Coexisting Cerebral Infarction in Alzheimer's Disease Is Associated with Fast Dementia Progression: Applying the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences Neuro

OBJECTIVES

To determine whether patients with Alzheimer's disease (AD) and coexisting cerebral infarction (CI) that satisfy the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) neuroimaging criteria for vascular dementia (VaD) progress faster than those who do not satisfy the neuroimaging criteria.

DESIGN

Retrospective cohort study.

SETTING

Multidisciplinary memory clinic in a tertiary hospital.

PARTICIPANTS

One hundred thirty consecutive patients with AD, with or without CI, followed up regularly for more than 1 year.

MEASUREMENTS

The patients were classified according to the distribution and severity of CI as defined according to the NINDS-AIREN neuroimaging criteria into those with AD and no CI (AD-N), those with AD and CI not fulfilling neuroimaging criteria (AD-I), and those with AD and CI fulfilling neuroimaging criteria (AD-V), and their differences in dementia progression were tested. The loss of independence, indicated by institution admission or a clinical dementia rating (CDR) score of 3, was defined as the endpoint for a poor outcome.

RESULTS

The mean age was 75.8, and 68.5% were women. The initial Mini-Mental State Examination (MMSE) score was 15.3+/-0.4, and the average duration of follow up was 30.4 months. Fifty-four patients had reached study endpoint at the time of analysis. AD-V (hazard ratio (HR)=3.1, 95% confidence interval (CI)=1.2-8.2), use of psychotropic drugs (HR=2.7, 95% CI=1.1-6.4), and initial MMSE score (HR=0.9, 95% CI=0.8-1.0) were independent predictors of poor outcome in the Cox regression model.

CONCLUSION

In AD, co-occurrence of CI with distribution and severity as defined in the NINDS-AIREN neuroimaging criteria for VaD is associated with faster dementia progression.

Cerebral cortical atrophy and silent brain infarcts in psychiatric patients

AIM

To assess the frequency of silent brain infarcts and cerebral cortical atrophy in psychiatric patients with cognitive dysfunction.

METHODS

One hundred and ninety four patients with cognitive dysfunction determined by the use of the Benton Visual Retention Test and Wechsler Memory Scale were analyzed according to age, gender, education, duration of psychiatric treatment, presence of mental disorders, neurological findings, and CT scan of neurocranium. The results were analyzed using descriptive statistics.

RESULTS

Average age of the group of patients studied was 48+/-9.7 years, and average duration of psychiatric treatment was 6+/-7.3 years. Regarding mental disorders, patients suffered from posttraumatic stress disorder (PTSD) in comorbidity with depression (21.1%), depressive disorder (14.4%), Complex PTSD (13.9%), PTSD (11.3%), and post-concussion syndrome (7.7%). Cerebral cortical atrophy was determined in 47.4%, silent brain infarct in 3.6%, whereas the combination of cerebral cortical atrophy and silent brain infarct was found in 26.3% of patients. In 22.6% of patients with cognitive dysfunction on the Benton Visual Retention Test and Wechsler Memory Scale CT scan findings were completely normal. Cerebral cortical atrophy was more frequent in patients with PTSD in comorbidity with depression (43%), PTSD (39.0%), Complex PTSD (26%), depression (25%), whereas the silent brain infarct was more frequent in patients with post-concussion syndrome (53.3%) and depression (42.8%).

CONCLUSION

Cerebral cortical atrophy and silent brain infarct are frequent findings in computerized tomography of the brain in psychiatric patients with cognitive dysfunction. Cerebral atrophy is frequent in patients with PTSD, whereas in patients with depression, besides cerebral atrophy, silent brain infarct is also frequently present.

Polymorphisms and vascular cognitive impairment after ischemic stroke

Environmental and genetic factors may both affect the risk of vascular cognitive impairment developing after a stroke. To identify factors affecting this risk, the cognitive status of 121 patients was examined 3 months after an ischemic stroke. In all patients and in 270 control subjects, 7 polymorphisms reported to affect risk of vascular ischemic disease were genotyped. In 51 patients (42.1%), vascular cognitive impairment resulted, defined by a Mini-Mental State Examination score of less than 24. These patients were older and more likely to be women. Alleles of none of the polymorphisms differed between patients with or without vascular cognitive impairment, except for glutamate-cysteine ligase modifier (GCLM) (odds ratio = 2.8, P = .006). When all stroke patients were considered, the GCLM genotype did not affect Mini-Mental State Examination scores. Testing the GCLM genotype in an independent group of stroke patients may determine whether this association with vascular cognitive impairment is genuine.

