Neurol Sci (2012) 33:801809

DOI 10.1007/s10072-011-0833-8

ORIGINAL ARTICLE

The assessment of colour perception, naming and knowledge:

a new test device with a case study
Rossella Pagani Giovanna Bosco Elisabetta Dalla Valle
Erminio Capitani Marcella Laiacona

Received: 26 July 2011 / Accepted: 20 October 2011 / Published online: 11 November 2011
Springer-Verlag 2011

Abstract Besides ocular diseases, also cerebral damage

may cause colour vision deficits; cerebral lesions may be
associated with a variety of clinical conditions that impair
colour processing. This study presents procedures and
normative data for a rapid, comprehensive seven-test battery aimed at assessing colour perception, colour naming
and object colour knowledge. The norms, obtained from 96
healthy Italian participants, allow normality/pathology
judgements on the basis of one-sided tolerance limits, after
adjusting the score of each test for the demographic variables of the proband subjects. We also report, as an
example, use of the battery in a stroke patient; this patient
was chosen because her lesion affected the left temporal
occipital cortex, an area sometimes associated with a deficit of colour processing. The patient resulted normal on

R. Pagani
UO Recupero e Rieducazione Funzionale, Ospedale San Paolo,
via Di Rudin` 8, Milan, Italy
e-mail: paganirossella@yahoo.it
G. Bosco
E. Dalla Valle
E. Capitani
Universita` degli Studi di Milano, Milan, Italy
e-mail: giovanna.bosco@unimi.it
E. Dalla Valle
e-mail: elisabetta.dallavalle@unimi.it
E. Capitani
e-mail: erminio.capitani@unimi.it
E. Capitani
Neurology Unit, AO San Paolo, via Di Rudin` 8, Milan, Italy
M. Laiacona (&)
Divisione di Neurologia, Fondazione S.Maugeri,
IRCCS, Istituto Scientifico di Veruno,
via per Revislate 13, 28010 Veruno, Novara, Italy
e-mail: marcella.laiacona@fsm.it

colour perception and colour name retrieval, but defective

on object colour knowledge probed using the stimulus
name. For the sound definition of the functional locus of
cognitive impairment at the single case level, a multi-faceted set of tasks is necessary.
Keywords Achromatopsia
Colour anomia

Object colour knowledge

Introduction
Besides ocular diseases, also cerebral damage may cause
colour vision deficits. According to Zeki [1], cerebral
lesions may be associated with a variety of clinical conditions that impair colour processing. In the first group, we
find disorders located at the early stages of colour perception. Achromatopsia is a term used to describe patients
who lose the ability itself to see colours; these patients
report that the world appears as if it has been drained of
colour and even bright, saturated colours look pale. As a
consequence, these patients cannot name and/or differentiate any colour, and are generally unable to point to a
colour on verbal command; nevertheless, they can still
differentiate shades of grey and have intact motion and
form vision (for review, see [1]). Dyschromatopsia is a
substantially similar term.
In a different class of disorders, patients are impaired at
the interface between colour perception and other stages of
cognitive processing. In Colour anomia [25] colours are
recognised but cannot be named, and in most cases pure
alexia and right hemianopia coexist. This disturbance is
exemplified by one of the cases reported by Gelb and
Goldstein [6], who did not recognize or recall the conventional names of colours but, presented with a given

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colour, could say cherry colour glass colour like an

