Neurobiology of Unilateral Spatial Neglect

Made you look! Consciously perceived, irrelevant instructional cues can hijack the attentional network

Functional neuroimaging studies of endogenous cued attention suggest that a fronto-parietal attentional network keeps track of current task objectives in working memory and enhances activity in posterior sensory regions that underlie the perceptual processing of behaviorally relevant stimuli. Relatively little is known, however, about whether consciously perceived, irrelevant instructional cues can hijack the attentional network, leading to an enhancement of the perceptual processing of irrelevant stimuli. Using a cross-modal attentional cueing task in combination with functional magnetic resonance imaging, we found that such irrelevant cues can indeed hijack the attentional network, as indexed by increased activity in (a) frontal regions that control attention and (b) sensory cortices that underlie the perceptual processing of task-irrelevant stimuli. Furthermore, we found that in left ventrolateral (but not dorsolateral) prefrontal regions, the magnitude of this increased activity varies with whether an irrelevant instructional cue is presented simultaneously with (versus after) a relevant instructional cue. These findings show that consciously perceived, irrelevant instructional cues can activate inappropriate task objectives in working memory, resulting in a hijacking of the attentional network. Moreover, they reveal different time courses of hijacking effects in ventrolateral and dorsolateral prefrontal regions, consistent with models in which these regions make distinct contributions to cognitive control.

Some surprising findings on the involvement of the parietal lobe in human memory

The posterior parietal lobe is known to play some role in a far-flung list of mental processes: linking vision to action (saccadic eye movements, reaching, grasping), attending to visual space, numerical calculation, and mental rotation. Here, we review findings from humans and monkeys that illuminate an untraditional function of this region: memory. Our review draws on neuroimaging findings that have repeatedly identified parietal lobe activations associated with short-term or working memory and episodic memory. We also discuss recent neuropsychological findings showing that individuals with parietal lobe damage exhibit both working memory and long-term memory deficits. These deficits are not ubiquitous; they are only evident under certain retrieval demands. Our review elaborates on these findings and evaluates various theories about the mechanistic role of the posterior parietal lobe in memory. The available data point towards the conclusion that the posterior parietal lobe plays an important role in memory retrieval irrespective of elapsed time. However, the available data do not support simple dichotomies such as recall versus recognition, working versus long-term memory. We conclude by formalizing several open questions that are intended to encourage future research in this rapidly developing area of memory research.

Role of right posterior parietal cortex in maintaining attention to spatial locations over time

Recent models of human posterior parietal cortex (PPC) have variously emphasized its role in spatial perception, visuomotor control or directing attention. However, neuroimaging and lesion studies also suggest that the right PPC might play a special role in maintaining an alert state. Previously, assessments of right-hemisphere patients with hemispatial neglect have revealed significant overall deficits on vigilance tasks, but to date there has been no demonstration of a deterioration of performance over time--a vigilance decrement--considered by some to be a key index of a deficit in maintaining attention. Moreover, sustained attention deficits in neglect have not specifically been related to PPC lesions, and it remains unclear whether they interact with spatial impairments in this syndrome. Here we examined the ability of right-hemisphere patients with neglect to maintain attention, comparing them to stroke controls and healthy individuals. We found evidence of an overall deficit in sustaining attention associated with PPC lesions, even for a simple detection task with stimuli presented centrally. In a second experiment, we demonstrated a vigilance decrement in neglect patients specifically only when they were required to maintain attention to spatial locations, but not verbal material. Lesioned voxels in the right PPC spanning a region between the intraparietal sulcus and inferior parietal lobe were significantly associated with this deficit. Finally, we compared performance on a task that required attention to be maintained either to visual patterns or spatial locations, matched for task difficulty. Again, we found a vigilance decrement but only when attention had to be maintained on spatial information. We conclude that sustaining attention to spatial locations is a critical function of the human right PPC which needs to be incorporated into models of normal parietal function as well as those of the clinical syndrome of hemispatial neglect.

Spatial neglect: clinical and neuroscience review: a wealth of information on the poverty of spatial attention

Hemispatial neglect (HSN) is a frequent, conspicuous neurobehavioral accompaniment of brain injury. Patients with HSN share several superficial similarities, leading earlier clinical neuroscientists to view neglect as a unitary condition associated with brain structures that mediate relatively discrete spatial cognitive mechanisms. Over the last two decades, research largely deconstructed the neglect syndrome, revealing a remarkable heterogeneity of behaviors and providing insight into multiple component processes, both spatial and nonspatial, that contribute to hemispatial neglect. This review surveys visual HSN, presenting first the means for detection and diagnosis in its manifold variations. We summarize cognitive operations relevant to spatial attention and evidence for their role in neglect behaviors and then briefly consider neural systems that may subserve the component processes. Finally, we propose several methods for rehabilitating HSN, including the challenges facing remediation of such a heterogeneous cognitive disorder.

Gender differences in unilateral spatial neglect within 24 hours of ischemic stroke

Hemispatial neglect is a common and disabling consequence of stroke. Previous reports examining the relationship between gender and the incidence of unilateral spatial neglect (USN) have included either a large numbers of patients with few neglect tests or small numbers of patients with multiple tests. To determine if USN was more common and/or severe in men or women, we examined a large group of patients (312 right-handed) within 24 hours of acute right hemisphere ischemic stroke. Multiple spatial neglect tasks were used to increase the sensitivity of neglect detection. No differences based upon gender were observed for the prevalence, severity, or a combined task measure of USN.

