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Annals of Physical and Rehabilitation... Jun 2023Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hemispatial neglect is a disabling cognitive disorder following stroke and effective therapies are required.
OBJECTIVES
To evaluate the effects of combined optokinetic stimulation (OKS) and cueing-assisted reading therapy (READ) on the remission of hemispatial neglect following stroke.
METHODS
Randomized, controlled, two-period, crossover trial conducted at a German neurorehabilitation center. Twenty participants with left neglect following right hemispheric stroke (mean age 66 years (SD 11), mean time since stroke 50 days (SD 33)) finished the trial (12 received OKSREAD first, 8 CONTROL first). The intervention consisted of 15 daily sessions of OKS (20 min) and text reading assisted by a therapist providing cues (20 min). The control treatment was a same-number, same-length neuropsychological treatment not targeting visuospatial attention. Primary outcomes were the change in performance of a customized neuropsychological test battery for neglect (0% worst - 100% best) and a test of neglect-related functional disability (Catherine Bergego Scale, 0 no impairment - 30 severest impairment), assessed before and after each treatment period. Secondary outcomes were performance in the 6 single tests composing the battery (e.g., omissions in text reading, center of cancellation in the Bells test, spatial bias of fixations when freely viewing photographs) and a clinical test of anosognosia.
RESULTS
Overall performance in the neglect test battery improved slightly more after OKSREAD than after CONTROL (d=6%; p=0.002). The remission of neglect-related functional disability did not differ between treatments (d=-2; p=0.291). Ipsilesional fixation bias during free viewing was the only secondary outcome that was improved by OKSREAD as compared to CONTROL (d= -2.8°; p=0.005).
CONCLUSION
At the applied intensity, the combined OKSREAD intervention slightly attenuated the ipsilesional attention bias in persons with neglect, but it did not improve neglect-related functional disability, anosognosia, or other neglect symptoms to a clinically meaningful degree.
CLINICAL TRIAL REGISTRATION
URL: http://www.
CLINICALTRIALS
gov. Unique identifier: NCT04273620.
Topics: Humans; Aged; Stroke Rehabilitation; Cues; Cross-Over Studies; Reading; Perceptual Disorders; Stroke; Agnosia; Neuropsychological Tests
PubMed: 36645965
DOI: 10.1016/j.rehab.2022.101713 -
Neuropsychologia Feb 2023Healthy observers recognize more accurately same-than other-race faces (i.e., the Same-Race Recognition Advantage - SRRA) but categorize them by race more slowly than...
Healthy observers recognize more accurately same-than other-race faces (i.e., the Same-Race Recognition Advantage - SRRA) but categorize them by race more slowly than other-race faces (i.e., the Other-Race Categorization Advantage - ORCA). Several fMRI studies reported discrepant bilateral activations in the Fusiform Face Area (FFA) and Occipital Face Area (OFA) correlating with both effects. However, due to the very nature and limits of fMRI results, whether these face-sensitive regions play an unequivocal causal role in those other-race effects remains to be clarified. To this aim, we tested PS, a well-studied pure case of acquired prosopagnosia with lesions encompassing the left FFA and the right OFA. PS, healthy age-matched and young adults performed two recognition and three categorization by race tasks, respectively using Western Caucasian and East Asian faces normalized for their low-level properties with and without-external features, as well as in naturalistic settings. As expected, PS was slower and less accurate than the controls. Crucially, however, the magnitudes of her SRRA and ORCA were comparable to the controls in all the tasks. Our data show that prosopagnosia does not abolish other-race effects, as an intact face system, the left FFA and/or right OFA are not critical for eliciting the SRRA and ORCA. Race is a strong visual and social signal that is encoded in a large neural face-sensitive network, robustly tuned for processing same-race faces.
Topics: Female; Humans; Young Adult; Cerebral Cortex; Magnetic Resonance Imaging; Pattern Recognition, Visual; Prosopagnosia; Recognition, Psychology; White People; East Asian People
PubMed: 36623806
DOI: 10.1016/j.neuropsychologia.2023.108479 -
Parkinsonism & Related Disorders Feb 2023Individuals with Huntington's disease (HD) commonly experience anosognosia, a lack of awareness of deficits. Thus, it is important to examine the accuracy of patient vs...
INTRODUCTION
Individuals with Huntington's disease (HD) commonly experience anosognosia, a lack of awareness of deficits. Thus, it is important to examine the accuracy of patient vs caregiver ratings on the basis of objective performance-based measures.
METHODS
The Anosognosia Scale (AS) was given to 33 patients with manifest HD and their caregivers. The AS consists of 8 items in which individuals rate their global abilities relative to same-aged peers. Scores range from very impaired to excellent. Caregiver and patient ratings were then correlated with objective measures.
