Age-related changes in visual pseudoneglect

Reduced Visuospatial Attention in Personal Space is Not Limited to the Affected Limb in Complex Regional Pain Syndrome

Purpose

Alterations in spatial attention have been reported in people with chronic pain and may be relevant to understanding its cortical mechanisms and developing novel treatments. There is conflicting evidence as to whether people with Complex Regional Pain Syndrome (CRPS) have reduced visuospatial attention to their affected limb and/or its surrounding space, with some evidence that these deficits may be greater in personal (bodily) space. We aimed to test the competing hypotheses of whether the visuospatial attentional bias is specific to the personal space of the affected limb or generalizes to the personal space of other parts of the affected side of the body.

Patients and Methods

Using visual Temporal Order Judgement tasks, we measured spatial attention in the personal space of the hands and feet of patients with upper (n=14) or lower (n=14) limb CRPS and pain-free controls (n=17). Participants judged the order of two light flashes presented at different temporal offsets on each of their hands or feet. Slower processing of the flash on one side relative to the other reflects reduced attention to that side of space.

Results

Controls prioritized stimuli on the non-dominant (left) relative to dominant side, consistent with the well-documented normal leftward bias of attention (ie "pseudoneglect"). Regardless of the location (upper or lower limb) of the pain or visual stimuli, people with CRPS showed no such asymmetry, representing reduced attention to the affected side (compared to the greater attention of controls to their non-dominant side). More severe CRPS symptoms were associated with a greater tendency to deprioritize stimuli on the affected side.

Conclusion

Our findings suggest that relative visuospatial bias in CRPS is generalized to the personal space of the affected side of the body, rather than being specific to the personal space of the CRPS-affected limb.

Uncovering the (un)attended: Pupil light responses index persistent biases of spatial attention in neglect

Visuospatial neglect is a frequent and disabling disorder, mostly after stroke, that presents in impaired awareness to stimuli on one side of space. Neglect causes disability and functional dependence, even long after the injury. Improving measurements of the core attentional deficit might hold the key for better understanding of the condition and development of treatment. We present a rapid, pupillometry-based method that assesses automatic biases in (covert) attention, without requiring behavioral responses. We exploit the phenomenon that pupil light responses scale with the degree of covert attention to stimuli, and thereby reveal what draws (no) attention. Participants with left-sided neglect after right-sided lesions following stroke (n = 5), participants with hemianopia/quadrantanopia following stroke (n = 11), and controls (n = 22) were presented with two vertical bars, one of which was white and one of which was black, while fixating the center. We varied which brightness was left and right, respectively across trials. In line with the hypotheses, participants with neglect demonstrated biased pupil light responses to the brightness on the right side. Participants with hemianopia showed similar biases to intact parts of the visual field, whilst controls exhibited no bias. Together, this demonstrates that the pupil light response can reveal not only visual, but also attentional deficits. Strikingly, our pupillometry-based bias estimates were not in agreement with neuropsychological paper-and-pencil assessments conducted on the same day, but were with those administered in an earlier phase post-stroke. Potentially, we pick up on persistent biases in the covert attentional system that participants increasingly compensate for in classical neuropsychological tasks and everyday life. The here proposed method may not only find clinical application, but also advance theory and aid the development of successful restoration therapies by introducing a precise, longitudinally valid, and objective measurement that might not be affected by compensation.

Impact of aging on perceptual asymmetries for horizontal and vertical stimuli in the greyscales task

Through the paper version of the grayscale task, this study examines the impact of aging and gender on horizontal and vertical pseudoneglect in healthy right-handed Japanese people. Participants included 168 (84 women and 84 men) healthy right-handed participants between the ages of 18 and 85, which were divided into three age cohorts (i.e., young, middle, and older). When administering the task, in the horizontal condition, the stimulus set of the grayscale task waspositioned at the center of the desk. In the vertical condition, the stimulus set was placed at the participants' eye level on the front screen. A reliable left bias was observed across all age groups in the horizontal task, although individual differences in the young group were significant. Moreover, gender differences and age-gender interactions were not confirmed. Similarly, in the vertical task, an upward bias was identified in both women and men across all age groups. Furthermore, there was a weak correlation between the horizontal and vertical bias index. These results were inconsistent with those of a previous study and other research using manual line bisection and landmark tasks. Further, we comprehensively deliberated on the cognitive/neural basis of horizontal and vertical pseudoneglect.

Using prism adaptation to alleviate perception of unilateral tinnitus: A case study

Tinnitus is described as an uncomfortable sound or noise heard by an individual in the absence of an external sound source. Treating this phantom perception remains difficult even if drug and nondrug therapies are used to alleviate symptoms. The present case study aimed to investigate whether prism adaptation could induce beneficial aftereffects in a tinnitus sufferer. A 75-year-old man, R. B., with chronic unilateral tinnitus in the left ear reported a self-estimation of parameters of his tinnitus-discomfort, pitch and loudness-and performed a manual line-bisection task to study the consequences of lateralized auditory disorder on spatial representation. Aftereffects of prism adaptation were assessed using a sensorimotor open-loop pointing task. In parallel, a control group completed the line-bisection task and the open-loop pointing task before and after lens exposure, under the same experimental condition as those of R. B. Throughout the pretests, the patient assessed his tinnitus at a constant medium pitch (around 3000 Hz), and he was biased toward the affected ear in both the sensorimotor task and the estimation of the subjective center in the manual line-bisection task. Although both optical deviations were effective, an exposure to prism adaptation to a rightward optical deviation (i.e., toward the unaffected ear) produced stronger aftereffects. In posttests, the tinnitus pitch decreased to 50 Hz and the subjective center was shifted toward the right side (i.e., unaffected ear side). Furthermore, the line-bisection task seemed to reflect the changes in the tinnitus perception, and spatial representation could be a new tool to assess tinnitus indirectly. Our findings suggest that prism adaptation may have benefits on unilateral tinnitus and open a new avenue for its treatment.

