Spatial bias and right hemisphere function: sex-specific changes with aging

A scoping review and critique of the Input-Output subtyping dimension of spatial neglect

Spatial neglect is a common and debilitating disorder after stroke whereby individuals have difficulty reporting, orienting, and/or responding to the contralesional side of space. Given the heterogeneity of neglect symptom presentation, various neglect subtypes have been proposed to better characterize the disorder. This review focuses on the distinction between Input neglect (i.e., difficulty perceiving and/or attending to contralesional stimuli) and Output neglect (i.e., difficulty planning and/or executing movements toward contralesional stimuli). Conceptualizations of Input and Output neglect have varied considerably. We provide a novel summary of the terminology, measurement approaches, and neural correlates of these subtypes. A protocol detailing our systematic scoping review strategy is registered on the Open Science Framework (https://osf.io/bvtxf/). For feasibility and greater comparability across studies, we limited our inclusion criteria to tasks focused on visual stimuli and upper-limb movements. A total of 110 articles were included in the review. Subtyping tasks were categorized based on whether they mainly manipulated aspects of the input (i.e., congruence of visual input with motor output, presence of visual input) or the output (i.e., modality, goal, or direction of output) to produce an Input-Output subtype dissociation. We used our review results to identify four main critiques of this literature: 1) lack of consistency/clarity in conceptual models; 2) methodological issues of dissociating Input and Output subtypes; 3) a need for updated neural theories; and 4) barriers to clinical application. We discuss the lessons learned from this subtyping dimension that can be applied to future research on neglect subtype assessment and treatment.

A Comparative Study on Line Bisection and Landmark Task Performance Using a Hybrid Online Setting

Bisection tasks are commonly used to assess biases and asymmetries in visuospatial attention in both patients and neurologically intact individuals. In these tasks, participants are usually asked to identify the midpoint and manually bisect a horizontal line. Typically, healthy individuals tend to show an attention processing advantage for the left visual field, known as “pseudoneglect.” Here, performance at two computerized versions of the task was compared to assess pseudoneglect in neurologically intact individuals. Specifically, we used a hybrid online setting in which subjects (n = 35) performed the online tasks under the video guidance of the experimenter. We measured attentional biases in the line bisection and landmark tasks. We found pseudoneglect in both tasks, although the bias was larger in the line bisection task. Overall, these findings show that hybrid online tasks may provide a valid setting to assess attentional biases and suggest their feasibility in the clinical setting.

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.

Spatial neglect treatment: The brain's spatial-motor Aiming systems

Animal and human literature supports spatial-motor "Aiming" bias, a frontal-subcortical syndrome, as a core deficit in spatial neglect. However, spatial neglect treatment studies rarely assess Aiming errors. Two knowledge gaps result: spatial neglect rehabilitation studies fail to capture the impact on motor-exploratory aspects of functional disability. Also, across spatial neglect treatment studies, discrepant treatment effects may also result from sampling different proportions of patients with Aiming bias. We review behavioural evidence for Aiming spatial neglect, and demonstrate the importance of measuring and targeting Aiming bias for treatment, by reviewing literature on Aiming spatial neglect and prism adaptation treatment, and presenting new preliminary data on bromocriptine treatment. Finally, we review neuroanatomical and network disruption that may give rise to Aiming spatial neglect. Because Aiming spatial neglect predicts prism adaptation treatment response, assessment may broaden the ability of rehabilitation research to capture functionally-relevant disability. Frontal brain lesions predict both the presence of Aiming spatial neglect, and a robust response to some spatial neglect interventions. Research is needed that co-stratifies spatial neglect patients by lesion location and Aiming spatial neglect, to personalize spatial neglect rehabilitation and perhaps even open a path to spatial retraining as a means of promoting better mobility after stroke.

