Visual-spatial neglect after right-hemisphere stroke: behavioral and electrophysiological evidence / 中华医学杂志(英文版)

Background:@#Visual-spatial neglect (VSN) is a neuropsychological syndrome, and right-hemisphere stroke is the most common cause. The pathogenetic mechanism of VSN remains unclear. This study aimed to investigate the behavioral and event-related potential (ERP) changes in patients with or without VSN after right-hemisphere stroke.@*Methods:@#Eleven patients with VSN with right-hemisphere stroke (VSN group) and 11 patients with non-VSN with righthemisphere stroke (non-VSN group) were recruited along with one control group of 11 age- and gender-matched healthy participants. The visual-spatial function was evaluated using behavioral tests, and ERP examinations were performed.@*Results:@#The response times in the VSN and non-VSN groups were both prolonged compared with those of normal controls (P < 0.001). In response to either valid or invalid cues in the left side, the accuracy in the VSN group was lower than that in the non-VSN group (P < 0.001), and the accuracy in the non-VSN group was lower than that in controls (P < 0.05). The P1 latency in the VSN group was significantly longer than that in the control group (F[2, 30] = 5.494, P = 0.009), and the N1 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.343, P = 0.022). When responding to right targets, the lefthemisphere P300 amplitude in the VSN group was significantly lower than that in the control group (F[2, 30] = 4.255, P = 0.025). With either left or right stimuli, the bilateral-hemisphere P300 latencies in the VSN and non-VSN groups were both significantly prolonged (all P < 0.05), while the P300 latency did not differ significantly between the VSN and non-VSN groups (all P > 0.05).@*Conclusions:@#Visual-spatial attention function is impaired after right-hemisphere stroke, and clinicians should be aware of the subclinical VSN. Our findings provide neuroelectrophysiological evidence for the lateralization of VSN.

Disociaciones entre prosodia emocional y lingüística en pacientes con lesiones cerebrales del hemisferio derecho / Dissociations between emotional and linguistic prosody in patients with right hemisphere lesions

El objetivo de este trabajo fue evaluar patrones de disociación entre el procesamiento de prosodia lingüística y emocional con el fin de analizar la independencia funcional entre ambos. Se realizó un estudio con un diseño de múltiples casos únicos de 17 pacientes con lesiones del hemisferio derecho debidas a accidente cerebro vascular. Se analizaron los perfiles de alteración/ conservación de la capacidad para procesar ambos tipos de prosodia con cuatro pruebas de comprensión y repetición de prosodia emocional y lingüística, y se comparó el rendimiento de cada paciente con un grupo control sano. Los resultados mostraron rendimiento disociado entre prosodia emocional y lingüística en la habilidad de comprensión prosódica en 3/17 pacientes y no se hallaron disociaciones dobles. El hallazgo de distintos patrones de alteración/conservación entre prosodia lingüística y emocional, tanto en la habilidad para comprender como para repetir prosodia, es evidencia que apoya el supuesto de independencia funcional entre los procesamientos de ambos tipos de prosodia.

The goal of this study was to evaluate dissociation patterns between processing of linguistic prosody and emotional (or affective) prosody, in order to analyze the functional independence between them. We carried out a multiple single-cases study of 17 patients with right hemisphere lesions due to stroke. The alteration / conservation profiles of the ability to process both types of prosody were analyzed with four tasks of comprehension and repetition of emotional and linguistic prosody. The performance of each patient was compared with a healthy control group. The results showed a dissociated performance between emotional and linguistic prosody in prosodic comprehension in 3/17 patients, and no double dissociations were found. Finding different patterns of alteration / conservation between linguistic and emotional prosody, both in the ability to understand and to repeat prosody, supports the assumption of functional independence between processing of both types of prosody.

