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Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, Cazzoli D. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery. J Neurosci 2024; 44:e1311232024. [PMID: 38565290 PMCID: PMC11112644 DOI: 10.1523/jneurosci.1311-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern 3010, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Department of Psychology, University of Bern, Bern 3012, Switzerland
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2
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Geiser N, Kaufmann BC, Knobel SEJ, Cazzoli D, Nef T, Nyffeler T. Comparison of uni- and multimodal motion stimulation on visual neglect: A proof-of-concept study. Cortex 2024; 171:194-203. [PMID: 38007863 DOI: 10.1016/j.cortex.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023]
Abstract
Spatial neglect is characterized by the failure to attend stimuli presented in the contralesional space. Typically, the visual modality is more severely impaired than the auditory one. This dissociation offers the possibility of cross-modal interactions, whereby auditory stimuli may have beneficial effects on the visual modality. A new auditory motion stimulation method with music dynamically moving from the right to the left hemispace has recently been shown to improve visual neglect. The aim of the present study was twofold: a) to compare the effects of unimodal auditory against visual motion stimulation, i.e., smooth pursuit training, which is an established therapeutical approach in neglect therapy and b) to explore whether a combination of auditory + visual motion stimulation, i.e., multimodal motion stimulation, would be more effective than unimodal auditory or visual motion stimulation. 28 patients with left-sided neglect due to a first-ever, right-hemispheric subacute stroke were included. Patients either received auditory, visual, or multimodal motion stimulation. The between-group effect of each motion stimulation condition as well as a control group without motion stimulation was investigated by means of a one-way ANOVA with the patient's visual exploration behaviour as an outcome variable. Our results showed that unimodal auditory motion stimulation is equally effective as unimodal visual motion stimulation: both interventions significantly improved neglect compared to the control group. Multimodal motion stimulation also significantly improved neglect, however, did not show greater improvement than unimodal auditory or visual motion stimulation alone. Besides the established visual motion stimulation, this proof-of-concept study suggests that auditory motion stimulation seems to be an alternative promising therapeutic approach to improve visual attention in neglect patients. Multimodal motion stimulation does not lead to any additional therapeutic gain. In neurorehabilitation, the implementation of either auditory or visual motion stimulation seems therefore reasonable.
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Affiliation(s)
- Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Brigitte Charlotte Kaufmann
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | | | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Psychology, University of Bern, Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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3
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Schumacher R, Halai AD, Lambon Ralph MA. Attention to attention in aphasia - elucidating impairment patterns, modality differences and neural correlates. Neuropsychologia 2022; 177:108413. [PMID: 36336090 PMCID: PMC7614452 DOI: 10.1016/j.neuropsychologia.2022.108413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
It is increasingly acknowledged that patients with aphasia following a left-hemisphere stroke often have difficulties in other cognitive domains. One of these domains is attention, the very fundamental ability to detect, select, and react to the abundance of stimuli present in the environment. Basic and more complex attentional functions are usually distinguished, and a variety of tests has been developed to assess attentional performance at a behavioural level. Attentional performance in aphasia has been investigated previously, but often only one specific task, stimulus modality, or type of measure was considered and usually only group-level analyses or data based on experimental tasks were presented. Also, information on brain-behaviour relationships for this cognitive domain and patient group is scarce. We report detailed analyses on a comprehensive dataset including patients' performance on various subtests of two well-known, standardised neuropsychological test batteries assessing attention. These tasks allowed us to explore: 1) how many patients show impaired performance in comparison to normative data, in which tasks and on what measure; 2) how the different tasks and measures relate to each other and to patients' language abilities; 3) the neural correlates associated with attentional performance. Up to 32 patients with varying aphasia severity were assessed with subtests from the Test of Attentional Performance (TAP) as well as the Test of Everyday Attention (TEA). Performance was compared to normative data, relationships between attention measures and other background data were explored with principal component analyses and correlations, and brain-behaviour relationships were assessed by means of voxel-based correlational methodology. Depending on the task and measure, between 3 and 53 percent of the patients showed impaired performance compared to normative data. The highest proportion of impaired performance was noted for complex attention tasks involving auditory stimuli. Patients differed in their patterns of performance and only the performance in the divided attention tests was (weakly) associated with their overall language impairment. Principal components analyses yielded four underlying factors, each being associated with distinct neural correlates. We thus extend previous research in characterizing different aspects of attentional performance within one sample of patients with chronic post stroke aphasia. Performance on a broad range of attention tasks and measures was variable and largely independent of patients' language abilities, which underlines the importance of assessing this cognitive domain in aphasic patients. Notably, a considerable proportion of patients showed difficulties with attention allocation to auditory stimuli. The reasons for these potentially modality-specific difficulties are currently not well understood and warrant additional investigations.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.
