Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

Abstract

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

Right and left neglect are not anatomically homologous: A voxel-lesion symptom mapping study

“…Within the consecutive sample included in this investigation 28.5% exhibited right-lateralised and 15.7% exhibited left-lateralised neglect. This finding is in line with previous research demonstrating that neglect deficits regularly occur following both right and left hemisphere damage ( Moore et al, 2021 ; Stone et al, 1992 ; Ten Brink et al, 2017 ). Similarly, as in previous studies, egocentric and allocentric neglect were found to be behaviourally doubly dissociated ( Chechlacz et al, 2010 , 2012 ).…”

“…Conversely, right egocentric neglect was found to be most strongly associated with damage to left hemisphere occipital areas while right allocentric neglect was related to damage to voxels within the left internal capsule white matter. While there was some degree of overlap (6.45%) between the neural correlates associated with left egocentric and left allocentric neglect, the voxels associated with right This finding is in line with previous research demonstrating that neglect deficits regularly occur following both right and left hemisphere damage (Moore et al, 2021;Stone et al, 1992;Ten Brink et al, 2017). Similarly, as in previous studies, egocentric and allocentric neglect were found to be behaviourally doubly dissociated (Chechlacz et al, 2010(Chechlacz et al, , 2012.…”

“…Given that visuospatial neglect deficits likely involve disconnection syndromes rather than a single critical lesion site, additional research using a range of analysis techniques is needed to further clarify the underlying networks implicated in spatial attentional deficits. In addition to impacting different spatial reference frames, Patients with visuospatial neglect can exhibit a diverse range of location or modality-specific behavioural phenotypes and functional outcomes ( Aimola et al, 2012 ; Binder et al, 1992 ; Connine et al, 1990 ; Guilbert et al, 2016 ; Laplane and Degos, 1983 ; Moore et al, 2021 ; Ten Brink et al, 2019 ). Future research is needed to specifically identify the neural correlates of these additional neglect subtypes.…”

“…In the VLSM analyses, egocentric severity was quantified using a centre of cancellation measure ( Rorden and Karnath, 2010 ). This metric was calculated by assigning each target a numeric weight based on location along the right/left axis, and averaging these weights (see Huygelier et al, 2020 ; Moore et al, 2021 ). Similarly, allocentric asymmetry was quantified by dividing the number of consistently-lateralised false positive responses by the number of reported targets (see Moore et al (2021) .…”

The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study

“…People with more severe allocentric neglect are less likely to make a full recovery from visuospatial neglect, potentially contributing to ongoing difficulties with walking safety. 56 For these reasons it would be advisable to continue to explore visuospatial neglect as a predictor for walking recovery, taking neglect subtypes into consideration.…”