orange and so on. Colour agnosia is a distinct disorder
where colours are seen and can be differentiated one from
another; however, when familiar objects that have a typical
colour are presented as outline drawings, or when only
their name is given, these objects cannot be properly
associated with their characteristic colour. This type of
deficit has been reported early in the classical neuropsychological literature, and has been interpreted in the past
[7] as a disconnection between the form and the colour of a
given object.
Between 1960 and the mid-1980s, a number of inquiries
investigated large series of brain damaged patients with the
question how colour-form association tasks were performed.
De Renzi et al. [8] in a seminal study found that many aphasics
made errors in an apparently non-verbal task, such as colouring the drawings of objects having a characteristic colour,
while right hemisphere damaged patients had only mildly
lower scores. These authors found among the left hemisphere
damaged patients a significant and specific correlation
between the colour-figure matching test and two tasks used for
assessing the basic construct of non-verbal intelligence, i.e.
the Raven Progressive Matrices and the Weigl Sorting Test
(both known to be affected among aphasic patients). Interpreting these data, the authors suggested that the basic deficit
underlying the impairment of aphasics was due to a more
pervading disorder, not strictly specific to colour knowledge
but similar to that found also in other tasks that require the
formation of associative bonds between discriminative features of the same event. However, Basso et al. [9] found that
among Brocas aphasics the colour-figure matching test correlated strongly only with Weigls sorting test, while among
Wernickes aphasics colour-figure matching correlated only
with Progressive Matrices, notwithstanding the identical level
of performance on the three tests between the different
aphasia-type groups. Consequently, the hypothesis that colour-figure association is sensitive to the impairment of a basic
and unitary non-verbal skill seemed no longer tenable.
More recently, the study of object colour knowledge has
been approached from a newer perspective, based on a
sharply fractionated description of cognitive skills and
explicit cognitive models. In this context, some authors
have introduced the label of Object colour knowledge
deficit with preserved colour naming. This deficit would
affect the stored representations that describe the properties
of an object [10, 11]. Distinct sensory properties of objects
(such as perceptual attributes, form and colour knowledge)
would be stored in autonomous systems and consequently
could be damaged independently of one another: for
instance, object form knowledge is dissociable from object
colour knowledge. It has been also suggested that general
modality-specific systems, among which that specialised in
colours [11], implement an organisational frame

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orthogonal to domain-specific conceptual representations

(animals, plant-life, conspecifics and perhaps tools).
Patients who present with loss of object colour knowledge but spared perception and naming of colours have not
been frequently reported. Valuable examples of this neuropsychological syndrome are cases RM [12], GG and AV
[10], PCO and IOC [11]. GG, AV, PCO and IOC showed
normal colour perception and normal colour naming, but
were unable to associate a given object to the appropriate
colour name, colour patch or colour crayon. As suggested
by Miceli et al. [11], the dissociation between spared
ability to name colour probes and impaired ability to access
object colour knowledge provides evidence for the functional independence of colour knowledge (for example,
that a coloured patch is yellow) and object colour knowledge (for example, that the canonical colour of bananas is
yellow). Moreover, object colour knowledge seems distinct from other types of perceptual and functional
knowledge. IOC was severely impaired in accessing object
colour knowledge, in spite of essentially spared access to
other stored properties of objects, such as form, and perceptual and functional properties, in line with the general
principle of an autonomous representation of different
knowledge modalities.
In this paper, we will not focus on the neuro-anatomical
substrate of the central deficit of colour processing, but
rather on the functional aspects of this condition. To briefly
summarize, the central deficit of colour processing, colour
anomia and impaired object colour knowledge have been
generally associated with lesions encroaching upon the
occipital and posterior basal temporal areas. More specifically, data coming from different approaches indicate that
colour perception activates a network of areas centred on
the ventral occipital cortex and on the lingual gyrus, while
object colour knowledge would be dependent on the left
fusiform gyrus (for a wider discussion and an experiment
see [13]). With respect to colour naming, the evidence is
less clear, and the relevant areas are probably closer to the
structures concerned with language processing. For
instance, Roux et al. [14], who followed an electrical
mapping approach, reported that a relative specialization of
the cortical areas involved in both object and colour naming
was found in all standard language areas, implying partial
anatomical segregation of different naming categories.
Turning back to a functional analysis, and based on the
above notions, a screening battery for the analysis of colour
perception, colour name retrieval and object colour
knowledge should permit to distinguish between cases of
central achromatopsia, colour anomia and object colour
knowledge impairment. In principle, some aspects of
object colour knowledge can be investigated even if a
patient suffers from achromatopsia, as one can use in this
case purely verbal stimuli for the different tasks. In any

Neurol Sci (2012) 33:801809

803

case, a set of different probes is needed to investigate the

different aspects of colour processing outlined above.
The aim of this paper is to introduce a new comprehensive test device with norms derived from a normal
control sample (colour test battery). Subsequently, we will
present an example of its application in the examination of
a brain damaged patient (case study).

