1
|
Cotta Ramusino M, Scanu L, Gritti L, Imbimbo C, Farina LM, Cosentino G, Perini G, Costa A. Neurophysiological Alterations of the Visual Pathway in Posterior Cortical Atrophy: Systematic Review and a Case Series. J Alzheimers Dis 2024; 98:53-67. [PMID: 38363610 DOI: 10.3233/jad-231123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background The clinical features of posterior cortical atrophy (PCA), a rare condition often caused by Alzheimer's disease, have been recently defined, while little is known about its neurophysiological correlates. Objective To describe neurophysiological alterations of the visual pathway as assessed using visual field test (VF), visual evoked potentials (VEP), and electroretinogram (ERG) in PCA patients. Methods Studies reporting VF, VEPs, and ERG in PCA patients were selected according PRISMA method. Of the 323 articles that emerged from the literature, 17 included the outcomes of interest. To these data, we added those derived from a patient cohort enrolled at our clinic. Results The literature review included 140 patients, half of them (50%) presented with homonymous hemianopia or quadrantanopia. VEPs were available in 4 patients (2 normal findings, 1 decreased amplitude, and 1 increased latency) and ERG in 3 patients (substantially normal findings). Our case series included 6 patients, presenting with homonymous lateral hemianopia in 50% and contralateral cortical atrophy. VEPs showed normal amplitude in 66-83% according to the stimulation check, and increased latency in 67% in absence of myelin damage on MRI. Latency was increased in both eyes in 50% and only on one side in the other 50%. Such alterations were observed in patients with more severe and symmetric atrophy. ERG showed normal findings. Conclusions Neurophysiological investigations of the visual pathway in PCA are almost absent in literature. Alterations involve both amplitude and latency and can be also monocular. A multiple-point involvement of the optical pathway can be hypothesized.
Collapse
Affiliation(s)
- Matteo Cotta Ramusino
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Lucia Scanu
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Linda Gritti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Camillo Imbimbo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lisa Maria Farina
- Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Perini
- Clinical Neuroscience Unit of Dementia, Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology and Center for Cognitive Disorders and Dementia (CDCD), IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
2
|
Toba MN, Migliaccio R, Potet A, Pradat-Diehl P, Bartolomeo P. Right-side spatial neglect and white matter disconnection after left-hemisphere strokes. Brain Struct Funct 2022. [PMID: 35925419 DOI: 10.1007/s00429-022-02541-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
Spatial neglect usually concerns left-sided events after right-hemisphere damage. Its anatomical correlates are debated, with evidence suggesting an important role for fronto-parietal white matter disconnections in the right hemisphere. Here, we describe the less frequent occurrence of neglect for right-sided events, observed in three right-handed patients after a focal stroke in the left hemisphere. Patients were tested 1 month and 3 months after stroke. They performed a standardized paper-and-pencil neglect battery and underwent brain MRI with both structural and diffusion tensor (DT) sequences, in order to assess both grey matter and white matter tracts metrics. Lesions were manually reconstructed for each patient. Patients presented signs of mild right-sided neglect during visual search and line bisection. One patient also showed pathological performance in everyday life. Structural MRI demonstrated left parietal strokes in two patients, in the region extending from the postcentral gyrus to the temporo-parietal junction. One of these two patients also had had a previous occipital stroke. The remaining patient had a left frontal stroke, affecting the precentral, the postcentral gyri and the basal ganglia. DT MRI tractography showed disconnections in the fronto-parietal regions, concerning principally the superior longitudinal fasciculus (SLF). These results suggest an important role for left SLF disconnection in right-side neglect, which complements analogous evidence for right SLF disconnection in left-side neglect.
