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Neumimycltology Review, Vol. 9, No.

1,1999

Russian Neuropsychology After Luria


Janna M. Glozman1-2

It is now more than 20 years after Luria's death in 1977. His collaborators, disciples, and followers both in Russia and abroad continue to further develop his work. The development of Russian
neuropsychology reflects the universal tendency to replace static neuropsychology, which relates
individuals' behavior to fixed cerebral lesions, with dynamic neuropsychology, which analyzes the
dynamics of brain-behavior interaction. Three types of Russian studies illustrate the latter approach:
(I) neuropsychological follow-up of different nosological groups of patients in the process of medical
or psychological treatment, (2) studies of cognitive evolution (developmental neuropsychology), and
(3) studies of cognitive involution (neurogeriatrics). All studies focus on cortico-subcortical and interhemispheric relationships. Another change in modern Russian neuropsychology consists of combining
the qualitative approach with the quantitative one, but the system of rating is based, following Luria's
tradition, on the psychological evaluation of each task's structure and the qualitative analysis of the
patients' performance and possibilities for its correction. Hence, Luria's creative and comprehensive
approach stimulates the further development of neuropsychology in Russia.
KEY WORDS: Neuropsychological development; interhemispheric interactions; Parkinsonism: neuropsychology of memory; neurolinguistics: cerebrovascular neuropsychology; developmental neuropsychology; neuropsychology of older persons; rehabilitation.

I would like to propose the following model of development in neuropsychology, which comprises three overlapping and coexisting phases (Fig. 1).

GENERAL TRENDS IN THE DEVELOPMENT OF


NEUROPSYCHOLOGY
It is now more than 20 years after Alexander R.
Luria's death in 1977. His collaborators, disciples, and
followers both in Russia and abroad continue to develop
his work. The development of Russian neuropsychology
reflects the universal tendency to replace static neuropsychology, which relates individuals' behavior to fixed cerebral lesions, with dynamic neuropsychology, which analyzes the dynamics of brain-behavior interaction (Rourke,
1982; Tupper and Cicerone, 1990). The ability of neuropsychology to adapt to changes in techniques, ideas, and
patients served accomplishes its potential to be of service
to humanity (Horton and Puente, 1986).

FIRST PHASE OF NEUROPSYCHOLOGY


DEVELOPMENT
In the first phase, the emphasis for neuropsychologists was on the brain and its relationship to different behaviors. The neuropsychology of this period was considered by Luria to be a "field of practical medicine" (Luria,
1973, p. 17). Similar understanding characterizes the book
of the French neuropsychologist H. Hecaen, Introduction
a la neuropsychologie (1972). The main and most valuable
attainment of this phase is a revision by Luria of the concepts of localizationism and antilocalizationism and the
creation of the theory of the dynamic and systemic cerebral organization of mental processes. The creation of this
theory resulted in functional analysis of different brain
systems and description of frontal, parietal, temporal, and
other syndromes.

1 Psychology Department, Moscow Stale University, Moscow, Russia.


- All correspondence should be directed to the author at Psychology
Department, Moscow State University, 8 Mohovaya St., b.5, Moscow
103009, Russia.

33
](Hl)-7.KBWW(>.MMX>33SI<!.(XV(>l<)99 plenum Publishing Corporation

Glozman

34

Fig. 1. Model of development in neuropsychology.

Recent development of the functional systems approach follows two main lines: (1) a study of intrahemispheric specialization (asymmetry) and interhemispheric
interactions and (2) research into subcortical brain
pathology.

The Problem of Interhemispheric Interaction


Study of interhemispheric interaction was started
during Luria's life by E. G. Simernitskaya, L. I.
Moskovichyute, and N. K. Korsakova. Interhemispheric
specialization for different forms of memory was demonstrated in research (Korsakova et al., 1979; Simernitskaya,
1978), as was the greater vulnerability of the right hemisphere to cerebral pathology (Korsakova et al., 1978). The
right hemisphere was found to be slower in information
processing than the left hemisphere (Krotkova et al., 1982)
and less able to regulate and accelerate one's mental activity (Enikolopova, 1998; Homskaya, 1995).
An important contribution was made by researchers
from Leningrad (now St. Petersburg) including Vadim L.
Deglin, Yakov A. Meerson, Ludvig I. Wasserman, N. N.
Nikolaenko, O. P. Trachenko, Alexandre G. Zalzman, and
others. It was shown, for instance, that each hemisphere
is specific for different types of reasoning, such as empirical or logical reasoning, and that there are unilaterally and bilaterally realized perceptive and verbal functions, or a "competence" of each hemisphere (Meerson and
Dobrovolskaya, 1998; Nikolaenko et al., 1997; Zalzman,
1989). The right hemisphere can analyze the perceptive
features of every stimulus, but not its semiotic (phonetic
and semantic) characteristics. Conversely, the left hemisphere is able to analyze categorical, phonetic, and seman-

