Eric Siéroff

Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke

Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

Right spatial neglect after left hemisphere stroke: qualitative and quantitative study

Objectives: Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke. Methods: Seventy-eight left hemisphere stroke patients were assessed. The test battery included a preliminary assessment of anosognosia and visual extinction, a clinical assessment of gaze orientation and personal neglect, and paper-and-pencil tests of spatial neglect in the peripersonal space. Only nonverbal tests were used. Results: Drawing and cancellation tasks revealed neglect in 10 to 13% of patients. The combined battery was more sensitive than any single test alone. A total of 43.5% of patients showed some degree of neglect on at least one measure. Anatomic analyses showed that neglect was more common and severe when the posterior association cortex was damaged. Conclusions: The frequency of occurrence of right neglect was, as expected, much lower than that reported in a study using the same assessment battery in right brain damage stroke patients. Nevertheless, neglect was found in a substantial proportion of patients at a subacute stage, suggesting that it should be considered in the rehabilitation planning of left brain damage stroke patients.

Independent effects of endogenous and exogenous spatial cueing: inhibition of return at endogenously attended target locations

Inhibition of return (IOR) is thought to reflect a bias against returning attention to previously attended locations. According to this view, IOR should occur only if attention is withdrawn from the target location prior to target appearance. In the present study, endogenous attention and exogenous cueing were manipulated orthogonally. IOR was observed both when a target appeared at an unexpected location, and when a target appeared at the expected location. A similar pattern of results was obtained in a reanalysis of data from a study with Neglect patients. These results suggest that IOR is independent of endogenous orienting.

Recognition of Visual Letter Strings Following Injury to the Posterior Visual Spatial Attention System.

Abstract Unilateral posterior lesions often produce a deficit in visual spatial attention. One result of this deficit is a loss of information from a word contralateral to the lesion when presented simultaneously with an ipsilateral word (interword extinction). However, when a single word presented at fixation covers the same visual angle there is frequently no extinction (Sieroff & Michel, 1987). Why are centred words not extinguished? Our studies attempt to discover the reason by comparing centred word and nonword letter strings. Nonwords do show extinction. Words are processed more accurately and show little evidence of extinction. Compound words appear to act like normal words, but segmenting letters into separate strings increases extinction. These results suggest that spatial attention is unnecessary for access to the lexical network that produces a visual word form.

Cueing Spatial Attention during Processing of Words and Letter Strings in Normals.

Abstract Work with patients has shown that lesions of the right posterior cortex produce a deficit that affects ability to report letters on the left side of a foveal nonsense string but has little effect on foveal words. We have proposed that this is the result of a deficit in visual spatial attention. The current studies use cues on the left and right of foveally centred letter strings to bias visual spatial attention in normals. The studies show that the cues serve to bias report to the cued side very strongly for nonword letter strings and are less effective the more wordlike the string becomes. These results show that covert attention controls access of letters to consciousness in those cases where spatial attention is used to organise input.

Impaired orienting of attention in left unilateral neglect: a componential analysis

Twenty-six patients suffering from damage to the right side of the brain, 19 of whom exhibited signs of left neglect, as well as 32 matched controls, ran 3 spatial cuing tasks. Patients were also tested with 2 cancellation tests, a line-bisection test, the copy of a complex drawing, and a visual extinction procedure. Results first showed correlations between extinction and cancellation tests performance on one hand, and between line bisection and copy on the other hand. Second, results demonstrated that an engagement deficit toward contralesional targets appeared to be the most striking feature of neglect, and the engagement score was correlated with the cancellation score and extinction. Most patients with neglect also presented a deficit in disengagement, a deficit of inhibition of return, and probably a deficit of alertness. Deficits in engagement and in disengagement, as well as poor scores in cancellation tests, seemed to be related with posterior cortical and subcortical lesions. Most important, even if an endogenous deficit (frequently related with a thalamic lesion) could aggravate the neglect behavior, neglect syndrome was mainly explained by a deficit of exogenous attention.