Colour test battery: materials and methods

Control sample
Ninety-six subjects (48 females and 48 males) without any
history of neurological or psychiatric symptoms volunteered to participate in this study. At a preliminary informal
inquiry none complained of colour perception difficulty.
Mean age was 59.1 years (SD = 12.3, range 4085) and
mean education was 11.7 years (SD = 4.6, range 317).
All data included in this manuscript were obtained in
compliance with regulations of Milan University and S.
Paolo Hospital, Milan.
Table 1 shows the distribution of the control sample
according to age and education.
All participants were given the whole battery in the
same session. The tests were presented in the same order
with which they are described below. On average the
battery administration lasted about 30 min.
Test device
The battery was designed to tap, separately, colour perception, colour naming and object colour knowledge. For
the latter type of investigation, besides tests based on a

Table 1 Demographic data of the control sample

Age/sex

Education years
38 years

(a) Colour perception

(a1) Ishihara plates. The coloured plates contain a circle
of dots in various colours and sizes. Within the circle of
dots, a digit or a path between two x marks is embedded
as a number of spots in a different colour. The digit/path
can be seen by a person with normal colour vision. In the
original form of this test [15], 24 plates (15 including a
digit stimulus and 9 a path) are given, and each subject
should read the digit stimulus or, if unable to read, should
trace the path by finger. In our study only plates 115 (all
including a digit stimulus) were considered for the performance quantification. Score: number of digits correctly
read out of 15. The examination of patients suffering from
impaired digit processing can yield only qualitative information. We did not collect quantitative control data about
the path following performance due to the lack of a satisfactory procedure for assessing the correspondence
between the printed line and the performed movement.
Moreover, patients may perform coarse finger movements
independently of the perception of the stimulus line.
(a2) Colourcolour matching.
Subjects were given a
sheet of paper with two columns of ten colour patches each
(size of patch was 2 9 2 cm). The colours were: brown,
grey, orange, violet, green, black, white, red, yellow and
blue randomly arranged within each column. The examiner
pointed to a colour patch on the left column, and participants were asked to point to the patch of the corresponding
colour on the right column. Score: number of correct
matches out of 10.
(b) Colour name retrieval and colour name comprehension

913 years

[13 years

4049 years
Female

Male

5059 years
Female

Male

Female

Male

5
4

4
4

2
4

6069 years

7085 years
Female
Male

chromatic stimulus, we introduced also tests of a purely

verbal nature in order to assess the ability to communicate
the objects colour independently of colour perception per
se. This should permit to examine object colour knowledge
even in patients affected by achromatopsia.

(b1) Colour naming. Participants were asked to name the

colour of the above ten patches displayed in vertical array.
Score: number of correctly named patches out of 10.
(b2) Pointing to colour on verbal command.
The
examiner spoke aloud a colour name, and the participant
was asked to point to the corresponding colour patch within
an array with the same 10 colour patches referred to above.
Score: number of correct responses out of 10.
(c) Object colour knowledge
(c1) Object typical colour naming. Participants were
asked to name the typical colour of each of ten objects

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named by the examiner (e.g. What colour is snow?). The

stimuli were: sun, cherry, sea, snow, meadow, coal, eggplant, smoke, carrot, chestnut. Score: number of correct
colour attributions out of 10.
(c2) Object name/colour name consistency. The previous
ten colours names were considered. The names of 35
objects with canonical colours (for example, cherry) were
presented one at the time together with one of the above
colour names, and participants were asked to judge whether
the colour name uttered by the examiner was appropriate or
not. Each object name was associated once with a correct
and once with a wrong colour (e.g. is a cherry red? and
is a cherry blue?): a total of 70 questions were given in a
standard randomised series where the questions relative to
the same object were never contiguous. Different semantic
categories of objects were included in the test: seven fruits
(cherry, loquat, lemon, banana, tangerine, strawberry,
chestnut), seven vegetables (maize-cob, eggplant, beetroot,
radish, carrot, garlic, zucchini), five prepared foods (steak,
sugar, coffee, saffron, olive-oil), five clothes (doctors
gown, cassock, bridal gown, cardinals robe, mechanics
overalls), three objects with typical colour (blackboard,
billiard table, firetruck), four substances (iron, coal, wood,
sulphur) and four natural elements (sky, snow, sun, sea). In
Italian, none of these names contains explicit information
about the objects colour (the Italian term for blackboard,
lavagna, contains no reference to the colour black). The
score was the number of correct responses out of 70. This
test, requiring only yes/no responses, taps object colour
knowledge by a totally verbal procedure, as the object
typical colour naming task presented above. However, a
crucial difference is that this test does not require the
subject to utter the name of the colour. In addition, it
employs a wider set of stimuli with respect to test c1.
(c3) Object name/colour patch consistency. The names of
the same 35 objects above were presented together with a
colour patch. Participants were asked to judge whether the
colour patch was appropriate or not. Also in this case each
object name was presented twice, one time associated with
a patch of the correct colour, the second time with a patch
of the wrong colour. A total of 70 questions were given,
and the two presentations of the same name were never
contiguous. For this test no colour name comprehension is
needed. Score: number of correct responses out of 70.
We did not include in our battery a colour-figure
matching test (CFMT), i.e. a pure non-verbal object colour
knowledge task, notwithstanding its wide use in the literature, as Della Sala et al. [16] have already published
procedures and norms for a colour-figure matching task
based on eight items (artichoke, banana, rabbit, an ivy leaf,
pear, ear of corn, pipe, cassock). Norms of this test, also

