Lobar asymmetries in subtypes of dyslexic and control subjects.

Reading involves phonologic decoding, in which readers "sound out" a word; orthographic decoding, in which readers recognize a word visually, as in "sight reading"; and comprehension. Because reading can involve multiple processes, dyslexia might be a heterogeneous disorder. This study investigated behavior and gross lobar anatomy in subtypes of dyslexic and control subjects. Subjects aged 18 to 25 years with identified reading problems and a group of healthy controls were given cognitive and behavioral tests and volumetric brain magnetic resonance imaging (MRI). Because atypical cerebral laterality has been proposed as a potential neural risk for dyslexia, dyslexic and control subjects were compared on anatomy of gross lobar regions. On asymmetry quotients, no significant differences were found between groups. Examination of the percentage of total brain volume of each structure revealed that control and dyslexic subjects were significantly different (P = .018). Dyslexic subjects had a larger percentage of brain volume than did the controls in the areas of total prefrontal (P = .003; 9.30% larger) and superior prefrontal (P = .004; 11.48% larger region). A Pearson correlation was performed to investigate whether a relationship existed between behavioral measures and either volumes of total prefrontal and total occipital regions or asymmetry quotients. A significant positive relationship between the left total occipital and word identification performance existed (R = .452, P = .045). Because it is believed by some that dyslexia occurs in varying degrees of severity, and because one of the research questions in this study is whether anatomy relates to severity or to distinct biologic groups, subjects were grouped according to both the nature and distinct pattern of reading or language performance and the degree of deficit. A battery of reading tests revealed five clinical subgroups of control (two) and dyslexic (three) subjects. These subgroups were statistically different on all cognitive and behavioral measures. When asymmetry was investigated across subgroups, significant differences between subgroups were found at the multivariate level (P = .043). Only the phonologic deficit groups (weak phonologic controls, phonologic deficit dyslexic subjects) had atypical asymmetry patterns. This finding suggests that lack of subtyping could have confounded earlier studies and that anomalous asymmetry might be related to phonologic dyslexia, whereas other subtypes might be reflective of environmental factors. Examination of volume at the subgroup level also showed differences between subgroups that might have implications for the nature of compensation. This study supports the concept that anomalous anatomy might reflect anomalous functional cerebral laterality, which could be a risk factor for developmental dyslexia, varying according to the nature of the deficit.