Sparing of country names in the context of phonological impairment

Neuropsychologia 46 (2008) 2079–2085

Sparing of country names in the context of phonological impairment Josette Rodriguez, Marina Laganaro ∗ Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospital and University of Geneva, Switzerland Received 12 July 2007; received in revised form 6 February 2008; accepted 7 February 2008 Available online 14 February 2008

Abstract Many single case studies have reported selective impairment of proper or common names in anomic speakers, providing evidence for a categorical organisation of the lexical-semantic network. These dissociations have been observed in oral and/or written naming and sometimes in comprehension. Here we report the case of an aphasic patient with severely impaired phonological encoding presenting a dissociation between proper and common names. Superior production of countries and nationalities was observed in all output tasks (naming, reading and repetition). The interest of a preservation of proper name categories in the context of phonological impairment lies in the question of the propagation of categorical organisation to the processes of phonological encoding. We suggest that the observed dissociation can be explained by relative sparing of countries and nationalities at lexical-semantic level as in previous reported cases and that this organisation spreads beyond lexical selection, to phonological encoding. © 2008 Elsevier Ltd. All rights reserved. Keywords: Proper names; Common names; Semantic; Dissociation; Phonological encoding

1. Introduction Most reports about dissociations among proper and common names concern anomia affecting selectively one or the other category. Selective anomia for proper names has been documented with several case studies of patients who were unable to retrieve proper names, but were unimpaired in retrieving common names (Fery, Vincent, & Br´edart, 1995; Lucchelli & De Renzi, 1992; McKenna & Warrington, 1980; Miceli et al., 2000; Semenza & Zettin, 1988, 1989). For example, the patient PC described by Semenza and Zettin (1988), was very impaired in retrieving countries, cities and persons with normal accuracy in naming objects, fruits and vegetables. The opposite pattern of impairment, with preserved proper names production and impaired retrieval of common names has also been reported, although less frequently (Cipolotti, 2000; Ramsberger, Miyake, Menn, Reilly, & Filley, 1999; Schmidt, Buchanan, & Semenza, 2004; Semenza & Sgaramella, 1993; Warrington & Clegg, 1993). A complete double dissociation between common and proper names produc-

∗ Corresponding author at: Service de Neuror´ ee´ ducation, Geneva University Hospitals, Av. Beau-S´ejour 26, CH-1211 Gen`eve 14, Switzerland. Tel.: +41 22 3823643; fax: +41 22 3828338. E-mail address: [email protected] (M. Laganaro).

0028-3932/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.neuropsychologia.2008.02.009

tion has been described by Pav˜ao Martins and Farrajota (2007) with two aphasic patients presenting the inverse anomic pattern on the same testing material. A few cases have been reported in which the dissociation was observed in comprehension (Van Lanker & Klein, 1990; Warrington & McCarthy, 1987; Yasuda & Ono, 1998). These global aphasic patients presented dissociation between the comprehension of proper and common names. Among the cases presenting with spared proper names, a few reports concerned preservation limited to geographical names, especially countries and nationalities. The reported cases with selective sparing of proper names limited to country and nationality names are very heterogeneous and often associated with a general cognitive decline. Two cases were reported by McKenna and Warrington (1978) and Warrington and Clegg (1993) presenting sparing of country names in the context of global aphasia. Incisa della Rocchetta, Cipolotti, and Warrington (1998) described a patient with Pick’s disease who displayed preserved country names production in the context of severe anomia. The case BF reported by Cipolotti (2000) also suffered from Pick’s disease and presented a modality specific preservation of countries and nationalities in oral production (not in the written modality) with very impaired naming of person’s names. In sum, published studies reporting dissociations between common and proper names in anomia described cases with an impaired word retrieval in the oral, written or both modalities in