Connectivity alterations underlying the breakdown of pseudoneglect: New insights from healthy and pathological aging

A right-hemisphere dominance for visuospatial attention has been invoked as the most prominent neural feature of pseudoneglect (i.e., the leftward visuospatial bias exhibited in neurologically healthy individuals) but the neurophysiological underpinnings of such advantage are still controversial. Previous studies investigating visuospatial bias in multiple-objects visual enumeration reported that pseudoneglect is maintained in healthy elderly and amnesic mild cognitive impairment (aMCI), but not in Alzheimer’s disease (AD). In this study, we aimed at investigating the neurophysiological correlates sustaining the rearrangements of the visuospatial bias along the progression from normal to pathological aging. To this aim, we recorded EEG activity during an enumeration task and analyzed intra-hemispheric fronto-parietal and inter-hemispheric effective connectivity adopting indexes from graph theory in patients with mild AD, patients with aMCI, and healthy elderly controls (HC). Results revealed that HC showed the leftward bias and stronger fronto-parietal effective connectivity in the right as compared to the left hemisphere. A breakdown of pseudoneglect in patients with AD was associated with both the loss of the fronto-parietal asymmetry and the reduction of inter-hemispheric parietal interactions. In aMCI, initial alterations of the attentional bias were associated with a reduction of parietal inter-hemispheric communication, but not with modulations of the right fronto-parietal connectivity advantage, which remained intact. These data provide support to the involvement of fronto-parietal and inter-parietal pathways in the leftward spatial bias, extending these notions to the complex neurophysiological alterations characterizing pathological aging.

Vertical pseudoneglect: Sensory-attentional versus action-intentional

INTRODUCTION

Healthy persons demonstrate an upward bias on the vertical-line bisection test (vertical or "altitudinal" pseudoneglect). This bias might be sensory-attentional or action-intentional in origin. To test the action-intention hypothesis, we analyze whether the direction of action has an effect on altitudinal pseudoneglect.

METHODS

Twenty-four healthy right-handed adults performed vertical-line bisection on an apparatus designed to distinguish the effects of sensory-attention and action-intention. Depending on hand placement, participants estimated line midpoints with a marker that moved in the same (congruent) or opposite (incongruent) direction as their hand movements. Two binary factors - hand movement in the upward versus downward direction and congruent vs incongruent hand movements - produced four conditions.

RESULTS

There was upward deviation from the midline across all conditions. Bisections in the incongruent condition were higher than in the congruent condition. Bisections were also higher with upward hand movements than with downward hand movements. There was not a significant interaction between these factors.

CONCLUSIONS

These results suggest that vertical pseudoneglect is primarily influenced by the allocation of allocentric attention, rather than action-intention. However, action-perceptual spatial incongruence increased this deviation. Perhaps the incongruent condition requires greater allocation of attention, but further exploration is needed. Additionally, these results suggest that visual attention follows the direction of motor action. Future studies of visual attention should consider the potential influence of this factor.

Hemodialyzed Individuals' Left Spatial Attentional Bias Is Normalized Following Successful Kidney Transplantation

BACKGROUND

Healthy people have a leftward spatial attentional bias, called pseudoneglect. Individuals with end-stage renal disease (ESRD) who are receiving hemodialysis often demonstrate an increase in their leftward spatial attentional bias. Whereas a successful kidney transplant often improves the cognitive functions of individuals who previously received hemodialysis, the effect of a kidney transplant on this abnormal allocation of spatial attention has not been investigated.

OBJECTIVE

To investigate the effects of kidney transplant on individuals who were being treated with dialysis and had an increase in their left spatial attentional bias.

METHOD

The performance of 20 hemodialyzed individuals with ESRD on the line bisection test was compared to that of 17 demographically matched individuals with ESRD, who had received a kidney transplant, and 23 demographically matched healthy controls (HC).

RESULTS

All of the participants exhibited a left spatial bias on the line bisection task. When compared with the HC, the hemodialyzed individuals demonstrated a significantly greater left spatial bias. There was, however, no difference in spatial bias between the HC and the individuals who had received a kidney transplant.

CONCLUSION

A successful kidney transplant can improve patients' abnormal leftward allocation of spatial attention. However, future studies are needed to better understand the mechanisms of this spatial attentional bias in hemodialyzed individuals and the normalization of bias following transplantation.

Time Interaction With Two Spatial Dimensions: From Left/Right to Near/Far

In this study, we explored the time and space relationship according to two different spatial codings, namely, the left/right extension and the reachability of stimulus along a near/far dimension. Four experiments were carried out in which healthy participants performed the time and spatial bisection tasks in near/far space, before and after short or long tool-use training. Stimuli were prebisected horizontal lines of different temporal durations in which the midpoint was manipulated according to the Muller-Lyer illusion. The perceptual illusory effects emerged in spatial but not temporal judgments. We revealed that temporal and spatial representations dynamically change according to the action potentialities of an individual: temporal duration was perceived as shorter and the perceived line’s midpoint was shifted to the left in far than in near space. Crucially, this dissociation disappeared following a long but not short tool-use training. Finally, we observed age-related differences in spatial attention which may be crucial in building the memory temporal standard to categorize durations.

Signatures of functional visuospatial asymmetries in early infancy

Adults present a large number of asymmetries in visuospatial behavior that are known to be supported by functional brain lateralization. Although there is evidence of lateralization for motor behavior and language processing in infancy, no study has explored visuospatial attention biases in the early stages of development. In this study, we tested for the presence of a leftward visuospatial bias (i.e., pseudoneglect) in 4- and 5-month-old infants using an adapted version of the line bisection task. Infants were trained to identify the center of a horizontal line (Experiment 1) while their eye gazes were monitored using a remote eye-tracking procedure to measure their potential gazing error. Infants exhibited a robust pseudoneglect, gazing leftward with respect to the veridical midpoint of the horizontal line. To investigate whether infants' pseudoneglect generalizes to any given object or is dependent on the horizontal dimension, in Experiment 2 we assessed infants' gaze deployment in vertically oriented lines. No leftward bias was found, suggesting that early visuospatial attention biases in infancy are constrained by the orientation of the visual plane in which the information is organized. The interplay between biological and cultural factors that might contribute to the early establishment of the observed leftward bias in the allocation of visuospatial attention is discussed.