tic characteristics of images and partly its perceptive features (Meerson and Zalzman, 1989). Each mental activity
is realized through the interaction of both hemispheres,
each making a specific contribution. Recent studies by
Homskaya and Batova (1998) have also shown interhemispheric differences in positive or negative character as well
as in intensity and stability of human emotions. New studies show that interhemispheric differences can be revealed
on both the cortical and the subcortical levels. Cognitive
defects specific for the left hemisphere are more evident
with cortical lesions, whereas subdominant syndromes appear predominantly after subcortical lesions of the right
hemisphere (Moskovichyute, 1998).
With this, there is a special cerebral mechanism of
interhemispheric interaction, ensured by the corpus callosum. Experimental study of its role in cognitive activity
was carried out by Lena Moskovichyute, one of Luria's
brightest disciples who now lives and works in Boston at
the VA Medical Center. Modality-specific (only visual or
tactile or acoustic) disturbances of interhemispheric interaction and the dyscopia-dysgraphia syndrome (ability to
write only with the right hand and draw only with the left
one) after partial dissection of the corpus callosum have
been described. It has been shown that the syndrome of the
bisected brain might be revealed only after dissection of
posterior regions of the corpus callosum (Moskovichyute,
Simernitskaya, et al., 1982).
The dynamic processes of different mental functions
after treatment depend on injury lateralization (Glozman
et al., 1991; Korsakova el al., 1978; Vasserman and Lassan,
1989; Vasserman and Tets, 1981). It was revealed that the
disturbances were more pronounced after left-hemisphere
lesions, but their regression was quicker and more thorough than that in patients with right-hemisphere damage.

35

Russian Neuropsychology After Luria

crucial for the PD pattern (Korsakova and Moskovichyute,


1985; Pillon et al., 1989). We measured the time of fulfillment of some motor, mnestic, and intellectual tests
(symptoms of bradykinesia, bradymnesia, and bradyphrenia), general brain activity of patients, and patients' verbal
activity in controlled and uncontrolled association tests.
The patients were also assessed using Wechsler Adult Intelligence Scale (WAIS) and Mini-Mental State (MMS)
methods and with a special standardized inventory of social adaptation (Glozman, 1991).
Significant difference in the degree and pattern of
cognitive disturbance was revealed between the group of
patients without cerebral atrophy or with mild cerebral atrophy and a group of patients with pronounced cerebral atrophy. Most of those patients (65%) of the latter group met
the criteria for dementia described in Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised
(DSM-IH-R) and had a high degree of social disintegration. These patients had pronounced cognitive disorders
in almost all mental spheres. Our recent studies also reveal
different patterns of cognitive disturbance in patients with
external and internal cerebral atrophy.
We can therefore represent the role of such factors
as aging, PD, and cerebral atrophy in the pathogenesis
of cognitive disorders. Nevertheless, PD should not be
considered as accelerated aging. The pattern of cognitive
disturbances in older persons with PD is a specific combination of "natural" brain alterations appearing with age
and specific impairments caused by the disease. The pattern is not the sum of both components, but a qualitatively
new complex of symptoms.
The analysis of the factors influencing the development of cerebral atrophy has revealed that cerebral atrophy is significantly more frequent for persons older than
60 years and for patients having more pronounced neurological symptoms. Although the duration of PD does not
contribute to the development of cerebral atrophy, the age

Meerson (1989) thinks that the "greater compensating capabilities of the left hemisphere are due to its particular
features such as abundance in neural connections, close
relationships with deep structures, greater mobility and
strength of nervous processes. All this contributes to the
formation of many flexible probabilistic relationships and
it assures a plasticity and a replaceability of some structures" (p. 37). In other recent studies, it has been found
that a transformation of interhemispheric interaction can
favor the rehabilitation process (Krotkova, 1998).