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the context of unimpaired phonological encoding. Errors produced by these patients were primarily no responses (Incisa della Rocchetta et al., 1998; McKenna & Warrington, 1978; Pav˜ao Martins & Farrajota, 2007; Warrington & Clegg, 1993) and semantic paraphasias (Cipolotti, 2000). Very rare reports on dissociations between semantic categories concerned patients producing phonological paraphasias. The patient RI described by Semenza and Sgaramella (1993) suffered from severe phonological impairment and his correct production was limited to monosyllabic words. The patient produced spontaneously surnames, often contextually inappropriate, and was able to name proper names (especially persons and some geographical names) with a phonological cue, while naming common names was severely impaired. Here we report the case of an aphasic patient (HK) with severe phonological impairment and relative preservation of countries and nationalities in comparison to common names and to other proper names. The severe impairment in speech production was similar in naming, repetition and reading tasks with many phonological transformations and conduites d’approche. The interest of a preservation of proper name categories in the context of phonological impairment lies in the question of the propagation of categorical organisation to the phonological encoding processes. 2. Case report HK is a 51-year-old native French-speaking man, who suffered traumatic brain injury (TBI) following an attack 5 years before the present study, causing left frontal-temporal-parietal lesions (see Fig. 1). He was naturally left-handed, forced to write with his right hand, and worked as an accountant until the accident. Neuropsychological assessment carried out during the first months after TBI revealed severe aphasia characterised by some very short correct sentences in spontaneous speech production and very impaired elicited production with phonological transformations (like “parapluie” (umbrella) produced [kolosele]) and no responses. Automatic speech was preserved only for digits. HK also had severe agraphia, alexia and acalculia. Seman-

tic assessment revealed impaired picture-to-picture matching (43/52) on the Pyramid and Palm Trees test (PPT, Howard & Patterson, 1992) and impaired intra-categorical word-to-picture matching (French adaptation of Laiacona, Barbarotto, Trivelli, & Capitani, 1993). Word-to-picture matching tasks revealed a dissociation in favour of words from the living categories (nonliving categories: respectively 40% and 36% correct in auditory and written word presentation; living categories: 66% correct in the auditory modality and 80% correct in the written modality). This dissociation was also observed in drawing from memory (Rodriguez & Martory, 1998), where the patient produced more semantic confusions (like drawing skirt for trousers) in manufactured objects (9 errors on 18 drawings) than in biological objects (4 errors on 18 drawings). Yes/no questions on visual and functional properties on the same items (Rodriguez & Martory, 1998, 72 questions) were 93% correct. Comprehension was less accurate for common names than for proper names: word-topicture matching for country names (pointing to countries on a European map) was 90% correct in the auditory and written modalities (13/14) and written city-to-country association was performed flawlessly (14/14). Neuropsychological examination at the moment of the present study, 5 years after TBI, still revealed severely impaired language production. Spontaneous production was characterised by correct and informative short sentences alternating with unintelligible sentences due to phonological transformations and aborted sentences (example: “Comment-¸ca? Mon nom. . ..c’´etait en [atR˜o]. . .[˜okRa]”). Phonological paraphasias were more frequent in elicited speech and appeared in naming, repetition and reading aloud. A length effect clearly appeared in all production tasks (see Table 1). Naming was correct only for some monosyllabic words and did not benefit from semantic or phonological cueing. No lexical effect was observed in repetition. Performances were lower on reading aloud than on the other output modalities and pseudo-words reading was abolished (see Table 1), while lexical decision was unimpaired (Lemay, 1990). Auditory comprehension was unimpaired on simple sentences (13/15) from the French version of the Boston Diagnostic Aphasia Examination (Mazaux & Orgogozo, 1981, hereby: F-BDAE), but still impaired on complex sentences and para-

Fig. 1. MRI scan 7 months post-TBI showing an extended left temporal lesion extending to frontal and parietal cortical and subcortical areas.

J. Rodriguez, M. Laganaro / Neuropsychologia 46 (2008) 2079–2085 Table 1 Percent correct production in naming, reading and repetition tasks Correct production

Repetition (%)

Reading (%)

Naming (%)

