How color agnosia is recognized, its symptoms and treatment

Speech auditory agnosia is a disorder of auditory perception that occurs not only in children, but also in adults. This is the inability to recognize sounds: the sound of rain, the ringing of a bell, intonation, timbre, similar words. Phonemic hearing – the ability to listen and hear the sounds of speech while maintaining physical hearing – suffers. Therefore, the child speaks as he hears, often not understanding what others want from him. For example, he may hear the command “knock the spoon on the table” as “asuchi okoy a lu” and not understand. I’ll tell you today how to fix this violation.

Causes of hearing loss

The main cause of this disorder is the immaturity of the wiring connections between different areas of the brain. It occurs as a result of birth injuries, fetal asphyxia, infectious diseases of the infant, stressful situations, and dementia. In this regard, two types of auditory perception disorders are distinguished: sensory alalia and speech auditory agnosia.

In the first case, the person does not understand the spoken speech, although he can clearly reproduce the phrase he heard. There is no connection between the auditory shell of the word and the object. For example, the sensor alalik will not understand the instruction “give me a mug” at all, but will clearly repeat “give me a mug.” An auditory-verbal agnosic incorrectly hears instructions and understands that something needs to be given. He may bring a fork instead of a mug and pronounce: “ay yku.” Speech auditory agnosia is also called phonemic hearing disorder.

Formation of phonemic awareness

Phonemic hearing is the ability to differentiate speech sounds. From birth to secondary school, a child goes a long way to learn not only to distinguish sounds, but also to correctly reflect them in writing, clearly observing the sequence in a word, without skipping or replacing them. Phonemic perception is an indicator of how well a person feels sounds in speech, pronounces words in a certain rhythm, without rearranging syllables in words.

The formation of phonemic perception includes not only speech development, but also motor planning and an increase in the volume of auditory-verbal memory. The ability to analyze the sound envelope of a word appears when the child can retain multi-step instructions in memory. Therefore, from the age of two we work on the development of auditory-verbal memory. Instructions: put a banana in a green plate, a watermelon in a red one. We start with a two-step instruction, then make it more complicated: first put a green pebble, then a red one, then a blue one. First we pronounce the command, the child must listen to it, hold it in his head and perform it correctly. Motor planning also develops here: what comes first, what comes next.

Work on the formation of phonemic hearing is carried out in three stages:

1 – recognition of non-speech sounds;

2 – work with musical instruments, development of tempo, rhythm, sound strength;

3 – recognition of speech sounds: similar words, syllables, sounds.

Causes of pathology

Agnosia is a violation of secondary, projection-associative processes in the cerebral cortex. That is, a person’s sense organs work normally, signals from them continue to flow to the necessary areas of the cortex, but it is in this area that a “breakdown” occurs. Already familiar information is not perceived by the brain and a person cannot recognize what he saw, heard or felt. This condition is very painful for the patient and is not always correctly perceived by others, who consider the symptoms of the disease to be a simulation or a manifestation of poor upbringing.

Agnosia can occur when neural connections are damaged due to:

Infectious and viral diseases affecting nervous tissue;
Brain hypoxia and hemorrhages;
TBI and concussions;
Neoplasms of the central nervous system;
Hereditary diseases and degenerative processes;
Perinatal lesions of the central nervous system in children.

The nature of the lesion and the type of agnosia depend on the location of the damage to the cortex. For example, true astereognosis is caused by damage to the postcentral areas of the cortex, and simultaneous agnosia occurs when the occipital lobe in the anterior part is damaged. Most often, visual agnosia is diagnosed, which develops with pathologies of the occipital lobes.

Diagnosis of the disease

Agnosia can manifest itself in different forms and varieties, which depend on the primary causes of damage to the human body. In each specific case, the disease proceeds differently, so diagnosis becomes noticeably more complicated, because it requires a comprehensive neurological examination of the patient.

To make a diagnosis of this pathology, clinical manifestations are taken into account and examinations such as computed tomography and MRI are also carried out to visualize the picture of the brain, neuropsychological and physical examination.

As a rule, the first stage of diagnosis consists of the doctor asking the patient to identify the objects offered to him using various senses. Subsequently, a neuropsychological study and special testing are organized, during which the doctor is able to determine existing sensitivity disorders. An analysis is also carried out of a person’s ability to use the senses and the subsequent correct identification of the information received.

Types of agnosia

There are several main groups of disorders:

Visual;
Auditory;
Olfactory;
Flavoring;
Tactile.

Visual agnosia is a violation of the recognition of visible objects or their properties. Thus, a person may stop recognizing the colors, volume, parts of an object, or “forget” what it is, although he has seen this object many times before and knows its purpose.