Opposed attentional hemi-bias on a visuoconstructive task in children with severe hyperactivity versus severe inattention

Twenty six empirical investigations have now established that children and adults with DSM-defined Attention deficit/Hyperactivity disorder (ADHD) of the Hyperactive type (ADHD-H) or, more commonly, Combined Hyperactive/Inattentive types (ADHD-C) manifest a small but significant visual attentional bias to the right side (left subclinical neglect), consistently suggesting the existence of a subtle right hemisphere dysfunction or hemispheric imbalance in hyperactive people. Only one research team has investigated and compared the DSM-defined Inattentive subtype (ADHD-I) to the Hyperactive subtype (ADHD-H), confirming that line bisection is biased to the right in ADHD-H and discovering that it is biased to the left in ADHD-I. We aimed to test whether a similar crossed double dissociation would extend to Rey's Complex Figure Copy Task (RCF-CT), a simple visuospatial-constructive task. Clinical files of 205 juvenile clients from 6 to 16 years of age from a neuropsychological private clinic specialized in ADHD were analysed. Extreme scores on the Connors-3 Hyperactivity vs Inattention Parent Rating scales associated, respectively, with significant rightward and significant leftward emplacement of the drawing on the page on the RCF-CT. These results replicate previous findings and extend the "energetics" model of hemispheric specialization.

Spatial asymmetries ("pseudoneglect") in free visual exploration-modulation of age and relationship to line bisection

When humans visually explore an image, they typically tend to start exploring its left side. This phenomenon, so-called pseudoneglect, is well known, but its time-course has only sparsely been studied. Furthermore, it is unclear whether age influences pseudoneglect, and the relationship between visuo-spatial attentional asymmetries in a free visual exploration task and a classical line bisection task has not been established. To address these questions, 60 healthy participants, aged between 22 and 86, were assessed by means of a free visual exploration task with a series of naturalistic, colour photographs of everyday scenes, while their gaze was recorded by means of a contact-free eye-tracking system. Furthermore, a classical line bisection task was administered, and information concerning handedness and subjective alertness during the experiment was obtained. The results revealed a time-sensitive window during visual exploration, between 260 and 960 ms, in which age was a significant predictor of the leftward bias in gaze position, i.e., of pseudoneglect. Moreover, pseudoneglect as assessed by the line bisection task correlated with the average gaze position throughout a time-window of 300–1490 ms during the visual exploration task. These results suggest that age influences visual exploration and pseudoneglect in a time-sensitive fashion, and that the degree of pseudoneglect in the line bisection task correlates with the average gaze position during visual exploration in a time-sensitive manner.

A Meta-Analysis of Line Bisection and Landmark Task Performance in Older Adults

Young adults exhibit a small asymmetry of visuospatial attention that favours the left side of space relative to the right (pseudoneglect). However, it remains unclear whether this leftward bias is maintained, eliminated or shifted rightward in older age. Here we present two meta-analyses that aimed to identify whether adults aged ≥50 years old display a group-level spatial attention bias, as indexed by the line bisection and the landmark tasks. A total of 69 datasets from 65 studies, involving 1654 participants, were analysed. In the meta-analysis of the line bisection task (n = 63), no bias was identified for studies where the mean age was ≥50, but there was a clear leftward bias in a subset where all individual participants were aged ≥50. There was no moderating effect of the participant’s age or sex, line length, line position, nor the presence of left or right cues. There was a small publication bias in favour of reporting rightward biases. Of note, biases were slightly more leftward in studies where participants had been recruited as part of a stand-alone older group, compared to studies where participants were recruited as controls for a clinical study. Similarly, no spatial bias was observed in the meta-analysis of the landmark task, although the number of studies included was small (n = 6). Overall, these results indicate that over 50s maintain a group-level leftward bias on the line bisection task, but more studies are needed to determine whether this bias can be modulated by stimulus- or state-dependent factors.

Right Hemisphere Memory Bias Does Not Extend to Involuntary Memories for Negative Scenes

Attention is unequally distributed across the visual field. Due to greater right than left hemisphere activation for visuospatial attention, people attend slightly more to the left than the right side. As a result, people voluntarily remember visual stimuli better when it first appears in the left than the right visual field. But does this effect-termed a right hemisphere memory bias-also enhance involuntary memory? We manipulated the presentation location of 100 highly negative images (chosen to increase the likelihood that participants would experience any involuntary memories) in three conditions: predominantly leftward (right hemisphere bias), predominantly rightward (left hemisphere bias), or equally in both visual fields (bilateral). We measured subsequent involuntary memories immediately and for 3 days after encoding. Contrary to predictions, biased hemispheric processing did not affect short- or long-term involuntary memory frequency or duration. Future research should measure hemispheric differences at retrieval, rather than just encoding.

The reliability of pseudoneglect is task dependent

Bisection tasks that require individuals to identify the midpoint of a line are often used to assess the presence of biases to spatial attention in both healthy and patient populations. These tasks have helped to uncover a phenomenon called pseudoneglect, a bias towards the left-side of space in healthy individuals. First identified in the tactile domain, pseudoneglect has been subsequently demonstrated in other sensory modalities such as vision. Despite this, the specific reliability of pseudoneglect within individuals across tasks and time has been investigated very little. In this study, we investigated the reliability of response bias within individuals across four separate testing sessions and during three line bisection tasks: landmark, line bisection and tactile rod bisection. Strong reliability was expected within individuals across task and session. Pseudoneglect was found when response bias was averaged across all tasks, for the entire sample. However, individual data showed biases to both left and right, with some participants showing no clear bias, demonstrating individual differences in bias. Significant, cross-session within-individual reliability was found for the landmark and tactile rod bisection tasks respectively, but no significant reliability was observed for the line bisection task. These results highlight the inconsistent nature of pseudoneglect within individuals, particularly across sensory modality. They also provide strong support for the use of the landmark task as the most reliable measure of pseudoneglect.

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Reliability of pseudoneglect was assessed across 4 sessions and 3 tasks.

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The landmark task was the most reliable test for pseudoneglect across sessions.

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Responses to line bisection and tactile rod were less reliable across sessions.

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Responses to different bisection tasks in the same individuals were not reliable.

