Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations

Margaret Moore; Elise Milosevich; Roland Beisteiner; Audrey Bowen; Matthew Checketts; Nele Demeyere; Helena Fordell; Olivier Godefroy; Jan Laczó; Timothy Rich; Lindy Williams; Kate Woodward-Nutt; Masud Husain

doi:10.1111/ene.15381

Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations

Eur J Neurol. 2022 Sep;29(9):2596-2606. doi: 10.1111/ene.15381. Epub 2022 Jun 30.

Authors

Margaret Moore^{1

2}, Elise Milosevich¹, Roland Beisteiner³, Audrey Bowen⁴, Matthew Checketts⁵, Nele Demeyere¹, Helena Fordell⁶, Olivier Godefroy⁷, Jan Laczó^{8

9}, Timothy Rich^{10

11}, Lindy Williams¹², Kate Woodward-Nutt¹³, Masud Husain^{1

14}

Affiliations

¹ Department Experimental Psychology, University of Oxford, Oxford, UK.
² Queensland Brain Institute, University of Brisbane, Brisbane, Qld, Australia.
³ Department of Neurology, Medical University of Vienna, Vienna, Austria.
⁴ Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance and University of Manchester, Manchester, UK.
⁵ Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁶ Neurosciences, Umeå University, Umeå, Sweden.
⁷ Department of Neurology and Laboratory of Functional Neurosciences and Pathologies, Amiens University Medical Center, Jules Verne University of Picardy, Amiens, France.
⁸ Memory Clinic, Department of Neurology, Second Faculty of Medicine and Motol University Hospital, Charles University, Prague, Czechia.
⁹ International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czechia.
¹⁰ Kessler Foundation, West Orange, New Jersey, USA.
¹¹ Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA.
¹² Cognitive Aging and Impairment Neurosciences Lab, University of South Australia, Adelaide, SA, Australia.
¹³ Research and Innovation, Northern Care Alliance National Health Service Group, Salford, UK.
¹⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Abstract

Background and purpose: Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time-limited clinical environments.

Methods: Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations.

Results: A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible.

Conclusions: This study provides consensus recommendations for rapid bedside detection of neglect in real-world, clinical environments.

Keywords: cognitive impairments; diagnostic screening programs; hemispatial neglect; stroke.

Publication types

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

MeSH terms

Agnosia*
Humans
Neurology*
Neuropsychological Tests
Perceptual Disorders* / diagnosis
Perceptual Disorders* / etiology
Stroke Rehabilitation*
Stroke* / complications
Stroke* / diagnosis

Abstract

Publication types

MeSH terms

Grants and funding