Abstract
Objective: Visuospatial neglect, whereby patients are unable to attend to stimuli on their contralesional side, is a neuropsychological condition commonly experienced after stroke. We aimed to investigate whether egocentric and allocentric neglect are functionally dissociable and differ in prevalence and laterality in the early poststroke period. Method: A consecutive sample of 366 acute stroke patients completed the Broken Hearts test from the Oxford Cognitive Screen. We evaluated the association between egocentric and allocentric neglect and contrasted the prevalence and severity of left-sided versus right-sided neglect. Results: Clinically, we found a double dissociation between ego- and allocentric neglect, with 50% of the neglect patients showing only egocentric neglect and 25% only allocentric neglect. Left-sided egocentric neglect was more prevalent and more severe than was right-sided egocentric neglect, though right-sided neglect was still highly prevalent in the acute stroke sample (35%). Left-sided allocentric neglect was more severe but not more prevalent than was right-sided allocentric neglect. At 6 months, in a representative subsample of 160 patients, we found neglect recovery rates to be 81% and 74% for egocentric and allocentric neglect, respectively. Conclusion: Dissociable ego- and allocentric neglect symptoms support a heterogeneous account of visuospatial neglect, which was shown to be highly prevalent for both the left and the right hemifields.
Highlights
Half of them presented with only egocentric neglect, one quarter with only allocentric neglect, and a further quarter with both egocentric and allocentric neglect
To explore the relationship between the severity of ego- and allocentric spatial biases in a more sensitive way, we correlated the ego- and allocentric asymmetry scores in the three groups. The patients with both ego- and allocentric neglect demonstrated a significant correlation between the asymmetry scores (N ϭ 45; r ϭ .55, p Ͻ .0001, large effect size); no correlation was present in patients with only egocentric or only allocentric neglect (N ϭ 131; r ϭ .02, p ϭ .78)
To determine whether there was any egocentric core bias in the allocentric neglect behavior on the test, we tested whether the false positive responses made by patients with allocentric neglect were asymmetrically distributed in egocentric space
Summary
Visuospatial neglect, whereby patients are unable to attend to stimuli on their contralesional side, is a neuropsychological condition commonly experienced after stroke. We evaluated the association between egocentric and allocentric neglect and contrasted the prevalence and severity of left-sided versus right-sided neglect. Conclusion: Dissociable ego- and allocentric neglect symptoms support a heterogeneous account of visuospatial neglect, which was shown to be highly prevalent for both the left and the right hemifields. Arguments that neglect is a unitary syndrome may be due to the lack of tests capable of identifying multiple types of neglect rather than the lack of diversity in neglect impairments themselves This may help explain why the prevalence of right-sided neglect has been underestimated, because allocentric neglect is often not explicitly assessed (see the overview by Parton, Malhotra, & Husain, 2004). We aimed to contrast the prevalence and severity of left- and right-sided egocentric and allocentric neglect in a large sample of acute stroke patients. Participants Gender (male/female) Age (years) Handedness (left/right/not specified) Education level (years) Stroke to test interval (days) Stroke etiology (ischemia/hemorrhage/not specified) Lesion side (left/right/bilateral/not specified)
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