Neuropsychology of Parkinsonism
Research into subcortical behavioral pathology after
thalamic, midbrain, or basal ganglia dysfunction or other
subcortical lesions was carried out by Luria (1973) from
the viewpoint of three main functional units of the brain,
which are discussed in moredetail later in this article. Subcortical regions maintain and regulate an optimal level of
cortical tone necessary for organized, goal-directed activity. A good model for studying cognitive disturbances
due to subcortical damage is Parkinson's disease (PD).
Study of PD was begun at Burdenko Neurosurgical Institute by Korsakova and Moskovichyute (1985) and then
continued by me and my colleagues at the Moscow Medical Academy. Six spheres of mental activity (patient's
general characteristics, praxis, gnosis, language, memory, intelligence) were assessed in more than 150 patients
by using Luria's battery and including both the qualitative and quantitative evaluation of the defects (Glozman
et at., 1996). The scoring system took into consideration
the primacy-nonprimacy of defects and the possibilities
of their correction, and utilized normative data (Glozman
et at., 1991; see also, other Glozman article in this issue).
In addition, special attention was attached to the neurodynainic features of cognitive activity, which are considered

Table I. Specific Disturbances of Mental Functions in Different Forms of Parkinson's Disease


(Mean Standard Deviation)
Forms of PD
Tremorous
Disturbances of

(n=18)

Akinelic-rigid
(n=26)

Significance of
Differences

1. Praxis
2. Gnosis
3. Memory
4. Speech
5. Intellect
Summarized score of mental
functions disturbances

0.3 0.1 7
O.I40.16
0.98 0.77
0.22 0.25
0.160.13
15.45 10.45

0.64 0.28
0.40 0.21
1. 93 1.02
0.55 0.47
!. 07 1.03
38.61 20.06

<O.OI
<0.05
<0.05
n/s
<0.05
<O.OI

36

Glozman
Table 11. Relationship Among Differenl Methods of Assessment (Mean Standard Deviation)
Lurian assessment (summarized ratings)
Mini-Mental State (MMS) exam scores
Wechsler Adult Intelligence Scale Revised
(WA1S-R) IQ scores

of onset of the disease is essential. Cerebral atrophy develops much more quickly if the onset of PD occurs at a
later age.
Cognitive disturbances were more pronounced in the
akinetic-rigid form of PD than in the tremorous form
(Table 1). The evidence from our Lurian assessments
correlated well with that from psychometric methods: The
higher the summarized Lurian ratings of disturbances, the
lower were the patient's achievements on Wechsler testing
and in MMS exams (Table 2).
It is possible to interpret the data from our investigations using Luria's conceptualization of three functional
units of the brain: the activational, the information processing and storage, and the control units (Luria, 1973).
Russian studies have revealed that the activational component of cognitive processes was impaired in all patients
with PD. Severe disorders of cognitive functions (praxis,
gnosis, speech, memory, intelligence) related to the second
functional unit of the brain were observed predominantly
in older patients with PD and cerebral atrophy. Executive
behavior defects related to the control and regulation of
cognitive functions occurred in patients with a long duration of PD (exceeding 5 years). Therefore, the involvement
of the first functional unit of the brain is the earliest and
most universally impaired, whereas the other two functional units are disturbed during specific conditions of the
evolution of PD.
Dementia should not be considered as an obligatory
component of PD; it is consequential to involvement of
all three brain functional units and provokes social disintegration of the patients. It should also be pointed out
that dementia in patients with PD and cerebral atrophy,
unlike that in patients without cerebral atrophy, is not limited to the symptoms of so-called subcortical dementia
(such as slowing and exhaustibility of mental activity).
It includes some cortical cognitive disorders, the pattern
of which is different from that of the cortical cognitive
disorders of Alzheimer's disease (AD). A detailed comparison of neuropsychological evidence in PD, AD, and
vascular pathology is now under study. Only one feature is
mentioned here: that of voluntary-regulation impairment
in patients with AD, illustrated by their drawings on command and by copying (Fig. 2). Conversely, in patients with
PD (especially in those without severe atrophy), cortical

0-25
28.9 2.0
1199

26-55
27.3 2.0
I07ll

>55
24.0
936

Fig. 2. Examples of voluntary-regulation disorders in older patients.

stimulation and regulation can often compensate for the


defects of subcortical activation.
This information has allowed us to work out a program of rehabilitation of motor subcortical disturbances
in PD that helps realize Luria's idea of the cortical (visual) mediation of movements, that is, with use of externalized compensations that are consequently internalized (Glozman, 1996a). Preliminary results reveal not only
the efficiency of the program for stable regression of specific movement problems, but also its generalized effect on
bradykinesia, bradyphrenia, and general cortical
activity.
A specific problem of Parkinsonism is depression.
To reveal specific manifestations of depression in
Parkinsonism, we looked at the psychological structure of
depression using the model shown in Fig. 3. This
allowed us to find objective criteria of the severity of
depression in Parkinsonism. It was revealed that a

Russian Neuropsychology After Luria

Fig. 3. The psychological structure of depression.

premorbid predisposition to depression is crucial for identifying the degree of depression severity after the onset of
Parkinsonism, and for patients, also the potential benefit
from pharmacotherapy.