Collapse
|
3
|
Johnson R. Disorders of higher visual processing in patients with acquired brain injury. NeuroRehabilitation 2022; 50:331-341. [DOI: 10.3233/nre-228016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Disorders of higher visual processing often impact patients with acquired brain injury. Even with treatment, these vision conditions can cause chronic challenges for patients. Understanding these conditions and their management can help improve functional independence and quality of life. OBJECTIVES: To discuss the various disorders of higher visual processing that result from acquired brain injury. Discussion to include classification, evaluation, and treatment techniques available to clinicians. METHODS: Peer reviewed journal articles were searched, primarily through PubMed. Articles spanning several decades were included in the review for historical context of these conditions, however an emphasis was placed on more recent publications for purposes of a discussion regarding clinical management of these conditions. RESULTS: Peer-reviewed articles and clinical trials from across several disciplines were included to frame a discussion of this varied group of conditions. CONCLUSION: Visual processing disorders have debilitating impacts on both the rehabilitation process as well as functional independence. Varied approaches are utilized in the treatment of these conditions with limited success. Understanding the benefits and limitations of both restorative and compensatory treatments will better help clinicians manage patients with these conditions.
Collapse
Affiliation(s)
- Ryan Johnson
- Artisan Pediatric Eyecare, Advanced Vision Therapy Center, 7960 W Rifleman St #110, Boise, ID, 83704, USA Tel.: +1 208 900 3336; Fax: +1 208 639 0329; E-mail:
| |
Collapse
|
4
|
Umeonwuka CI, Roos R, Ntsiea V. Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: A cross-sectional survey of South African neurorehabilitation physiotherapists. S Afr J Physiother 2022; 78:1624. [PMID: 35402745 PMCID: PMC8991368 DOI: 10.4102/sajp.v78i1.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Unilateral spatial neglect (USN) affects the rehabilitation process leading to poor functional outcomes after stroke. South African physiotherapists’ level of uptake of available evidence in USN rehabilitation and the barriers they encounter are not known. Objectives To evaluate knowledge, current practice enablers and barriers to USN management in stroke survivors amongst physiotherapists in South Africa. Methods Our cross-sectional survey used a total sampling technique. Questionnaires were sent to neurorehabilitation physiotherapists in South Africa. Descriptive and inferential statistics analysed the data. Results The overall knowledge score of USN was 14.11 ± 5.23 of a total of 25. The knowledge was good for definitions of USN; moderate for incidences, causes, screening, diagnosis and prognosis of USN and poor for pharmacological approaches to the management of USN. A significant low positive correlation between respondents’ age (r = 0.46; p = 0.016) and years of practice as a physiotherapist (r = 0.43; p = 0.026) and knowledge of USN was found. The most frequently utilised intervention was constraint-induced movement therapy; the commonly utilised assessment tool was the comb and razor test. ‘Inadequate therapy time’ (55.56%) and ‘lack of relevant equipment for rehabilitation of USN’ (38.89%) were identified as major barriers to USN rehabilitation. Major enablers to USN rehabilitation were the ‘presence of multidisciplinary stroke team in clinical practice’ (83.35%) and ‘availability of adequate staff’ (76.47%). Conclusion Physiotherapists demonstrated a fair knowledge of USN although knowledge about pharmacological management of USN was modest. Current practice in post-stroke USN by South African neuro-physiotherapists follows current evidence and practice guidelines. Clinical implication Our study shows the level of knowledge and current practice of post-stroke USN rehabilitation. The demonstrated fair knowledge of USN may be improved through training, curriculum modifications or continuing professional development. Identified barriers to the rehabilitation of post-stroke USN can assist health policy, managers and clinicians to improve stroke-specific care.
Collapse
Affiliation(s)
- Chuka I Umeonwuka
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Abstract
Alzheimer disease (AD) is defined neuropathologically by abnormal extra-cellular β-amyloid plaques combined with intraneuronal tau aggregation. Patients sharing the same neuropathological features but presenting different clinical manifestations and evolutions have led to the notion of AD spectrum. This spectrum encompasses typical and atypical forms of AD. For all of them, specific parts of the temporal lobes, as well as their structural and functional connections with other brain regions, are affected. In typical amnestic late-onset Alzheimer's disease (>65 years old; LOAD), tau pathology gradually spreads to the brain from the medial temporal lobe (MTL). MTL is an inhomogeneous structure consisting of several subregions densely connected to each other and to other cortical and subcortical brain regions. These regions play a crucial role in the storage of information in episodic memory. In less common early-onset AD (<65 years old; EOAD), a large proportion of patients presents atypical clinical manifestations, in which memory impairment is not inaugural and predominant. Instead, these patients have predominant and/or isolated deficits in language, visuospatial, motor, or executive/behavioral functions. In atypical variants, brain damage is mainly centered on the posterior regions, with relative sparing of the MTL. However, the temporal lobe also appears to be variably and specifically damaged in some subtypes of EOAD. For example, the left superior temporal gyrus is the core of brain damage in the language variant, as well as the ventral regions of the temporal lobe play an important role in the clinic of the visual variant.
