accessed word meaning via theinput orthographic lexicon and the semantic system.This interpretation can be maintained, as if the patientaccessed the semantic system through output lexicalmechanisms, he would access the word meaning by thephonological representation of the irregular word readincorrectly. For instance, PF read the foreign word<pizza> incorrectly. He performed regularization andevoked aloud the word [piza], however he explainedthe meaning of the word <pizza> correctly. In this ex-ample, if PF had accessed the semantic system by theoutput phonological lexicon, he would state that the


Fig. 2. Dual-route cognitive model of reading showing PF’s functional disturbances (∗) in access to the output logophonic lexicon from thesemantic system and from the input orthographic lexicon (adapted and complemented from Rapcsak et al. [31].)

word [piza] refers to the verb “step” (<pisa>/[piza] inPortuguese) or to the leaning tower in Italy.

On the same task in the logographic system, PF wasable to provide meaning for incorrectly read wordsshowing preserved written comprehension of kanjicharacters. The data suggest the input lexical processesto the semantic system are relatively preserved, and thedeficits in lexical reading in both alphabetic and logo-graphic systems are due to impairment in post-semanticlexical processing.

Post-semantic lexical processing involves phonolog-ical representations of stimuli. Therefore post-semanticlexical processes do not depend on the orthographic,logographic or syllabic or alphabetic nature of stimuli.Thus, tasks that test the phonological lexicon and theoutput lexical mechanisms suit the oral language, in-dependently of written code. Regarding output lexicalmechanisms, PF performed well on tasks to verify theoutput phonological lexicon in Portuguese (homophon-ic nonword – irregular word matching) and in Japanese(kanji – katakana matching). The output lexical mech-anisms were also tested through picture naming tasks.PF’s low performance in Japanese and Portuguese inthese tasks can neither be attributed to failures in per-ceptual mechanisms nor to the semantic system, giv-en the absence of failures in visual picture recognitionalong with preservation of the semantic system exam-ined in the written comprehension tasks. Therefore, wepropose the hypothesis that PF’s naming impairmentis correlated with damage to the lexical reading routeand is post-semantic and prior to the phonological lexi-con. The characteristics of PF’s spontaneous speech in

Portuguese and in Japanese (non-fluent) and the typeof mistakes in some of the formal tests (absence of re-sponses in kanji reading and Portuguese and Japanesepicture naming) point to a locus in lexical reading dueto dysfunction in access to the phonological output lex-icon from the semantic and the orthographic input lex-icon (see Fig. 2).

To support this claim we compared the results fromPF in some tasks with those obtained by the patientSU, described by Sasanuma [35]who presented surfacedyslexia in Japanese (Table 4). Patient SU had Wer-nicke’s aphasia, fluent speech and preservedword com-prehension. Similar to PF, SU presented difficulties inthe picture naming tasks and in kanji reading. How-ever, after a qualitative analysis of errors in the tasks,it seems errors differed between SU and PF. WhereasPF presented a high number of no responses in picturenaming and kanji reading, SU showed a high incidenceof circumlocutions in naming and irrelevant errors (sub-stitution of the target word by another word with nosemantic or formal relationship to the target), circum-locutions and semantic paralexias in kanji reading. SUpresented only 2.9% of no responses in kanji readingwhile in picture naming, irrelevant errors together withthe absence of response comprised 19.6% errors.

Sasanuma [35] claimed SU had impairment in theoutput phonological lexicon. Errors showed the pa-tient had no difficulty in accessing the phonologicalrepresentations stored in the output phonological lex-icon. However, a functional disturbance in the out-put phonological lexicon itself, explained failures in-cluding circumlocutions and semantic mistakes. The


Table 4Data comparison for PF and SU (described by Sasanuma [35]) in linguistic abilities

PF (Portuguese data) PF (Japanese data) SU (Japanese data)

Aphasia type Broca Broca WernickeFluency Non-fluent Non-fluent FluentWord oral comprehension(number and percentagecorrect)

9/9 (100.0%) 8/9 (88.9%) 20/20 (100.0%)

Picture naming (numberand percentage correct)

17/40 (42.5%) 6/40 (15.0%) 49/100 (49.0%)

Types of erros in namingtask

Absence of response –21/23Semantic paraphasia –1/23Verbal paraphasia – 1/23

Absence of response –33/34Categorization – 1/34

Circumlocution – 31/51Semantic paraphasia –7/51Irrelevant/Absence – 10/51Phonemic paraphasia –2/51