Depending on the type of disorder:

Color agnosia - a patient with a similar disorder ceases to distinguish colors, even if he knew them before.
Prosopagnosia or facial agnosia - with this type of disorder, patients cease to recognize and differentiate the faces of others, including their own or their loved ones.
Letter agnosia - recognition of alphabet symbols is impaired, counting and reading skills are lost. With this type of disorder, secondary alexia is formed.
Object agnosia is one of the most difficult types for the patient. He loses the ability to understand what kind of objects surround him and why they are needed, but at the same time he can describe them, partially guess their purpose and use them after demonstration. Object agnosia can be complete or partial, when the patient loses the ability to recognize certain objects. “Misrecognition” also extends to the depiction of objects.
Optical-spatial agnosia - patients cannot recognize the space around them, even if it is familiar to them. They do not know how to navigate when necessary to find a road or show it on a map.

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There is a distinction between depth agnosia - a violation of the assessment of objects in volume; in such patients the concepts of “far-close”, “long-short”, and so on are impaired.

Impaired stereoscopic vision - objects lose their volume or cannot be assessed.

One-way spatial - half of the objects in the field of vision are “lost” or they are not recognized by the patient.

Violation of topographic orientation - in a mild form, this type is often found in people suffering from “topographic cretinism” - the inability to understand where to go, remember the road or make out it on the map. With more severe disorders, the patient cannot independently move around the streets even in familiar surroundings.

Simultaneous agnosia - with this type, patients do not perceive their surroundings in full. They perceive only 1 object at a time; the entire “picture” does not appear in the patient’s brain.
Apperceptive - the ability to perceive an object as a whole is lost, with normal perception of individual parts of the object.
Agnosia due to optomotor disorders (Balint's syndrome) - patients lose the ability to focus vision on the desired object, they cannot consciously direct their gaze in a given direction. This disorder interferes with a person’s ability to communicate, perform activities, read, and write.

Auditory agnosia occurs when it is impossible to recognize the meaning of words or individual sounds, with normal conduction of sounds to the cerebral cortex. Acoustic agnosia develops when the temporal gyrus of the cortex is damaged.

Simple auditory agnosia – lack of recognition of individual sounds
Hearing-speech - speech recognition of others is impaired. For the patient, it sounds like a collection of unfamiliar sounds without meaning.
Tonal - patients cease to distinguish the tonality of what they hear, emotions in speech, timbre and other shades.

Somatoagnosia is a violation of body pattern recognition; the patient cannot assess the location of body parts, their size and other parameters.

Anosognosia - the patient refuses to recognize the absence of any body part, existing disorder or disease. Thus, a person with paralyzed limbs continues to consider himself healthy.

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Autotopagnosia - recognition of certain parts of the body is impaired, most often on one side. The following varieties are distinguished:

Autotopagnosia hemicorpus (hemisomatoagnosia) - the patient “forgets” about one half of his body, although its functions may be preserved. He doesn't use 1 leg and 1 arm or all of 1 half of his body.
Somatoparagnosia - a part of the body is no longer perceived as one’s own. The patient may believe that his leg or arm is someone else’s or that it is an inanimate object that for some reason ended up next to him. Usually such a disorder is accompanied by a violation of the purification of the integrity, size, and weight of one’s body.
Somatic allosthesia is an unusual type of disorder in which the patient may feel that he has “grown” extra limbs. At the same time, phantom limbs can “hurt”, “itch” and cause other disturbances to their owner.
Autotopagnosia of posture - a clear perception of one's body is disrupted. Patients cannot feel where parts of the body are currently located, what they are “doing” and somehow influence their activities.
Impaired right-left orientation - in this case, the patient confuses these concepts and cannot determine the corresponding parts of the world, his body, and so on.
Finger agnosia (Gerstmann syndrome) - patients cannot distinguish between their fingers and confuse them, for example, when asked to show a certain finger or repeat the doctor’s movement. This makes it difficult to perform certain activities in daily life.

Tactile agnosia is characterized by impaired recognition of objects by touch. This may be a violation of sensitive sensitivity - the patient ceases to understand what kind of surface he is touching: soft, hard, smooth, rough, and so on.

Olfactory and gustatory agnosia

The processes of recognizing smells or tastes previously familiar to the patient are disrupted.

Treatment of the disease

Such pathology can manifest itself in different ways and to varying degrees of severity. In this regard, before starting the treatment process, doctors conduct special studies to make the most accurate diagnosis.

Violation of the motivational component of perception

It was shown above that a decrease in generalization leads to agnosia, and changes in the functional state of the activity of analyzers lead to deceptions of the senses. Now let’s ask ourselves the question: how does a change in the motivational component of perception affect perceptual activity?

The answer to this question was obtained by B.V. Zeigarnik and the staff of her laboratory in a study of the perception of patients with the so-called frontal syndrome, who had severe impairments of control and voluntariness, whose behavior was characterized by aspontaneity and lack of correction. Let's start with examples.

The patient, who received a severe injury to the left frontal lobe, had difficulty recognizing objects drawn with a dotted line or shaded, and was unable to grasp and convey the meaning of two paintings successively depicting simple subjects (in one painting, two guys are smoking near a haystack; in the other, they are running away from a fire haystack). Patient: “Here two are sitting, and here two are running.” The patient does not notice that we are talking about a sequential image.