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4
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Kaufmann BC, Cazzoli D, Pastore-Wapp M, Vanbellingen T, Pflugshaupt T, Bauer D, Müri RM, Nef T, Bartolomeo P, Nyffeler T. Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad. Brain 2022; 146:1467-1482. [PMID: 36200399 PMCID: PMC10115237 DOI: 10.1093/brain/awac359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
In everyday life, information from different cognitive domains - such as visuospatial attention, alertness, and inhibition - needs to be integrated between different brain regions. Early models suggested that completely segregated brain networks control these three cognitive domains. However, more recent accounts, mainly based on neuroimaging data in healthy participants, indicate that different tasks lead to specific patterns of activation within the same, higher-order and "multiple-demand" network. If so, then a lesion to critical substrates of this common network should determine a concomitant impairment in all three cognitive domains. The aim of the present study was to critically investigate this hypothesis, i.e., to identify focal stroke lesions within the network that can concomitantly impact visuospatial attention, alertness and inhibition. We studied an unselected sample of 60 first-ever right-hemispheric, subacute stroke patients using a data-driven, bottom-up approach. Patients performed 12 standardized neuropsychological and oculomotor tests, four per cognitive domain. Principal component analyses revealed a strong relationship between all three cognitive domains: 10 of 12 tests loaded on a first, Common Component. Analysis of the neuroanatomical lesion correlates using different approaches (i.e., Voxel-Based and Tractwise Lesion-Symptom Mapping, Disconnectome maps) provided convergent evidence on the association between severe impairment of this Common Component and lesions at the intersection of Superior Longitudinal Fasciculus II and III, Frontal Aslant Tract and, to a lesser extent, the Putamen and Inferior Fronto-Occipital Fasciculus. Moreover, patients with a lesion involving this region were significantly more impaired in daily living cognition, which provides an ecological validation of our results. A probabilistic functional atlas of the multiple-demand network was performed to confirm the potential relationship between patients' lesion substrates and observed cognitive impairments as a function of the MD-network connectivity disruption. These findings show, for the first time, that a lesion to a specific white matter crossroad can determine a concurrent breakdown in all three considered cognitive domains. Our results support the multiple-demand network model, proposing that different cognitive operations depend on specific collaborators and their interaction, within the same underlying neural network. Our findings also extend this hypothesis by showing (1) the contribution of SLF and FAT to the multiple-demand network, and (2) a critical neuroanatomical intersection, crossed by a vast amount of long-range white matter tracts, many of which interconnect cortical areas of the multiple-demand network. The vulnerability of this crossroad to stroke has specific cognitive and clinical consequences; this has the potential to influence future rehabilitative approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.,Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - René M Müri
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
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5
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Geiser N, Kaufmann BC, Rühe H, Maaijwee N, Nef T, Cazzoli D, Nyffeler T. Visual Neglect after PICA Stroke-A Case Study. Brain Sci 2022; 12:brainsci12020290. [PMID: 35204053 PMCID: PMC8869876 DOI: 10.3390/brainsci12020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022] Open
Abstract
After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS). However, it remains unclear whether visual neglect can also be part of CCAS. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellar-cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions.
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Affiliation(s)
- Nora Geiser
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland;
| | - Brigitte Charlotte Kaufmann
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
- Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
- Institut du Cerveau—Paris Brain Institute—ICM, Inserm, CNRS, Sorbonne Université, 75013 Paris, France
| | - Henrik Rühe
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
| | - Noortje Maaijwee
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland;
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland;
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland; (N.G.); (B.C.K.); (H.R.); (N.M.); (D.C.)