Effect of Culturally Mediated Right-Favoritism on the Direction of Pseudoneglect on Line Bisection Tasks

Objectives: Arabs have a right-to-left language and engage in favoring of the right side or limb when implementing daily routine practices. The purpose of this research is to explore the effect this cultural attitude might have on pseudoneglect, by comparing with a southeast Asian sample that has a left-to-right language structure. Methods: Participants were from two separate ethnic groups (Arabs and Filipinos), residing in Saudi Arabia, healthy individals 18 years and above were allowed to volunteer in the study. The participants were recruited at King Saud University Medical City and the general community by both convenience and snowball sampling. Social demographic information such as gender, age, years of education, dominant hand, was also documented. The line bisection task (LBT) contained 36 randomly assorted lines of three different lengths placed at five different locations on a white sheet. The percent deviation score (PDS) was used to quantify pseudo-neglect. Tests of statistical significance including t-tests and mixed-effects regression were performed to determine if differences existed among different demographic variables or among line properties, respectively. Results: A total of 256 were enrolled (Arabs 52.3%). The overall PDS mean and standard deviation (SD) was -0.64 (2.87), p = 0.0004, which shows a significant leftward deviation in the entire cohort. PDS was -1.26 (2.68) in Filipinos, and -0.08 (2.94) in Arabs. The difference was statically significant (p < 0.0001). Mixed effects model showed positive changes in the PDS value as the length of the line increased (p < 0.0001) and as the line was more rightward placed (p < 0.0001). However, Filipino participants would still exhibit negative changes in the PDS value in comparison to Arabs (p < 0.0001); There were no significant associations between PDS and other factors such as age, years of education and gender. Conclusion: Differences found here between two distinct ethnic groups support the hypothesis that certain cultural aspects such as language direction and other cultural practices influence direction and degree of pseudo-neglect.

Frontal lesions predict response to prism adaptation treatment in spatial neglect: A randomised controlled study

Spatial neglect commonly follows right hemisphere stroke. It is defined as impaired contralesional stimulus detection, response, or action, causing functional disability. While prism adaptation treatment is highly promising to promote functional recovery of spatial neglect, not all individuals respond. Consistent with a primary effect of prism adaptation on spatial movements, we previously demonstrated that functional improvement after prism adaptation treatment is linked to frontal lobe lesions. However, that study was a treatment-only study with no randomised control group. The current study randomised individuals with spatial neglect to receive 10 days of prism adaptation treatment or to receive only standard care (control group). Replicating our earlier results, we found that the presence of frontal lesions moderated response to prism adaptation treatment: among prism-treated patients, only those with frontal lesions demonstrated functional improvements in their neglect symptoms. Conversely, among individuals in the standard care control group, the presence of frontal lesions did not modify recovery. These results suggest that further research is needed on how frontal lesions may predict response to prism adaptation treatment. Additionally, the results help elucidate the neural network involved in spatial movement and could be used to aid decisions about treatment.

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.

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.

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.

Decreased leftward 'aiming' motor-intentional spatial cuing in traumatic brain injury

OBJECTIVE

To characterize the mediation of attention and action in space following traumatic brain injury (TBI).

METHOD

Two exploratory analyses were performed to determine the influence of spatial 'Aiming' motor versus spatial 'Where' bias on line bisection in TBI participants. The first experiment compared performance according to severity and location of injury in TBI. The second experiment examined bisection performance in a larger TBI sample against a matched control group. In both experiments, participants bisected lines in near and far space using an apparatus that allowed for the fractionation of spatial Aiming versus Where error components.

RESULTS

In the first experiment, participants with severe injuries tended to incur rightward error when starting from the right in far space, compared with participants with mild injuries. In the second experiment, when performance was examined at the individual level, more participants with TBI tended to incur rightward motor error compared to controls.

CONCLUSIONS

TBI may cause frontal-subcortical cognitive dysfunction and asymmetric motor perseveration, affecting spatial Aiming bias on line bisection. Potential effects on real-world function need further investigation. (PsycINFO Database Record

Are Older Adults Less Embodied? A Review of Age Effects through the Lens of Embodied Cognition

Embodied cognition is a theoretical framework which posits that cognitive function is intimately intertwined with the body and physical actions. Although the field of psychology is increasingly accepting embodied cognition as a viable theory, it has rarely been employed in the gerontological literature. However, embodied cognition would appear to have explanatory power for aging research given that older adults typically manifest concurrent physical and mental changes, and that research has indicated a correlative relationship between such changes. The current paper reviews age-related changes in sensory processing, mental representation, and the action-perception relationship, exploring how each can be understood through the lens of embodied cognition. Compared to younger adults, older adults exhibit across all three domains an increased tendency to favor visual processing over bodily factors, leading to the conclusion that older adults are less embodied than young adults. We explore the significance of this finding in light of existing theoretical models of aging and argue that embodied cognition can benefit gerontological research by identifying further factors that can explain the cause of age-related declines.

Dorsal anterior cingulate cortex in typically developing children: Laterality analysis

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Gray matter density asymmetry in the dACC is region-specific in children.

