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Peripheral Dysgraphia: Dissociations of Lowercase from Uppercase Letters and of Print from Cursive Writing

Ingles, Janet L. PhD*,†; Fisk, John D. PhD†,‡,§; Fleetwood, Ian MD; Burrell, Steven MD; Darvesh, Sultan MD, PhD‡,#

Cognitive and Behavioral Neurology: March 2014 - Volume 27 - Issue 1 - p 31–47
doi: 10.1097/WNN.0000000000000022
Case Reports

Clinical analyses of patients with acquired dysgraphia provide unique opportunities to understand the cognitive and neural organization of written language production. We report J.B., a 50-year-old woman with peripheral dysgraphia who had prominent dissociations in her ability to write in lowercase versus uppercase and print versus cursive. We gave J.B. a series of tasks that evaluated her skills at writing uppercase and lowercase print and cursive, spelling aloud and in writing, writing numbers and symbols, and visual letter recognition and imagery. She was impaired in printing letters, with lowercase more affected than uppercase, but her cursive writing was relatively intact. This pattern was consistent across letter, word, and nonword writing tasks. She was unimpaired on tasks assessing her visual recognition and imagery of lowercase and uppercase letters. Her writing of numbers was preserved. J.B.’s handwriting disorder was accompanied by a central phonological dysgraphia. Our findings indicate functional independence of graphomotor programs for print and cursive letter styles and for letters and numbers. We discuss the relationship between peripheral and central writing disorders.

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*School of Human Communication Disorders

Departments of Psychology and Neuroscience




Diagnostic Radiology

#Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada

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The authors declare no conflicts of interest.

Reprints: Janet L. Ingles, PhD, School of Human Communication Disorders, Dalhousie University, 1256 Barrington Street, PO Box 15000, Halifax, Nova Scotia, Canada B3H 4R2 (e-mail:

Received July 23, 2012

Accepted June 13, 2013

© 2014 by Lippincott Williams & Wilkins.