Hemispatial neglect reflected on visual memory.

PURPOSE: Recent studies of hemispatial neglect have revealed both lateralized and nonlateralized attention mechanisms contributing to the syndrome. In addition, neglect patients show impaired spatial working memory and diminished working memory capacity. The aim of this study was to investigate, how neglect would be reflected in their performances in commonly used clinical visual memory tests. METHODS: Twelve patients with right hemisphere lesions and left neglect and twelve matched controls were assessed with the Behavioural Inattention Test, the visual reproduction of the WMS-R, the object memory test, the Rey figure test and the list learning test. Visuo-spatial span was explored with the Corsi block test. RESULTS: The severity of neglect was significantly associated with the naming of objects from the left side, with the copying of the Rey figure and with the immediate visual reproduction of the WMS-R. In comparison to the matched controls, the patients named and copied fewer items from both sides and showed impaired immediate and delayed recall of visual material, more so from the left side. After recovery, patients were still impaired in their visual search, whereas their immediate reproduction of visual material was no longer significantly different from the control subjects. The deficit in delayed recall of visual material persisted and was lateralized to the left side of the recollected memories. The role of hemianopia was analyzed. CONCLUSIONS: Patients with neglect exhibited spatial working memory bias and diminished nonlateralized attention capacity in encoding and immediate recall. The deficit in delayed recall was lateralized to the left side of memorized material.

Comparison of the Behavioural Inattention Test and the Catherine Bergego Scale in assessment of hemispatial neglect.

The objective of the study was to correlate visual and behavioural assessments of hemispatial neglect caused by cerebrovascular accident. We assessed 17 consecutive right-hemisphere stroke patients with hemispatial neglect: the Catherine Bergego Scale (CBS) was used to evaluate neglect in spontaneous behaviour and the conventional subtests of the Behavioural Inattention Test (BIT C) were used to assess visual neglect. The proportional severity of both visual and behavioural neglect was calculated in each individual patient. Dissociations were found between mild neglect in visual screening tasks and moderate or severe neglect in behaviour, although in most patients, neglect was equally evident in both tests. Only the line bisection subtest from the BIT correlated significantly with the CBS, yet both tests showed good internal consistency. The line bisection test and several items of the CBS were especially sensitive in detecting the combination of visual field deficit and hemispatial neglect. In conclusion, we propose that visual fields should always be assessed in patients with neglect because neglect may be exacerbated by a visual field deficit and this can cause prolonged functional disability in everyday life situations. Specific rehabilitation methods might also be needed in neglect with or without hemianopia.

Rehabilitation of hemispatial neglect: A randomized study using either arm activation or visual scanning training.

PURPOSE: Hemispatial neglect, a failure to orient to the contralateral side of the lesion, is a disabling disorder after stroke. Previously arm activation combined with visual training or visual scanning training were found effective in rehabilitation of hemispatial neglect. The aim of this study was to determine whether left arm activation alone could be sufficient to produce a long lasting amelioration of neglect comparable to the effect obtained with traditional visual scanning training. METHODS: Twelve neglect patients less than six months from stroke were randomized either into 20-30 hours of left arm activation training or 10 hours of traditional visual scanning training as a part of a comprehensive rehabilitation program. All patients received 48~hours of therapy during the 3-week rehabilitation. RESULTS: Visual neglect of the arm activation group recovered significantly in the conventional subtests of the Behavioural Inattention Test both post-rehabilitation and at 6-months follow-up. The improvement of the visual scanning training group was almost significant at the end of the rehabilitation and significant by the follow-up. The behavioural neglect observed in the Catherine Bergego Scale was alleviated nearly significantly at the post-rehabilitation in both groups. The effect was maintained in the arm activation group at 6-months. CONCLUSION: The arm activation training appears beneficial even without supplementary visual neglect rehabilitation, although the traditional visual scanning training may have further effects in cognition.

Delirium episode as a sign of undetected dementia among community dwelling elderly subjects: a 2 year follow up study.

Cognitive decline is commonly stated as one of the main risk factors for delirium. The aim was to assess the importance of a delirium episode as a symptom of an underlying dementia among community dwelling healthy elderly people in a prospective 2 year follow up study. The study patients consisted of 51 people living at home and older than 65 years of age, without severe underlying disorders including diagnosed dementia, admitted consecutively as emergency cases to hospital because of an acute delirious state and followed up for 2 years. The diagnosis of delirium and dementia were based on the DSM-III-R criteria. The community dwelling patients were evaluated and tested annually by a clinical investigator, a geriatric study nurse, and a neuropsychologist. The medical records of the institutionalised patients were also evaluated. Dementia was diagnosed immediately after the assurance that delirium symptoms had subsided in 14 out of 51 subjects (27%) and the additional 14 subjects were diagnosed as being demented during the 2 year follow up, 28 out of 51 patients (55%) altogether. Alzheimer's disease or mixed dementia was diagnosed in 14 out of 51 patients (27%), vascular dementia in 10 (20%), and dementia with Lewy bodies in two (4%). One case of alcoholic dementia and one case of a non-alcoholic hepatic encephalopathia were also found. A delirium episode is often the first sign of dementia requiring attention from medical and social professionals.

Effect of dichloromethylene diphosphonate (Cl2MDP) on immune function in breast cancer patients with bone metastases.

Immune function was studied in normocalcemic breast cancer patients with bone metastases treated with either dichloromethylene diphosphonate (Cl2MDP) or placebo. The results showed no significant difference between the two patient groups. This suggests that Cl2MDP does not markedly impair the host's defense mechanisms, and in this respect can be safely used in the treatment of patients with resorptive bone disease.