Kanji reading − 48/120 (40.0%) 26/130 (20.0%)

Types of errors in kanjireading

− Absence of response –57/72Unclassifiable – 5/72Visual – 5/72Semantic paralexia – 2/72Formal paralexia – 1/72Phonemic paralexia – 1/72

Irrelevant – 47/104Circumlocution – 22/104Semantic paralexia –15/104Neologism – 14/104On/Kun – 3/104Absence of response –3/104

comparison between SU and PF corroborates our hy-pothesis that PF’s functional disorder is localized inaccess to the output phonological lexicon. As PF hadan access dysfunction, he did not retrieve phonologicalrepresentations stored in the output phonological lexi-con, presenting as poor kanji reading and picture nam-ing, and absent responses. In contrast, SU presentedwith preserved access between the semantic system andthe output phonological lexicon, therefore SU was ableto retrieve the phonological representations of lexicalitems stored in the output phonological lexicon. How-ever, as SU presented a cognitive dysfunction in theoutput phonological lexicon, she produced inadequateoral answers in kanji reading and picture naming.

The present case study allowed us to test the multiroute reading model to explain disturbance of a bilin-gual patient tri-scriptal reader across three differentwriting systems. Impairment in lexical reading wasverified in the reading the written codes in Portugueseand Japanese. Critically in both languages reading im-pairment was impaired in a similar way. Moreover,there was evidence that the same functional disturbancein access to the phonological output lexicon from thesemantic system and from the orthographic input lexi-con was responsible for the acquired dyslexia in threewriting systems. Some multiple route reading modelsassume a third non-semantic lexical pathway availableto support the oral reading of irregularly spelled wordsand logographic characters without access to the mean-

ing of those characters. PF was able to read via mean-ing albeit at an impaired level. To test the veracity ofthe lexical non-semantic pathway in biscriptal readingin a Japanese-Portuguese speaker it will be necessary tofind a patient who can read aloud words without accessto meaning in both languages. No such case has yetbeen reported.

In sum, the impact of reading disturbance in bilin-gual speakers who are tri-scriptal readers varies ac-cording to the division of labour between the use ofthe lexical reading and non-lexical reading pathways.We found evidence of a correlated reading impairmentto kanji reading and written words that are irregularlyspelled in Portuguese in addition to an impairment toaccess to phonological output in both languages. Welocate the damage to impairment in a common lexicalreading pathway. There was no evidence of an effectof language status (L1 versus L2) or an effect of typeof script on PF’s impaired reading performance (for asimilar conclusion see Tainturier et al. and Druks et al.this volume).

Acknowledgments

We are grateful to PF and his wife for their time andcollaboration.


Appendix

List of kanji stimuli in the reading aloud task


References

[1] A. Ardila, Errors resembling semantic paralexias in Spanish-speaking aphasics, Brain and Language 41 (1991), 437–445.

[2] A.A. Beaton and N.W.Davies, Semantic errors in deep dyslex-ia: Does orthography depth matter? Cognitive Neuropsychol-ogy 24(3) (2007), 312–323.

[3] A. Caramazza, On drawing inferences about the structure fromthe analysis of patterns of impaired performance: the case forsingle-patients studies, Brain and Language 5 (1986), 41–66.

[4] P. Caramelli, M.A.M.P. Parente, M.L. Hosogi, M. Bois andA.R. Lecours, Unexpected reading dissociation in a Brazilian“nisei” with crossed aphasia, Behavioural Neurology 7 (1994),165–170.

[5] M.T. Carthery-Goulart and M.L.H. Senaha, Diagnosis and re-habilitation attempt of a patient with acquired dyslexia, De-mentia and Neuropsychologia 1 (2007), 89–96.

[6] L. Chiacchio, D. Grossi, M. Stanzione and L. Trojano, Slowlyprogressive aphasia associated with surface dyslexia, Cortex29 (1993), 145–152.

[7] M. Coltherart, J. Masterson, S. Byng, M. Prior and J. Rid-doch, Surface dyslexia, Quarterly Journal of ExperimentalPsychology 35A (1983), 469–495.

[8] M. Coltheart, K. Patterson and J.C. Marshall, eds, DeepDyslexia, Routledge, London, 1980.

[9] F. Cuetos, F. Valle-Arroyo and M.P. Suarez, A case of phono-logical dislexia in Spanish, Cognitive Neuropsychology 13(1996), 1–24.