Doesn't it look like agnosia? But that's not true. The fact that recognition difficulties are pseudo-agnostic is indicated by the fact that as soon as you asked the patient to “look carefully” at how he gave an adequate answer. The difficulty of recognition in this case is not an agnostic disorder in the narrow sense of the word, but is a consequence of the fact that the patients did not carry out an active search process, which is always included in the act of perception.

It is especially difficult for patients with damage to the frontal lobes of the brain to understand a series of pictures depicting a plot in a sequential order. Thus, one such patient with damage to the basal parts of the frontal lobes of the brain was presented with a series of five pictures depicting a wolf chasing a boy through a snowy clearing in the forest. “Look, you’re a mischievous person, you climbed a tree to get apples or something,” says the patient, barely looking at this picture. After the experimenter's persistent request to look more closely, the patient correctly describes the plot.

Thus, the data presented show that a significant role in such disorders is played by a violation of controllability and voluntariness, i.e., the motivational component of perception suffers.

This involuntariness is manifested in another peculiar phenomenon - in such patients there is no change in figure and ground in Rubin's reversible figures. As you know, if you fix an image for a long time, the process of changing figure and background occurs by itself; otherwise, it is enough to draw the subject’s attention to the possibility of such a change in order to arbitrarily trigger this process. In the patients described, this process of changing figure and ground cannot be voluntarily caused.

Likewise, they do not form hypotheses when presented with Rorschach blots.

Let us provide two pieces of evidence that the noted disturbances in perception are personal-based.

The first (theoretical) comes from Freud.

In American psychology, the term personality denotes a certain integrative system that ensures the integrity and constancy of an individual’s behavior and which is constantly in danger of destruction either from forbidden instinctual drives or from demands imposed by the external world (dog below and dog above). The presence of such a constant conflict creates a certain level of anxiety. When it increases, psychological defense mechanisms are launched, the purpose of which is to eliminate the source of anxiety and return the individual to a state of comfort.

As an example, let us dwell on the form of psychological defense that is called perceptual. The activation of the perceptual defense mechanism is associated with the degree of structure of the perceptual material. An uncertain, conflictual or unfamiliar situation that requires a restructuring of behavioral patterns and adaptation to new relationships can lead to an increase in the level of anxiety. It is intolerance to uncertainty that causes perceptual defense (for example, denial of an obvious fact), i.e., a disorder of perception.

Second (experimental) proof according to B.V. Zeigarnik. The experimental procedure was as follows. The subjects were presented with complex plot pictures and pictures with an unclear plot under conditions of different motivation, which was created, firstly, with the help of different instructions; secondly, by varying degrees of image uncertainty.

The pictures used in the experiment were images of more or less complex situations (a mother bathing a child, a group of excited women, etc.), blurry photographs of objects (flowers, wet pavement, Rorsch blots). The difference in the instructions was as follows. In option “A,” picture cards were offered with “blind” instructions to describe what was depicted. Option B stated that the purpose of the experiment was to explore imagination. In option "B", subjects were warned that the purpose of the study was to determine their mental abilities. In each variant, different sets of pictures were presented. Thus, in all three options, the goal of the task remained unchanged, only its motivation changed.

The experiments involved healthy subjects, patients with epilepsy and patients with schizophrenia.

Healthy subjects. Under the conditions of option “A,” the perception process was not determined by the experimentally specified motivation. Because of this, the immediate goal of the activity—meaningful interpretation—did not acquire independent motivating force.

Qualitatively different results were obtained in options “B” and “C”, where the motives introduced by the instructions set a certain direction of activity.

Normally, this was expressed in the fact that the subjects became interested in the task and the experimenter’s assessment. The nature of the formulation of hypotheses has also changed - they have become more detailed and emotionally rich. The central place in the description of plot pictures began to be occupied by the disclosure of the inner world of the depicted characters. Formal answers have disappeared.

We will demonstrate the peculiarities of perception in a patient with epilepsy using the example of the patient’s statements when presented with a picture depicting a group of excited women.

“There are several people in this picture. There is a woman standing on the left, and another woman next to her. Her hair is dark, she folds her arms over her chest and cries. A boy is running towards her, raising his hands, as if he wants to calm her down... Behind the boy, a woman is holding a child or he is sitting on something, pressed against her, hugging her with his right hand... In the left corner there are two more women...", etc.

The above example shows how activity, initially aimed at a meaningful interpretation of a picture, turns into a scrupulous description of its individual fragments. In some cases, this inhibits the process of generating hypotheses, leading to the emergence of formal answers.

The perception activity of patients with schizophrenia has a different type. Despite the “intellectual” focus of the study, the patients did not show interest in the task, did not respond to the experimenter’s assessment, and did not correct their mistakes. The activity of patients is characterized by extreme convolution, the absence of search activity, so pronounced in the norm. The patients’ statements are extremely laconic, unemotional, and mostly only generally state some plot or subject content of the pictures: “Some kind of misfortune,” “The person is thinking.”

Thus, analysis of the research results in options “A”, “B” and “C” made it possible to establish the dependence of perception on motivation. With the introduction of meaning-forming motives, a new motivational structure is formed, different in normal and pathological conditions.