Transcranial electric stimulation optimizes the balance of visual attention across space

OBJECTIVE

Transcranial direct current stimulation (tDCS) provides a way to modulate spatial attention by enhancing the ratio of neural activity between the left and right hemispheres, with a potential benefit for the rehabilitation of visual neglect.

METHODS

We tested the effect of bilateral tDCS in healthy individuals performing a visual detection task. This protocol consists in the positioning of the anode and cathode on mirror positions over the left and right parietal areas. The stimulation was repeated over three days to maximize the chance to observe a bias to the hemispace controlateral to the anode.

RESULTS

Compared to a sham treatment, left anodal - right cathodal stimulation enhanced attention across the full range of space, since the first day with no build-up effect on the next days, and modified the balance of left-right omissions when stimuli appeared at the same time.

CONCLUSION

Bilateral tDCS improved detection in both visual fields, with no privileged processing of one side, except when concurrent stimuli were presented. The results provide partial support to the hemispheric rivalry hypothesis.

SIGNIFICANCE

The technique has the potential to boost attention in neglect patients but should be used as an adjuvant rather than as an alternative to functional rehabilitation.

Intra- and inter-task reliability of spatial attention measures in healthy older adults

At present, there is a lack of systematic investigation into intra- and inter-task consistency effects in older adults, when investigating lateralised spatial attention. In young adults, spatial attention typically manifests itself in a processing advantage for the left side of space ("pseudoneglect"), whereas older adults have been reported to display no strongly lateralised bias, or a preference towards the right side. Building on our earlier study in young adults, we investigated older adults, aged between 60 to 86 years, on five commonly used spatial attention tasks (line bisection, landmark, grey and grating scales and lateralised visual detection). Results confirmed a stable test-retest reliability for each of the five spatial tasks across two testing days. However, contrary to our expectations of a consistent lack in bias or a rightward bias, two tasks elicited significant left spatial biases in our sample of older participants, in accordance with pseudoneglect (namely the line bisection and greyscales tasks), while the other three tasks (landmark, grating scales, and lateralised visual detection tasks) showed no significant biases to either side of space. This lack of inter-task correlations replicates recent findings in young adults. Comparing the two age groups revealed that only the landmark task was age sensitive, with a leftward bias in young adults and an eliminated bias in older adults. In view of these findings of no significant inter-task correlations, as well as the inconsistent directions of the observed spatial biases for the older adults across the five tested tasks, we argue that pseudoneglect is a multi-component phenomenon and highly task sensitive. Each task may engage slightly distinct neural mechanisms, likely to be impacted differently by age. This complicates generalisation and comparability of pseudoneglect effects across different tasks, age-groups and hence studies.

Age-related changes in the allocation of spatially directed focal attention

OBJECTIVES

Leftward deviation on a horizontal line bisection test (pseudoneglect) might be induced by right hemispheric dominance for mediating spatial or global attention, or a hemispheric asymmetry in the ability to spatially disengage attention. With aging, this leftward bias is reduced, likely due to the aging-related deterioration of right hemisphere mediated functions (right hemi-aging) or hemispheric asymmetry reduction in old adults (HAROLD).

METHODS

Forty-seven healthy adults divided into younger and older groups performed a modified Posner spatial-attentional task.

RESULTS

Overall, younger individuals responded faster to left than right-sided imperative stimuli. In contrast, older participants did not reveal a right-left asymmetry to imperative stimuli. The younger group also revealed a strong inverse relationship between the reaction time to right valid cues and the leftward attentional bias while performing the line bisection task (pseudoneglect).

CONCLUSIONS

Our results provide support for both the right hemisphere spatial-attentional dominance hypothesis of pseudoneglect and the right hemi-aging hypotheses.

Hand asymmetries of tactile attention in younger and older adults

Background/Objectives: The allocation of attention can alter the perception of magnitude. When performing line bisections, young adults deviate leftward (pseudoneglect), a bias thought to be induced by right hemisphere dominance for allocating spatial attention. However, when performing body bisections young adults deviate rightward, suggesting left hemisphere dominance for allocating body-centered attention. With aging, there is a reduction of pseudoneglect thought to result from either an age-related decrease in right hemispheric functions (right hemi-aging) or from hemispheric asymmetry reduction in older adults (HAROLD). The goal of this study was to learn if there are tactile body-centered perceptual-attentional right-left asymmetries in that change with aging. Methods: The participants were younger and older healthy adults. Semmes-Weinstein Monofilaments were used to test for differences in the perceived magnitude of pressure differences between a reference stimulus and test stimuli applied to the right and left palmar thenar eminence. Results: Young adults perceived the magnitude of difference in the lightest pressure stimuli applied to the right hand as being greater than the older adults. Young adults perceived the magnitude of difference between the lightest pressure and reference applied to the right hand to be greater than the left hand, but older adults perceived a lighter stimulus greater on the left compared to the right. Conclusions: Whereas the right hemisphere appears to be dominant in mediating spatial attention, the left hemisphere may play a dominant role in the allocation of body-centered attention. Like the aging-related reduction of the visual perception of the magnitude (length) of the left side of a line, this tactile reduction in magnitude (pressure) perception in older adults suggests that with aging, there is a reduction of left-hemispheric mediated allocation of tactile attention, and this result is not fully consistent with either the HAROLD or hemi-aging models.

Aging and Orienting of Visual Attention: Emergence of a Rightward Attentional Bias with Aging?

Although some studies described the apparition of a rightward bias of attention with aging, no study has examined if this bias could be explained by modifications based on age in the mechanisms of attention orienting and, specially, in the cueing effects. 48 participants of different ages were tested with a spatial cueing paradigm to assess mechanisms of attention orienting. Our results suggest the appearance of specific difficulties to orient and reorient attention towards the left side of space with aging. These results identified a right attentional anchoring with aging.