SECOND PHASE OF NEUROPSYCHOLOGY


DEVELOPMENT
Returning to the proposed model of development in
neuropsychology (see Fig. 1), in the second phase the
structure of mental activity or higher mental functions
has been the focus of attention and secondarily the localization of such processes in the brain. Such study gave
birth to different syndromes of mental disturbances: local
or regional disturbances, resulting in research on the neuropsychology of memory (Luria, 1976b), neurolinguistics
(Luria, 1976a), and so on; diffuse syndromes after cerebrovascular pathology; syndromes of underdevelopment
or atypical development, studied by developmental neuropsychology; and last, mental dysfunctions in healthy
subjects in specific functional states or with some individual particularities or accentuations in cognitive performances. This last line of investigation gave birth to study
of the neuropsychology of individual differences. The recent development of each of these lines of investigation is
described briefly next.

Neuropsychology of Memory
The actual studies of memory disorders, and their
structure and underlying mechanisms, are mainly approached with respect to interhemispheric interaction in mnestic activity (Korsakova and Mikadze, 1982; Korsakova
et al., 1979; Simernitskaya, 1978). It has been found that
the right hemisphere assumes more elementary, involuntary, and automatized forms of mnestic activity, whereas
the left hemisphere is responsible for complex, voluntary
forms of memorizing (Simernitskaya, 1978). Further, it
has been revealed that the right hemisphere takes part in the
first stage of immediate memorizing, then the left hemisphere participates in delayed recall (Korsakova et al.,
\ 979). Coding and reproduction of verbal information are
based on linguistic characteristics, mediated by the func-

37

tions of the left hemisphere, whereas visual information is


mainly coded on perceptive characteristics, and its memorizing and reproduction are effectuated predominantly by
the right hemisphere. Recognition processing is less specified than is recall and can be relatively preserved in many
types of local brain damage. Hence, "information processing can be effectuated through several parallel channels,
each operating with different characteristics. Included in
each channel during information processing is information that depends upon the level of organization of the
material" (Korsakova and Mikadze, 1982, p. 109).
Our last studies of memory disorders in patients with
PD revealed hemispherically specific types of mistakes:
For example, a lesion in the dominant hemisphere increased retroactive inhibition, whereas one in the nondominant hemisphere influenced more proactive inhibition. The left hemisphere is predominantly responsible for
activity and selectivity of memorizing, and the right one
ensures retention of item order and plasticity or flexibility
of memorizing.

Neurolinguistics
Neurolinguistics has had intensive development after
Luria at the Laboratory of Neuropsychology of Moscow
Medical Academy, directed by L. S. Tsvetkova. Studies
of lexical-semantic disorders in aphasia by T. V. Akhutina
and me provided new knowledge about language mechanisms, the organization of grammar and of the inner lexicon in normal subjects and in subjects with pathology
(Akhutina, 1981; Akhutina and Glozman, 1995;GIozman,
1978). One example of recent developments in neurolinguistics in Russia is a comparative study to assess vocabulary in cortical and subcortical pathology (Glozman,
1996b). For the purposes of this investigation, we worked
out an analysis of data from the controlled and uncontrolled word association test, which includes both the process of recall and the structure of the vocabulary words
received.
Dynamic features of the associative process include
both agility and motility (ability to shift). The first is measured by the average output, the second through a nonproductive recall index. The next step in our analysis is
a detailed study of the subject's verbal production. It can
reveal first the structure of lexicon, that is, its different
partsthe kernel, peripheral, or individualistic features
and then the psycholinguistic features that determine the
relation of a given word to a specific part of lexicon.
Our research group analyzed 140 sets of words, which
amounted to 1,381 items of vocabulary, in four age- and
education-matched groups of subjects: healthy subjects,

