Poster Session 03 Program Schedule
02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)
Poster Session 03: Neurotrauma | Neurovascular
Final Abstract #74
When Hemianopia Looks like Neglect: Patients with Posterior Stroke show Neglect like Performance on the Broken Hearts Test
Randi Starrfelt, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Pia Mostad, St. Olav University Hospital, Trondhjem, Norway
Alex Leff, UCL Queen Square Institute of Neurology and Institute of Cognitive Neuroscience, University College London, London, United Kingdom
Matthew Lambon Ralph, MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
Ro Robotham, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Category: Stroke/Cerebrovascular Injury and Disease (Adult)
Keyword 1: stroke recovery
Keyword 2: visuospatial neglect
Keyword 3: neuropsychological assessment
Objective:
Patients with visual field deficits may show neglect like performance on cancellation tasks in the acute phase following stroke. The effect is thought to subside in the months following a stroke, but few studies have addressed this issue in chronic stroke patients.
In a sample of chronic patients with strokes affecting the Posterior Cerebral Artery (PCA), we investigated whether there is a difference in how patients with and without visual field deficits perform on a cancellation task. Patients with PCA strokes are not expected to be impaired in cancellations tasks in the chronic phase, as their lesions do not affect areas typically associated with neglect. Thus, neglect like performance patterns in this group may reflect visual field deficits and hemianopic completion, rather than neglect proper.
Participants and Methods:
Data from 59 patients from the Back of the Brain-project were included. Time since stroke ranged from 9 to 300 months (Mdn = 23, IQR = 33). Visual fields were assessed with a computerized visual field test, testing the central 10 degrees of the visual field. The results were classified into right, left or bilateral field deficits, and macular splitting or sparing. The severity of the visual field deficit was classified using % correct detected points. The Broken Hearts Tests, a cancellation task from the Oxford Cognitive Screen, was used to test for neglect and scored according to the test manual. We tested whether there was a significant difference between the patients with and without visual field deficits with regards to completion time, and type and number of errors. We also determined the proportion of patients performing below cut-off for ego- and allocentric neglect.
Results:
48 patients showed evidence of visual field deficits. Patients with visual field deficits had significantly worse performance on most performance variables derived from the Broken Hearts Test. Performance did not differ significantly between patients with left and right visual field defects. There was a significant correlation between severity of visual field deficits and completion time (r (58) = -.43, p < .001), and 6 patients with the most severe visual field deficits did not complete the test within the time limit. Two patients (3.4%) fell below cutoff for egocentric neglect, and 10 patients (17%) below cutoff for allocentric neglect. The patients scoring below cutoff for allocentric neglect had visual field defects affecting the central 5 degrees, half of them (n=5) with macular splitting.
Conclusions:
Visual field deficits caused by stroke in posterior cerebral areas may significantly affect patients’ performance on cancellation tasks, even in the chronic phase. Visual field deficits may make performance generally slow, but can also result in patterns of performance mimicking allocentric neglect. Current knowledge does not support the hypothesis that patients with posterior stroke suffer from neglect, and it is likely that the allocentric errors result from hemianopic completion. The results suggests that clinicians should be cautious when interpreting performance on cancellation tests for patients with visual field deficits.
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