Ipsilesional Bias and Processing Speed are Important Predictors of Functional Dependency in the Neglect Phenomenon After a Right Hemisphere Stroke

Abstract

Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.

Keywords:

• Cerebral infarction
• Right hemisphere
• Hemispatial neglect
• Prognosis
• Spatial behavior

Acknowledgments

The authors wish to thank the research nurse Ingrid Eriksson for her excellent assistance with the patients in this study.

This study received grants from the Swedish Research Council (K2011-65X-14605-09-6), the Swedish state (ALFGBG-148861), the Swedish Heart Lung Foundation (20100256), Göteborg Foundation for Neurological Research, the Swedish Stroke Association, the Signhild Engkvists foundation, Herbert and Karin Jacobssons foundation and John and Britt Wennerströms foundation. There are no conflicts of interest relating to this manuscript.