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Superior dACC has greater connectivity with right control/left default network.

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Inferior dACC has greater connectivity with right visual and default network.

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Boys are more lateralized in ipsilateral connectivity with visual cortex than girls.

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Boys and girls differ in age-related laterality changes of dACC connectivity.

We aimed to elucidate the dACC laterality in typically developing children and their sex/age-related differences with a sample of 84 right-handed children (6–16 years, 42 boys). We first replicated the previous finding observed in adults that gray matter density asymmetry in the dACC was region-specific: leftward (left > right) in its superior part, rightward (left < right) in its inferior part. Intrinsic connectivity analysis of these regions further revealed region-specific asymmetric connectivity profiles in dACC as well as their sex and age differences. Specifically, the superior dACC connectivity with frontoparietal network and the inferior dACC connectivity with visual network are rightward. The superior dACC connectivity with the default network (lateral temporal cortex) was more involved in the left hemisphere. In contrast, the inferior dACC connectivity with the default network (anterior medial prefrontal cortex) was more lateralized towards the right hemisphere. The superior dACC connectivity with lateral visual cortex was more distinct across two hemispheres in girls than that in boys. This connection in boys changed with age from right-prominent to left-prominent asymmetry whereas girls developed the connection from left-prominent to no asymmetry. These findings not only highlight the complexity and laterality of the dACC but also provided insights into dynamical structure–function relationships during the development.

Midline Body Actions and Leftward Spatial "Aiming" in Patients with Spatial Neglect

Spatial motor–intentional “Aiming” bias is a dysfunction in initiation/execution of motor–intentional behavior, resulting in hypokinetic and hypometric leftward movements. Aiming bias may contribute to posture, balance, and movement problems and uniquely account for disability in post-stroke spatial neglect. Body movement may modify and even worsen Aiming errors, but therapy techniques, such as visual scanning training, do not take this into account. Here, we evaluated (1) whether instructing neglect patients to move midline body parts improves their ability to explore left space and (2) whether this has a different impact on different patients. A 68-year-old woman with spatial neglect after a right basal ganglia infarct had difficulty orienting to and identifying left-sided objects. She was prompted with four instructions: “look to the left,” “point with your nose to the left,” “point with your [right] hand to the left,” and “stick out your tongue and point it to the left.” She oriented leftward dramatically better when pointing with the tongue/nose, than she did when pointing with the hand. We then tested nine more consecutive patients with spatial neglect using the same instructions. Only four of them made any orienting errors. Only one patient made >50% errors when pointing with the hand, and she did not benefit from pointing with the tongue/nose. We observed that pointing with the tongue could facilitate left-sided orientation in a stroke survivor with spatial neglect. If midline structures are represented more bilaterally, they may be less affected by Aiming bias. Alternatively, moving the body midline may be more permissive for leftward orienting than moving right body parts. We were not able to replicate this effect in another patient; we suspect that the magnitude of this effect may depend upon the degree to which patients have directional akinesia, spatial Where deficits, or cerebellar/frontal cortical lesions. Future research could examine these hypotheses.

Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment

Prism adaptation treatment (PAT) is a promising rehabilitative method for functional recovery in persons with spatial neglect. Previous research suggests that PAT improves motor-intentional "aiming" deficits that frequently occur with frontal lesions. To test whether presence of frontal lesions predicted better improvement of spatial neglect after PAT, the current study evaluated neglect-specific improvement in functional activities (assessment with the Catherine Bergego Scale) over time in 21 right-brain-damaged stroke survivors with left-sided spatial neglect. The results demonstrated that neglect patients' functional activities improved after two weeks of PAT and continued improving for four weeks. Such functional improvement did not occur equally in all of the participants: Neglect patients with lesions involving the frontal cortex (n = 13) experienced significantly better functional improvement than did those without frontal lesions (n = 8). More importantly, voxel-based lesion-behavior mapping (VLBM) revealed that in comparison to the group of patients without frontal lesions, the frontal-lesioned neglect patients had intact regions in the medial temporal areas, the superior temporal areas, and the inferior longitudinal fasciculus. The medial cortical and subcortical areas in the temporal lobe were especially distinguished in the "frontal lesion" group. The findings suggest that the integrity of medial temporal structures may play an important role in supporting functional improvement after PAT.