Processamento comunicativo em adultos com AVC unilateral de hemisfério direito: avaliação através de bateria breve / Procesamiento comunicativo en adultos con ACV unilateral del hemisferio derecho: evaluación a través de una batería breve / Communicative processing in adults with unilateral right hemisphere stroke: assessment by means of a short battery

Pacientes com lesão cerebrovascular de hemisfério direito (LHD) tendem a apresentar déficits comunicativos. Este estudo visou a investigar o processamento comunicativo de pacientes com acidente vascular cerebral (AVC) de hemisfério direito. A amostra incluiu 100 participantes: 25 com LHD, 25 com AVC de hemisfério esquerdo (LHE) e 50 controles neurologicamente preservados (PNP). Os participantes responderam a um questionário de dados sociodemográficos, ao Mini Exame do Estado Mental para avaliar capacidade cognitiva geral, à Escala de Depressão Geriátrica de 15 pontos e à Escala Beck de Depressão para investigar sintomas depressivos, ao Teste dos Sinos para avaliar heminegligência, e à Escala Rankin Modificada para verificar capacidade funcional. O processamento comunicativo foi avaliado com a Bateria Montreal de Avaliação da Comunicação, versão abreviada - Bateria MAC Breve. Os escores foram comparados por One-Way ANOVA e Qui-quadrado. Houve diferenças significativas entre os grupos LHD e PNP em 89% das tarefas, mas não entre os grupos LHD e LHE. Além disso, o grupo LHD apresentou desempenho comunicativo inferior ao grupo PNP. Tais achados sugerem evidências de cooperação interhemisférica para os processamentos comunicativos.

Los pacientes con lesión cerebrovascular de hemisferio derecho (LHD) tienden a presentar déficits comunicativos. Este estudio tuvo como objetivo investigar el procesamiento comunicativo de pacientes con accidente cerebrovascular (ACV) de hemisferio derecho. La muestra incluyó 100 participantes: 25 con LHD, 25 con ACV de hemisferio izquierdo (LHI) y 50 controles neurológicamente preservados (CNP). Los participantes respondieron a un cuestionario sociodemográfico, el Mini Examen del Estado Mental para medir la capacidad cognitiva general; la Escala de Depresión Geriátrica y la Escala Beck de Depresión, para investigar los síntomas depresivos; el Test de Marcación de Campanas, para evaluar heminegligencia, y la Escala de Rankin Modificada, para verificar la capacidad funcional. El procesamiento comunicativo fue evaluado con la Batería Montreal de Evaluación de la Comunicación, versión abreviada - Batería MAC Abreviada. Las puntuaciones fueron comparadas por ANOVA de una vía y Chi-cuadrado. Hubo diferencias significativas entre los grupos LHD y CNP en 89% de las tareas, pero no entre los grupos LHD y LHI. Además, el grupo LHD presentó un desempeño comunicativo inferior al grupo CNP. Tales descubrimientos sugieren evidencias de cooperación interhemisférica para los procesamientos comunicativos.

Patients with right hemisphere brain damage (RBD) usually experience communication impairments. This study aims to investigate the communication processing in patients who suffered a stroke in the right hemisphere. The sample comprised 100 participants: 25 with RBD, 25 with left hemisphere brain damage (LBD) and 50 neurologically healthy controls (NHC). Participants answered a sociodemographic questionnaire, the Mini Mental State Examination to measure general cognitive ability, the Geriatric Depression Scale and the Beck Depression Scale to investigate depressive symptoms, the Bells Test to evaluate hemineglect and the Modified Ranking Scale to verify functional capacity. The communication processing was assessed with the use of the Montreal Communication Evaluation Battery, brief version - Brief MAC Battery. The scores were compared using a One-Way ANOVA and the Chi-squared test. There were significant differences between RBD and NHC groups in 89% of the tasks, but not between RBD and LBD groups. Furthermore, the RBD showed inferior communication skills compared to the NHC group. These findings indicate an interhemispheric cooperation for communication processing.

Event-related Potential Patterns Reflect Reversed Hemispheric Activity during Visual Attention Processing in Children with Dyslexia: A Preliminary Study

