Nele Demeyere

The Oxford Cognitive Screen (OCS): Validation of a stroke-specific short cognitive screening tool

There is currently no existing freely available short screen for cognitive problems that targets stroke survivors specifically. We have developed a short cognitive screen, the Oxford Cognitive Screen (OCS), to be completed in 15-20 min, designed for use with stroke patients. To maximize inclusion, the test is aphasia- and neglect friendly and covers domains of cognition where deficits frequently occur after stroke, including apraxia and unilateral neglect as well as memory, language, executive function, and number abilities. Domain-specific scores are returned to help direct rehabilitation. This article presents the normative data in a large sample of 140 neurologically healthy participants, a report on incidences of impairments in a sample of 208 acute stroke patients (within 3 weeks of stroke onset), measures of test-retest reliability on an alternate form and convergent and divergent validity. In addition, the full test materials are made freely available for clinical use.

Automatic statistical processing of visual properties in simultanagnosia.

Previous research has suggested that, when operating in a distributed attention mode, the visual system automatically represents visual displays by their overall statistics, rather than their individual properties. Recent neuropsychological work shows partly preserved distributed attention in simultanagnosic patients, who are typically defined as only perceiving one object at a time. Here we assessed whether GK, a patient with simultanagnosia, shows averaging of stimulus properties when distributing his attention across a set of items. We manipulated different stimulus properties in two experiments: color shades and size. We found that, when GK was in a distributed mode of attention, he (incorrectly) identified the mean object from two classes of exemplars more than in a control condition, when only one exemplar class was present. Overall, this study suggests that automatic statistical processing of color and size is possible in simultanagnosia.

Distributed and focused attention: Neuropsychological evidence for separate attentional mechanisms when counting and estimating.

Evidence is presented for 2 modes of attention operating in simultanagnosia. The authors examined visual enumeration in a patient, GK, who has severe impairments in serially scanning across a scene and is unable to count the numbers of items in visual displays. However, GKs ability to judge the relative magnitude of 2 displays was consistently above chance, even when overall luminosity did not vary with the number of items present. In addition, several variables had a differential impact on GKs counting and magnitude estimation. Magnitude estimation but not counting was facilitated by using elements that grouped more easily and by presenting the elements in regular configurations. In contrast, counting was facilitated by placing the elements in different colors while magnitude estimation was disrupted. Also GKs performance on magnitude estimation tasks was disrupted by asking him to count the elements present. The data suggest that GK can process visual stimuli in either a focused or distributed attention mode. When in a focused attention mode, performance is limited by poor serial scanning of attention due to an impaired explicit representation of visual space.

The neuroanatomy of visual enumeration: Differentiating necessary neural correlates for subitizing versus counting in a neuropsychological voxel-based morphometry study

This study is the first to assess lesion–symptom relations for subitizing and counting impairments in a large sample of neuropsychological patients (41 patients) using an observer-independent voxel-based approach. We tested for differential effects of enumerating small versus large numbers of items while controlling for hemianopia and visual attention deficits. Overall impairments in the enumeration of any numbers (small or large) were associated with an extended network, including bilateral occipital and fronto-parietal regions. Within this network, severe impairments in accuracy when enumerating small sets of items (in the subitizing range) were associated with damage to the left posterior occipital cortex, bilateral lateral occipital and right superior frontal cortices. Lesions to the right calcarine extending to the precuneus led to patients serially counting even small numbers of items (indicated by a steep response slope), again demonstrating an impaired subitizing ability. In contrast, impairments in counting large numerosities were associated with damage to the left intraparietal sulcus. The data support the argument for some distinctive processes and neural areas necessary to support subitization and counting with subitizing relying on processes of posterior occipital cortex and with counting associated with processing in the parietal cortex.

Neuropsychological evidence for a dissociation in counting and subitizing

There is a long and ongoing debate about whether subitizing and counting are separable processes. In the present paper we report a single case, MH, who presents with a dissociation in subitizing and counting. MH was spared in his ability to enumerate small numbers accurately along with a marked inability to count larger numbers. We show that non-visual counting was intact and visual counting improved when a motor record of counting could be maintained. Moreover, when larger numbers of items were spatially grouped into 2 subitizable units, performance dramatically improved. However, color grouping did not aid MHs performance, despite his being sensitive to color segmentation. In addition, MH made more re-visits of inspected locations than controls, and he was less aware of a re-visitation being made. The data cannot be explained in terms of general working memory problems (verbal working memory was relatively spared), or general number comprehension problems (e.g., simple sums and counting of auditory items was intact); but they can parsimoniously be accounted for in terms of impaired visuo-spatial memory. The findings support the argument that at least some processes are specific to counting and are not required for subitization – in particular spatial coding and memory for previously inspected locations.

Antisaccades and executive dysfunction in early drug-naive Parkinson's disease: The discovery study

Cognitive impairment is well recognized in Parkinsons disease (PD), but when it begins to develop is unclear. The aim of this study was to identify early signs of cognitive impairment along with abnormalities in saccadic behavior in newly diagnosed unmedicated PD patients.