Antidepressant prophylaxis for poststroke depression: a meta-analysis

Given the high incidence of poststroke depression, its serious sequelae, and inherent problems with diagnosis, prophylactic use of antidepressants may be a viable management strategy in patients experiencing stroke. The purpose of this study was to assess the prophylactic effects of antidepressants in nondepressed patients with stroke. A meta-analysis of randomized placebo-controlled trials evaluating the prophylactic effects of antidepressants in nondepressed patients with stroke was conducted. Literature searches in MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, Cochrane library, and CNKI from 1950 to August 2006 were used to identify the relevant studies. Outcome measures included the occurrence rate of newly developed poststroke depression cases and severity of depressive symptoms as indicated by mean depression rating scale scores. The effect size was presented as rate difference or weighted mean difference. From 10 randomized clinical trials, a total of 703 nondepressed patients after stroke were identified. The pooled occurrence rate of newly developed poststroke depression cases in the intervention and control groups were 12.54 (41/327) and 29.17% (91/312), respectively (pooled rate difference=-0.17, 95% confidence interval: -0.26 to -0.08). Prophylactic effects of antidepressants were not related to duration of use {coefficient of Pearson's correlation [gamma]=0.57, P=0.11}. In conclusion, antidepressant prophylaxis is associated with a significant reduction in the occurrence rate of newly developed poststroke depression, suggesting antidepressants may be considered along with other vascular preventive strategies in the management of stroke patients.

The effect of a therapy dog on the communication skills of an adult with aphasia

Little evidence-based research has been published within the field of communication disorders on the role of dogs as catalysts for human communication. This single participant study, a point of entry into this realm of research, explores the effects of a therapy dog on the communication skills of a patient with aphasia receiving intensive speech and language therapy within a rehabilitation setting. The researchers conclude that the presence of the dog does have the potential to stimulate both overt social-verbal and social-nonverbal communication.

LEARNING OUTCOMES

As a result of this activity the reader will be able to (1) describe the beneficial role of dogs to serve as catalysts for human communication (2) describe ways in which a person with aphasia may be assisted by a therapy dog and (3) become familiar with an animal-assisted therapy (AAT) program set-up for patients with communication disorders within a rehabilitation setting.

Comparing Mattis Dementia Rating Scale--initiation/perseveration subset and frontal assessment battery in stroke associated with small vessel disease

Forty-two controls and 32 patients with stroke associated with small vessel disease (SSVD) were administered the Mattis Dementia Rating Scale Initiation / Perseveration subset (MDRS I/P) and Frontal Assessment Battery (FAB). Both tests showed comparably good ability in Receiver Operating Characteristics curves analysis (AUCMDRS I/P=0.887; AUC FAB=0.854, p=.833) in discriminating between controls and patients and correctly classified over 78% of subjects. Verbal fluency and motor programming contributed most to the discriminating power in the two tests. The MDRS I/P and FAB are useful in discriminating between controls and SSVD patients in a hospital setting.

Secondary obsessive-compulsive disorder related to diaschisis after pontine infarction, successfully treated with paroxetine

This report describes a case of secondary obsessive-compulsive disorder related to diaschisis after pontine infarction. A 71-year-old male developed obsessive images, after a pontine infarction. A brain magnetic resonance imaging scan showed a low intensity area in the right pons on T1-weighted image, while brain single photon emission computed tomography showed low cerebral blood flow in the temporal lobe as well as the pons. In this case, infarction in the pons appeared to cause dysfunction in the temporal lobe via the neural projection network, an example of so-called 'diaschisis'. This case suggests that brainstem infarction and decreased temporal lobe perfusion can lead to secondary obsessive-compulsive disorder.