Collapse
Affiliation(s)
- Raffaella Migliaccio
- Paris Brain Institute, INSERM U1127, Hôpital de la Pitié-Salpêtrière, Paris, France; Department of Neurology, Institut de la mémoire et de la maladie d'Alzheimer, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | | |
Collapse
|
6
|
Abstract
Visuospatial neglect is a frequent and disabling consequence of injuries to the right hemisphere. Patients with neglect show signs of impaired attention for left-sided events, which depends on dysfunction of fronto-parietal networks. After unilateral injury, such as stroke, these networks and their contralateral homologs can reorganize following multiple potential trajectories, which can be either adaptive or maladaptive. This article presents possible factors influencing the profile of evolution of neglect towards recovery or chronicity, and highlights potential mechanisms that may constrain these processes in time and space. The integrity of white matter pathways within and between the hemisphere appears to pose crucial connectivity constraints for compensatory brain plasticity from remote brain regions. Specifically, the availability of a sufficient degree of inter-hemispheric connectivity might be critical to shift the role of the undamaged left hemisphere in spatial neglect, from exerting maladaptive effects, to promoting compensatory activity.
Collapse
Affiliation(s)
- P Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, hôpital de la Pitié-Salpêtrière, 75013 Paris, France.
| |
Collapse
|
7
|
Zhang Y, Xing Y, Li C, Hua Y, Hu J, Wang Y, Ya R, Meng Q, Bai Y. Mirror therapy for unilateral neglect after stroke: A systematic review. Eur J Neurol 2021; 29:358-371. [PMID: 34558762 DOI: 10.1111/ene.15122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The effect of mirror therapy for unilateral neglect after stroke currently remains uncertain. METHODS This systematic review investigated the effect of mirror therapy on neglect and daily living activities in patients with unilateral neglect after stroke when compared with no treatment, sham mirror therapy, or routinely applied therapies only. We performed a systematic electronic search of PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data to identify relevant randomized control trials (RCTs). RESULTS We included five RCTs in the data synthesis. Mirror therapy (combined or not with other treatments) was more effective in improving neglect as compared with sham mirror therapy or no treatment (combined or not with the other therapies; standard mean difference [SMD] = 1.62, 95% confidence interval [CI] = 1.03-2.21, p < 0.00001). Mirror therapy (combined or not with other therapies) was effective in improving daily living activities as compared with sham mirror therapy or no treatment (combined or not with the other therapies; SMD = 2.09, 95% CI = 0.63-3.56, p = 0.005). CONCLUSIONS Our results show that mirror therapy effectively improves neglect and daily living activities in patients with unilateral neglect after stroke. Future trials with high methodological quality and larger sample sizes are needed to determine the immediate and long-term effect of appropriate mirror therapy protocol for unilateral neglect.
Collapse
Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Xing
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Congqin Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Ru Ya
- Department of Rehabilitation Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Qiong Meng
- Department of Internal Medicine, Shanghai No. 3 Rehabilitation Hospital, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Vestito L, Trombini M, Mori L, Dellepiane S, Trompetto C, Morando M, Bandini F. Improved visuospatial neglect after tDCS and computer-assisted cognitive training in Posterior Cortical Atrophy: a single-case study. Neurocase 2021; 27:57-63. [PMID: 33332244 DOI: 10.1080/13554794.2020.1862242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Visuospatial neglect (VN) frequently occurs in Posterior Cortical Atrophy (PCA) and requires specific rehabilitation. In this single-case study, we investigated the efficacy of a computer-assisted cognitive training (CCT) alone or coupled with multiple sessions of anodal transcranial direct-current stimulation (A-tDCS) over the right posterior parietal cortex in improving left VN symptoms in a patient with PCA. The digital ReMoVES platform was used for both VN assessment and training. We found a significant improvement after CCT combined with A-tDCS within the limits of a single-case, our results suggest, for the first time, the usefulness of this combined approach in a neurodegenerative disorder.