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derived from an Italian control sample, were calculated

with an approach similar to that used in the present inquiry.
Statistical methods
Control scores were analysed by means of simultaneous
multiple regression, to check the influence of age, education
(years of schooling) and sex. For each test, we searched the
best fitting linear regression model that could be used to adjust
original scores for the demographic variables. In this way, we
built a linear model through which it was possible to calculate
the score expected for a given subject on the basis of age,
education and sex. The effect of each predictor variable was
studied partialling out the effect held in common with the
other variables. A predictor term was included in the final
model only when the significance level related to each term
corresponded to a p value B0.05. Taking this model as a basis,
we calculated from the raw score an adjusted score, by adding
or subtracting the contribution given by each significant
concomitant variable in the final correction model. Following
this approach, scores can be directly confronted across subjects of different age, education et cetera. Adjusted scores
were then ranked, and by means of a nonparametric procedure
[17], we set tolerance limits. In this way, we found both the
outer and inner one-sided tolerance limits [18]. Above the
outer tolerance limit one expects to find at least 95% of the
normal population (with 95% confidence); hence, when a
score is below the outer tolerance limit, the subject can be
declared not normal with 95% confidence. Above the inner
tolerance limit one expects to find at most 95% of the population (with 95% confidence); hence, when a score is above the
inner tolerance limit, the subject can be declared normal with
95% confidence. When a score falls between the outer and
inner tolerance limits, no inferentially controlled judgement is
possible. Given our sample size, outer and inner tolerance
limits were fixed, respectively, on the basis of the values
corresponding to the 2nd and 9th ranked scores of each test
after demographic adjustments.
Results
The results of the regression analyses are shown in Table 2.
The influence of age was always significant, apart from the
object name/colour patch consistency inquiry. The influence of education was significant only in pointing to colour
on verbal command and in the object name/colour patch
consistency inquiry. In the colour/colour matching, 95 out
of 96 control subjects scored at ceiling; therefore a performance needed to be flawless to attain the normality
mark. A significant difference between females and males
was never observed (significance was approached only on
colour naming).

Neurol Sci (2012) 33:801809

805

Table 2 The effects of age, education and sex within the linear
regression model of each test of the battery (for further details see the
test description in Methods and Statistical methods)
(a) Colour perception
(a1) Ishihara plates
Age F(1, 94) = 20.853, p \ 0.0001
Education F(1, 94) \1, ns

Adjusted score: raw score

- 0.062 (age - 59.073)

Sex F(1, 94) \1, ns

(a2) Colour/colour matching
No variability
(b) Colour name retrieval and colour name comprehension
(b1) Colour naming
Age F(1, 94) = 13.545, p = 0.0004
Education F(1, 94) = 1.565, ns

Adjusted score: raw score

? 0.020 (age - 59.073)

Sex F(1, 94) = 3.586, p = 0.061, ns

(b2) Pointing to coloura
Age F(1, 94) = 8.419, p = 0.005
Education F(1, 94) = 8.113,
p = 0.005
Sex F(1, 94) = 2.058, ns

Adjusted score: raw score

? 0.007 (age - 59.073)
- 0.019 (education
- 11.677)