[10] A.R. Ferreres, M.M. Cuitino andA. Olmedo, Acquired surfacedyslexia in Spanish: a case report, Behavioural Neurology 16(2005), 71–84.

[11] A.R. Ferreres and G. Miravalles, The production of semanticparalexias in a Spanish-speaking aphasic, Brain and Language49 (1995), 153–172.

[12] T. Fushimi, K. Komori, M. Ikeda, K. Patterson, M. Ijuin andH. Tanabe, Surface dyslexia in a Japanese patient with se-mantic dementia: evidence for similarity-based orthography-to-phonology translation, Neuropsychologia 41 (2003), 1644–1658.

[13] M.L. Hosogi and M.A.M.P. Parente, As dislexias adquiridascom utilizacao da via perilexical: manifestacao das dislex-ias de superfıcie, in: Temas em neuropsicologia e neurol-inguıstica, B.P. Damasceno and M.I.H. Coudry, eds, Tec Art,Sao Paulo, 1995, pp. 174–179.

[14] M.L. Hosogi, M.A.M.P. Parente, A. Yamadori, A.R. Lecoursand T. Suzuki, Protocolo de leitura das escritas japonesaspara o projeto Human Frontier Science Program (H.F.S.P.),in: M.L.H. Senaha, Dislexia adquirida em um paciente nisei:repercussao da lesao cerebral em diferentes sistemas de es-crita, Unpublished Master’s degree thesis, University of SaoPaulo, 1997.

[15] I. Jibiki and N. Yamaguchi, The Gogi (word-meaning) syn-drome with impaired kanji processing: alexia with agraphia,Brain and Language 45 (1993), 61–69.

[16] P. Karanth, The search for deep dyslexia in syllabic writingsystems, Journal of Neurolinguistics 15 (2002), 143–155.

[17] N. Kuratani, A. Kobayashi and S. Okunishi, A new dictionaryof kanji usage, Gakken, Tokyo, 1990.

[18] A.R. Lecours, L. Melancon and M.A.M.P. Parente, Os aresda linguagem escrita, in: Dislexia: implicacoes do sistemade escrita do portugues, A.R. Lecours and M.A.M.P. Parente,eds, Artes Medicas, Porto Alegre, 1997, pp. 153–162.

[19] A.S. Manarini, Influencia do sistema de escrita do portugues

nos processamentos perilexicais da leitura, Unpublished Mas-ter’s degree thesis, University of Sao Paulo, 1996.

[20] K. Meguro, M.L.H. Senaha, P. Caramelli, J. Ishizaki, R.Y.S.Chubacci, M. Meguro, H. Ambo, R. Nitrini, A. Yamadori,Language deterioration in four Japanese-Portuguese bilingualpatients with Alzheimer’s disease: a trans-cultural study ofJapanese elderly immigrants in Brazil, Psychogeriatrics 3(2)(2003), 63–68.

[21] E. Miles, Dyslexia may show a different face in differentlanguages, Dyslexia 6(3) (2000), 193–201.

[22] K. Nakamura, K. Meguro, H. Yamazaki, J. Ishizaki, H. Saito,N. Saito, M. Shimada, S. Yamaguchi, Y. Shimada and A.Yamadori, Kanji-predominant alexia in advanced Alzheimer’sdisease, Acta Neurologica Scandinavica 97 (1998), 237–243.

[23] M. Paradis, H. Hagiwara and N. Hildebrant, NeurolinguisticAspects of the Japanese Writing System, Academic Press,Florida, 1985.

[24] M.A.M.P. Parente, M.L. Hosogi, A.P. Delgado and A.R.Lecours, Conduta clınica, in: Dislexia: Implicacoes do Sis-tema de Escrita do Portugues, A.R. Lecours and M.A.M.P.Parente, eds, Artes Medicas, Porto Alegre, 1997, pp. 85–105.

[25] M.A.M.P. Parente and A. Nakamura, A influencia do nıvel deaprendizagem no protocolo de leitura em japones, Relatoriodo projeto: Influencia dos codigos alfabetico, silabico e mor-fologico nos processamentos da leitura, 1994.

[26] K. Patterson, T. Suzuki, T. Wydell and S. Sasanuma, Progres-sive aphasia and surface alexia in Japanese, Neurocase 1(2)(1995), 155–165.

