A selective deficit in imageable concepts: a window to the organization of the conceptual system

Nissim, a 64 years old Hebrew-speaking man who sustained an ischemic infarct in the left occipital lobe, exhibited an intriguing pattern. He could hold a deep and fluent conversation about abstract and complex issues, such as the social risks in unemployment, but failed to retrieve imageable words such as ball, spoon, carrot, or giraffe. A detailed study of the words he could and could not retrieve, in tasks of picture naming, tactile naming, and naming to definition, indicated that whereas he was able to retrieve abstract words, he had severe difficulties when trying to retrieve imageable words. The same dissociation also applied for proper names—he could retrieve names of people who have no visual image attached to their representation (such as the son of the biblical Abraham), but could not name people who had a visual image (such as his own son, or Barack Obama). When he tried to produce imageable words, he mainly produced perseverations and empty speech, and some semantic paraphasias. He did not produce perseverations when he tried to retrieve abstract words. This suggests that perseverations may occur when the phonological production system produces a word without proper activation in the semantic lexicon. Nissim evinced a similar dissociation in comprehension—he could understand abstract words and sentences but failed to understand sentences with imageable words, and to match spoken imageable words to pictures or to semantically related imageable words. He was able to understand proverbs with imageable literal meaning but abstract figurative meaning. His comprehension was impaired also in tasks of semantic associations of pictures, pointing to a conceptual, rather than lexical source of the deficit. His visual perception as well as his phonological input and output lexicons and buffers (assessed by auditory lexical decision, word and sentence repetition, and writing to dictation) were intact, supporting a selective conceptual system impairment. He was able to retrieve gestures for objects and pictures he saw, indicating that his access to concepts often sufficed for the activation of the motoric information but did not suffice for access to the entry in the semantic lexicon. These results show that imageable concepts can be selectively impaired, and shed light on the organization of conceptual-semantic system.