Glozman

38
patients with PD, and patients with motor and sensory
forms of aphasia. It was found first that cortically based
brain damage, provoking aphasia, decreases verbal activity more than a subcortical lesion in patients with PD does.
The verbal output was below the lower limit of normal
variation in 76% of patients with aphasia and in 35% of
patients with PD. A decrease of verbal activity correlated
with the severity of cognitive disturbances in PD and with
aphasia severity. An increase of verbal activity was a good
indicator of rehabilitation of the patient with aphasia and
was a good means to evaluate the effect of reeducation of
patients with aphasia.
Given these results, no significant differences were
noted between patients with motor aphasia and patients
with sensory aphasia for generation of both nouns and
verbs. This finding throws into question the usefulness of
the fluency factor as a main dimension for subdivision
among aphasic syndromes. The differences between them
were revealed, instead, through a qualitative analysis of the
process of recall, particularly in preferential use of a syntagmatic or paradigmatic strategy of generation of words.
This evidence correlates well with Luria-Jakobson's approach to aphasia, which differentiates two main types of

aphasic disturbances, those due to a lesion of posterior


regions of the brain and those due to a lesion of anterior regions of the brain, with a predominant impairment
in paradigmatic or syntagmatic relations in grammar as
well as in vocabulary (Akhutina, 1981; Glozman, 1978;
Goodglass, 1993; Jakobson, 1956; Luria, 1976a).
In addition, the number of nonproductive items was
particularly high in the group with sensory aphasia. Types
of errors were also different: perseverations in the group
with motor aphasia and word combinations in the group
with sensory aphasia. The semantization index, reflecting
the tendency to group the named words into meaningfully
related groups, was significantly decreased in all patients
with brain damage, compared with the index of healthy
subjects. The number of words in each semantic group
was restricted. This may suggest a narrowness of vocabulary, predominantly its verbal part, through both cortical
and subcortical brain damage. Further, both healthy subjects and patients with aphasia preferred to produce words
within a restricted category, whereas patients with PD often resorted to a situational description. Such an unusual
finding could be explained by categorization difficulties
that often occur in PD (Huber and Cummings, 1992).

Fig. 4. The transformation of the lexicon after cortical (aphasia) and subcortical (Parkinsonism) brain damage.

39

Russian Neuropsychology After Luria


Regarding the structure of lexicon, our research group
found that both cortical brain damage and subcortical brain
damage change little the structure of the nominal part of
lexicon, but they transform significantly the structure of
verbs in both groups with aphasia. The transformation
manifests in deindividualization of the lexicon, that is, in
restriction of the individual part and expansion of peripheral and kernel lexicon. The degree of lexicon transformation is significantly more pronounced in aphasia than
in PD (Fig. 4). In both motor and sensory aphasias, the
individual parts of verbs totally disappear in patients with
severely disturbed fluency.
Psycholinguistic analysis reveals that the frequency
and the time of appearance of words in childhood are the
main criteria to form the kernel part of lexicon. Further, a
typical characteristic of verbal production in healthy subjects is a personal reflection in the named words, which
are some words from the professional vocabulary or words
related to scholarship for students, and so on. In contrast
to healthy subjects, all groups of patients showed a significant decrease in this feature. This defect is a key symptom
of a deep transformation of vocabulary through brain damage, with a relatively preserved kernel part of lexicon but
a limited individualized part, which mostly reflects one's
unique living experiences.
In conclusion, aphasic disorders of speech due to a
cortical lesion of the brain result in a deep transformation
of the lexicon and a modification of interrelationships between the internal parts of the lexicon. These characteristics are an indicator of a disturbance of both linguistic
competence and linguistic performance in patients with
aphasia. In PD, as a result of a subcortical lesion of the
brain, the internal structure of the lexicon is relatively
preserved, which means that the disturbance involves predominantly the linguistic performance of the individual.
Nevertheless, both cortical and subcortical brain damage
can interfere with verbal fluency.
In addition, recent studies in neurolinguistics as well
as in neuropsychology as a whole are characterized by an
interest in the problems of interhemispheric interaction.
Thus, it has been shown that in bilinguals and polyglots,
aphasia often appears after a lesion in the right hemisphere and depends on the circumstances of the secondlanguage acquistion and use (Kotik-Fridgutet, 1998).
Another model for studying interhemispheric interaction
involves cases of aphasia in left-handers. A Russian study
(Shohor-Trotskaya, 1998), for instance, showed conduction and transcortical aphasias to be more noted in lefthanders, whereas partial afferent-motor, efferent-motor,
and acoustic-gnostic aphasias, as described by Luria, are
more common for right-handers with lesions of the left
hemisphere.