Monosyllabic words Bi-syllabic words Tri-syllabic words

65 25 0

38 13 0

60 8 0

Monosyllabic pseudo-words Bi-syllabic pseudo-words

63 28

0 0

graphs (13/24 in the Montr´eal-Toulouse aphasia examination, Nespoulous et al., 1992). Written comprehension was unimpaired on single words (79/80 at LEXIS, De Partz et al., 2001), but his score was reduced on sentences and paragraphs (FBDAE: 6/10). Severe dysgraphia was still observed. Semantic assessment revealed normal scores on pictures and on words matching tasks from the Pyramid and Palm Trees test (47/52) and on intra-categorical word-to-picture matching tests (all scores above 90%). Oral calculation was impossible, while written calculation was correct for all operations. He had mild oral apraxia and no limb apraxia. Visual-spatial memory scores were in normal range on Rey’s complex figure (Osterrieth, 1944), on the Corsi block test (Milner, 1971) and on the Rey visual design-learning test (RVDLT, Rey, 1968). Performance was in normal range on auto-activation, mental flexibility and planning tasks (Frises de Luria and non-verbal fluency, Regard, Strauss, & Knapp, 1982), He had right neglect and impaired performances on attention tests (TEA, Zimmermann & Fimm, 1994). Non-verbal intellectual processes were in normal range (Progressive matrices, Raven et al., 1998). In sum, HK presented with severe aphasia and produced many phonological paraphasias in all verbal output modalities. Auditory and written comprehension was preserved on single words and simple sentences, but still impaired on complex sentences and texts. The semantic impairment reported at the beginning of his hospitalisation had disappeared. HK also suffered from severe agraphia and phonological dyslexia added to impaired phonological encoding. Since the production of correct multi-syllabic proper names has been observed in spontaneous and elicited speech (e.g. “c’est un Chinois, un homme qui. . .est tr`es connu. . .c’est le plus connu des Chinois”; ”c’est un [˜agε], non un Allemand, mais il a. . .en Suisse, puis apr`es il est . . .,les Am´ericains. Il est tr`es connu . . ., les [e] de tous les pays”.), in depth assessment of the production of proper names was carried out in comparison to common names.

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3.1.1. Country/object names Twenty-two toponymes (country names) and 22 object names were selected, matched on length in syllables (1, 2 and 3 syllables) and syllabic structure. Lexical frequency was verified in the French database Lexique (New et al., 2001) for common names and nationalities: there was no significant difference between the two categories (t(42) = 1.02, p = .3). For the naming task, pictures corresponding to common names were black and white drawings; for countries and nationalities, target countries were coloured on a black and white map of the continent. Reading aloud and repetition was assessed on the same 44 words. 3.1.2. Several object categories, countries and nationalities Twenty words were selected from each of four categories of common names (animals, fruits and vegetables, clothes, and objects) and two categories of proper names (countries and nationalities). Words were matched across categories on length in syllables and CV structure. As for the material described above, none of the common name categories differed from the proper names in terms of lexical frequency (animals vs. countries: t(40) = 1.1, p = .27, all other t’s < 1). For the naming task, nationalities were represented with symbols of persons drawn in the target country. Reading aloud and repetition was assessed on the same 120 words. 3.1.3. Different categories of proper names Twenty words were selected from each of five categories of proper names (countries, capitals, rivers or mountains, famous persons, and first names), matched on length and with similar CV structure. Only reading and repetition were elicited with this material.

3.2. Procedure and scoring Naming, reading and repetition were carried out during different sessions by two experienced speech and language therapists. The stimuli were presented in pseudo-random order for each task. Transcription was made online and some sessions were recorded and transcription was checked by a second therapist. Productions which were correct at the first attempt or after a conduite d’approche (e.g. [ele//oli//oliz//oliv] for “olive” or [kR␧n//gRεs] for “Gr`ece”) were scored as correct. HK sometimes produced the nationality instead of the country name: these responses were also scored as a correct when they were entirely correct (without phonological paraphasias). Errors were scored as follows: • Substitution: maximum of one phoneme substitution per each syllable in the word ([otRys] for “autruche”—ostrich; [eR˜a] for “orange”); • omission: maximum of one phoneme elision per word ([˜agløt␧] for “Angleterre”; [talin] for “Staline”); • formal error: word error with a phonological similarity to the target word (“molle”—soft, for “melon”; “moto” for “mouton”—sheep); • semantic paraphasia: word error with a semantic relationship to the target (“main”—hand for “bras”—arm); • circumlocution: the production of an adequate circumlocution for the target word (“`a cˆot´e des Allemands”—next to Germans, for “Austria”); • neologism: non-word production with more than one phoneme transformed per each syllable ([kokilin] for “coccinelle”—ladybird; [akRa] for “Argentine”); • fragment: single phoneme or single syllable production (ex. [ba//ta] for banane).

3. Method

4. Results 3.1. Material Naming, reading and repetition of common and proper names were assessed with the material described below. Particular care was taken in matching words from the different categories on phonological properties, like word length and CV structure, in order to ensure that the observed differences between categories were not due to these phonological factors.