A new procedure for communication with a patient with minimal motor function and fatigability

As with eye movements in locked-in syndrome, severe motor dysfunction should be coped with by an agreed system of interpretation to express feelings and needs. However, it is possible that such patients might make errors in the agreed system of interpretation through fatigue, which would cause misunderstandings. We report here a new questioning and verifying strategy for an agreed system of interpretation. Our questioning strategy is characterized by repeating questions in different forms, specifically by affirmative and negative sentences (Double-Checked agreed system of interpretation). When the patient wants to express "Yes", a single movement is required for an affirmative question and no movement is required for a negative one. When the patient wants to express "No", no movement is required for an affirmative question and one movement is required for a negative one. The Double-Checked agreed system of interpretation can help patients to cope with fatigability and can also help to prevent misunderstandings. If the same responses to both affirmative and negative questions are given, we can consider that those answers reflect fatigue. In addition, we have developed a strategy to evaluate the patient's understanding of the Double-Checked agreed system of interpretation by modifying the Western Aphasia Battery. This report describes how to apply the Double-Checked agreed system of interpretation, using the example of a 48-year-old brain-injured man with minimal motor function and severe fatigability.

Rasch analysis of the scoring scheme of the HADS Depression subscale in Chinese stroke patients

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for depression in medically ill patients. The purpose of this study was to examine the optimal scoring scheme, unidimensionality and item fit of the depression subscale of the HADS (HADS-D) in stroke survivors. A research assistant administered the HADS-D to 100 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the HADS-D scores, administered the SCID-DSM-III-R to all 100 patients and made a DSM-IV diagnosis of depression, which served as the benchmark for judging the performance of the HADS-D in screening for depression. Rasch analysis has shown that the HADS-D was unidimensional; low endorsements for the higher coded alternative response categories were found in the sample. In clinical samples with a low frequency of depression, the scoring categories of the HADS-D may be reduced.

Neuropsychological findings in young-adult stroke patients

There are few data on neuropsychological deficits in young-adult stroke patients. This study investigates cognitive conditions in a young-adult stroke population, as well as tasks that detect their neuropsychological impairment. Forty 18- to 47-year-old stroke patients, and a matched control group, completed a neuropsychological battery to evaluate deficits related to cognition, daily activities and mood. Patients performed worse than controls; five patients were classified as demented, three had global cognitive impairment and eight partial cognitive impairment. Cognitive impairment was more closely associated with reduced performance of daily activities than with motor deficits.

Psychoneuroimmunology of stroke

There is now considerable evidence from both experimental and clinical studies that immune and inflammatory processes can contribute to the onset of stroke and the neurologic and psychologic outcomes. Several specific therapeutic targets have been identified that may significantly improve the devastating impact of stroke.

Painting after right-hemisphere stroke - case studies of professional artists

Changes in the style of professional artists as an immediate consequence of cerebrovascular disease are an intriguing phenomenon for the neuroscientist. While left-hemisphere damage is commonly provoking alterations in verbal production and comprehension, right-hemisphere stroke often leads to left-sided visuospatial neglect. We present a case series of 13 professional artists with right-hemisphere stroke and compare examples of their poststroke artwork with their prestroke artwork.

[Neuropsychological approach to visual attention]

Visual experience depends critically on visual attention, which selects a particular aspect of a visual display. Recent clinical, neuroimaging, and animal studies revealed that visual attention was divided into active and passive or top-down and bottom-up attention. Although these dichotomies are clear-cut in definition, visual attention could be modulated by many factors. Detailed observation of brain-injured patients provides with evidence for dynamic and fine control of visual attention. We observed patients with dorsal simultanagnosia and that with callosal disconnection syndrome. Patients with dorsal simultanagnosia demonstrated that extent of visual attention was dynamically changed depending on the level of visual processing. Despite the ability to read a kanji character and to describe its components correctly, a patient could not notice a component that he had just written and could not assemble individual components to make up a correct kanji character. He could point to an overlapping area of two figures. But once he started to color the overlapping area, he missed the margin of the area and colored much larger area. Another patient with dorsal simultanagnosia missed borderlines between columns of a newspaper and read letters continuously across columns. In contrast, he could point to lines between figures or meaningless patterns easily. These findings indicated that visual attention was directed automatically to meaningful characters. A patients with callosal disconnection syndrome demonstrated left unilateral spatial neglect only when he used his right hand to draw figures. Right hand movement, controlled by the left hemisphere, elicited visual attention to the right hemispace, resulting in the left unilateral spatial neglect. Thus visual attention is not simply top-down or bottom up, but is implicitly affected by the visual recognition as well as motor component of the task.