DNA methylation of dopamine-related gene promoters is associated with line bisection deviation in healthy adults

Handedness and language lateralization are the most investigated phenotypes among functional hemispheric asymmetries, i.e. differences in function between the left and the right half of the human brain. Both phenotypes are left hemisphere-dominant, while investigations of the molecular factors underlying right hemisphere-dominant phenotypes are less prominent. In the classical line bisection task, healthy subjects typically show a leftward attentional bias due to a relative dominance of the right hemisphere for visuospatial attention. Based on findings of variations in dopamine-related genes affecting performance in the line bisection task, we first tested whether DNA methylation in non-neuronal tissue in the promoter regions of DBH, SLC6A3, and DRD2 are associated with line bisection deviation. We replicated the typical behavioral pattern and found an effect of DNA methylation in the DBH promoter region on line bisection deviation in right-aligned trials. A second exploratory analysis indicated that an overall DNA methylation profile of genes involved in dopamine function predicts line bisection performance in right-aligned trials. Genetic variation in dopamine-related genes has been linked to attention deficit hyperactivity disorder (ADHD), a neurodevelopmental trait associated with rightward attentional bias. Overall, our findings point towards epigenetic markers for functional hemispheric asymmetries in non-neuronal tissue not only for left hemisphere-dominant, but also for right hemisphere-dominant phenotypes.

Interactions between spatial attention and alertness in healthy adults: A meta-analysis

Attending to the visuospatial field is paramount for safety. The inability to sufficiently allocate attention in the environment could lead to unfavourable consequences. One's ability to attend quickly to left- and right-sided stimuli can vary depending on the person's level of alertness. A dominant model of this relationship proposes that low alertness is associated with a rightward bias in attention, with increases in alertness shifting attention leftward. The current study sought to synthesise the literature on spatial attention and alertness and identify modulators of this relationship in healthy adults. Nineteen articles meeting inclusion criteria were identified for meta-analysis. A small effect of alertness on spatial bias (d = .302) with no evidence for a systematic publication bias was found. Of the five investigated modulators, namely, the experimental design relative to alertness, direction of alertness manipulation, measurement of alertness, the nature of the spatial task, and handedness, only the latter was identified as a significant modulator of the relationship between alertness and spatial attention. The review's findings tie in with the influential framework by Corbetta and Shulman (2011) and support the idea to increase alertness as a rehabilitation approach to reduce inattention to the left side in neglect patients. Findings also suggest a need for future research to investigate neurological processes that underlie the alertness and spatial attention relationship, and a need to examine the transfer effects of laboratory-based experiments for real-world implications.

The Trajectory of Pseudoneglect in Adults: A Systematic Review

Neurologically healthy adults tend to display a reliable leftward perceptual bias during visuospatial tasks, a phenomenon known as pseudoneglect. However, the phenomenon in older adults is not well understood, and a synthesis of research that examines pseudoneglect using the line bisection task, as well as other tasks, in the context of aging is lacking. The aim of the current systematic review is to integrate the available research on pseudoneglect in late adulthood, and to discuss the association between age and a bias to the left hemispace. The systematic search revealed that five different tasks have been used to examine pseudoneglect in younger and older adults, and that participants over 60 years of age have demonstrated inconsistent perceptual biases (e.g., enhanced leftward bias, suppressed leftward bias, and rightward bias). Based on current evidence, although some age-related trends in the perceptual bias can be identified within each task, no firm conclusions about the effects of age on pseudoneglect can be drawn. A number of recommendations for future research are outlined throughout the review, including use of smaller age ranges within age groups, differentiating between neurologically healthy participants and those with clinical diagnoses, continued examination of gender, and consistent use of stimuli and methods of analyses within each task to improve internal comparability.

Age-Related Changes in the Allocation of Vertical Attention

OBJECTIVES

Healthy individuals often have a leftward and upward attentional spatial bias; however, there is a reduction of this leftward bias with aging. The right hemisphere mediates leftward spatial attention and age-related reduction of right hemispheric activity may account for this reduced leftward bias. The right hemisphere also appears to be responsible for upward bias, and this upward bias might reduce with aging. Alternatively, whereas the dorsal visual stream allocates attention downward, the ventral stream allocates attention upward. Since with aging there is a greater atrophy of the dorsal than ventral stream, older participants may reveal a greater upward bias. The main purpose of this study was to learn if aging influences the vertical allocation of spatial attention.

METHODS

Twenty-six young (17 males; mean age 44.62±2.57 years) and 25 healthy elderly (13 males; mean age 72.04±.98 years), right-handed adults performed line bisections using 24 vertical lines (24 cm long and 2 mm thick) aligned with their midsagittal plane.

RESULTS

Older adults had a significantly greater upward bias than did younger adults.

CONCLUSIONS

Normal upward attentional bias increases with aging, possibly due to an age-related reduction of the dorsal attentional stream that is responsible for the allocation of downward attention. (JINS, 2018, 24, 1121-1124).

Spatial biases in deaf, blind, and deafblind individuals as revealed by a haptic line bisection task

In this study, we investigated whether auditory deprivation leads to a more balanced bilateral control of spatial attention in the haptic space. We tested four groups of participants: early deaf, early blind, deafblind, and control (normally hearing and sighted) participants. Using a haptic line bisection task, we found that while normally hearing individuals (even when blind) showed a significant tendency to bisect to the left of the veridical midpoint (i.e., pseudoneglect), deaf individuals did not show any significant directional bias. This was the case of both deaf signers and non-signers, in line with prior findings obtained using a visual line bisection task. Interestingly, deafblind individuals also erred significantly to the left, resembling the pattern of early blind and control participants. Overall, these data critically suggest that deafness induces changes in the hemispheric asymmetry subtending the orientation of spatial attention also in the haptic modality. Moreover, our findings indicate that what counterbalances the right-hemisphere dominance in the control of spatial attention is not the lack of auditory input per se, nor sign language use, but rather the heavier reliance on visual experience induced by early auditory deprivation.