[27] K. Patterson, T. Suzuki and T.N. Wydell, Interpreting a caseof Japanese phonological alexia: the key is in phonology,Cognitive Neuropsychology 13(6) (1996), 803–822.

[28] M.A.M. Pimenta, Dissociacoes nos diferentes sistemas de es-crita: hipoteses sobre as manifestacoes de dislexia adquiridaem leitores do sistema alfabetico portugues e em bilınguesnipo-brasileiros, in: Temas em Neurolinguıstica, L.L. Mansurand N. Rodrigues, eds, Tec Art, Sao Paulo, 1993, pp. 45–62.

[29] I. Raman and B.S. Weekes, Acquired dyslexia in a Turkish-English speaker, Annals of Dyslexia 55(1) (2005), 79–104.

[30] I. Raman and B.S. Weekes, Deep dysgraphia in Turkish, Be-havioural Neurology 16 (2005), 59–69.

[31] S.Z. Rapcsak isn’t in document (http://www.sciencedirect.com/scidirimg/entities/REemail.gif) isn’t in document, M.L.Henry, S.L. Teague, S.D. Carnahan and P.M. Beeson, Do dual-route models accurately predict reading and spelling perfor-mance in individuals with acquired alexia and agraphia? Neu-ropsychologia 45(11) (2007), 2519–2524.

[32] A. Ruiz, A.I. Ansaldo and A.R. Lecours, Two cases of deepdyslexia in unilingual hispanophone aphasics, Brain and Lan-guage 46 (1994), 245–256.

[33] Y. Sakurai, K. Sakai, M. Sakuta and M. Iwata, Naming diffi-culties in alexia with agraphia for kanji after a left posteriorinferior temporal lesion, Journal of Neurology, Neurosurgery,and Psychiatry 57 (1994), 609–613.

[34] S. Sasanuma, Acquired dyslexia in Japanese: clinical featuresand underlying mechanisms, in: Deep Dyslexia, M. Coltheart,K. Patterson and J.C. Marshall, eds, Routledge, London, 1980,pp. 48–89.

[35] S. Sasanuma, Surface dyslexia and dysgraphia: how are theymanifested in Japanese? in: Surface dyslexia: Neuropsycho-logical and Cognitive studies of phonological reading, K.E.Patterson, J.C. Marshall and M. Coltheart, eds, Lawrence Erl-baum, London, 1985, pp. 225–249.

[36] S. Sasanuma, H. Ito, K. Patterson and T. Ito, Phonological


alexia in Japanese: a case study, Cognitive Neuropsychology13(6) (1996), 803–822.

[37] M.L.H. Senaha, P. Caramelli, R. Nitrini, H. Charchat-FichmanandB.S. Weekes, Semantic dementiawithout surface dyslexia,Brain and Language 99(1–2) (2006), 33–34.

[38] M.L.H. Senaha, P. Caramelli, C.S. Porto and R. Nitrini, Se-mantic dementia: Brazilian study of 19 cases, Dementia eNeuropsychologia 4 (2007), 366–373.

[39] A. Silveira and M.A.M.P. Parente, Leitura letra-por-letra: umadislexia periferica? in: Temas em Neuropsicologia e Neurol-inguıstica, B.P. Damasceno and M.I.H. Coudry, eds, Tec Art,Sao Paulo, 1995, pp. 185–189.

[40] M. Sugishita, K. Otomo, S. Kabe and K. Yunoki, A crit-ical appraisal of neuropsychological correlates of Japaneseideogram (kanji) and phonogram (kana) reading, Brain 115(1992), 1563–1585.

[41] B. Vidigal and M.A.M.P. Parente, As dislexias adquiridas comutilizacao da via lexical: manifestacoes das dislexias profundae fonologica no portugues, in: Temas em Neuropsicologia eNeurolinguıstica, B.P. Damasceno and M.I.H. Coudry, eds,Tec Art, Sao Paulo, 1995, pp. 180–184.

[42] B.S. Weekes, Acquired disorders of reading and writing:Cross-script comparisons, Behavioural Neurology 16 (2005),51–57.

[43] B.S. Weekes, I.F. Su, W.G. Yin and X.H. Zhang, Oral readingin bilingual aphasia: evidence from Mongolian and Chinese,Bilingualism: Language and Cognition 10(2) (2007), 201–210.

[44] J. Yamada, Developmental deep dyslexia in Japanese: a casestudy, Brain and Language 51 (1995), 444–457.

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