RESULTS
Caregivers' evaluations of patients' cognitive and motoric abilities were more highly correlated with objective measures than patients' ratings. Specifically, caregivers' AS item scores were highly correlated with objective measures of walking (Unified Huntington Disease Rating Scale (UHDRS) tandem walking score [r = 0.57, p = .001] vs. patient [r = 0.39, p = .031]); dexterity (UHDRS pronation supination score [r = 0.55, p = .011] vs. patient [r = 0.18, p = .393]); speech (UHDRS dysarthria score [r = 0.55, p = .004] vs. patient [r = 0.03, p = .854]); memory (MoCA score [r = -.45, p = .048] vs. patient [r = -.11, p = .963]); attention (Trails Making Test A score [r = 0.58, p = .004] vs. patient [r = 0.08, p = .686]); and word retrieval (category fluency ([r = -.58, p = .004] vs. patient [r = -.02, p = 1.00]). Moreover, both the UHDRS total motor score (TMS) (F(1,29) = 7.50, p = .010) and the Mini Mental Status Exam (MMSE) (F(1,31) = 5.40, p = .027) were significant predictors of patient levels of anosognosia.
CONCLUSIONS
Our findings indicate that caregivers may be better able to rate HD patients' cognitive and motor abilities than patients themselves. Both cognitive and motor severity are significant predictors of levels of anosognosia in HD.
Topics: Humans; Huntington Disease; Caregivers; Self Report; Walking; Agnosia
PubMed: 36610230
DOI: 10.1016/j.parkreldis.2022.105272 -
Medicine Dec 2022The aim of this study is to verify the functional activation in a patient with anosognosia for hemiplegia following left brain lesions.
OBJECTIVE
The aim of this study is to verify the functional activation in a patient with anosognosia for hemiplegia following left brain lesions.
METHODS
We report a case of a 53-year-old right-handed female patient. She came to our rehabilitative unit with a diagnosis of an ischemic major stroke in the left internal carotid artery and important hemiplegia to the right side. She underwent functional magnetic resonance imaging (fMRI), during which she performed a motor imagery task.
RESULTS
The fMRI assessment showed an ischemic lesion in the frontotemporal and insular left areas. In the fMRI experiment, we revealed activation of the residual neural patterns of both hemispheres.
CONCLUSION
We underlined an interest in the compensation mechanism that involved neural networks near brain lesions and some areas of the contro-lesional hemisphere, suggesting that the synaptic plasticity permitted an intra and inter-hemispheric reorganization of the cerebral system.
Topics: Humans; Female; Middle Aged; Hemiplegia; Magnetic Resonance Imaging; Agnosia; Cerebral Cortex; Neuronal Plasticity
PubMed: 36596042
DOI: 10.1097/MD.0000000000032526 -
Annals of Indian Academy of Neurology Oct 2022Cerebral visual disorders include a range of common and rare deficits. They can be divided into effects on low-, intermediate-, and high-level forms of visual...
Cerebral visual disorders include a range of common and rare deficits. They can be divided into effects on low-, intermediate-, and high-level forms of visual processing. Low-level deficits are various forms of homonymous hemifield scotomata, which affect all types of vision within their borders. Intermediate-level deficits refer to impairments of colour or motion perception, which affect either one hemifield or the entire field when lesions are bilateral. High-level deficits are divided into those of the ventral (occipitotemporal) or dorsal (occipitoparietal) stream. Occipitotemporal lesions affect various aspects of object recognition, ranging from general visual agnosia to selective agnosias, such as prosopagnosia or topographagnosia from right or bilateral lesions, and pure alexia from left-sided lesions. Occipitoparietal lesions cause the various components of Bálint syndrome, namely, simultanagnosia, optic ataxia, and ocular motor apraxia. They can also cause other impairments of visuospatial or visuotemporal processing, such as astereopsis and sequence-agnosia. Because of anatomic proximity, certain deficits cluster together to form a number of cerebral visual syndromes. Treatment of these disorders remains challenging, with frequent reliance on strategic substitutions rather than restorative approaches.
PubMed: 36589033
DOI: 10.4103/aian.aian_136_22 -
Scientific Reports Dec 2022Insight impairment contributes significantly to morbidity in psychiatric disorders. The neurologic concept of anosognosia, reflecting deficits in metacognitive awareness...
Insight impairment contributes significantly to morbidity in psychiatric disorders. The neurologic concept of anosognosia, reflecting deficits in metacognitive awareness of illness, is increasingly understood as relevant to psychopathology, but has been little explored in psychiatric disorders other than schizophrenia. We explored anosognosia as an aspect of insight impairment in n = 71 individuals with DSM-5 hoarding disorder. We used a standardized clutter severity measure to assess whether individuals with hoarding disorder underreport home clutter levels relative to independent examiners. We then explored whether underreporting, as a proxy for anosognosia, is predicted by clinical or neurocognitive behavioral measures. We found that individuals with hoarding disorder underreport their clutter, and that underreporting is predicted by objective severity of clutter. In an n = 53 subset of participants, we found that underreporting is predicted by altered performance on tests of cognitive control and inhibition, specifically Go/No-Go and Stroop tests. The relation of underreporting to objective clutter, the cardinal symptom of hoarding disorder, suggests that anosognosia may reflect core pathophysiology of the disorder. The neurocognitive predictors of clutter underreporting suggest that anosognosia in hoarding disorder shares a neural basis with metacognitive awareness deficits in other neuropsychiatric disorders and that executive anosognosia may be a transdiagnostic manifestation of psychopathology.