On the entire corpus of common and proper names, which was assessed with the three oral production tasks (material a and b), HK produced 23% of correct responses in the naming tasks, 33% in the repetition task and 29% in the reading task. The difference between performance on the three tasks did not

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Table 2 Distribution (number and percent) of error sub-types in the repetition, reading and naming tasks

Total number of errors Semantic No responses Formal Circumlocutions Phonological Distribution of phonological errors Substitutions (%) Omissions (%) Fragments (%) Neologisms (%)

Repetition (N = 164)

Reading (N = 164)

Naming (N = 164)

109 0 49 (45%) 9 (8%) 0 51 (47%)

116 2 (2%) 26 (22%) 6 (5%) 3 (3%) 79 (68%)

127 3 (2%) 76 (60%) 3 (2%) 10 (8%) 35 (28%)

29 12 41 18

11 8 57 24

11 9 69 11

reach significance (χ2 (2) = 9.7, p = .085). Distribution of error types is shown in Table 2. No responses and phonological errors were differently distributed among tasks (respectively χ2 (2) = 34.9, p < .0001; χ2 (2) = 40.0, p < .0001), with more no responses in naming and repetition and more phonological errors in the reading task. The distribution of phonological errors was very similar between the three output tasks with a predominance of word fragments. In the comparison between proper names and common names (Table 3) higher accuracy appeared for proper names (45% correct) than for common names (18% correct). This difference is significant at Pearson Chi-square (χ2 (1) = 50.7, p < .0001). It should be emphasized that the correct score for proper names included the production of the nationality instead of the country name or the opposite. These productions were scored only when the word was phonologically correct (e.g. [alm˜a] “Allemand”, German, instead of [almaŋ]“Allemagne”, Germany; [kanada]Canada” instead of [kanadj˜ε], “Canadien”, Canadian). We decided to score them correctly because these morphologically related productions proved correct phonological encoding even on longer words, while only short words were phonologically correct in other categories and errors were mostly phonological paraphasias. An example of different kind of errors and of morphologically related correct forms is provided in Table 4. The proportion of correctly produced nationality instead of country names represented 37.6% of his correct responses and the production of country names for nationalities 6% of total corTable 3 Distribution of error sub-types on common and proper names Common names (N = 306)

Proper names (N = 186)

Correct production (%) No response (%) Semantic paraphasia (%) Formal paraphasia (%) Circumlocution (%) Phonological paraphasia

18.1 36.6 1.9 4.8 1 37.6

44.6 21.5 0 2.7 5.4 25.8

Distribution of phonological errors Substitutions and omissions (%) Fragments and neologisms (%)

29 71

23 77

rect responses. These transformations were observed in all tasks (naming, reading and repetition). He also produced less phonological paraphasias and no responses on proper names than on common names (respectively, χ2 = 7.2, p < .01 and χ2 = 12.4, p < .001) and more circumlocutions (χ2 = 8.7, p < .01). However, circumlocutions were observed mainly in the naming task (24% of circumlocutions on proper names and 1% on common names). These circumlocutions often included the correct production of an other proper name (other countries or nationalities, e.g. “c’est le copain des Franc¸ais” – it’s French friend for Spain “pas les Chinois” – not Chinese for Japan). Phonological distant errors (like fragments and neologisms) were more frequent than phonological errors close to the target word (phoneme substitution or omission) on both word categories. Importantly, the superior production accuracy for proper names was observed in all production tasks (naming reading and repetition, see Table 4). All Chi squares for the comparison between proper and common names are >10, all p’s < .01). 4.1. Common name categories Table 5 reports production accuracy on the four subcategories of common names. Although production was very impaired on all categories, animals and vegetables were proTable 4 (A) Correct responses for common and proper names in naming, reading and repetition and (B) examples of responses for common and proper names in each production task

(A) Accuracy Common names Proper names

Picture naming (%)

Repetition (%)

Reading (%)

13 41

25 51

17 50

Target item

Picture naming

Repetition

Reading

(B) Examples Cloche (bell) Bouton (button) Am´erique Chine

[ke] [bus] [bu] les Am´ericains (Americans) les Chinois (Chinese)

[klOs] [buto] [ete] Chine

[t˜o] [bo][po][pos] am´ericain chinois

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Table 5 Response accuracy in the different categories of common names

Animals (20) Fruits and vegetables (20) Objects (20) Clothes (20)

Naming (%)

Repeating (%)

Reading (%)

Total (%)

