Selective speech motor, syntax and cognitive deficits associated with bilateral damage to the putamen and the head of the caudate nucleus: a case study.

Deficits in speech production, sentence comprehension and abstract reasoning occurred in a subject having profound bilateral damage to the putamen and the caudate nucleus. Acoustic analyses indicated that the subject's speech was degraded due to inappropriate sequencing of articulatory gestures that involve different articulatory structures. Transitions between sounds were slow and often did not achieve target configurations. The subject had a 14% error rate comprehending distinctions in meaning conveyed by syntax in English sentences; normal controls make virtually no errors in this test. Cognitive deficits involving impaired sequencing occurred: the subject had a 70% error rate on the Odd Man Out test when making decisions within a single category. Cognitive perseveration occurred when the subject was asked to shift categories. In contrast, performance was within normal ranges in tests of lexical access and memory. The pattern of deficits provides evidence for basal ganglia involvement in the regulation of sequencing across modalities.