(c) Object colour knowledge

(c1) Object typical colour naming
Age F(1, 94) = 36.714, p \ 0.001
Education F(1, 94) \1, ns

Adjusted score: raw score

? 0.029 (age - 59.073)

Sex F(1, 94) = 1.157, ns

(c2) Object name/colour name consistency
Age F(1, 94) = 3.877, p = 0.052
Education F(1, 94) = 1.125, ns

Adjusted score: raw score

? 0.031 (age - 59.073)

Sex F(1, 94) = 1.831, ns

(c3) Object name/colour patch consistency
Age F(1,94) \1, ns
Education F(1,94) = 5.346,
p = 0.023

Adjusted score: raw score

- 0.071 (education
- 11.677)

Sex F(1,94) \1, ns

a

In the pointing to colour test the effect of age was significant even
in a model that included education: F(1, 93) = 6.480, p = 0.013.
Also the education effect was still significant in a model that included
age: F(1, 93) = 6.215, p = 0.014

Table 3 reports the correction grids for the most frequent combinations of age and education; intermediate
values can be obtained by interpolation or using the original linear models reported in Table 2.
For each test inner and outer tolerance limits are
reported: as explained in the Statistical methods, subjects with scores below the outer limit should be considered
pathological, while those with scores above the inner limit
can be considered normal. Subjects with scores included
between the outer and the inner limits are better viewed as
borderline cases.
This battery was designed to allow us to distinguish
between the different aspects of colour processing, namely

colour perception, colour name retrieval and comprehension and object colour knowledge; however, it should be
borne in mind that an impaired colour perception or colour
name retrieval may influence the assessment of the later
stages. We will briefly discuss the influence of each deficit
on the tests of the battery.
For a pure assessment of colour name retrieval a sound
colour perception is required. Colour naming could be
assessed also by giving the objects name (see Table 2,
task c1) but this would be no longer a pure naming test,
as it would also tap object colour knowledge. Object
colour knowledge can be evaluated by means of the
object name/colour name consistency task even if patients
are affected by pure achromatopsia, whereas the object
name/colour patch consistency task can be performed
even if patients are affected by a deficit of colour name
comprehension. Table 4 illustrates the expected pattern of
performance according to the different combinations of
functional impairment. In this table, we have considered
also the colour-figure matching tests, not included in the
present battery, because its norms are available from the
literature. Among the defective skills indicated in Table 4,
we did not include language or visual form agnosia. A
language deficit should not directly impair CFMT, but
might be detrimental on tests c2 and c3. Vice versa,
visual form agnosia is expected to impair CFMT but not
c2 and c3.

A patient study: case MARI

This section exemplifies the neuropsychological assessment of colour processing and colour cognition in a single
patient. This patient was chosen because her lesion affected
the left temporaloccipital cortex, an area sometimes
associated with a deficit of colour processing. Moreover,
she was not affected by a severe deficit of language comprehension, and this enabled to administer colour tests of
verbal format. It is commonly accepted that for the sound
definition of the functional locus of cognitive impairment
at the single case level, a multi-faceted set of tasks is
necessary. Accordingly, besides the colour battery at issue
and the colour-figure matching test, our patient was given
other tasks relevant to the study of semantics to evaluate
the different aspects of object knowledge.
The patient presented here, MARI was a right-handed
75-year-old woman, with 5 years of education, who suffered in December 2004 from an ischaemic stroke. At the
visual field examination, she presented a deficit on the right
lower quadrant. CT scan disclosed a left posterior temporal
softening in the distribution of the posterior branches of the
middle cerebral artery that mostly affected the posterior
aspect of T1 and also involved the anterior aspects of the

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Neurol Sci (2012) 33:801809

Table 3 Corrections to be added to, or subtracted from, the raw scores according to age and education (expressed as years of schooling). Outer
and inner one-sided tolerance limits are also reported (see Statistical methods)
(a) Colour perception
(a1) Ishihara plates
Age

40

45

50

55

60

65

70

75

80

85

-0.05

-0.87

-0.56

-0.02

?0.06

?0.37

?0.68

?0.99

?1.30

?1.61

Outer limit 7.8, inner limit 11.3, controls mean 13.55

(a2) Colour/colour matching
The normal control group showed almost no variability, therefore the role of the concomitant variables could not be determined. Both tolerance
limits (outer and inner) were associated to the top score, and only flawless performances should be considered normal
(b) Colour name retrieval and colour name comprehension
(b1) Colour naming
Age