Neglected attention in apparent spatial compression

Halligan and Marshall [Cortex 27 (1991) 623] devised a new test to evaluate the hypothesis that in visual neglect, left space is systematically compressed rightwards. In the critical condition of the original study, rows of horizontally arranged numbers with a target arrow pointing to one of them from the opposite margin of the display were presented. When asked to verbally identify the number indicated by the arrow, a right brain-damaged patient with left neglect and hemianopia often indicated a number to the right of the target. The more the target was located on the left, the greater the response shift rightward, as if rightward compression were linearly proportional to the co-ordinates of Euclidian space. However, a possible alternative account could be that the patients attention was attracted by the numbers located to the right of the target digit, thus biasing her responses toward numbers on the right. To explore this hypothesis, we asked normal participants and patients with right hemisphere lesions, with and without neglect or hemianopia, to mark on the margin of a sheet the approximate location indicated by an arrow situated on the opposite margin. In three different conditions, the arrow indicated either one of several numbers or lines in a row, or a blank location on the sheet margin. Only patients with left neglect, and especially those with associated hemianopia, deviated rightward, and then crucially only on those conditions where visible targets were present, consistent with the attentional bias account.

Attentional cueing effect in the identification of words and pseudowords of different length

Three experiments studied the influence of spatial attention on familiar and unfamiliar letter string identification. Siéroff and Posners (1988) cueing procedure was used: A cue indicated in advance either the beginning (left) or the end (right) of a foveally presented letter string that participants were instructed to read aloud. Results showed that the precue had a stronger influence on pseudoword than on word identification. Similar results were obtained when participants were instructed to report the identity of the cue or not. For pseudowords, a cueing effect was obtained regardless of length (6, 8, and 10 letters), whereas only 10-letter words showed such an effect, though to a lesser degree than pseudowords of the same length. However, results showed that shorter words were also influenced by the cue location when the exposure duration was reduced. Results are compatible with an early role of spatial attention in letter string processing, but they also suggest that the lexical status of a letter string can directly influence the distribution of attention before the identification process is completely achieved. Although orienting of spatial attention seems heavily involved in a pseudoword identification, some spatial attention mechanism could also take place in the case of familiar words. The results are discussed within two theoretical frameworks concerning the involvement of spatial attention in word identification: The “replacement” theory and the “redistribution” theory.

Orienting of spatial attention in Huntington's Disease

To explore the functioning of spatial attention in Huntingtons Disease (HD), 14 HD patients and 14 age-matched controls performed a cued response time (RT) task with peripheral cues. In Experiment 1, cues were not informative about the future target location, thus eliciting a purely exogenous orienting of attention. At short stimulus-onset asynchrony (SOA), controls showed an initial facilitation for cued locations, later replaced by a cost (inhibition of return, IOR). Patients had a larger and more persistent validity effect, with delayed IOR, resulting from a larger cost for uncued targets. This suggests an impairment of attentional disengaging from cued locations. In Experiment 2, 80% of the cues were valid, thus inducing an initially exogenous, and later endogenous, attentional shift towards the cued box. The validity effect was larger in patients than in controls, again as a result of a disproportionate cost for uncued targets. In Experiment 3, 80% of the cues were invalid, thus inviting participants to endogenously re-orient attention towards the uncued box. Patients could take advantage of invalid cues to re-orient their attention towards the uncued targets but at a longer SOA than controls, thus suggesting that endogenous orienting is preserved in HD, but slowed down by the disengage deficit. The disengage deficit correlated with several radiological and biological markers of HD, thus suggesting a causal relationship between HD and attentional impairments. Cued RT tasks are promising tools for the clinical monitoring of HD and of its potential treatments.

How Voluntary is ‘Voluntary’ Orienting of Attention?

HOW VOLUNTARY IS ‘VOLUNTARY’ ORIENTING OF ATTENTION? Caroline Decaix1,2, Eric Sieroff2 and Paolo Bartolomeo1,3 (1INSERM Unit 324, Centre Paul Broca, 2ter rue d’Alesia, 75014 Paris, France; 2Universite Rene Descartes (Paris 5), Laboratoire de Psychologie Experimentale, cnrs URA 8581, Paris, France; 3Neuroscience Department, Henri-Mondor Hospital, Creteil, France)