Cerebrovascular Pathology
The study of diffuse neuropsychological syndromes
after cerebrovascular pathology is due primarily to vascular neurosurgery (Luria et al., 1970; Moskovichyute,
Serbinenko, et al., 1982). Luria's neuropsychology was
based primarily on patients with circumscribed brain lesions. This made impossible a direct transfer of established neuropsychological syndromes to cerebro vascular
disease, where each cerebral artery provides a blood supply to many brain areas. Luria, in his book about cerebrovascular pathology (Luria et al., 1970), introduced a
new approach to the analysis of brain correlates of the
neuropsychological findings: (1) He showed which cognitive impairments might be associated with dysfunction
of medial frontal areas versus those that might be associated with basal frontal dysfunction, and so forth; (2)
he described new defects that could be observed only in
cases of combined damaged areas; (3) he used a longitudinal approach and postulatedin an era without CT
scans and other methods of visualizationthat some defects were caused by infarcts in anterior cerebral artery
(ACA) regions and that other lesions were reversible and
associated with temporary spasm of the vessel (temporary
ischemia of its territory). In addition, he noted that different neuropsychological patterns could be associated with
different stages of the disease.
This background allowed Lena Moskovichyute to
formulate a number of basic principles for cerebrovascular
neuropsychology (unpublished, with personal authorization):
Another approach to the concept of a lesion: the
lesion as a possible combination of brain areas
involved in the pathological process
Another approach to brain con-elates of cognitive impairments: the search for reversible and
irreversible deficits
Possible longitudinal study
Analysis of all pathophysiological processes for
different stages of cerebrovascular disease
Moskovichyute also described cognitive deficits caused by anatomical pathology of the ACAs and of the
middle cerebral arteries (MCAs); such pathology includes
occlusion, stenosis, aneurysm, malformation, and hemodynamic changes distal to this lesion: spasm, steal, and so
forth. Thus, an occlusion of the MCA causes pronounced
aphasias, apraxias, and agnosias. MCA spasm causes distinct memory impairments, and sometimes acoustic-agnostic and acoustic-amnestic aphasias. MCA steal never results in pronounced aphasias or amnesias, and all deficits
are usually mild or moderate in severity. An occlusion

40

of the ACA causes pronounced aphasia, apraxia, lack of


motivation, and a perseveration syndrome. ACA spasm results in a confusional state and severe amnesia (modality
nonspecific). ACA steal causes variable and mild or moderate impairments, and more often a parietal dysfunction
can be seen.

Neuropsychology of Older Persons


Another kind of diffuse neuropsychological syndrome
is observed during cognitive involution, or in neurogeriatric patients. Studies of this syndrome have been carried
out in Moscow by two groups of neuropsychogists: One
group, directed by N. K. Korsakova, works in psychiatric
clinics, and another group, directed by me, works in neurological centers. The interest in geriatric problems is a
result of the fact that in the last few decades attention
around the world has focused on the prolongation of life
expectancy. There is a resulting increased proportion of
older persons in the world's population. Hence, it is necessary to identify criteria for normal (physiological) and
abnormal aging, methods of prophylaxis and treatment,
and early diagnosis and correction of cognitive disturbances in older persons. Application of Luria's systemic
approach to problems of older persons makes it possible
to show both disturbed and preserved functionseven
in cases of diffuse cerebral pathologyand to evaluate
the patients' capabilities. Thus, from my viewpoint, as
an example, preserved abilities for logical reasoning and
correct judgmenteven in cases of severe mnestic and
regulatory disturbancesmake the diagnosis of dementia
unjustified.
Luria's conception of three functional units of the
brain may work well in differentiating normal and abnormal aging (Korsakova, 1996, 1998). In older persons
without pathology, the functioning of the first unitthat of
activationis predominantly disturbed, and this is manifested in general slowness, aspontaneity in all activities,
increased inhibition of memorized information by interfering stimuli, and restriction of the volume of mental activities when different programs must be simultaneously
retained and realized.
According to Korsakova's data, the process of involution in older persons is not linear. Neurodynamic disturbances are more pronounced in the early years of older
age, between 50 and 65 years, which is considered "a
kind of involutional crisis" (Korsakova, 1996, p. 36), and
they are stabilized in the period from 65 to 75 years, with
some parametersfor instance, memoryapproaching
the preinvolutional level. Consecutive positive or negative