Prism adaptation and spatial neglect: the need for dose-finding studies

Spatial neglect is a devastating disorder in 50–70% of right-brain stroke survivors, who have problems attending to, or making movements towards, left-sided stimuli, and experience a high risk of chronic dependence. Prism adaptation is a promising treatment for neglect that involves brief, daily visuo-motor training sessions while wearing optical prisms. Its benefits extend to functional behaviors such as dressing, with effects lasting 6 months or longer. Because one to two sessions of prism adaptation induce adaptive changes in both spatial-motor behavior (Fortis et al., 2011) and brain function (Saj et al., 2013), it is possible stroke patients may benefit from treatment periods shorter than the standard, intensive protocol of ten sessions over two weeks—a protocol that is impractical for either US inpatient or outpatient rehabilitation. Demonstrating the effectiveness of a lower dose will maximize the availability of neglect treatment. We present preliminary data suggesting that four to six sessions of prism treatment may induce a large treatment effect, maintained three to four weeks post-treatment. We call for a systematic, randomized clinical trial to establish the minimal effective dose suitable for stroke intervention.

Ipsilesional neglect: behavioral and anatomical correlates

[Correction Notice: An Erratum for this article was reported in Vol 29(2) of Neuropsychology (see record 2014-42242-001). The funding source information was missing from the author note, and A. M. Barrett's institutional affiliation was incorrect. The funding source information and Barrett's correct institutional affiliation are provided in the erratum.]

OBJECTIVE

The sparse existing research on ipsilesional neglect supports an association of this disorder with damage to the right frontal and subcortical brain networks. It is believed that dysfunction in these networks may result in primarily "aiming" motor-intentional spatial errors. The purpose of this study was to confirm whether frontal-subcortical circuits are indeed commonly affected in ipsilesional neglect and to determine the relative presence of "aiming" motor-intentional versus "where" perceptual-attentional spatial errors in these individuals.

METHODS

We identified 12 participants with ipsilesional neglect based on a computerized line bisection task and used the line bisection data to quantify participants' perceptual-attentional and motor-intentional errors. We were able to discriminate between these 2 biases using the algebraic solutions for 2 separate equations, one for "aiming" and one for "where" biases. Lesion mapping was conducted for all participants using MRIcron software; lesion checklist and overlap analysis were created from these images.

RESULTS

A greater percentage of participants with ipsilesional neglect had frontal/subcortical damage (83%) compared with the expected percentage (27%) observed in published patient samples with contralesional neglect. We observed the greatest area of lesion overlap in frontal lobe white matter pathways. Nevertheless, participants with ipsilesional neglect made primarily "where" rather than "aiming" spatial errors.

CONCLUSION

Our data confirm previous research suggesting that ipsilesional neglect may result from lesions to the right frontal-subcortical networks. Furthermore, in our group, ipsilesional neglect was also strongly associated with primarily "where" perceptual-attentional bias, and less so with "aiming" motor-intentional spatial 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.

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.

Presence of Motor-Intentional Aiming Deficit Predicts Functional Improvement of Spatial Neglect With Prism Adaptation

Background Spatial neglect is a debilitating disorder for which there is no agreed on course of rehabilitation. The lack of consensus on treatment may result from systematic differences in the syndrome's characteristics, with spatial cognitive deficits potentially affecting perceptual-attentional "Where" or motor-intentional "Aiming" spatial processing. Heterogeneity of response to treatment might be explained by different treatment impacts on these dissociated deficits: prism adaptation, for example, might reduce Aiming deficits without affecting Where spatial deficits.

OBJECTIVE

Here, we tested the hypothesis that classifying patients by their profile of Where-versus-Aiming spatial deficit would predict response to prism adaptation and specifically that patients with Aiming bias would have better recovery than those with isolated Where bias. Methods We classified the spatial errors of 24 subacute right stroke survivors with left spatial neglect as (1) isolated Where bias, (2) isolated Aiming bias, or (3) both. Participants then completed 2 weeks of prism adaptation treatment. They also completed the Behavioral Inattention Test and Catherine Bergego Scale (CBS) tests of neglect recovery weekly for 6 weeks. Results As hypothesized, participants with only Aiming deficits improved on the CBS, whereas those with only Where deficits did not improve. Participants with both deficits demonstrated intermediate improvement. Conclusion These results support behavioral classification of spatial neglect patients as a potential valuable tool for assigning targeted, effective early rehabilitation.

