Interaction between spatial neglect and attention deficit in patients with right hemisphere damage

Yusaku Takamura; Shintaro Fujii; Satoko Ohmatsu; Koki Ikuno; Kohei Tanaka; Atsushi Manji; Hiroaki Abe; Shu Morioka; Noritaka Kawashima

doi:10.1016/j.cortex.2021.03.036

Interaction between spatial neglect and attention deficit in patients with right hemisphere damage

Cortex. 2021 Aug:141:331-346. doi: 10.1016/j.cortex.2021.03.036. Epub 2021 May 19.

Authors

Yusaku Takamura¹, Shintaro Fujii², Satoko Ohmatsu³, Koki Ikuno⁴, Kohei Tanaka⁵, Atsushi Manji⁶, Hiroaki Abe⁷, Shu Morioka⁸, Noritaka Kawashima⁹

Affiliations

¹ Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan.
² Graduate School of Health Sciences, Kio University, Nara, Japan; Nishiyamato Rehabilitation Hospital, Nara, Japan.
³ Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan; Regenerative Rehabilitation Section of Department of Rehabilitation, Hospital of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan.
⁴ Nishiyamato Rehabilitation Hospital, Nara, Japan.
⁵ Shizuoka Rehabilitation Hospital, Shizuoka, Japan.
⁶ Saitama Misato Rehabilitation Hospital, Saitama, Japan.
⁷ Konan Hospital, Miyagi, Japan.
⁸ Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center, Kio University, Nara, Japan.
⁹ Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan; Regenerative Rehabilitation Section of Department of Rehabilitation, Hospital of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan. Electronic address: nori@rehab.go.jp.

PMID: 34126288
DOI: 10.1016/j.cortex.2021.03.036

Abstract

Unilateral spatial neglect (USN) was originally regarded as a parietal syndrome, but it has become evident that USN is a disturbance in the widespread attention network. Here, we focused on an interaction between spatial neglect and non-spatial aspect of attention deficit, and aimed to establish a novel evaluation approach based on the characteristics of the spatial distribution of reaction times. We tested 174 patients with right hemisphere damage and divided them based on their prescreening scores on the Behavioral Inattention Test (BIT): (1) USN++ (n = 79: BIT<131), (2) USN+ (n = 47: BIT≥131 with history of USN), and (3) RHD (n = 48: without neglect symptom). The patients were asked to conduct a touch panel-based pointing task toward 2D-arranged (seven columns × five rows) circular targets on a PC monitor, and the reaction time to each object was recorded. To evaluate aspects of attention deficit and neglect symptoms, we calculated the total average of the reaction time for all objects (RT_mean) and the ratios of the right and left space (L/R_ratio), respectively. The results revealed that RT_mean and L/R_ratio can be regarded as independent evaluation parameters for attention deficit and neglect symptoms, respectively. Voxel-based lesion-symptom mapping based on RT_mean and L/R_ratio values revealed relevant lesions with attention-related brain areas (middle temporal gyrus, angular gyrus, and inferior frontal gyrus), and neglect-related brain areas (superior temporal gyrus and superior longitudinal fascicules). A cluster analysis with Gaussian mixture model detected six different states of USN with an interaction between neglect symptoms and attention deficit. Interestingly, the recovery process after USN can be properly explained by the transition pattern from one cluster to another. Our results suggest that a novel evaluation approach to distinguish between neglect symptoms and attention deficit, namely the characterization of the interaction between RT_mean and L/R_ratio, provides useful information for understanding pathological features of USN.

Keywords: Attention deficit; Behavioral inattention test; Exogenous attention; Unilateral spatial neglect; Voxel-based lesion-symptom mapping.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Functional Laterality
Humans
Parietal Lobe
Perceptual Disorders*
Reaction Time
Space Perception
Stroke*
Temporal Lobe