Thematic role assignment in patients with Broca's aphasia: Sentence–picture matching electrified

An event-related brain potential experiment was carried out to investigate on-line thematic role assignment during sentence-picture matching in patients with Broca's aphasia. Subjects were presented with a picture that was followed by an auditory sentence. The sentence either matched the picture or mismatched the visual information depicted. Sentences differed in complexity, and ranged from simple active semantically irreversible sentences to passive semantically reversible sentences. ERPs were recorded while subjects were engaged in sentence-picture matching. In addition, reaction time and accuracy were measured. Three groups of subjects were tested: Broca patients (N=10), non-aphasic patients with a right hemisphere (RH) lesion (N=8), and healthy aged-matched controls (N=15). The results of this study showed that, in neurologically unimpaired individuals, thematic role assignment in the context of visual information was an immediate process. This in contrast to patients with Broca's aphasia who demonstrated no signs of on-line sensitivity to the picture-sentence mismatches. The syntactic contribution to the thematic role assignment process seemed to be diminished given the reduction and even absence of P600 effects. Nevertheless, Broca patients showed some off-line behavioral sensitivity to the sentence-picture mismatches. The long response latencies of Broca's aphasics make it likely that off-line response strategies were used.

[Neuropsychological approach to visual attention]

Visual experience depends critically on visual attention, which selects a particular aspect of a visual display. Recent clinical, neuroimaging, and animal studies revealed that visual attention was divided into active and passive or top-down and bottom-up attention. Although these dichotomies are clear-cut in definition, visual attention could be modulated by many factors. Detailed observation of brain-injured patients provides with evidence for dynamic and fine control of visual attention. We observed patients with dorsal simultanagnosia and that with callosal disconnection syndrome. Patients with dorsal simultanagnosia demonstrated that extent of visual attention was dynamically changed depending on the level of visual processing. Despite the ability to read a kanji character and to describe its components correctly, a patient could not notice a component that he had just written and could not assemble individual components to make up a correct kanji character. He could point to an overlapping area of two figures. But once he started to color the overlapping area, he missed the margin of the area and colored much larger area. Another patient with dorsal simultanagnosia missed borderlines between columns of a newspaper and read letters continuously across columns. In contrast, he could point to lines between figures or meaningless patterns easily. These findings indicated that visual attention was directed automatically to meaningful characters. A patients with callosal disconnection syndrome demonstrated left unilateral spatial neglect only when he used his right hand to draw figures. Right hand movement, controlled by the left hemisphere, elicited visual attention to the right hemispace, resulting in the left unilateral spatial neglect. Thus visual attention is not simply top-down or bottom up, but is implicitly affected by the visual recognition as well as motor component of the task.

Action and object processing in aphasia: from nouns and verbs to the effect of manipulability

The processing of words and pictures representing actions and objects was tested in 21 aphasic patients and 20 healthy controls across three word production tasks: picture-naming (PN), single word reading (WR) and word repetition (WRP). Analysis 1 targeted task and lexical category (noun-verb), revealing worse performance on PN and verb items for both patients and control participants. For Analysis 2 we used data collected in a concurrent gesture norming study to re-categorize the noun-verb items along hand imagery parameters (i.e., objects that can/cannot be manipulated and actions which do/do not involve fine hand movements). Here, patients displayed relative difficulty with the 'manipulable' items, while controls displayed the opposite pattern. Therefore, whereas the noun-verb distinction resulted simply in lower verb accuracy across groups, the 'manipulability' distinction revealed a 'double-dissociation' between patients and control participants. These results carry implications for theories of embodiment, lexico-semantic dissociations, and the organization of meaning in the brain.

[Neural mechanisms for object and color recognition]

We reported double-dissociation between the visual processing of the edges and the surfaces of objects. Patients with lateral occipital damage showed selective impairment in the perception of edges whereas those with medial ventral occipital damage showed selective impairment in the perception of the 3D structure of the surface. Patients with medial ventral occipital damage also exhibited impaired perception of color, which is also a surface property. Those results were consistent with those from neuroimaging studies. Taken together, those studies suggest that objects may be processed in two separate pathways in the ventral occipital cortex: the edges of objects are processed in the lateral pathway and the surface of objects are processed in the medial pathway. Both edges and surfaces play important roles in object recognition, and both types of perception should be evaluated in patients with visual agnosia.

