The influence of traumatic brain injury on the allocation of vertical spatial attention

Visual vertical neglect in acquired brain injury: a systematic review

Vertical neglect represents a visuospatial deficit occurring as a possible consequence of acquired brain injury (ABI). Differently from unilateral spatial neglect on horizontal space, vertical neglect is poorly studied in the literature and rarely assessed in clinical practice. In the available studies, the terms "radial," "vertical," and "altitudinal" neglect are often used interchangeably, although they do not describe the same spatial dimension. "Altitudinal" and "vertical" refer to the sagittal plane, whereas "radial" refers to the transverse plane. The term "vertical" is sometimes used interchangeably with respect to both axes. The aim of this systematic review was to identify the main characteristics of vertical neglect after ABI, the diagnostic tools used, and the treatment options. We also proposed a clarification of the manifestations and characteristics of vertical and radial neglect. The 23 articles reviewed, showed that the vertical neglect occurred more frequently on the lower space than on the upper space, that its presence was associated with horizontal neglect, and that it could also occur with compromise of the radial space, with the near radial being more common. The most frequent etiology associated with vertical neglect is vascular, particularly ischaemic. The lesions side are very heterogeneous and include both cortical and subcortical areas and all lobes, although the temporal lobe is most affected. With regard to the assessment tools, paper and pencil tasks are the most commonly used diagnostic tools to identify vertical neglect, although in recent years the use of computer-based tasks increased. Taken together, our results suggest that vertical neglect may be underestimated in patients with right hemisphere lesions and should always be assessed, especially in cases where the patient shows signs of horizontal neglect. The clinical assessment of vertical neglect is very important since it can lead to important functional limitations in everyday life, such as poor wheelchair handling, stumbling over unnoticed obstacles located below (or above), walking down stairs, taking off shoes.

Short-Term Benefits of Continuous Positive Airway Pressure Treatment on Cognition in the Obstructive Sleep Apnea Syndrome: A Retrospective Study

The Obstructive Sleep Apnea Syndrome (OSAS) significantly impacts cognitive functioning. The prolonged use (more than 3 months) of ventilotherapy with continuous positive airway pressure (CPAP) seems to have positive effects in restoring cognitive difficulties. However, there is poor evidence about its possible short-term effect. We investigated whether the short use (less than 15 days at testing) of CPAP improved the cognitive functioning in fifty individuals with OSAS by collecting retrospective neuropsychological measures about verbal memory and learning, information processing speed, attention (i.e., alerting, orienting, and executive system), and executive functions (i.e., strategic reasoning, problem-solving, and mental planning). The predictive role of days of CPAP use on the neuropsychological scores was assessed by hierarchical multiple linear regression analyses, over and above the possible role of demographics, body mass index, level of OSAS severity, and the level of anxiety and depression. The average number of days since CPAP adaptation was 4.70 (SD = 3.90; range = 0-15). As the days of CPAP adaptation increased, verbal learning and long-term memory significantly improved, contrary to the other assessed domains. Our results show a significant improvement in some cognitive functions even after a short treatment with CPAP, pointing to the importance of the early use of ventilotherapy to rapidly improve cognitive functioning. Identifying which cognitive functions can or cannot be restored with CPAP use may enable the design of complementary neuropsychological interventions focused on those residual difficulties, possibly enhancing patients' compliance to the treatment.

Visuomanual Vertical Prism Adaptation: Aftereffects on Visuospatial and Auditory Frequency Representations

Sensorimotor aftereffects have been widely studied after lateral prism adaptation but not after vertical prism adaptation. It is thus well-known that lateral prism adaptation produces aftereffects on visuospatial representation and, recently, on auditory perception. This study aimed to explore the sensorimotor after-effects of vertical prism adaptation as well as its aftereffects on vertical visuospatial representation (Experiment 1) and on auditory frequency representation (Experiment 2). The experimental procedure was similar in both experiments: before and after prism adaptation to an upward or a downward optical deviation, healthy young participants performed an visual open-loop pointing task and a visual (Experiment 1) or an auditory (Experiment 2) perceptual bisection task. In the visual task, the participants had to indicate if they perceived the bisection as higher or lower than the true center of a line. In the auditory task, the participants had to indicate if they perceived the target auditory frequency closer to the low or the high limit of an auditory interval. For sensorimotor aftereffects, pointing errors were computed by means of a vertical touchscreen. For the perceptual bisection task, we measured the percentage of “down” (Experiment 1) or “low” responses (Experiment 2), and we computed the visual (Experiment 1) or the auditory (Experiment 2) subjective center for each participant. Statistical analyses were carried out separately for each optical deviation in each experiment. Sensorimotor aftereffects were observed in both experiments, in the opposite direction to the optical deviation (all ps < 0.01). No significant aftereffects occurred on visuospatial representation (all ps > 0.5), whereas the percentage of “low” responses and the auditory subjective center significantly increased after adaptation to a downward optical deviation (all ps < 0.05). Unlike lateral prism adaptation aftereffects that have been previously shown in both visuospatial horizontal representation and auditory frequency representation, aftereffects of vertical prism adaptation occurred in the auditory frequency representation but not in the vertical visuospatial representation. These results suggest that both vertical and lateral prism adaptations share a common substrate dedicated to the auditory modality (probably the temporal cortex), and that vertical adaptation does not act on the neural substrate of vertical visuospatial representation.

Visuospatial Attention Allocation as an Indicator of Cognitive Deficit in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Traumatic Brain Injury (TBI) is defined by changes in brain function resulting from external forces acting on the brain and is typically characterized by a host of physiological and functional changes such as cognitive deficits including attention problems. In the present study, we focused on the effect of TBI on the ability to allocate attention in vision (i.e., the use of endogenous and exogenous visual cues) by systematically reviewing previous literature on the topic. We conducted quantitative synthesis of 16 selected studies of visual attention following TBI, calculating 80 effect size estimates. The combined effect size was large (g = 0.79, p < 0.0001) with medium heterogeneity (I² = 68.39%). Subgroup analyses revealed an increase in deficit with moderate-to-severe and severe TBI as compared to mild TBI [F_{(2, 76)} = 24.14, p < 0.0001]. Task type was another key source of variability and subgroup analyses indicated that higher order attention processes were severely affected by TBI [F_{(2, 77)} = 5.66, p = 0.0051). Meta-regression analyses revealed significant improvement in visual attention deficit with time [p(mild) = 0.031, p(moderate-to-severe) = 0.002, p(severe) < 0.0001]. Taken together, these results demonstrate that visual attention is affected by TBI and that regular assessment of visual attention, using a systematic attention allocation task, may provide a useful clinical measure of cognitive impairment and change after TBI.