OBJECTIVE: Individuals with dyslexia experience reading difficulties, whereas their other cognitive abilities seem normal. The purpose of this study was to investigate the event-related potential (ERP) patterns of children with dyslexia during a target-detection task. METHODS: Seventeen children with dyslexia and 18 children without this disorder participated in this study. We evaluated their writing and reading ability, symptoms of attention-deficit/hyperactivity disorder, and intelligence quotient. ERPs were recorded while participants performed a target-detection task, and the peak amplitude and latency of P100 and P300 were analyzed. The lateral asymmetry index (LAI) was calculated for each ERP component. RESULTS: The dyslexic group exhibited longer reaction times and larger P100 amplitudes than the non-dyslexic group in the right hemisphere. The P100 latency was also significantly delayed in the right hemisphere of those in the dyslexic group compared with those in the non-dyslexic group. The P300 amplitude was larger in the right hemisphere compared with left hemisphere in the dyslexic group, whereas no interhemispheric differences were observed with respect to the P300 latency. The LAI for P100 showed a significant right hemispheric dominance, whereas the LAI for P100 was significantly correlated with the accuracy of target detection in children with dyslexia. CONCLUSION: Our results suggest that right hemispheric dominance acts as an ancillary system that compensates for poor reading in children with dyslexia.

Depressive signs and cognitive performance in patients with a right hemisphere stroke / Sinais depressivos e desempenho cognitivo em pacientes com lesão de hemisfério direito

ABSTRACT Purpose: This study investigated the influence of suggestive signs of depression (SSD) in right-hemisphere brain-damaged (RHD) patients following a stroke on their cognitive performance measured by a brief neuropsychological assessment battery. Methods: Forty-two adults with RHD after a single episode of stroke and 84 matched controls participated in this study. They were assessed by means of the Geriatric Depression Scale and by Brief Neuropsychological Assessment Battery NEUPSILIN. Results: Almost half of the patients showed SSD. The RHD group with SSD (RHD+) showed poorer performance in at least one task among all evaluated cognitive domains (concentrated attention, visual perception, working memory, episodic verbal memory and semantic memory, auditory and written language, constructional praxia and verbal fluency). Conclusion: The association of depression and RHD seems to enhance the occurrence and the severity of cognitive déficits. A brief neuropsychological assessment can be useful to identify cognitive impairment caused by this neuropsychiatric disorder.

RESUMO Objetivo: Investigar a influência de sinais sugestivos de depressão (SSD) em pacientes com acidente vascular cerebral (AVC) de hemisfério direito (HD) no desempenho em um instrumento de avaliação neuropsicológica breve. Métodos: Participaram 42 adultos pós-episódio único de lesão cerebrovascular de HD (LHD) e 84 controles emparelhados. Administraram-se a Escala de Depressão Geriátrica GDS-15 e o Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. Resultados: Aproximadamente metade da amostra de pacientes apresentou SSD. O grupo com LHD com SSD (LHD+) obteve desempenho inferior em no mínimo uma tarefa dos domínios cognitivos avaliados (atenção concentrada, percepção visual, memória de trabalho, memória verbal episódica e memória semântica; linguagem oral e escrita; praxia construtiva e fluência verbal). Conclusão: A associação de depressão e LHD parece aumentar a extensão dos déficits cognitivos, sendo que uma avaliação neuropsicológica breve pode ser útil na identificação de alterações cognitivas neste quadro neuropsiquiátrico.

Inferential abilities based on pictorial stimuli in patients with right hemisphere damage: influence of schooling / Habilidades inferenciais a partir de estímulos pictóricos em pacientes com lesão de hemisfério direito: influência da escolaridade

Inferences are mental representations, formed through the interaction between explicit linguistic information and an individual?s world knowledge. It is well known that individuals with brain damage in the right hemisphere (RH) often fail on this task and that schooling may be a variable affecting this. Objective: To compare the effect of schooling on an inference comprehension task based on pictorial stimuli in patients with RH lesion. Methods: The inferential abilities of 75 controls and 50 patients with RH lesion were assessed through the pictorial stimuli from the instrument ?300 exercises of comprehension of logical and pragmatic inferences and causal chains?. Both groups were stratified into two subgroups according to schooling level: 4 to 8 years and 9 or more years. Results and Conclusion: Highly educated subjects performed better than low educated individuals, both on intergroup and intragroup comparisons (p<0.0001) for logical and pragmatic inference ability.