25 20 0 0

30 25 10 25

25 25 20 10

27 23 10 12

Table 6 Response accuracy in the different categories of proper names

Capitals (20) Rivers/mountains (20) Countries (20) Famous people (20) First names (20)

Repeating (%)

Reading (%)

Total (%)

20 30 45 30 20

0 0 40 10 5

10 15 42 20 12

duced more accurately than objects and clothes. The difference between animate and inanimate objects is significant at Fisher’s test in the naming task (p < .01), not in reading and repetition (p’s > .4). 4.2. Proper name categories Among proper names, better production accuracy appeared for country names than for the other categories (see Table 6). Total scores were significantly higher on countries than on the other categories of proper names (minimum Fisher’s p = .05), however, this difference was due mainly to the reading task. 5. Discussion We presented an aphasic patient with a severe phonological impairment who displayed a relative preservation of countries and nationalities in comparison to other proper names and to common names. Differently from other cases presented in the literature, the dissociation between common and proper names was observed in the context of very impaired phonological encoding. Moreover, more accurate production for country names appeared in all oral production tasks (naming, reading and repetition). Neuropsychological observation of a dissociation between word categories indicates a categorical organisation with selective impairment of one of these categories. Semantic or lexical loci of impairment have been proposed for the dissociation among proper and common name categories. An underlying semantic impairment has been suggested for the cases presenting with the dissociation in comprehension tasks, but also when the dissociation was observed in word retrieval. For example, the case APA (Miceli et al., 2000) with specific impairment for proper names and the case FH (Lyons, Hanley, & Kay, 2002) with a specific anomia for common names displayed semantic impairment limited to the categories of names they were unable to retrieve. These dissociations indicate selective impairments

of particular semantic networks from a functional and neuronal perspective (Lyons et al., 2002). A lexical locus of impairment has been proposed for other case studies, who displayed the dissociation in naming tasks with preserved comprehension and semantics (Fery et al., 1995; Lucchelli & De Renzi, 1992; McKenna & Warrington, 1980; Semenza & Zettin, 1988, 1989) or with a selective dissociation of proper names only in one output modality, like the cases described by Cipolotti (2000) or Schmidt et al. (2004). Modalityspecific dissociations have been interpreted in the framework of an independent network model (Caramazza, 1997). Following this account, different pathways activate phonological and orthographic lexemes from semantics and lexical knowledge is categorically organised. This proposition has received neurobiological support by Damasio, Grabowski, Tranel, Hichwa, and Damasio (1996), who also suggested that lexical representation is organized by category and underlined by different neural networks in the left temporal lobe. For instance, Cipolotti (2000) attributed to a selectively spared lexical-phonological network for countries and nationalities the pattern observed in BF, who displayed category specific preserved oral naming and semantic paraphasias. Differently from previously reported cases presenting with selective sparing of countries and nationalities (Cipolotti, 2000; Incisa della Rocchetta et al., 1998; McKenna & Warrington, 1978; Warrington & Clegg, 1993) HK had severly impaired phonological encoding. We will therefore analyse and discuss three possible interpretations for the dissociation observed in HK in relation to severe phonological impairment and spared semantics. The first hypothesis concerns a categorically organised lexical network as suggested for modality specific sparing of country names by Cipolotti (2000). However, this proposition was made in the context of anomia, in which the patient displayed severe word-finding difficulties, without phonological transformations. We might therefore consider categorical organisation of phonological representations and processes. Common names and proper names may have different underlying processes not only at semantic and lexical level, but also at phonological level. The proposition of a particular status in phonological encoding has been made in the past for example for functional words, due to their relative immunity to phonological errors (Garrett, 1975). However, alternative explanations have been proposed for the sparing of functional words in phonological errors (see for example Dell, 1990) and this differential phonological encoding hypothesis has already been ruled out in other cases with a preserved word class category in the context of impaired phonological encoding (Cohen, Verstichel, & Dehaene, 1997).