Right-lateralised lane keeping in young and older British drivers

Young adults demonstrate a small, but consistent, asymmetry of spatial attention favouring the left side of space (“pseudoneglect”) in laboratory-based tests of perception. Conversely, in more naturalistic environments, behavioural errors towards the right side of space are often observed. In the older population, spatial attention asymmetries are generally diminished, or even reversed to favour the right side of space, but much of this evidence has been gained from lab-based and/or psychophysical testing. In this study we assessed whether spatial biases can be elicited during a simulated driving task, and secondly whether these biases also shift with age, in line with standard lab-based measures. Data from 77 right-handed adults with full UK driving licences (i.e. prior experience of left-lane driving) were analysed: 38 young (mean age = 21.53) and 39 older adults (mean age = 70.38). Each participant undertook 3 tests of visuospatial attention: the landmark task, line bisection task, and a simulated lane-keeping task. We found leftward biases in young adults for the landmark and line bisection tasks, indicative of pseudoneglect, and a mean lane position towards the right of centre. In young adults the leftward landmark task biases were negatively correlated with rightward lane-keeping biases, hinting that a common property of the spatial attention networks may have influenced both tasks. As predicted, older adults showed no group-level spatial asymmetry on the landmark nor the line bisection task, but they maintained a mean rightward lane position, similar to young adults. The 3 tasks were not inter-correlated in the older group. These results suggest that spatial biases in older adults may be elicited more effectively in experiments involving complex behaviour rather than abstract, lab-based measures. More broadly, these results confirm that lateral biases of spatial attention are linked to driving behaviour, and this could prove informative in the development of future vehicle safety and driving technology.

Pseudoneglect is maintained in aging but not in mild Alzheimer's disease: new insights from an enumeration task

Neurologically healthy young adults display a behavioral bias, called pseudoneglect, which favors the processing of stimuli appearing in the left visual field. Pseudoneglect arises from the right hemisphere dominance for visuospatial attention. Previous studies investigating the effects of normal aging on pseudoneglect in line bisection and greyscale tasks have produced divergent results. In addition, scarce systematic investigations of visual biases in dementia have been reported. The aim of the present study was to evaluate whether the leftward bias appearing during an enumeration task in young adults would be preserved in normal aging and at different stages of severity of Alzheimer's disease. In Experiment 1, young and older healthy adults showed a comparable pseudoneglect, performing better when targets appeared in the left visual field. In Experiment 2, the leftward bias was maintained in amnesic mild cognitive impairment patients (aMCI), but it vanished in mild Alzheimer's disease patients (AD). The maintenance of pseudoneglect in normal aging and in aMCI patients is consistent with compensatory phenomena involving the right fronto-parietal network, which allow maintaining the right hemisphere dominance. Conversely, the lack of pseudoneglect in the sample of AD patients likely results from a loss of the right hemisphere dominance, caused by the selective degeneration of the right fronto-parietal network. These results highlight the need of further systematic investigations of visuospatial biases along the continuum of normal and pathological aging, both for a better understanding of the changes characterizing cognitive aging and for improvements in the evaluation of neglect in Alzheimer's disease.

Crashing Left vs. Right: Examining Navigation Asymmetries Using the SHRP2 Naturalistic Driving Study Data

The magnitude of leftward bias demonstrated in pseudoneglect has been found to differ between younger and older adults in laboratory settings. The objective of this study was to examine the association between age and asymmetries in navigation in a naturalistic setting by examining the frequency of the location of impact on participants' vehicles during crashes and near crashes. The location of impact following crashes and near crashes, and participant's age and gender were retrieved from the SHRP2 NDS database, a large scale naturalistic driving study. Over the course of the study, data were collected from 3,546 participants driving in the United States of America (right-side traffic directionality), which included 1,465 crashes and 2,722 near crashes. During crashes and near crashes, irrespective of age, the location impact was most often on the front side of the participant vehicle. In contrast with results from laboratory environments, age was not associated with the location of impact during crashes and near crashes, and overall, crashes were over-represented on the left side of the vehicle compared to the right. Specifically, crashes were 1.41 times as likely to occur on the left compared to the right side of participants' vehicles. Overall, these findings inform future research that attempts to apply laboratory research, regarding asymmetry in navigation, to naturalistic settings.

The asymmetrical effect of leftward and rightward prisms on intact visuospatial cognition

Rightward prismatic adaptation (RPA) can reduce neglect symptoms in patients whereas adaptation to leftward deviating prisms (LPA) can induce neglect-like behavior in healthy subjects. One influential anatomo-functional model of prismatic adaptation (PA) postulates that it inhibits activity of the posterior parietal cortex (PPC) contralateral to the prismatic deviation. By hypo-activating the PPC and thus eventually acting on interhemispheric balance, both LPA and RPA could possibly affect visuospatial perception in healthy subjects, however, such behavioral modulation has seldom been reported after RPA. In the light of recent evidence showing that LPA-induced visuospatial shift need time to develop we hypothesized that RPA might induce significant changes in visuospatial cognition on a longer time scale. We thus assessed the Landmark task, as well as sensorimotor aftereffects, several times over 8 h after a single session of either LPA or RPA. In agreement with previous reports, sensorimotor effects were symmetrical and long-lasting, with both LPA and RPA inducing shifts of comparable amplitudes in the direction opposite to the deviation that lasted up to 8 h. Visuospatial cognition assessed by Landmark performance, was also significantly modulated for up to 8 h, but only after LPA. Interestingly, the timing and direction of this modulation differed according to participants' baseline bias. An initial leftward bias led to a rapid, but short-lasting rightward shift, whereas an initial rightward bias led to a slower-developing and longer-lasting leftward shift. These findings shed new light on a so-far relatively overlooked feature of spatial cognition that may interact with the effect of PA: the state of the visuospatial system prior to PA should be taken into account when attempting to understand and modulate visuospatial cognition in healthy and brain-damaged populations. This highlights the need for refining current models of PA's mechanisms of action.

Order Information in Verbal Working Memory Shifts the Subjective Midpoint in Both the Line Bisection and the Landmark Tasks

A largely substantiated view in the domain of working memory is that the maintenance of serial order is achieved by generating associations of each item with an independent representation of its position, so-called position markers. Recent studies reported that the ordinal position of an item in verbal working memory interacts with spatial processing. This suggests that position markers might be spatial in nature. However, these interactions were so far observed in tasks implying a clear binary categorization of space (i.e., with left and right responses or targets). Such binary categorizations leave room for alternative interpretations, such as congruency between non-spatial categorical codes for ordinal position (e.g., begin and end) and spatial categorical codes for response (e.g., left and right). Here we discard this interpretation by providing evidence that this interaction can also be observed in a task that draws upon a continuous processing of space, the line bisection task. Specifically, bisections are modulated by ordinal position in verbal working memory, with lines bisected more towards the right after retrieving items from the end compared to the beginning of the memorized sequence. This supports the idea that position markers are intrinsically spatial in nature.

