Attention Deficits in Stroke Patients: The Role of Lesion Characteristics, Time from Stroke, and Concomitant Neuropsychological Deficits

Abstract

Attention impairments are frequent in stroke patients with important consequences on the rehabilitation outcomes and quality of life. The aim of the study was to perform a comprehensive assessment of selective and intensive attention processes in a large population of brain-damaged patients, evaluating the influence of the side and site of the brain lesion, the time from stroke, and the concomitant presence of aphasia or neglect. We assessed 204 patients with a first unilateral brain lesion and 42 healthy individuals with three subtests of the Test of Attentional Performance (TAP): Alertness, Go-No Go, and Divided Attention. 44.4% of patients had an impairment in both intensive and selective aspects of attention, 5.6% had deficits only in the intensive component, and 31.8% had deficits only in selective tasks. More than 80% of the patients fell below the cut-off point on at least one task. Patients with a right hemispheric lesion (RHL) were more impaired than patients with a left hemispheric lesion (LHL) especially in tonic and phasic alertness. Patients with total anterior infarcts (TACI) presented the worst profile compared to other stroke subtypes, with a difference between total and lacunar subtypes in the Alertness test, independent of the presence of warning. Patients in the chronic phase had shorter RTs than acute patients only in the Alertness test. In patients with LHL, the presence of aphasia was associated with a greater deficit in selective attention. In patients with RHL, the presence of unilateral neglect was associated with impaired alertness and selective attention. Attention deficits are common after a unilateral first stroke. In keeping with the hierarchical organization of attention functions, results confirm the important role of the right hemisphere for the intensive components of attention, also highlighting the involvement of left hemisphere functioning for the selective aspects, possibly indicating a role of its linguistic functions.

Dissecting the cognitive phenotype of post‐stroke fatigue using computerized assessment and computational modeling of sustained attention

“…Results did not reveal any significant association between stroke location/laterality or lesion volume and outcome variables (RT or FSS), suggesting that, in this sample, lesion location and volume are not strong predictors of subjective fatigue or attentional function as measured by ANT. Whereas the lack of a robust relationship between lesion location/lesion volume and FSS score is in line with previous reports (Choi‐Kwon, Han, Kwon, & Kim, 2005; Mead et al, 2011), the literature is not conclusive, and right hemispheric lesions are frequently associated with attentional dysfunction and neglect (Robertson, Ridgeway, Greenfield, & Parr, 1997; Spaccavento et al, 2019; Vallar & Perani, 1986). The current lack of predictive value of stroke location highlights the complex etiology of attentional function in chronic stroke patients.…”

Influence of Background Musical Emotions on Attention in Congenital Amusia

“…This spared performance in congenital amusia stands in sharp contrast with executive control deficits documented in several populations, including the elderly (Zhu et al, 2010 ; Fernandez et al, 2019a ) and patients with visual attentional developmental disorders (e.g., ADHD) (Johnson et al, 2008 ; Mogg et al, 2015 ) who show abnormal distractor susceptibility (i.e., more errors/larger RTs in incongruent trials) in several paradigms, including the ANT version with arrow flankers as used here. Similarly, an attenuation of alerting states has been reported in ADHD (Johnson et al, 2008 ) and patients with strokes (Spaccavento et al, 2019 ) compared to the control population, but it was not seen in the amusic group. Finally, the age-related slowing in visual attention was similar in the amusic and control participants who were relatively old but age-matched suggesting that musical deficits have no distinctive impact on attentional performance with increasing age.…”

The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment

“…OSA patients have shown decreased activation in brain regions involved in the go/no go task [ 85 ]. Moreover, dysfunction of prefrontal regions of the brain cortex has largely been postulated in OSA patients (e.g., [ 12 , 58 ] In a recent study by our group on attention deficits in neurological patients, those suffering from partial anterior circulation infarcts were found to be more impaired in all attention tasks [ 86 ]. Finally, it is worth noting that the cognitive control of wakefulness and arousal (i.e., intrinsic alertness) arises from a network that includes cortical and subcortical structures (dorsolateral prefrontal cortex, anterior cingulate gyrus, parietal cortex, thalamus, and brainstem) [ 72 , 73 , 75 ].…”