Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke
Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke
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DOI：
10.1136/jnnp.73.2.160
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发表时间：
2002-08-01
影响因子：
11
通讯作者：
Rousseaux, M
中科院分区：
文献类型：
--
作者：
Azouvi, P;Samuel, C;Rousseaux, M
目的：缺乏一致的评估方法是造成卒中后空间忽视发生率报告的可变性的原因。本研究的目的是评估右脑卒中后不同的忽视测试的敏感性。方法：对206例亚急性右半球卒中患者进行了一系列测试，包括病感失认和视觉消失的初步评估，凝视定向和个人忽视的临床评估，以及周围个人空间的空间忽视的纸笔测试。将患者与先前报道的对照组进行比较。一个亚组患者（n=69）接受了日常生活中忽视的行为评估。结果：最敏感的纸笔尺寸为取消任务的起始点。整个电池比任何单独的测试都要灵敏。大约85%的患者在至少一项测量中表现出某种程度的忽视。一个重要的发现是，对日常生活中忽视的行为评估比任何其他单一的忽视测量都更敏感。36%的病例认为行为忽视为中度至重度。一项因子分析显示，纸笔测试与两个潜在因素有关。在个人外忽视、个人忽视、病感失认和消失之间发现分离。解剖分析表明，当后联合皮层受损时，忽视更为常见和严重。结论：自动向右偏向是临床最敏感的忽视指标。行为评估比任何单一的纸笔测试都要敏感。研究结果也支持了忽视是一种异质性疾病的假设。
Objectives: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke.Methods: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations.Results: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients Presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged.Conclusions: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.