Are drawing perseverations part of the neglect syndrome?

Abstract

Unilateral neglect patients typically omit to cancel contralesional targets. Moreover, they can repeatedly cancel ipsilesional stimuli exhibiting what is termed ‘perseverative behavior’. Two alternative accounts of this behavior have been proposed. According to one of them, it is considered as integral to neglect and due either to a perceptual (allochiria), or a premotor (directional hypokinesia) pathological mechanism leading to the ipsilesional displacement of contralesional responses. According to the other one, perseverations are interpreted as the consequence of motor–control–disinhibition co-occurring with, although independent of, spatial neglect. We compared some crucial predictions of these two hypotheses on a group of 10 right-brain-damaged patients, eight with neglect and two without neglect, showing a perseverative behavior in both conventional and experimental cancellation tasks. In our experiment, the spatial location and the numerosity of targets were manipulated to obtain different degrees of horizontal alignment between targets on the left and on the right of the central vertical axis of the sheet. We found that ipsilesional perseverations were not influenced by left neglected targets and were not correlated to neglect severity. Additionally, perseverative errors were associated with right basal ganglia lesions rather than with presence of neglect. These findings support the view that two different pathological mechanisms might be involved in left spatial neglect and ipsilesional perseverative behavior.