Attentional Orienting and Dorsal Visual Stream Decline: Review of Behavioral and EEG Studies

Every day we are faced with an overwhelming influx of visual information. Visual attention acts as the filtering mechanism that enables us to focus our limited neural resources, by selectively processing only the most relevant and/or salient aspects of our visual environment. The ability to shift attention to the most behaviorally relevant items enables us to successfully navigate and interact with our surroundings. The dorsal visual stream is important for the rapid and efficient visuospatial orienting of attention. Unfortunately, recent evidence suggests that the dorsal visual stream may be especially vulnerable to age-related decline, with significant deterioration becoming evident quite early in the aging process. Yet, despite the significant age-related declines to the dorsal visual stream, the visuospatial orienting of attention appears relatively well preserved in older adults, at least in the early stages of aging. The maintenance of visuospatial orienting of attention in older adults appears to be facilitated by the engagement of compensatory neural mechanisms. In particular, older adults demonstrate heightened activity in the frontal regions to compensate for the reduced activity in the posterior sensory regions. These findings suggest that older adults are more reliant on control processes mediated by the anterior regions of the frontoparietal attention network to compensate for less efficient sensory processing within the posterior sensory cortices.

Anticlockwise or clockwise? A dynamic Perception-Action-Laterality model for directionality bias in visuospatial functioning

Orientation bias and directionality bias are two fundamental functional characteristics of the visual system. Reviewing the relevant literature in visual psychophysics and visual neuroscience we propose here a three-stage model of directionality bias in visuospatial functioning. We call this model the 'Perception-Action-Laterality' (PAL) hypothesis. We analyzed the research findings for a wide range of visuospatial tasks, showing that there are two major directionality trends in perceptual preference: clockwise versus anticlockwise. It appears these preferences are combinatorial, such that a majority of people fall in the first category demonstrating a preference for stimuli/objects arranged from left-to-right rather than from right-to-left, while people in the second category show an opposite trend. These perceptual biases can guide sensorimotor integration and action, creating two corresponding turner groups in the population. In support of PAL, we propose another model explaining the origins of the biases - how the neurogenetic factors and the cultural factors interact in a biased competition framework to determine the direction and extent of biases. This dynamic model can explain not only the two major categories of biases in terms of direction and strength, but also the unbiased, unreliably biased or mildly biased cases in visuosptial functioning.

Prismatic Adaptation Induces Plastic Changes onto Spatial and Temporal Domains in Near and Far Space

A large literature has documented interactions between space and time suggesting that the two experiential domains may share a common format in a generalized magnitude system (ATOM theory). To further explore this hypothesis, here we measured the extent to which time and space are sensitive to the same sensorimotor plasticity processes, as induced by classical prismatic adaptation procedures (PA). We also exanimated whether spatial-attention shifts on time and space processing, produced through PA, extend to stimuli presented beyond the immediate near space. Results indicated that PA affected both temporal and spatial representations not only in the near space (i.e., the region within which the adaptation occurred), but also in the far space. In addition, both rightward and leftward PA directions caused opposite and symmetrical modulations on time processing, whereas only leftward PA biased space processing rightward. We discuss these findings within the ATOM framework and models that account for PA effects on space and time processing. We propose that the differential and asymmetrical effects following PA may suggest that temporal and spatial representations are not perfectly aligned.

Beyond the Sensorimotor Plasticity: Cognitive Expansion of Prism Adaptation in Healthy Individuals

Sensorimotor plasticity allows us to maintain an efficient motor behavior in reaction to environmental changes. One of the classical models for the study of sensorimotor plasticity is prism adaptation. It consists of pointing to visual targets while wearing prismatic lenses that shift the visual field laterally. The conditions of the development of the plasticity and the sensorimotor after-effects have been extensively studied for more than a century. However, the interest taken in this phenomenon was considerably increased since the demonstration of neglect rehabilitation following prism adaptation by Rossetti et al. (1998). Mirror effects, i.e., simulation of neglect in healthy individuals, were observed for the first time by Colent et al. (2000). The present review focuses on the expansion of prism adaptation to cognitive functions in healthy individuals during the last 15 years. Cognitive after-effects have been shown in numerous tasks even in those that are not intrinsically spatial in nature. Altogether, these results suggest the existence of a strong link between low-level sensorimotor plasticity and high-level cognitive functions and raise important questions about the mechanisms involved in producing unexpected cognitive effects following prism adaptation. Implications for the functional mechanisms and neuroanatomical network of prism adaptation are discussed to explain how sensorimotor plasticity may affect cognitive processes.

The relevance of aging-related changes in brain function to rehabilitation in aging-related disease

The effects of aging on rehabilitation of aging-related diseases are rarely a design consideration in rehabilitation research. In this brief review we present strong coincidental evidence from these two fields suggesting that deficits in aging-related disease or injury are compounded by the interaction between aging-related brain changes and disease-related brain changes. Specifically, we hypothesize that some aphasia, motor, and neglect treatments using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in stroke patients may address the aging side of this interaction. The importance of testing this hypothesis and addressing the larger aging by aging-related disease interaction is discussed. Underlying mechanisms in aging that most likely are relevant to rehabilitation of aging-related diseases also are covered.