Right hemisphere role in cognitive reserve

High levels of education, occupational complexity, and/or premorbid intelligence are associated with lower levels of cognitive impairment than would be expected from a given brain pathology. This has been observed across a range of conditions including Alzheimer's disease (Roe et al., 2010), stroke (Ojala-Oksala et al., 2012), traumatic brain injury (Kesler et al., 2003), and penetrating brain injury (Grafman, 1986). This cluster of factors, which seemingly protect the brain from expressing symptoms of damage, has been termed "cognitive reserve" (Stern, 2012). The current review considers one possible neural network, which may contribute to cognitive reserve. Based on the evidence that the neurotransmitter, noradrenaline mediates cognitive reserve's protective effects (Robertson, 2013) this review identifies the neurocognitive correlates of noradrenergic (NA) activity. These involve a set of inter-related cognitive processes (arousal, sustained attention, response to novelty, and awareness) with a strongly right hemisphere, fronto-parietal localization, along with working memory, which is also strongly modulated by NA. It is proposed that this set of processes is one plausible candidate for partially mediating the protective effects of cognitive reserve. In addition to its biological effects on brain structure and function, NA function may also facilitate networks for arousal, novelty, attention, awareness, and working memory, which collectively provide for a set of additional, cognitive, mechanisms that help the brain adapt to age-related changes and disease. It is hypothesized that to the extent that the lateral surface of the right prefrontal lobe and/or the right inferior parietal lobe maintain structural (white and gray matter) and functional integrity and connectivity, cognitive reserve should benefit and behavioral expression of pathologic damage should thus be mitigated.

Line copying: distinct "where" and "aiming" spatial bias in healthy adults

BACKGROUND

Spatial bias in natural, implicit tasks such as reaching and grasping may manifest differently from that in arbitrary laboratory-experiment line bisection tasks. Because spatial processing in everyday activities is difficult to quantify, it is important to study spatial behavior in an implicit laboratory task. Drawing tasks of copying lines or objects integrate spatial perceptual-attentional ("where") input and motor-intentional ("aiming") output, and may be more implicit than line bisection because participants are unaware that the placement of their drawings will be assessed.

OBJECTIVES

We examined whether it is possible to distinguish "where" and "aiming" spatial biases in a line-copying task. We examined changes in "where" and "aiming" biases in response to bottom-up versus top-down cues (hemispace presentation and drawing direction).

METHODS

In 13 healthy adults, we collected copied-line displacements and lengths in both the natural (left-right congruency) and reversed (left-right incongruency) viewing conditions, to distinguish "where" and "aiming" biases.

RESULTS

Participants displaced lines leftward (P=0.01) as they copied, displaying primarily a "where" bias. They displaced lines in the drawing direction irrespective of viewing condition, a finding consistent with induced "aiming" effects (P=0.291). Presenting lines on participants' right or left side did not affect the "where" spatial bias. Cues did not affect copied-line lengths.

CONCLUSIONS

We showed that an implicit laboratory-experiment task of copying lines can discern complex stages of spatial processing in healthy adults. Further evaluation of this task will greatly contribute to the understanding of mechanisms of human spatial cognition.

Disentangling input and output-related components of spatial neglect

Spatial neglect is a heterogeneous disorder with a multitude of manifestations and subtypes. Common clinical paper and pencil neglect tests fail to differentiate between these subtypes. For example, neglect patients typically bisect lines to the right. This bias can be caused by an underestimation of the left half of the line (input-related deficit), by the failure to direct actions toward the left side of space (output-related deficit), or by a mixture of these impairments. To disentangle these impairments, we used a test consisting of a line bisection task on a touch screen monitor (manual motor task) and the subsequent judgment of one's own bisection performance (visual perceptual task). It was hypothesized that patients with mainly output-related neglect should be better able to recognize their misbisected lines than patients with purely input-related neglect. In a group of 16 patients suffering from spatial neglect after right brain damage, we found that patients were three times more likely to suffer from a predominantly input-related than from an output-related subtype. The results thus suggest that neglect is typically an input-related impairment. Additional analysis of the line bisection task revealed that temporal (slowness in initiation and execution of contralateral movements) and spatial (insufficient movement amplitude toward the contralesional side) aspects of output-related neglect were mutually unrelated. This independence raises the possibility that a fine-grained differentiation of output-related neglect is required. That is, impairments in lateralized temporal and spatial aspects of movements may underlie different neglect subtypes.