Topics: Humans; Hoarding Disorder; Agnosia; Diagnostic and Statistical Manual of Mental Disorders; Metacognition
PubMed: 36526652
DOI: 10.1038/s41598-022-25532-4 -
Behavior Research Methods Dec 2023Developmental prosopagnosia is characterized by severe, lifelong difficulties when recognizing facial identity. Unfortunately, the most common diagnostic assessment...
Developmental prosopagnosia is characterized by severe, lifelong difficulties when recognizing facial identity. Unfortunately, the most common diagnostic assessment (Cambridge Face Memory Test) misses 50-65% of individuals who believe that they have this condition. This results in such excluded cases' absence from scientific knowledge, effect sizes of impairment potentially overestimated, treatment efficacy underrated, and may elicit in them a negative experience of research. To estimate their symptomology and group-level impairments in face processing, we recruited a large cohort who believes that they have prosopagnosia. Matching prior reports, 56% did not meet criteria on the Cambridge Face Memory Test. However, the severity of their prosopagnosia symptoms and holistic perception deficits were comparable to those who did meet criteria. Excluded cases also exhibited face perception and memory impairments that were roughly one standard deviation below neurotypical norms, indicating the presence of objective problems. As the prosopagnosia index correctly classified virtually every case, we propose it should be the primary method for providing a diagnosis, prior to subtype categorization. We present researchers with a plan on how they can analyze these excluded prosopagnosia cases in their future work without negatively impacting their traditional findings. We anticipate such inclusion will enhance scientific knowledge, more accurately estimate effect sizes of impairments and treatments, and identify commonalities and distinctions between these different forms of prosopagnosia. Owing to their atypicalities in visual perception, we recommend that the prosopagnosia index should be used to screen out potential prosopagnosia cases from broader vision research.
Topics: Humans; Prosopagnosia; Recognition, Psychology; Visual Perception; Facial Recognition; Pattern Recognition, Visual
PubMed: 36459376
DOI: 10.3758/s13428-022-02017-w -
Neuropsychologia Dec 2022Anosognosic patients show a lack of awareness for their hemiplegia coupled with a distorted sense of agency for the actions performed by the plegic limbs. Since...
OBJECTIVES
Anosognosic patients show a lack of awareness for their hemiplegia coupled with a distorted sense of agency for the actions performed by the plegic limbs. Since anosognosia is often associated with right brain damage, this hemisphere seems to play a dominant role in monitoring awareness for motor actions. Therefore, we would expect that anosognosic patients show distorted awareness and sense of agency also for actions performed with the unimpaired limb.
METHOD
To test this hypothesis, we induced illusory actions that could be congruent or incongruent with a preceding verbal command. A group of 16 right brain-damaged patients performed this task and then rated i) their ability to anticipate the actions, ii) their sense of agency and iii) their sense of ownership for each limb. Measures of awareness, neglect and motor impairment were also considered for the patient group.
RESULTS
Following incongruent actions with the unimpaired limb, less aware patients showed a relatively mild distortion in all three aspects. In addition, we also found a crucial relationship between motor impairment (for the plegic limb) and sense of agency for both plegic and healthy limbs.
CONCLUSION
Although the distortion linked to both limbs supports the initial hypothesis that the right hemisphere is responsible for monitoring awareness for action for the whole body, our data also suggest that the observed distortion may be linked to a motor compensatory phenomenon, not necessarily related to awareness processes.
Topics: Humans; Hemiplegia; Functional Laterality; Awareness; Agnosia; Brain Injuries
PubMed: 36370826
DOI: 10.1016/j.neuropsychologia.2022.108421 -
Cortex; a Journal Devoted To the Study... Dec 2022Individuals with developmental prosopagnosia (DP) all exhibit impairments in face memory, but the specificity of these face memory impairments is debated. One problem is...
Individuals with developmental prosopagnosia (DP) all exhibit impairments in face memory, but the specificity of these face memory impairments is debated. One problem is that standard behavioural tasks are not able to provide independent measurement of face perception, face memory, and face matching (the decision process required to judge whether two instances of a face are of the same individual or different individuals). The present study utilised a new test of face matching, the Oxford Face Matching Test (OFMT), and a novel analysis strategy to derive these independent indices. Twenty-nine individuals with DP and the same number of matched neurotypical controls completed the OFMT, the Glasgow Face Matching Test, and the Cambridge Face Memory Test. Results revealed individuals with DP exhibit impairments in face perception, face memory and face matching. Collectively, these results suggest that face processing impairments in DP are more comprehensive than has previously been suggested.
Topics: Humans; Prosopagnosia; Facial Recognition; Pattern Recognition, Visual; Memory Disorders
PubMed: 36368179
DOI: 10.1016/j.cortex.2022.09.012