40

45

50

55

60

65

70

75

80

85

-0.38

-0.28

-0.18

-0.08

?0.02

?0.12

?0.22

?0.32

?0.42

?0.52

Outer limit 7.81, inner limit 8.39, controls mean 9.53

(b2) Pointing to colour
Age

40

45

50

55

60

65

70

75

80

85

-0.01

?0.02

?0.06

?0.10

?0.13

?0.17

?0.21

?0.25

?0.28

?0.32

-0.07

-0.03

?0.04

?0.08

?0.11

?0.15

?0.19

?0.23

?0.26

13

-0.17

-0.13

-0.09

-0.06

-0.02

?0.02

?0.06

?0.09

?0.13

?0.17

17

-0.24

-0.21

-0.17

-0.13

-0.10

-0.06

-0.02

?0.01

?0.05

?0.09

Education

Outer limit 8.18, inner limit 10.00, controls mean 9.90

(c) Object colour knowledge
(c1) Object typical colour naming
Age
40
45
-0.54

-0.40

50

55

60

65

70

75

80

85

-0.26

-0.12

?0.03

?0.17

?0.31

?0.45

?0.60

?0.74

Outer limit 7.65, inner limit 8.77, controls mean 9.49

(c2) Object name/colour name consistency
Age

40

45

50

55

60

65

70

75

80

85

-0.58

-0.43

-0.28

-0.12

?0.03

?0.18

?0.33

?0.48

?0.63

?0.79

Outer limit 62.21, inner limit 66.42, controls mean 68.61

(c3) Object name/colour patch consistency
Education

13

17

?0.47

?0.26

-0.09

-0.38

Outer limit 64.62, inner limit 66.98, controls mean 69.01

lateral occipital gyri. The calcarine cortex, cuneus, fusiform, lingual gyri and the basal occipital gyri were not
damaged.
General neuropsychological assessment (April 2005)
MARI was cooperative and did not present attention
impairments. Her spontaneous language was fluent, with
some anomic latencies but without semantic paraphasias or
neologisms. MARI was given a naming task based on 60
pictures from the Snodgrass and Vanderwart [19] set
assembled by Laiacona et al. [20]. In this test, she scored
47/60 correct (against a pathology threshold of 48/60),
without a significant difference between stimuli belonging

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to biological categories and artefacts. On a verbal comprehension test (pointing to a picture on verbal command
on a display with four semantic foils) based on the same
material, she performed flawlessly. She presented moderately slow reading, sometimes with a syllable by syllable
approach. MARI was not impaired on a preliminary clinical assessment of basic visual perceptual skills, nor
affected by unilateral neglect. In summary, she presented
marginal naming impairment without an overt deficit of
verbal auditory comprehension.
After this preliminary examination, we analysed more in
depth the integrity of colour processing. To correctly
interpret the status of colour processing, prior to its
assessment, we performed a study of semantic knowledge.

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807

Table 4 Expected sparing/impairment of each test of the colour

battery when a given skill is defective
Defective skills

A. Colour perception

Information level

Pathology
threshold

MARIs
score

Judgement

Overall (360 questions)

336/360
(93%)

275/360
(76%)

Pathological

180 questions about

biological stimuli

162/180
(90%)

126/180
(70%)

Pathological

180 questions about

artefacts

169/180
(94%)

150/180
(83%)

Pathological

Tests
a1

a2

b1

b2

B. Colour naming

BB. B ? Colour name

comprehension

c1

c2

c3

CFMT

*
*

C. Object colour
knowledge

120 superordinate
questions

115/120
(96%)

96/120
(80%)

Pathological

120 questions about

perceptual properties

109/120
(91%)

90/120
(75%)

Pathological

120 questions about

functional properties

107/120
(89%)

89/120
(74%)

Pathological

A?B

A ? BB

A?C

B?C

BB ? C
A ? B ? C, or
A ? BB ? C

Table 5 Semantic knowledge

CFMT designates the colour-figure matching test

The test abbreviations (indicated in the top row) are extensively
defined in Table 2
The asterisk indicates which of the tests indicated in the columns is
expected to be impaired when a given skill is defective or when
there is a multiple skill deficit

