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Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke
  1. P Azouvi1,
  2. C Samuel1,
  3. A Louis-Dreyfus1,
  4. T Bernati2,
  5. P Bartolomeo3,
  6. J-M Beis4,
  7. S Chokron5,
  8. M Leclercq6,
  9. F Marchal7,
  10. Y Martin8,
  11. G de Montety1,
  12. S Olivier1,
  13. D Perennou9,
  14. P Pradat-Diehl7,
  15. C Prairial10,
  16. G Rode11,
  17. E Siéroff12,
  18. L Wiart13,
  19. M Rousseaux2,
  20. for the French Collaborative Study Group on Assessment of Unilateral Neglect (GEREN/GRECO)
  1. 1Service de Rééducation Neurologique, Formation de Recherche Claude Bernard and Université René Descartes, Hôpital Raymond Poincaré, Garches, France
  2. 2Service de Rééducation Neurologique, CHRU, Lille, France
  3. 3INSERM U324, Centre Paul Broca, Paris, France
  4. 4Centre de Réadaptation, Lay-St-Christophe, France
  5. 5Laboratoire de Psychologie Experimentale, CNRS UMR 5105, Grenoble, France
  6. 6Centre Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
  7. 7Service de Rééducation, Hôpital de la Salpétriére, Paris, France
  8. 8Centre de Rééducation l'Espoir, Lille-Hellemmes, France
  9. 9Service de Rééducation Neurologique, Centre Medical, Le Grau du Roi, France
  10. 10CRN, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
  11. 11Service de Rééducation Neurologique, Hôpital Henry Gabrielle, Lyon, France
  12. 12Laboratoire de Psychologie Expérimentale, Université René Descartes, Paris, France
  13. 13Centre de la Tour de Gassies, Bruges, Belgium
  1. Correspondence to:
 Dr P Azouvi, Service de Rééducation Neurologique, Hôpital Raymond Poincaré, 92380 Garches, France;
 philippe.azouvi{at}rpc.ap-hop-paris.fr

Abstract

Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke.

Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations.

Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged.

Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

  • neglect
  • stroke
  • assessment
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