Inferências são representações mentais, formadas através da interação entre a informação linguística explícita e o conhecimento de mundo de um indivíduo. Sabe-se que indivíduos com lesão cerebral em hemisfério direito (HD) frequentemente falham nesse tipo de tarefa e que, a escolaridade pode ser uma variável que afeta tal competência. Objetivo: Comparar o efeito da escolaridade em um teste de compreensão de inferência a partir de estímulos visuais, em pacientes com lesão de HD. Métodos: As habilidades inferenciais de 75 controles e 50 pacientes com lesão de HD foram avaliadas a partir de estímulos pictóricos do intrumento ?300 exercícios de compreensão de inferências lógicas e pragmáticas e cadeias causais?. Ambos os grupos foram divididos em dois subgrupos de acordo com o nível de escolaridade: 4 a 8 anos e 9 anos ou mais. Resultados e Conclusão: O grupo mais escolarizado apresentou melhor desempenho do que os menos escolarizados, seja nas comparações intragrupos e intergrupos (p<0.0001), tanto na compreensão de inferências lógicas quanto pragmáticas.

Processamento léxico-semântico explícito e priming semântico em lesão cerebral de hemisfério direito / Explicit lexical-semantic processing and semantic priming on right brain damage

É fundamental a melhor compreensão de alterações neuropsicológicas decorrentes de lesão de hemisfério cerebral direito (LHD). O objetivo deste estudo foi comparar os efeitos de priming semântico (EPS) e o desempenho em tarefas de processamento léxico-semântico explícito entre pacientes com LHD (n=11) e controles saudáveis (n=11). Investigaram-se também subgrupos de pacientes com LHD com relação a associações e dissociações entre o desempenho em tarefas de processamento léxicosemântico explícito (evocação lexical com critério semântico e julgamento semântico) e de priming semântico através de um estudo de série de casos. O priming semântico foi avaliado por uma tarefa de decisão lexical com estímulos monossêmicos com forte relação semântica e um Stimulus Onset Asynchrony de 500ms. Ambos os grupos apresentaram EPS e não diferiram significativamente nas tarefas de processamento léxico-semântico explícito. Contudo, no estudo de série de casos houve uma heterogeneidade no perfil de desempenho na amostra de pacientes em tarefas de processamento léxico-semântico explícito e de priming semântico. Os resultados indicam a importância de estudos de série de casos para o melhor entendimento de alterações no processamento léxico-semântico em LHD

It is essential a better understanding of neuropsychological deficits resulting from right hemisphere brain damage (RHD). This study aimed to compare semantic priming effects (SPE) and performance on explicit lexicalsemantic processing tasks between RHD patients (n=11) and healthy controls (n=11). It were also investigated subgroups of patients with RHD regarding associations and dissociations between performance on explicit lexical-semantic processing (lexical retrieval based on semantic criteria and semantic judgment) and semantic priming tasks through a case series investigation. Semantic priming was evaluated through a lexical decision task with monosemic stimuli with strong semantic relationship and 500ms Stimulus Onset Asynchrony. Both groups showed SPE and did not differ significantly on explicit lexicalsemantic processing tasks. However, there was heterogeneity in the performance of the patients sample on explicit lexical-semantic processing and priming tasks on the case series investigation. Results indicate the importance of case series investigations to a better understanding of deficits on lexical-semantc processing after RHD

Right cerebral hemisphere and central auditory processing in children with developmental dyslexia / El hemisferio cerebral derecho y el procesamiento auditivo central en ninos con dislexia del desarrollo

Objective We hypothesized that if the right hemisphere auditory processing abilities can be altered in children with developmental dyslexia (DD), we can detect dysfunction using specific tests. Method We performed an analytical comparative cross-sectional study. We studied 20 right-handed children with DD and 20 healthy right-handed control subjects (CS). Children in both groups were age, gender, and school-grade matched. Focusing on the right hemisphere’s contribution, we utilized tests to measure alterations in central auditory processing (CAP), such as determination of frequency patterns; sound duration; music pitch recognition; and identification of environmental sounds. We compared results among the two groups. Results Children with DD showed lower performance than CS in all CAP subtests, including those that preferentially engaged the cerebral right hemisphere. Conclusion Our data suggests a significant contribution of the right hemisphere in alterations of CAP in children with DD. Thus, right hemisphere CAP must be considered for examination and rehabilitation of children with DD. .