The implications of state-dependent tDCS effects in aging: Behavioural response is determined by baseline performance

Young adults typically display a processing advantage towards the left side of space ("pseudoneglect"), possibly as a result of right parietal dominance for spatial attention. This bias is ameliorated with age, with older adults displaying either no strongly lateralised bias, or a slight bias towards the right. This may represent an age-related reduction of right hemispheric dominance and/or increased left hemispheric involvement. Here, we applied anodal transcranial direct current stimulation (atDCS) to the right posterior parietal cortex (PPC; R-atDCS), the left PPC (L-atDCS) and a Sham protocol in young and older adults during a titrated lateralised visual detection task. We aimed to facilitate visual detection sensitivity in the contralateral visual field with both R-atDCS and L-atDCS relative to Sham. We found no differences in the effects of stimulation between young and older adults. Instead the effects of atDCS were state-dependent (i.e. related to task performance at baseline). Relative to Sham, poor task performers were impaired in both visual fields by anodal stimulation of the left posterior parietal cortex (PPC). Conversely, good performers maintained sensitivity in both visual fields in response to R-atDCS, although this effect was small. We highlight the importance of considering baseline task ability when designing tDCS experiments, particularly in older adults.

Implicit interactions between number and space in digit-color synesthesia

In digit-color synesthesia, a variant of grapheme-color synesthesia, digits trigger an additional color percept. Recent work on number processing in synesthesia suggests that colors can implicitly elicit numerical representations in digit-color synesthetes implying that synesthesia is bidirectional. Furthermore, morphometric investigations revealed structural differences in the parietal cortex of grapheme-color synesthetes, i.e., in the brain region where interactions between number and space occur in non-synesthetic subjects. Based upon these previous findings, we here examined whether implicitly evoked numerical representations interact with spatial representations in synesthesia in such a way that even a non-numerical, visuo-spatial task (here: line bisection) is modulated, i.e., whether synesthetes exhibit a systematic bisection bias for colored lines. Thirteen digit-color synesthetes were asked to bisect two sets of lines which were colored in their individual synesthetic colors associated with a small or a large digit, respectively. For all colored line stimuli combined, digit-color synesthetes showed--like control subjects (n = 13, matched for age, gender, IQ and handedness)--a pseudo-neglect when bisecting colored lines. Measuring the color-induced change of the bisection bias (i.e., comparing the biases when bisecting lines colored according to a small number vs those lines corresponding to a large number) revealed that only digit-color synesthetes were significantly influenced by line color. The results provide further evidence for the bidirectional nature of synesthesia and support the concept of a mental number line. In addition, they extend previous reports on bidirectionality in synesthesia by showing that even non-numerical, visuo-spatial performance can be modulated by implicit bidirectional processes.

Combining language and space: sentence bisection in unilateral spatial neglect

In line bisection right-brain-damaged patients with left spatial neglect show a rightward deviation, with respect to the line's physical center. In word bisection ortho-phonological features of the stimulus' final (right-sided) part modulate performance of both patients and healthy participants (Veronelli, Vallar, Marinelli, Primativo, & Arduino, 2014). We investigated the role of linguistic factors in sentence bisection, in patients with and without neglect, and control participants. The effects of information in the right-sided part of the sentence (Experiment #1), and of lexical and syntactic violations (Experiment #2) were assessed. Neglect patients showed an overall rightward bias, larger than those of patients without neglect and controls. The neglect patients' bias was modulated by stimulus type, decreasing from lines, to letter strings and to all types of sentences. In sum, in visuo-manual sentence bisection a basic linguistic mechanism, such as sentence readability, brings about a more leftward appreciation of the stimulus, reducing the neglect patients' rightward bias.

A rightward shift in the visuospatial attention vector with healthy aging

The study of lateralized visuospatial attention bias in non-clinical samples has revealed a systematic group-level leftward bias (pseudoneglect), possibly as a consequence of right hemisphere (RH) dominance for visuospatial attention. Pseudoneglect appears to be modulated by age, with a reduced or even reversed bias typically present in elderly participants. It has been suggested that this shift in bias may arise due to disproportionate aging of the RH and/or an increase in complementary functional recruitment of the left hemisphere (LH) for visuospatial processing. In this study, we report rightward shifts in subjective midpoint judgment relative to healthy young participants whilst elderly participants performed a computerized version of the landmark task (in which they had to judge whether a transection mark appeared closer to the right or left end of a line) on three different line lengths. This manipulation of stimulus properties led to a similar behavioral pattern in both the young and the elderly: a rightward shift in subjective midpoint with decreasing line length, which even resulted in a systematic rightward bias in elderly participants for the shortest line length (1.98° of visual angle, VA). Overall performance precision for the task was lower in the elderly participants regardless of line length, suggesting reduced landmark task discrimination sensitivity with healthy aging. This rightward shift in the attentional vector with healthy aging is likely to result from a reduction in RH resources/dominance for attentional processing in elderly participants. The significant rightward bias in the elderly for short lines may even suggest a reversal of hemisphere dominance in favor of the LH/right visual field under specific conditions.

Auditory deprivation affects biases of visuospatial attention as measured by line bisection

In this study, we investigated whether early deafness affects the typical pattern of hemispheric lateralization [i.e., right hemisphere (RH) dominance] in the control of spatial attention. To this aim, deaf signers, deaf non-signers, hearing signers, and hearing non-signers were required to bisect a series of centrally presented visual lines. The directional bisection bias was found to be significantly different between hearing and deaf participants, irrespective of sign language use. Hearing participants (both signers and non-signers) showed a consistent leftward bias, reflecting RH dominance. Conversely, we observed no evidence of a clear directional bias in deaf signers or non-signers (deaf participants overall showing a non-significant tendency to deviate rightward), suggesting that deafness may be associated to a more bilateral hemispheric engagement in visuospatial tasks.

Representational pseudoneglect: a review

Pseudoneglect, the tendency to be biased towards the left-hand side of space, is a robust and consistent behavioural observation best demonstrated on the task of visuospatial line bisection, where participants are asked to centrally bisect visually presented horizontal lines at the perceived centre. A number of studies have revealed that a representational form of pseudoneglect exists, occurring when participants are asked to either mentally represent a stimulus or explore a stimulus using touch in the complete absence of direct visuospatial processing. Despite the growing number of studies that have demonstrated representational pseudoneglect there exists no current and comprehensive review of these findings and no discussion of a theoretical framework into which these findings may fall. An important gap in the current representational pseudoneglect literature is a discussion of the developmental trajectory of the bias. The focus of the current review is to outline studies that have observed representational pseudoneglect in healthy participants, consider a theoretical framework for these observations, and address the impact of lifespan factors such as cognitive ageing on the phenomenon.