Hemispatial neglect

TLDR

The study aimed to determine the prevalence of motor, perceptual, peripersonal, and personal neglect subtypes, their association with other deficits, and their neuroanatomic substrates in right‑hemisphere stroke patients in rehabilitation. The authors evaluated 166 right‑hemisphere stroke patients in rehabilitation using neglect and subtype assessments, attention, motor and sensory function, functional disability, family burden measures, and performed detailed lesion analyses. Neglect was present in 48% of patients, and those with neglect exhibited greater motor, sensory, visual extinction, basic attention deficits, and anosognosia, and neglect severity better predicted functional independence and family burden than lesion count, with personal, peripersonal, motor, and perceptual subtypes identified, supporting their distinct existence and a distributed neural system underlying neglect.

Abstract

<b><i>Objective:</i></b> To assess the relative frequency of occurrence of motor, perceptual, peripersonal, and personal neglect subtypes, the association of neglect and other related deficits (e.g., deficient nonlateralized attention, anosognosia), and the neuroanatomic substrates of neglect in patients with right hemisphere stroke in rehabilitation settings. <b><i>Methods:</i></b> The authors assessed 166 rehabilitation inpatients and outpatients with right hemisphere stroke with measures of neglect and neglect subtypes, attention, motor and sensory function, functional disability, and family burden. Detailed lesion analyses were also performed. <b><i>Results:</i></b> Neglect was present in 48% of right hemisphere stroke patients. Patients with neglect had more motor impairment, sensory dysfunction, visual extinction, basic (nonlateralized) attention deficit, and anosognosia than did patients without neglect. Personal neglect occurred in 1% and peripersonal neglect in 27%, motor neglect in 17%, and perceptual neglect in 21%. Neglect severity predicted scores on the Functional Independence Measure and Family Burden Questionnaire more accurately than did number of lesioned regions. <b><i>Conclusions:</i></b> The neglect syndrome per se, rather than overall stroke severity, predicts poor outcome in right hemisphere stroke. Dissociations between tasks assessing neglect subtypes support the existence of these subtypes. Finally, neglect results from lesions at various loci within a distributed system mediating several aspects of attention and spatiomotor performance.