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland;
- Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +41-41-205-5686
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6
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Kaufmann B, Cazzoli D, Bartolomeo P, Frey J, Pflugshaupt T, Knobel S, Nef T, Müri R, Nyffeler T. Auditory spatial cueing reduces neglect after right-hemispheric stroke: a proof of concept study. Cortex 2022; 148:152-167. [DOI: 10.1016/j.cortex.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
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Matias-Guiu JA, Pytel V, Delgado-Álvarez A, Delgado-Alonso C, Cortés-Martínez A, Fernández-Oliveira A, Matías-Guiu J. The Five-Point Test: Normative data for middle-aged and elderly Spaniards. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1323-1331. [PMID: 33470870 DOI: 10.1080/23279095.2021.1873137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Five-Point Test (5PT) is a neuropsychological tool for examining design or figural fluency. In this study, we aimed to provide normative data for the 5PT in Spain. Also, we aimed to compare the norms collected in our research with other normative studies from other populations to evaluate a potential cross-cultural application of 5PT. One hundred and ninety-two healthy subjects aged were enrolled. The mean age was 68.48 ± 9.68 years old (range 50-89), and mean years of education were 10.65 ± 5.22. There were 117 (60.9%) women. The overlapping interval strategy was used to maximize the sample size. Age- and education-adjusted scores were estimated using linear regression analysis. Intraclass correlation coefficient was used to calculate agreement with norms from other countries. Age and years of formal education showed moderate correlations with the scores, while the influence of sex was non-significant. Intraclass correlation coefficient (absolute agreement) between Spanish and German norms was 0.956 (95% confidence interval 0.906-0.978). Norms for unique designs at 1, 2, and 3 minutes are provided. Our study confirms the influence of age and education on design fluency and provides normative data for people older than 50 years old. We hypothesize that 5PT might be a useful test in cross-cultural settings.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Vanesa Pytel
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Alfonso Delgado-Álvarez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | - Ana Cortés-Martínez
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
| | | | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, San Carlos Institute for Health Research (IdiSSC), Universidad Complutense, Madrid, Spain
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8
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Kaufmann BC, Cazzoli D, Pflugshaupt T, Bohlhalter S, Vanbellingen T, Müri RM, Nef T, Nyffeler T. Eyetracking during free visual exploration detects neglect more reliably than paper-pencil tests. Cortex 2020; 129:223-235. [DOI: 10.1016/j.cortex.2020.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/02/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
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9
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Primary Cognitive Factors Impaired after Glioma Surgery and Associated Brain Regions. Behav Neurol 2020; 2020:7941689. [PMID: 32300377 PMCID: PMC7132357 DOI: 10.1155/2020/7941689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/08/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022] Open
Abstract
Previous studies have shown that cognitive impairments in patients with brain tumors are not severe. However, to preserve the postsurgical QOL of patients with brain tumors, it is important to identify “primary” cognitive functions and associated brain regions that are more vulnerable to cognitive impairments following surgery. The objective of this study was to investigate primary cognitive factors affecting not only simple cognitive tasks but also several other cognitive tasks and associated brain regions. Patients with glioma in the left (n = 33) and the right (n = 21) hemisphere participated in the study. Seven neuropsychological tasks from five cognitive domains were conducted pre- and 6 months postoperation. Factor analyses were conducted to identify “primary” common cognitive functions affecting the task performance in left and right glioma groups. Next, lesion analyses were performed using voxel-based lesion-symptom mapping (VLSM) to identify critical brain regions related to impairments of the primary cognitive functions. Factor analysis revealed two primary cognitive components in each glioma group. The first cognitive component in the left glioma group affected the digit span forward and backward tasks and concept shifting and the letter-digit substitution tasks. VLSM analysis revealed significant regions from the posterior middle temporal gyri to the supramarginal gyrus. The second cognitive component affected verbal memory, and verbal fluency tasks and VLSM analysis indicated two different significant regions, the medial temporal regions and the middle temporal gyrus to the posterior parietal lobes. The first cognitive component in the right glioma group affected positive and negative factor loadings on the task, such that the positive cognitive component affected only the Stroop color-word task. VLSM related to deficits of the Stroop task revealed significant regions in the anterior medial frontal cortex. On the other hand, the negative component affected concept shifting, word fluency, and digit span forward tasks, and VLSM revealed significant regions in the right inferior frontal cortex. It is suggested that primary cognitive functions related to specific brain regions were possibly affected by glioma resection.