[Neural mechanisms for object and color recognition]

We reported double-dissociation between the visual processing of the edges and the surfaces of objects. Patients with lateral occipital damage showed selective impairment in the perception of edges whereas those with medial ventral occipital damage showed selective impairment in the perception of the 3D structure of the surface. Patients with medial ventral occipital damage also exhibited impaired perception of color, which is also a surface property. Those results were consistent with those from neuroimaging studies. Taken together, those studies suggest that objects may be processed in two separate pathways in the ventral occipital cortex: the edges of objects are processed in the lateral pathway and the surface of objects are processed in the medial pathway. Both edges and surfaces play important roles in object recognition, and both types of perception should be evaluated in patients with visual agnosia.

GRAND ROUNDS: Topographical Heading Disorientation - A Case Study

We report the case of a patient with selective topographic orientation deficits in both familiar and novel environments after bilateral medial occipital infarctions. Extensive neuropsychological assessment revealed intact functioning in all other cognitive domains. The findings are interpreted in terms of a dissociation between the retrosplenial posterior cingulate and the superior parietal lobule in the right hemisphere.

General and disease-specific risk factors for depression after ischemic stroke: a two-step Cox regression analysis

BACKGROUND

Post-stroke depression (PSD) frequently complicates stroke and is associated with an impaired functional outcome, more severe cognitive deficits, a reduced quality of life, and a higher mortality. The aim of this study was to assess whether general risk factors for major depressive disorder (MDD) in the community are also risk factors for PSD, and to identify additional, stroke-related risk factors.

METHODS

In a hospital setting, 190 consecutively admitted patients were assessed for MDD 1 month after stroke, and at follow-up after 3, 6, 9 and 12 months. A Cox model was created with four established risk factors for MDD in the community (female sex, prior personal history of depression, positive family history of depression, and somatic comorbidity other than stroke). Five potential disease-related risk factors (disability, cognitive deterioration, inter- and intrahemispheric lesion location, and generalized vascular damage on computed tomography (CT) scan) were then added individually to this model, to see whether these would improve the significance of the overall model.

RESULTS

The Cox model of four general risk factors for depression in the community was shown to be a valid model to predict depression in stroke patients. Of the disease-specific factors, only incorporation of "disability" in this model improved its significance.

CONCLUSION

Established risk factors for depression in the community are also predictors of depression in the first year after stroke. Disability is a non-specific disease-related variable that is associated with PSD. The contribution of stroke-specific factors may be less than is generally assumed.

Die Apathy Evaluation Scale: Erste Ergebnisse zu den psychometrischen Eigenschaften einer deutschsprachigen Übersetzung der Skala

Apathy is a common feature of a variety of different psychiatric, neurological, and medical disorders. It can be defined as lack of motivation affecting cognitive, emotional, and overt behavioural aspects. Despite being associated with other clinical disorders, apathy can also occur as an independent syndrome (e. g., after brain injuries), now depicting a primary loss of motivation. However, apathy is predominantly assessed within the scope of superordinate psychiatric disorders. As a syndrome-independent scale, the Apathy Evaluation Scale (AES) claims to assess levels of apathy in different disorders. The aim of the present study is to provide German speaking researchers with an authorized German translation of the AES (AES (D)). The scale was evaluated in a sample of 217 subjects, consisting of patients suffering from dementia (n=120), remission-phase schizophrenia (n=20), Parkinson's disease (n=12), stroke (n=28), as well as elderly healthy controls (n=37). Preliminary results concerning the factorial structure, item characteristics, reliability, and construct validity demonstrate favourable statistical properties and suggest that the AESD is comparable to its original. The scale seems well-suited to detect apathy in different clinical groups. Differences between informant sources (clinician interview, self-, and informant ratings) seem to be related to the severity of symptoms or expert practice.