Objectivo Examinamos si las habilidades del procesamiento auditivo central (PAC) del hemisferio derecho se encuentran alteradas en niños con dislexia del desarrollo (DD), por medio de pruebas específicas. Método Realizamos un estudio comparativo transversal. Estudiamos 20 niños diestros con DD y 20 niños controles (C) sanos. Los niños de ambos grupos fueron pareados por edad, género y grado escolar. Utilizamos varias pruebas para medir alteraciones del PAC, tales como: determinación de patrones de frecuencia; duración del sonido; reconocimiento de tono musical e identificación de sonidos ambientales, enfatizando la contribución del hemisferio derecho. Comparamos los resultados entre los niños con DD y C. Resultados Los niños con DD mostraron menores puntuaciones que los C en todas las subpruebas del PAC, incluyendo aquellas que involucran preferencialmente al hemisferio cerebral derecho. Conclusión Los datos obtenidos sugieren una contribución significativa del hemisferio derecho para producir alteraciones del PAC en niños con DD. Por lo tanto, las PAC que involucran al hemisferio derecho deben ser consideradas en la evaluación y rehabilitación de niño s con DD. .

Avaliação da prosódia emocional em adultos com lesão de hemisfério direito / Emotional prosody assessment in adults with right brain damage

Uma lesão de hemisfério direito pode gerar alterações comunicativas, comprometendo habilidades dos processamentos discursivo, pragmático-inferencial, léxico-semântico e prosódico (nos níveis compreensivo e expressivo). Uma das sequelas que vem sendo estudadas é a disprosódia. No entanto, o conhecimento sobre os instrumentos de avaliação para seu diagnóstico ainda é restrito. Este artigo visa a apresentar uma revisão sistemática sobre os instrumentos de avaliação da prosódia emocional em estudos de pessoas com lesão de hemisfério direito. Fez-se uma busca de resumos nas bases SciELO, LILACS e PubMed, com as palavras-chave "hemisfério", "direito", "prosódia" e "emocional". Encontraram-se 14 estudos apenas na base PubMed. A maioria utiliza tarefas experimentais, com pouca frequência de testes padronizados, sendo que seis investigações tiveram a participação de um mesmo pesquisador. Ressalta-se o caráter relativamente recente e incipiente dos estudos internacionais sobre a avaliação de déficits prosódicos após lesão cerebral direita, havendo uma importante lacuna nacional nessa área de diagnóstico neuropsicológico.

A right hemisphere brain damage can cause communicative impairments, compromising skills in discursive, pragmatic-inferential, lexical-semantic, and prosodic (at the comprehensive and expressive levels) processing. One of the sequelae which has been studied is dysprosody. However , the knowledge of the assessment instruments for its diagnosis is yet uncertain. The aim of this article is to present a systematic review on the emotional prosody assessment instruments in studies of people with right hemisphere brain damage. Abstracts were searched for in SciELO, Lilacs and PubMed databases, using the keywords "right", "hemisphere", "emotional" and "prosody". 14 studies were found only in Medline database. Most of them use experimental tasks, with standardized tests being less frequent, and six investigations were conducted by the same researcher. The relatively recent and incipient nature of the international studies on the assessment of prosodic deficits after right hemisphere brain damage must be highlighted, as well as an important national gap in this field of neuropsychological diagnosis.

Hemispheric specialization for communicative processing: neuroimaging data on the role of the right hemisphere

Neuropsychology has traditionally studied language emphasizing the exclusive control of the left hemisphere of the brain over this process. With the growing development of this area in psychology and the availability of neuroimaging techniques, a critical analysis of the traditional concept of cerebral dominance for language and of the bases of the neurobiological representations of this cognitive function is crucial. In this context, this review aims to investigate evidence brought by neuroimaging studies on the role of the right hemisphere in communicative processing in healthy individuals. Data suggest a co-activation of brain hemispheres in this processing, with an important contribution given by the right hemisphere in discursive, pragmatic-inferential, and prosodic processing.

Models of brain asymmetry in emotional processing

Two models of brain asymmetry in emotional processing were reviewed: the right hemisphere and the valence hypotheses. The first states a dominant role for the right hemisphere in emotional processing, whereas the second assumes that the left hemisphere is dominant for positive emotions and the right hemisphere for negative ones. Different methods, such as the divided visual field technique, have supported both hypotheses. The amygdala and the prefrontal cortex are presented as important structures involved on brain asymmetry in emotional processing. The paper ends pointing out new perspectives for the study of the neural subtrates of different components of emotions.