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Kaufmann BC, Knobel SEJ, Nef T, Müri RM, Cazzoli D, Nyffeler T. Visual Exploration Area in Neglect: A New Analysis Method for Video-Oculography Data Based on Foveal Vision. Front Neurosci 2020; 13:1412. [PMID: 32038129 PMCID: PMC6987148 DOI: 10.3389/fnins.2019.01412] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022] Open
Abstract
Video-oculography during free visual exploration (FVE) is a valuable tool to evaluate visual attention spatial allocation in neglect patients after right-hemispheric stroke. In conventional FVE analyses, the position of a visual fixation is conceived as a single point in space. Here, we describe a new complementary method to analyze FVE data based on foveal vision, leading to an accurate estimate of the portion of the picture that was effectively explored. In 15 neglect patients and 20 healthy controls, visual exploration areas (i.e., considering 1° visual angle around every single fixation) were computed. Furthermore, the proportion of single and overlapping fixations was analyzed. Overlapping fixations were further categorized into capture fixations (successive overlapping fixation, putatively reflecting problem of disengagement) and re-capture fixations (temporally distant overlapping fixations, putatively reflecting spatial working memory deficits). The results of this new analysis approach were compared to the ones of conventional approaches. Conventional analyses showed the typical visual attention deficits in neglect patients versus healthy controls: significantly less fixations and time spent within the left and significantly more fixations and time spent within the right screen half. According to the results of our new approach, patients showed a significantly smaller visual exploration area within the left screen half. However, the right visual exploration area did not differ between groups. Furthermore, in neglect patients, the proportion of overlapping fixations within the right screen half was significantly higher than within the left screen half, as well as significantly higher than in healthy controls within either screen halves. Whereas neglect patients showed significantly more capture fixations than healthy controls, the number of re-capture fixations did not differ between groups. These results suggest that, in neglect patients, the efficiency of visual exploration is also reduced within the right screen half and that impaired disengagement might be an important mechanism leading to overlapping fixations. Our new analysis of the visual exploration area, based on foveal vision, may be a promising additional approach in visual attention research. It allows to accurately measure the portion of the picture that was effectively explored, disentangle single from overlapping fixations, and distinguish between capture and re-capture fixations.
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Affiliation(s)
- Brigitte Charlotte Kaufmann
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Samuel Elia Johannes Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René Martin Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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11
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Nyffeler T, Vanbellingen T, Kaufmann BC, Pflugshaupt T, Bauer D, Frey J, Chechlacz M, Bohlhalter S, Müri RM, Nef T, Cazzoli D. Theta burst stimulation in neglect after stroke: functional outcome and response variability origins. Brain 2019; 142:992-1008. [DOI: 10.1093/brain/awz029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Tim Vanbellingen
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Brigitte C Kaufmann
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | - Julia Frey
- Neurocenter, Luzerner Kantonsspital, Switzerland
| | | | | | - René M Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
- Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Switzerland
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Paladini RE, Wyss P, Kaufmann BC, Urwyler P, Nef T, Cazzoli D, Nyffeler T, Müri RM. Re-fixation and perseveration patterns in neglect patients during free visual exploration. Eur J Neurosci 2019; 49:1244-1253. [PMID: 30561071 DOI: 10.1111/ejn.14309] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 11/28/2022]
Abstract
The literature suggests that neglect patients not only show impairments in directing attention toward the left, contralesional space, but also present with perseverative behavior. Moreover, previous studies described re-fixations during visual search tasks, and interpreted this finding as an impairment of spatial working memory. The aim of the present study was to study re-fixations and perseverations (i.e., recurrent re-fixations to same locations) during free visual exploration, a task with high ecological validity. We hypothesized that: (1) neglect patient would perform re-fixations more frequently than healthy controls within the right hemispace; and, (2) the re-fixation behavior of neglect patients would be characterized by perseverative fixations. To test these hypotheses, we assessed 22 neglect patients and 23 healthy controls, measuring their eye movements during free exploration of naturalistic pictures. The results showed that neglect patients tend to re-fixate locations within the ipsilesional hemispace when they freely explore naturalistic pictures. Importantly, the saliency of discrete locations within the pictures has a stronger influence on fixation behavior within the contralesional than within the ipsilesional hemispace in neglect patients. Finally, the results indicated that, for re-fixations, saliency plays a more important role within the contralesional than the ipsilesional hemispace. Moreover, we found evidence that re-fixation behavior of neglect patients is characterized by frequent recurrent re-fixations back to the same spatial locations which may be interpreted as perseverations. Hence, with the present study, we could better elucidate the mechanism leading to re-fixations and perseverative behavior during free visual exploration in neglect patients.
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Affiliation(s)
- Rebecca E Paladini
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Patric Wyss
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Clinics, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - René M Müri
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Clinics, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
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13
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Mapping functional brain organization: Rethinking lesion symptom mapping and advanced neuroimaging methods in the understanding of human cognition. Neuropsychologia 2018; 115:1-4. [PMID: 29704522 DOI: 10.1016/j.neuropsychologia.2018.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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