Glozman
dynamics depends upon almost successful surmounting
of the crisis, by means of mastering compensation (visual cues, exteriorization of the program, prolongation of
memorizing phases, replacement of simultaneous problem solving by successive problem solving with verbal
regulation, and so on) and eliminating risk factors, such
as somatic or neurological diseases or drastic changes in
stereotyped activities. "Taking account of various means
for surmounting deficits in mental functioning by normal
elderly, one can say, that ageing is a stage of individual
development, necessitating a change in strategies, voluntary selection and use of new forms of mediating mental
activity.... This agrees with contemporary views on involution focussing both on deficite and positive aspects: formation of new means of self-conservation as a personality
in a general continuum of one's own space" (Korsakova,
1996, p. 36).
Mental activity at this stage of ontogenetic development is directed more toward self-regulation than to
cognition. In pathological atrophic states, such as AD or
senile dementia, not only these symptoms are aggravated,
but defects in functioning of the two other cerebral units
(that for coding/information processing and that for regulatory activity) are also demonstrated. Defects of spatial
analysis are of special importance for provoking mental
disorders in older persons (Balashova, 1998). Nevertheless, a Lurian assessment reveals differential involvement
of each of these units in the various types of dementia,
with more preserved executive functions connected to the
frontal lobes in AD, compared with such functions in senile dementia.
A combination of psychometric and qualitative Lurian
methods of neuropsychological assessment permits neuropsychologists to better understand the mechanisms of
executive disturbances in different forms of cerebral pathology in older persons (Glozman, Levin, et al., 1998). A
comprehensive neuropsychological assessment finds that
impaired performance on the Wisconsin Card Sorting Test
in vascular dementia is due not only to the inability to
switch from one strategy to another (resulting in perseverative responses), but also to global intellectual decline possibly associated with widespread cerebral involvement. In
patients with AD, the poor performance may be explained
first by a deficit in short-term and logical memory, and
constructional ability, which mediates the executive behavior. In each kind of cerebral pathology, the executive
disturbances are connected to specific patterns of cognitive disturbances.
Analysis of experimental data using Luria's theory
of three functional brain units helps demonstrate that it
is more correct to speak about cortical and subcortical

41

Russian Neuropsychology After Luria


components of dementia, which are dynamically connected
with each other. The evolution of vascular pathology in
older persons manifests mainly in neurodynamic (subcortical) disturbances, and the progression of cognitive disturbances leading to the appearance of a vascular dementia
is predominantly due to regulatory and operational deficits
connected to cortical brain regions. A "corticalization" of
the cognitive and executive disturbances thus occurs. The
evolution of AD is realized by the consecutive "frontalization" and "subcorticalization" of impairments, that is, by
superimposed neurodynamic and regulatory impairments
upon operational ones.

Developmental Neuropsychology
Another line of development in neuropsychology
deals with studies of cognitive evolution and specific disturbances of mental activity after brain damage in children.
This work was begun during Luria's life by his disciple
E. Simernitskaya. She assessed 306 children with localized brain damage, using an adapted Luria battery
(Simernitskaya, 1982). Interhemispheric and intrahemispheric differentiation, typical for adults, was also revealed in children. Nevertheless, some symptoms, namely,
aphasic disturbances, were significantly less frequent and
had a different pattern than that in adults after similar lesions. Another difference consisted of a quick regression
or resolution of symptoms after surgery. The degree and
character of the participation of different cerebral regions
in cognitive functioning varies with ontogenic evolution as
a result of the increasing integration of cerebral structures
during development. According to Simernitskaya, underdeveloprnent of inter- and intrahemispheric connections in
small children explains the limited effect of localized lesions and the improved potential for functional restoration
in children.
The further growth of developmental neuropsychology in Russia follows two main lines: the study of individual features during the development of cognitive functions
(Akhutina, 1998;Mikadze, 1996,1998) and analysis of interhemispheric interaction and the "dysgenetic syndrome"
in childhood (Semenovich et at., 1998). It has been shown
that Lurian methods are extremely sensitive to individual dissociations in cognitive development, other causes
of nontypical development, and learning disabilities. This
evidence often forms a basis for the development of individual corrective education programs that use the child's
potentials to help surmount cognitive difficulties or underdevelopment.