Semantic knowledge (verbal probes about verbally

presented stimuli)
The study of semantic knowledge was based on verbal
probes regarding the 60 stimuli used for the examination of
naming and verbal comprehension [20]. The semantic
probes investigated with this instrument never concerned
knowledge about the typical colour of any stimulus.
The statistical comparisons between different sections of
the questionnaire were co-varied for a set of covariates (for
example lexical frequency, item familiarity, question difficulty, and others). Details of this test are reported in
Laiacona et al. [20].
Scores lower than the worst score found in a sample of
60 normal elderly with low education (mean years of
schooling = 6.2, range 58) were considered as a fully
defective performance. The results are displayed in
Table 5.
On the Semantic questionnaire, overall MARI responded
correctly to 275/360 (76%) questions; she provided the
correct response to 126/180 questions on biological entities
(70%), and to 150/180 questions on artefacts (83%). Considering the pathology thresholds reported in Table 4, MARI
was clearly defective on both category domains. However,
by inspection, she fared worse with biological entities than
with artefacts: this difference closely approached significance after co-varying for all the nuisance variables
that differentiate biological from artefact stimuli

(Chi-square = 3.746, p = 0.053). MARI responded with

comparable accuracy to questions on superordinate and
subordinate information after co-variance for all variables
(Chi-square = 1.294, p = 0.255, ns). The response accuracy on questions tapping perceptual and associative
features was quite comparable (Chi-square = 2.387, p =
0.122, ns): MARI responded correctly to 90/120 (75%)
questions tapping perceptual properties and to 89/120
(74.2%) questions evaluating associative properties. No
interaction between the type of information inquired and
category domain emerged.
Summing up, MARI presented a moderate, homogeneous impairment of semantic retrieval, that did not distinguish between different levels of knowledge, and tended
to be slightly more severe for biological categories than
artefacts.
Colour processing assessment
MARI underwent the standardized examination presented
in the first section of this study, that separately taps colour
perception, colour name retrieval and object colour
knowledge.
Table 6 shows the outcome of each task.
MARI showed normal colour perception. Regarding
colour naming and comprehension, there was only a confusion between grey and black in the identification of the
patch corresponding to the colour name said by the
examiner. She was not defective in naming the colour of
the patches shown by the examiner.
Regarding object colour knowledge, her performance on
the typical colour naming task was borderline. However,
she was impaired on both consistency tasks (c2 and c3)
between object name and colour name or colour patch
stimuli. Her performance seemed not to depend on the
stimulus category. In both tests, there were 14 stimuli
concerning fruit and vegetables, and 21 stimuli concerning

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Table 6 Outcome of the colour
tests

Neurol Sci (2012) 33:801809

Test

Stimuli

Normality
threshold

Pathology
threshold

Adjusted
score

Classification

(a1) Ishihara plates

15 stimuli

[11.3

\7.8

14.99/15

Normal

(a2) colour/colour matching

10 stimuli

10

10

Normal

(a) Colour perception

(b) Colour name retrieval and colour name comprehension

(b1) colour naming

10 stimuli

[8.39

\7.81

10

Normal

(b2) pointing to colour

10 stimuli

10

\8.18

9.25/10

Borderline

(c1) Object typical colour naming

10 stimuli

[8.77

\7.65

8.45

Borderline

(c2) Object name/colour name

consistency (verbal/verbal task)

70 stimuli

[66.42

\62.21

60.48

Pathological

(c3) Object name/colour patch

consistency (verbal/visual task)

70 stimuli

[66.98

\64.62

59.47

Pathological

(c) Object colour knowledge

the other categories. In the object name/colour name consistency task, the fruit and vegetable stimuli were 24/28
correct (85.7%), and the remaining stimuli were 36/42
correct (85.7%). In the object name/colour patch consistency task, fruit and vegetables were 24/28 correct (85.7%)
and the remaining stimuli were 35/42 correct (83.3%).
As MARI presented substantially normal colour perception, naming and comprehension, her failures on object/
colour consistency tasks may possibly derive from a
semantic impairment of object colour knowledge or from a
defective verbal access to the same type of knowledge. On
typical colour naming, a pure verbal task, her borderline
performance was due to her failure to retrieve the typical
colour of eggplant and of carrot: this failure was observed
also in the consistency tasks (c2 and c3) tapping the same
verbal stimuli, and this is likely to reflect an underlying
semantic deficit.
Finally, our patient was given the CFMT, a totally nonverbal task not included in our normative study as a version
of this test was already available from the literature [16].
For this test that simply requires to associate to an outline
drawing the most appropriate coloured pencil, MARI
scored 15/16, a fully normal performance.

