Which perseverative behaviors are symptoms of spatial neglect?

Abstract

Spatial neglect is a characterized by a failure to attend or make movements towards left-sided stimuli. Common paper-and-pencil tasks to diagnose spatial neglect are sensitive to perseverative errors, including additional marks over already cancelled targets and "scribbling" out a target. Here, we examine whether functionally distinct perseverative behaviors are related to spatial neglect. Line cancellation tasks of 45 healthy controls and 220 right-hemisphere stroke survivors were examined for recurrent marks (RM) and continuous marks (CM) perseverations. We found that RM perseveration correlated with neglect severity, while CM perseveration did not. Examination of lesion profiles for the two groups indicated distinct anatomical correlates, with RM lesions overlapping regions implicated in spatial neglect including the rolandic operculum, superior temporal gyrus, and inferior parietal lobule.

Trial registration: ClinicalTrials.gov NCT00350012 NCT00989430.

Keywords: Activities of daily living; Allochiria; Barthel index; Disengagement of attention; Functional disability; Hyperkinesia; Lesion mapping; Motor disinhibition; Motor perseveration; Neglect; Perseveration; Spatial motor; Spatial representation; Stroke; Working memory.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Fig. 1

The Albert Cancellation Task of the BIT assesses for the presence of spatial neglect (left sided omissions) as well as repetitive behaviors on cancelled targets. The participants below both demonstrate severe spatial neglect. Panel A demonstrates recurrent marking (RM) perseveration and Panel B demonstrated continuous marking (CM) perseveration.

Fig. 2

Contrast of lesion maps for N+RM+ and N+CM+. The top (A) shows lesions that were present patients with neglect and RM+ compared to CM+ including the inferior frontal gyrus, superior temporal gyrus, rolandic operculum, inferior parietal lobule, and supramarginal gyrus. The bottom panel (B) shows areas lesioned in patients with neglect and CM+ compared to RM+, highlighting the orbitofrontal cortex and more subcortical regions involving the hippocampus and putamen. The maps are presented with the right hemisphere showing on the left and numbers above each slice correspond to MNI z coordinates of each transverse section.

Fig. 3

Overlapped lesion maps for the (A) Neglect and Perseveration, (B) Neglect Only, and (C) Perseveration only groups. The maps are presented with the right hemisphere showing on the left and numbers above each slice correspond to MNI z coordinates of each transverse section.

Fig. 4

Brain regions significantly associated with neglect and perseveration (N+P+). Voxels that survived the statistical threshold of FWE p

Fig. 5

Follow-up pair-wise t-tests indicates that neglect reduces functional independence following stroke, with the greatest impact in those with both perseveration and neglect. Error bars represent standard error of the mean.