Neuropsychology of Individual Differences


A new line of investigation in contemporary neuropsychology is that of individual differences, which is
an application of neuropsychological concepts and methods to the assessment of healthy subjects. These studies have been conducted by Homskaya and her disciples
from Moscow, Orenburg, and Kharkov (Homskaya, 1996;
Homskaya and Batova, 1998; Homskaya et al., 1997;
Moskvin and Moskvina, 1998; Privalova, 1998). Determination of normal functioning is of fundamental value
for a better understanding of pathological disturbances.
A neuropsychological approach to individual differences
tries to explain normal functioning by using principles of
cerebral organization, particularly characteristics of interhemispheric asymmetry (motor, acoustic, and visual) and
interhemispheric interaction. This approach allowed the
group of researchers directed by Homskaya to identify 27
possible profiles of lateral brain organization in normal
subjects and the correlation of these profiles to aspects of
cognitive, motor, and emotional activity of the subjects,
as well as to their adaptive abilities. Each profile of interhemispheric organization has its own "psychological
status" (Homskaya et al., 1997).

THIRD PHASE OF NEUROPSYCHOLOGY


DEVELOPMENT
Neuropsychology and Real Life
The third phase of development in neuropsychology
(see Fig. 1) focuses on the interrelationship between a patient and his or her society or environment. This phase necessarily integrates neuropsychological and real life data.
The neuropsychological assessment of both adults and
children should emphasize the patient's strengths, which
are important in his or her rehabilitation program and predict his or her ultimate integration into society. Programs
of rehabilitation should take into account patients' social
needs. This principle was first realized in aphasiology as
the so-called sociopsychological aspect of rehabilitation
(Tsvetkova et al., 1979, 1985), and now it is embodied in
work in developmental neuropsychology.
The recent advancement of developmental neuropsychology deals with problems of diagnosis and prophylaxis
of learning disability (Akhutina, 1998; Akhutina et al.,
1996; Mikadze, 1996). Early diagnosis of abilities and
readiness for school, as well as timely correction of learning difficulties at preschool or elementary grades, can

Glozman

42
prevent stable learning disabilities. Neuropsychological
diagnosis of causes responsible for learning problems is
based on three main concepts: (1) heterogeneity in the
maturation of brain structures and connections in the development of functional systems, (2) a correspondence between the child's abilities and exigencies of the learning
programs, and (3) the fact that a Lurian neuropsychological assessment can identify the cerebral zones involved
in various functional systems and reveal corresponding
weaknesses (Akhutina, 1998; Mikadze, 1996, 1998).
Different adaptations of Luria's battery are now used
for qualitative and quantitative (standardized) neuropsychological assessment of children at preschool and school
ages. The emphasis of these assessments is a modification
from diagnostic evaluation to prognostic and corrective
suggestions; that is, the main task is to suggest corrective
strategies for the child. Luria's approach provides great
scope for accomplishing this task together with investigating the process of functional system maturation (Akhutina
et al., 1996).
Neuropsychological assessment of children with
Luria's battery is now combined with a new method of
"tracking diagnosis" (Pylaeva, 1998), or systematic observation of a child at lessons or at play by the neuropsychologist. This method reveals neurodynamic features of
the child's activity as well as his or her zone of proximal development, using Vygotsky's theory, which makes
it possible to develop and carry out an individualized program of correction. Akhutina and Pylaeva worked out several methods of developing the functions of control and
programming in 5- to 7-year-old children, based on this
principle of proximal development. Thus, in common actions, an adult first realizes these disturbed functions for a
child, transferring them gradually to the child. The transfer
is effected through externalized means and by a visualized
siep-by-step program of actions that is consequently internalized and compressed by the child.
The next problem is that of the qualitative and quantitative evaluation of the outcome of rehabilitation efforts
and the degree of a patient's ultimate integration into society. A multiscale inventory was developed to evaluate
patients' social readjustment at the three main levels of a
patient's work-related, family-related, and day-to-day activity (Glozman, 1991). This inventory was successfully
used in follow-up of neurosurgical and Parkinsonian patients. A new inventory is now being developed, and it is
being designed to evaluate the level of social adaptation
or disintegration, including that of caregivers (Glozman,
Bicheva, et al., 1998). It is the first step to a neuropsychological understanding of the family (not counting a study
of interfamily relationships of patients with aphasia that
was part of a more general exploration of interrelations

between communication disorders and personality in different nosological groups; Glozman, 1987/in press).

CONCLUSION
This brief review provided some insight into the variety and abundance of neuropsychological studies in the
post-Luria period. In summary, three main trends can be
seen in the development of Russian neuropsychology after
Luria:
1. Extensive further expansion of research and practice, that is, embracing numerous new domains and
nosological patient groups
2. Combination of qualitative and quantitative approaches
3. A social and personality-based orientation
All the aforesaid proves that Luria's creative and comprehensive approach stimulates the further development of
neuropsychology in Russia and throughout the world.

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