Processo de adaptação da bateria Montreal de avaliação da comunicação: bateria MAC - ao português brasileiro / Adaptation process to Brazilian Portuguese of the Montreal communication evaluation battery: MAC battery

O presente estudo tem por objetivo apresentar a adaptação do Protocole Montréal d'Évaluation de la Communication - Protocole MEC (Bateria Montreal de Avaliação da Comunicação - Bateria MAC) ao Português Brasileiro. Esta bateria canadense foi construída para avaliar quatro processamentos comunicativos de ativação do hemisfério direito: discursivo, pragmático-inferencial, léxico-semântico e prosódico. Participaram do estudo seis tradutores, três juízes especialistas, 54 juízes não-especialistas e 16 participantes dos estudos piloto. Os procedimentos gerais promovidos foram tradução, análise de critérios psicolingüísticos por juízes e aplicação do instrumento em estudos piloto. As tarefas Interpretação de metáforas, Discurso narrativo e Julgamento semântico exigiram um processo de adaptação mais complexo e rigoroso. Com base em critérios psicolingüísticos, realizaram-se algumas mudanças nos estímulos, com a finalidade principal de manutenção do objetivo de cada tarefa do instrumento original. Este instrumento neuropsicológico pode ser uma ferramenta de avaliação da comunicação de indivíduos com lesão de hemisfério direito, lesão frontal, traumatismo crânio-encefálico e demência.

This research aims to present the adaptation of the Protocole Montréal d'Évaluation de la Communication - Protocole MEC (Montreal Communication Evaluation Battery - MAC Battery) to Brazilian Portuguese, in accordance with psycholinguistics criteria. MAC Battery is a Canadian instrument constructed to evaluate right hemisphere communicative and linguistic abilities, considering four processing domains: discoursive, pragmatic-inferential, lexical-semantic and prosodic. The participants were six translators, three specialist judges, 54 non-specialist judges and 16 subjects from pilot studies. Adaptation procedures included translation, judge analysis of psycholinguistics criteria and two pilot tests. Some tasks required a harder stimulus adaptation process - Metaphor interpretation, Narrative discourse and Semantic judgement - focusing a main finality: to keep each task's objective as idealized in the original instrument. This neuropsychological test can be used to evaluate communication abilities of patients with right brail damage, frontal lesion, traumatic brain injury and dementia.

Brain Processing of Nonliteral Language:ERP Researches / 中国临床心理学杂志

The nonliteral language and the literal language may be stored and processed differently in the brain. This review examines studies on idiom,metaphor and prosody processing by event-related brain potentials(ERPs). Many kinds of nonliteral languages,may be automatic speech modulated by the right hemisphere. What are to be further examined is the research paradigm of nonliteral language,the development of automatic speech and the social and emotional interaction.

Classification of Spontaneous Thalamic Hemorrhagy for Management and Prediction of Prognosis

65 patients with spontaneous thalamic hemorrhage(TH) diagnosed by CT scan were treated in Catholic Medical Center. Of total 340 patients with spontaneous intracerebral hemorrhage from 1980 to 1983, TH occured in 19.1%. In order to analyse prognosis and guideline of management we classified TH into 4 types with the topographic involvement of thalamus : Type I-the anteromedial TH in 3 cases(4.8%) showed no specific correlation between symptoms and site of hematoma. The prognosis was good with medical treatment alone. Type II-the posterolateral TH in 23 cases(35.2%), mainly spreaded into the internal capsule and the midbrain. Aphasia was one of the main clinical features and the prognosis was worse with both conservative and surgical treatment than those of type I and III. Type III-the dorsal TH in 26 cases(40%), often extended to the lateral ventricle and were localizing in the thalamic area. Emotional change was more occasionally indicated. Type IV-the massive TH in 13 cases(20%), was extensively involved in the thalamus and spreaded to all direction. Symptoms and signs were various and surgery was not indicated because the prognosis was poor. Aphasia was noted in the left TH, but right-hemisphere cortical dysfunction were found mainly in the right TH. The prognoses of the patients with aphaia and/or right hemisphere cortical dysfunction were poorer than those of the patients without. We consider that the patients in type II or III with aphasia and/or right-hemisphere cortical dysfunction should be managed with EVD or stereotaxic urokinase therapy for better neurological outcome.