Bilateral Field Advantage in Visual Enumeration

A number of recent studies have demonstrated superior visual processing when the information is distributed across the left and right visual fields than if the information is presented in a single hemifield (the bilateral field advantage). This effect is thought to reflect independent attentional resources in the two hemifields and the capacity of the neural responses to the left and right hemifields to process visual information in parallel. Here, we examined whether a bilateral field advantage can also be observed in a high-level visual task that requires the information from both hemifields to be combined. To this end, we used a visual enumeration task—a task that requires the assimilation of separate visual items into a single quantity—where the to-be-enumerated items were either presented in one hemifield or distributed between the two visual fields. We found that enumerating large number (>4 items), but not small number (<4 items), exhibited the bilateral field advantage: enumeration was more accurate when the visual items were split between the left and right hemifields than when they were all presented within the same hemifield. Control experiments further showed that this effect could not be attributed to a horizontal alignment advantage of the items in the visual field, or to a retinal stimulation difference between the unilateral and bilateral displays. These results suggest that a bilateral field advantage can arise when the visual task involves inter-hemispheric integration. This is in line with previous research and theory indicating that, when the visual task is attentionally demanding, parallel processing by the neural responses to the left and right hemifields can expand the capacity of visual information processing.

The BCoS cognitive profile screen: Utility and predictive value for stroke.

OBJECTIVE We examined the utility of the Birmingham Cognitive Screen (BCoS) in discriminating cognitive profiles and recovery of function across stroke survivors. BCoS was designed for stroke-specific problems across 5 cognitive domains: (a) controlled and spatial attention, (b) language, (c) memory, (d) number processing, and (e) praxis. METHOD On the basis of specific inclusion criteria, this cross-section observational study analyzed cognitive profiles of 657 subacute stroke patients, 331 of them reassessed at 9 months. Impairments on 32 measures were evaluated by comparison with 100 matched healthy controls. Measures of affect, apathy, and activities of daily living were also taken. Between-subjects group comparisons of mean performance scores and impairment rates and within-subject examination of impairment rates over time were conducted. Logistic regressions and general linear modeling were used for multivariate analysis of domain-level effects on outcomes. RESULTS Individuals with repeated stroke experienced significantly less cognitive recovery at 9 months than those with a first stroke despite similar initial level of cognitive performance. Individuals with left hemisphere lesions performed more poorly than those with right hemisphere lesions, but both groups showed similar extent of recovery at 9 months. BCoS also revealed lesion-side-specific deficits and common areas of persistent problems. Functional outcome at 9 months correlated with domain-level deficits in controlled attention, spatial attention, and praxis over and above initial dependency and concurrent levels of affect and apathy. CONCLUSION The study demonstrates how BCoS can identify differential cognitive profiles across patient groups. This can potentially help predict outcomes and inform rehabilitation.

The neural substrates of drawing: A voxel-based morphometry analysis of constructional, hierarchical, and spatial representation deficits

Deficits in the ability to draw objects, despite apparently intact perception and motor abilities, are defined as constructional apraxia. Constructional deficits, often diagnosed based on performance on copying complex figures, have been reported in a range of pathologies, perhaps reflecting the contribution of several underlying factors to poor figure drawing. The current study provides a comprehensive analysis of brain–behavior relationships in drawing disorders based on data from a large cohort of subacute stroke patients (n = 358) using whole-brain voxel-wise statistical analyses linked to behavioral measures from a complex figure copy task. We found that (i) overall poor performance on figure copying was associated with subcortical lesions (BG and thalamus), (ii) lateralized deficits with respect to the midline of the viewer were associated with lesions within the posterior parietal lobule, and (iii) spatial positioning errors across the entire figure were associated with lesions within visual processing areas (lingual gyrus and calcarine) and the insula. Furthermore, deficits in reproducing global aspects of form were associated with damage to the right middle temporal gyrus, whereas deficits in representing local features were linked to the left hemisphere lesions within calcarine cortex (extending into the cuneus and precuneus), the insula, and the TPJ. The current study provides strong evidence that impairments in separate cognitive mechanisms (e.g., spatial coding, attention, motor execution, and planning) linked to different brain lesions contribute to poor performance on complex figure copying tasks. The data support the argument that drawing depends on several cognitive processes operating via discrete neuronal networks and that constructional problems as well as hierarchical and spatial representation deficits contribute to poor figure copying.

The frequency and severity of extinction after stroke affecting different vascular territories.

We examined the frequency and severity of visual versus tactile extinction based on data from a large group of sub-acute patients (n=454) with strokes affecting different vascular territories. After right hemisphere damage visual and tactile extinction were equally common. However, after left hemisphere damage tactile extinction was more common than visual. The frequency of extinction was significantly higher in patients with right compared to left hemisphere damage in both visual and tactile modalities but this held only for strokes affecting the MCA and PCA territories and not for strokes affecting other vascular territories. Furthermore, the severity of extinction did not differ as a function of either the stimulus modality (visual versus tactile), the affected hemisphere (left versus right) or the stroke territory (MCA, PCA or other vascular territories). We conclude that the frequency but not severity of extinction in both modalities relates to the side of damage (i.e. left versus right hemisphere) and the vascular territories affected by the stroke, and that left hemisphere dominance for motor control may link to the greater incidence of tactile than visual extinction after left hemisphere stroke. We discuss the implications of our findings for understanding hemispheric lateralization within visuospatial attention networks.