Increased Cognitive Load Reveals Unilateral Neglect and Altitudinal Extinction in Chronic Stroke

J Int Neuropsychol Soc. 2019 Jul;25(6):644-653. doi: 10.1017/S1355617719000249. Epub 2019 May 21.

Abstract

Objective: Neuropsychological studies suggest that the ability to compensate for the presence of spatial neglect highly depends on the attentional resources a patient can rely on. The present research aimed to study neglect in situations where attentional resources are limited due to multitasking.

Method: We examined two patients more than 3 years after a right-hemispheric stroke. Both had received neuropsychological rehabilitation for left neglect and did not show any impairment in standard tests. We used a dual-task paradigm combining a peripheral target detection task with a central shape recognition task. Peripheral targets could appear in left/right positions but also in lower/upper positions.

Results: In patient #1, dual-task condition exacerbated left neglect and extinction. Patient #2 did not show any sign of neglect along the horizontal axis, but omitted half of the lower targets when they were presented simultaneously with upper targets under dual-task condition. This behavior reflects altitudinal extinction as the detection of single targets appearing either in upper or lower position was preserved.

Conclusion: The present findings show that dual-tasking is a sensitive tool for the quantitative and qualitative assessment of spatial attention deficits, which are often overlooked by standard methods, especially in chronic stage. (JINS, 2019, 25, 644-653).

Keywords: Parietal lobe; attentional bias; chronic brain damage; neuropsychological tests; perceptual disorders; stroke rehabilitation.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attention / physiology*
  • Chronic Disease
  • Executive Function / physiology*
  • Form Perception / physiology
  • Humans
  • Male
  • Middle Aged
  • Pattern Recognition, Visual / physiology*
  • Perceptual Disorders / etiology
  • Perceptual Disorders / physiopathology*
  • Space Perception / physiology*
  • Stroke / complications
  • Stroke / physiopathology*
  • Visual Fields / physiology