Summary and discussion

With respect to objects, MARI was flawless on the wordpicture matching test, and only marginally impaired on
object picture naming. With respect to colours, she was not
affected by colour perception impairment, and was substantially normal on colour name retrieval and comprehension. Also the colour-figure matching test was normal. Since
word picture matching was flawless, we presume that the
input stage of the tasks (object name comprehension and

123

colour perception) was not likely to cause the deficits

observed on some of the colour-knowledge tests (c2 and c3).
Interestingly, MARI was impaired on some semantic
verbal tasks (probes about object properties and three tests
of object/colour knowledge), but was normal on a nonverbal task tapping information about the colour of an
object (the colour-figure matching test). How can we
interpret this finding? The normal performance on the
(non-verbal) CFMT excludes a general impairment in
ability to associate different aspects of an objects knowledge, such as colour and shape, concomitant with left
hemisphere lesion and not necessarily proportional to the
aphasia severity. On the other hand, the conceptual
knowledge impairment presented by MARI on verbal tasks
was not confined to colours and affected the semantic
probes about different categories and different types of
knowledge.
The discrepancy between CFMT (spared) and the two
consistency tasks c2 and c3 (impaired) might be due to the
fact that these tests are based on different sets of stimuli. In
particular, CFMT includes 5/8 fruit and vegetable stimuli
(62.5%) while the two consistency tasks include 14/35 fruit
and vegetable stimuli (40%). At a closer look, however, as
reported in the results section, on c2 and c3 tests MARIs
performance with fruit and vegetable stimuli was almost
identical to her performance with the remaining stimuli.
Therefore, it is hard to believe that the discrepancy
between CFMT and tests c2 and c3 was due to the heterogeneity of the stimuli included in each task.
To better account for this discrepancy, we suggest two
hypotheses. The first is that, although MARI was not
impaired at the level of object name comprehension, a
subtle, sub-clinical language impairment might have marred the performance only when the task had a heavy verbal
component. The reason why task c1 (typical colour

Neurol Sci (2012) 33:801809

naming) was less clearly impaired with respect to the

consistency tasks notwithstanding its verbal content might
be that test c1 concerns very frequent and familiar stimuli,
that might be over-learned and easier with respect to other
material.
A second explanation might be that knowledge about the
colour of a given stimulus is neither homogeneous nor
represented in a unique cognitive store. This is suggested
by the literature about stored form knowledge. Capitani
et al. [21] in their review of semantic category specific
impairment found four cases where the knowledge of the
visual aspect of biological objects was impaired when
investigated through verbal probes, but was normal on the
non-verbal picture reality decision test. In eight other cases,
the knowledge about the objects shape was impaired both
on verbal inquiry and the non-verbal picture reality decision. In the former four cases, the impairment on the verbal
probes could not depend on a general and superordinate
verbal deficit, because these probes were disproportionately impaired for biological categories with respect to
artefacts. The discrepancy between semantic probes and
picture reality judgement was more convincingly explained
by supposing that object form knowledge is represented in
two distinct stores: (1) a pre-semantic store, that supports
the proficiency with the picture reality decision (see also
[22]), and (2) a semantic store, containing channel-free
general information. Coming back to object colour information, an intriguing possibility would be that even this
type of object knowledge is stored in multiple cognitive
structures, or that the information contained in a unique
store might be selectively not accessible for the language
system. From a more general perspective, the interrelations
between semantics and peripheral visual stores are still
under-specified, and this holds true also for colour
knowledge. We believe that the systematic study of
patients with a multifaceted test battery is a necessary step
for providing empirical constraints to a theoretical interpretation of this intriguing phenomenon.
Acknowledgments This study was supported by Milan University
Funds. Rosemary Allpress revised the English text. Daniela Sacco
assisted with MARIs neuropsychological examination.
Conflict of interest No conflict of interest exists for the authors of
this study.

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