Neuronal plasticity and functional recovery after ischemic stroke

Ischemic stroke affects many new patients each year. The sequelae of brain ischemia can include lasting sensorimotor and cognitive deficits, which negatively impact quality of life. Currently, treatment options for improving poststroke deficits are limited, and the development of new clinical alternatives to improve functional recovery after stroke is actively under investigation. Anti-Nogo-A immunotherapy to reduce the central nervous system inhibitory environment, cell transplantation strategies, pharmacological agents, and movement-based therapies represent emerging treatments of poststroke deficits through enhancement of neuroanatomical plasticity.

Functional MRI of the primary somatosensory cortex in extinction to simultaneous bilateral tactile stimuli due to right temporal lobe stroke

Patients with right posterior temporoparietal cortical lesions often exhibit extinction to tactile double simultaneous stimuli (EDSS). It is not known whether sensory unawareness-extinction results from suppression of sensory input into the somatosensory cortex (SI), inhibition of SI, or interference which prevents SI output from activating and being fully processed by association areas. A patient with EDSS due to a right temporal stroke sparing SI and posterior parietal cortex and eight age-matched healthy controls were studied with fMRI during tactile stimulation. The volume of activation of SI during tactile stimulation of the right hand, the left hand and both hands was measured and the patient's volume of activation was compared to that of the control subjects in each of these stimulus conditions. Although the patient demonstrated behavioral EDSS, during fMRI the patient's activation of SI on both sides was within the range of the control participants' volumes of activation. These findings suggest that EDSS in patients with a right temporal lobe stroke results from processing abnormalities that occur after these afferent tactile stimuli are processed by SI.

Dissociation of egocentric and allocentric coding of space in visual search after right middle cerebral artery stroke

Spatial representations rely on different frames of reference. Patients with unilateral neglect may behave as suffering from either egocentric or allocentric deficiency. The neural substrates representing these reference frames are still under discussion. Here we used a visual search paradigm to distinguish between egocentric and allocentric deficits in patients with right hemisphere cortical lesions. An attention demanding search task served to divide patients according to egocentric versus allocentric deficits. The results indicate that egocentric impairment was associated with damage in premotor cortex involving the frontal eye fields. Allocentric impairment on the other hand was linked to lesions in more ventral regions near the parahippocampal gyrus (PHG).

Breakdown of functional connectivity in frontoparietal networks underlies behavioral deficits in spatial neglect

Spatial neglect is a syndrome following stroke manifesting attentional deficits in perceiving and responding to stimuli in the contralesional field. We examined brain network integrity in patients with neglect by measuring coherent fluctuations of fMRI signals (functional connectivity). Connectivity in two largely separate attention networks located in dorsal and ventral frontoparietal areas was assessed at both acute and chronic stages of recovery. Connectivity in the ventral network, part of which directly lesioned, was diffusely disrupted and showed no recovery. In the structurally intact dorsal network, interhemispheric connectivity in posterior parietal cortex was acutely disrupted but fully recovered. This acute disruption, and disrupted connectivity in specific pathways in the ventral network, strongly correlated with impaired attentional processing across subjects. Lastly, disconnection of the white matter tracts connecting frontal and parietal cortices was associated with more severe neglect and more disrupted functional connectivity. These findings support a network view in understanding neglect.

Right hemispatial neglect: frequency and characterization following acute left hemisphere stroke

The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed patients within 48h of left hemisphere stroke to determine the frequency and distribution of types of right USN using cognitive testing and MRI imaging. The distribution of USN types was different from the previously reported distribution following acute right hemisphere stroke. In this left hemisphere stroke population, allocentric neglect was more frequent than egocentric neglect.

Neural correlates of modality-specific spatial extinction

Sites of lesions responsible for visual, tactile, and/or motor extinction have not been clearly identified. We sought to determine the frequency of extinction in various modalities immediately after acute ischemic stroke, the rate of co-occurrence of extinction across modalities, and areas of infarct and/or hypoperfusion associated with each modality of extinction. A total of 148 patients with right supratentorial stroke were studied. In Study 1, 88 patients without hemiplegia, hemianesthesia, or visual field cuts were tested within 24 hours of onset for visual, tactile, and motor extinction, and underwent magnetic resonance diffusion and perfusion imaging. Associations between modality of extinction and areas of neural dysfunction (hypoperfusion/infarct) were identified. Of the 88 patients, 19 had only tactile extinction, 8 had only visual extinction, 12 had only motor extinction, 14 had extinction in two or more modalities, and 35 had no extinction. Tactile extinction was associated with neural dysfunction in the inferior parietal lobule; visual extinction was associated with dysfunction in the visual association cortex; and motor extinction was associated with neural dysfunction in the superior temporal gyrus. In Study 2, data from 60 patients who were excluded from Study 1 because of motor deficits were analyzed in the same way to determine whether frontal lesions contributed to visual or tactile extinction. Results again demonstrated that tactile extinction is associated with inferior parietal dysfunction, and visual extinction is associated with dysfunction of the visual association cortex. Potential accounts of the results, based on the "hemisphere rivalry" model of extinction and the limited attentional capacity model, are considered.