Single voxel proton magnetic resonance spectroscopy in post-stroke depression

Mood disorders are associated with structural, metabolic and spectroscopic changes in prefrontal regions. In the case of depression associated with stroke, there is little information about the biochemical profile of these regions, as assessed by proton magnetic resonance spectroscopy ((1)H-MRS). In a group of first-ever stroke patients, we studied the association between post-stroke depression and (1)H-MRS measurements in unaffected frontal lobes. Twenty-six patients with a first ischemic stroke located outside the frontal lobes were included in the study. Single voxel proton magnetic resonance spectroscopy ((1)H-MRS) was performed to assess N-acetylaspartate/creatine (NAA)/Cr, glutamate+glutamine (Glx)/Cr, choline (Cho)/Cr and myo-inositol (mI)/Cr ratios. Patients were assessed within the first 10 days after stroke and again four months later. The diagnosis of depression was made on the basis of clinical observation, interview and Hamilton Depression Rating Scale scores. In a group of 26 patients, eight (31%) met criteria for depression at the first assessment, and nine (35%) met criteria for depression at follow-up. Patients with depression in the immediate post-stroke phase had significantly higher Glx/Cr ratios in the contralesional hemisphere than non-depressive patients. No biochemical differences were found between the groups at 4-month follow-up. These findings suggest that post-stroke depression is accompanied by changes in frontal lobe glutamate/glutamine levels, perhaps reflecting abnormalities in glutamatergic transmission in the immediate post-stroke period.

The cerebellum and emotional experience

While the role of the cerebellum in motor coordination is widely accepted, the notion that it is involved in emotion has only recently gained popularity. To date, functional neuroimaging has not been used in combination with lesion studies to elucidate the role of the cerebellum in the processing of emotional material. We examined six participants with cerebellar stroke and nine age and education matched healthy volunteers. In addition to a complete neuropsychological, neurologic, and psychiatric examination, participants underwent [15O]water positron emission tomography (PET) while responding to emotion-evoking visual stimuli. Cerebellar lesions were associated with reduced pleasant experience in response to happiness-evoking stimuli. Stroke patients reported an unpleasant experience to frightening stimuli similar to healthy controls, yet showed significantly lower activity in the right ventral lateral and left dorsolateral prefrontal cortex, amygdala, thalamus, and retrosplenial cingulate gyrus. Frightening stimuli led to increased activity in the ventral medial prefrontal, anterior cingulate, pulvinar, and insular cortex. This suggests that alternate neural circuitry became responsible for maintaining the evolutionarily critical fear response after cerebellar damage.

Transverse patterning and human amnesia

The transverse patterning (TP) task (A+ B-, B+ C-, C+ A-) has played a central role in testing the hypothesis that medial-temporal (and, in particular, hippocampal) brain damage selectively impairs learning on at least some classes of configural (i.e., nonlinear) learning tasks. Results in the animal and human literature generally support that hypothesis. Reed and Squire [Impaired transverse patterning in human amnesia is a special case of impaired memory for two-choice discrimination tasks. Behavioral Neuroscience, 113, 3-9, 1999], however, advanced an alternative account in which impaired TP performance in amnesia reflects a generic scaling artifact arising from the greater difficulty of the TP task compared to the elemental (i.e., linear) control task that is typically used. We begin with a critique of Reed and Squire, countering their conceptual arguments and showing that their results, when analyzed appropriately, support the configural deficit hypothesis. We then report results from eight new amnesic patients and controls on an improved version of the TP task. Despite substantial practice, accuracy of patients with bilateral hippocampal damage due to anoxia reached and maintained an asymptote of only 54% correct, well below the maximum accuracy obtainable (67%) in the absence of configural learning. A patient with selective bilateral damage to the anterior thalamic nuclei exhibited a TP accuracy asymptote that was near 67%, a pattern of two out of three correct consecutive trials, and a pattern of nearly always answering correctly for two of the three TP item pairs. These results are consistent with a set of unique and parameter-free predictions of the configural deficit hypothesis.

Common neuropsychological deficits associated with stroke survivors' impaired performance on a useful field of view test

Useful field of view is a measure of information processing in peripheral vision that has potential for predicting impaired driving performance. The present study was performed to examine whether common neuropsychological deficits resulting from stroke might be associated with useful field of view impairment. 46 stroke survivors had impaired useful field of view test performance when compared to individuals without stroke (t30.6= -4.33, p<.001). The impairments in useful field of view of stroke survivors were associated with impaired peripheral fields, slowed processing speeds, and diminished attention. Such impairment was not localized to lesions in any particular brain area. Results allow the inference that common neuropsychological impairments may have contributed to inefficient extraction of visual information from peripheral vision.