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Furthermore, the similarity in the subtypes of phonological errors between common and proper names in HK rather favours similar phonological encoding processes between these two categories. A second hypothesis has been proposed by Semenza and Sgaramella (1993) for their patient RI who could name only person’s names after a phonemic cue in the context of impaired phonology. The authors suggested that two separate pathways for proper and common names spread from the semantic level to the lexical-phonological representations (see also Semenza, 2006). Preserved proper names can be attributed to impairment limited to the common name channel or to easier access to proper names due to the particular one-to-one relationship these representations have with their referent. This latter explanation was supported by the fact that phonological cue helped the correct production of proper names in RI. However, in the case of our patient HK the phonological cue was ineffective and the dissociation was observed in all oral production tasks. Finally, an alternative interpretation concerns the propagation of a categorical semantic or lexical organisation to the level of phonological encoding. In the case of HK, it should be remembered that a semantic impairment was observed during the first months after stroke. This impairment decreased and was no more objectivised with standard assessment tasks at the moment of the study, but after-effects of impaired semantic categories may have subsisted without appearing in standard tests. This interpretation states that the semantic organisation spreads beyond to the lexical-phonological level. A similar interpretation has been proposed by Cohen et al. (1997) for a case presenting preserved production of numbers in the context of phonological jargon. The authors suggested that the categorical organisation spreads to the level of phonological encoding. However, in the case of preserved numbers, a mechanism responsible for more automatic language processes may also be involved. The interpretation of an impairment in earlier levels of encoding which are organized along semantic categories spreading to phonological encoding is supported in HK by several observations. First, as already mentioned, he might have had repercussions of a semantic impairment. The semantic impairment described in the post-acute phase was already category-specific inside common names and proper names were relatively preserved. Second, variations in production accuracy between specific common and proper name categories were also observed in the present study. Indeed, among proper names, only countries were relatively preserved in comparison to other categories of proper names and to different categories of common names. Selective sparing of country names based on a semantic impairment or semantic organisation has been tied to different interpretations. First, it has been proposed that geographical names differ from other proper names’ semantic representations because of their spatial representation. These geographical representations might be linked to other visuo-spatial representations in the right hemisphere (Cipolotti, 2000; Warrington & Clegg, 1993). This hypothesis is supported by the fact that most reported patients had preserved visuo-spatial abilities and the

right hemisphere was relatively spared even in the cases with Pick’s disease (Cipolotti, 2000). An alternative explanation proposed by McKenna and Warrington (1978) and Incisa della Rocchetta et al. (1998) attributes country names to a superordonate semantic category in the context of hierarchichal semantic organisation of proper names. Arguments in favour of this suggestions came from the observation that their patient TM said “Germany” when he was asked to name Hitler or that patient FC described by McKenna and Warrington (1978) said “India” for the picture of Gandhi. Both interpretations, the spatial based semantic representation and the superordonate hypothesis might be applied to the dissociation observed in HK. Indeed, he had spared right hemisphere and visuo-spatial abilities, and he also sometimes produced a country name or a nationality instead of famous people (for example, he said “c’est le plus grand des Chinois” about Mao). However, how can the fact that the dissociation between common and proper names has also been observed in repetition and reading fit with spreading of lexical-semantic properties to the phonological level? Since HK was unable to read pseudo-words, he probably accomplished word reading only through a lexicalsemantic route. The observation of the same dissociations in reading aloud is therefore compatible with the interpretation of a lexical-semantic organisation spreading to the phonological level. By contrast, HK had similar scores in repeating words and pseudo-words. He could therefore use a non-lexical route in repetition, which seems at odd with a pre-phonological interpretation of the categorical effect. Nevertheless, sub-lexical repetition processes were very impaired (only about 70% of mono-syllabic non-words could be repeated correctly and almost no disyllabic pseudo-words), which may suggest that word repetition was also accomplished mainly via a lexical-semantic route, thus reflecting the lexical-semantic organisation. Moreover, permutations between nationality and country names were also observed in reading and repetition, which favours the hypothesis of a lexical-semantic reading strategy. These morphological derivations might also be interpreted as semantically and phonologically related errors (mixed errors). This suggests that both, semantics and phonology concur in activating the related word (Dell, Schwartz, Martin, Saffran, & Gagnon, 1997; Foygel & Dell, 2000). The observation that country names are often better preserved than other proper names (person names for instance) has been attributed to the fact that nations can be transformed (e.g. adjectivised), which increases their semantic connotations (Cohen & Burke, 1993) and enables their retrieval (Lucchelli & De Renzi, 1992). Therefore, phonological-semantic neighborhood between countries and nationalities might facilitate their correct retrieval and phonological encoding in HK. 6. Conclusion HK presented better production accuracy for proper names, especially countries and nationalities, than for common names in the context of very impaired phonological encoding in all oral production tasks. The interpretation of dissociation between word categories refers to the problem of the organisation of the lexical semantic system. The present case raises the question of

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