Superior written over spoken picture naming in a case of frontotemporal dementia

Two main hypotheses have been proposed regarding the role of phonology in w ritten word production. According to the phonological mediation hypothesis, the retrieval of the lexical phonological representation of a word is an o bligatory prerequisite to the retrieval of its spelling. Therefore, deficit s to the phonological lexicon should affect both spoken and written picture naming, In contrast, the orthographic autonomy hypothesis posits that the lexical orthographic representations of words can be accessed without any n ecessary phonological mediation. In support of this view, cases of preserve d written naming despite impaired lexical phonology have been reported foll owing brain damage. In this report, we replicate this basic pattern of perf ormance in case YP, a 60-year-old woman with a pattern of frontotemporal de mentia, As her disease progressed, YP's ability to write down the names of pictures remained very good despite a severe decline in oral naming. Furthe r testing indicated that this deficit was not primarily due to an articulat ory or post-lexical phonological deficit. YP's case provides strong additio nal support for the orthographic autonomy hypothesis. The significance of t his case with respect to the characterization of dementia syndromes is disc ussed.