Collapse
Affiliation(s)
| | - Marco Trombini
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Laura Mori
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvana Dellepiane
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Morando
- Department of Naval, Electric, Electronic and Telecommunications Engineering (DITEN), University of Genoa, Genoa, Italy
| | - Fabio Bandini
- Department of Neurology, San Paolo Hospital, Savona, Italy
| |
Collapse
|
9
|
Vilimovsky T, Chen P, Hoidekrova K, Petioky J, Harsa P. Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial. PLoS One 2021; 16:e0245425. [PMID: 33481828 PMCID: PMC7822563 DOI: 10.1371/journal.pone.0245425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/01/2021] [Indexed: 11/21/2022] Open
Abstract
Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.
Collapse
Affiliation(s)
- Tomas Vilimovsky
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peii Chen
- Kessler Foundation, West Orange, NJ, United States of America
- Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, United States of America
| | - Kristyna Hoidekrova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Department of Kinanthropology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jakub Petioky
- Rehabilitation Center Kladruby, Kladruby, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Harsa
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
10
|
Abstract
Attention allows us to prioritize the processing of external information according to our goals, but also to cope with sudden, unforeseen events. Attention processes rely on the coordinated activity of large-scale brain networks. At the cortical level, these systems are mainly organized in fronto-parietal networks, with functional and anatomical asymmetries in favor of the right hemisphere. Dysfunction of these right-lateralized networks often produce severe deficit of spatial attention, such as visual neglect. Other brain-damaged patients avoid moving the limbs contralateral to their brain lesion, even in the absence of sensorimotor deficits (motor neglect). This paper first summarizes past and current evidence on brain networks of attention; then, it presents clinical and experimental findings on visual and motor neglect, and on the possible mechanisms of clinical recovery.
Collapse
Affiliation(s)
- P Bartolomeo
- Sorbonne Université, Institut du Cerveau, Paris Brain Institute, ICM, Inserm, CNRS, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France.
| |
Collapse
|
11
|
Zhang Y, Hua Y, Bai Y. Applications of Functional Magnetic Resonance Imaging in Determining the Pathophysiological Mechanisms and Rehabilitation of Spatial Neglect. Front Neurol 2020; 11:548568. [PMID: 33281698 PMCID: PMC7688780 DOI: 10.3389/fneur.2020.548568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a neuroimaging tool which has been applied extensively to explore the pathophysiological mechanisms of neurological disorders. Spatial neglect is considered to be the failure to attend or respond to stimuli on the side of the space or body opposite a cerebral lesion. In this review, we summarize and analyze fMRI studies focused specifically on spatial neglect. Evidence from fMRI studies have highlighted the role of dorsal and ventral attention networks in the pathophysiological mechanisms of spatial neglect, and also support the concept of interhemispheric rivalry as an explanatory model. fMRI studies have shown that several rehabilitation methods can induce activity changes in brain regions implicated in the control of spatial attention. Future investigations with large study cohorts and appropriate subgroup analyses should be conducted to confirm the possibility that fMRI might offer an objective standard for predicting spatial neglect and tracking the response of brain activity to clinical treatment, as well as provide biomarkers to guide rehabilitation for patients with SN.
Collapse
Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
12
|
Checketts M, Mancuso M, Fordell H, Chen P, Hreha K, Eskes GA, Vuilleumier P, Vail A, Bowen A. Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey. Neuropsychol Rehabil 2020; 31:1495-1526. [PMID: 32691688 DOI: 10.1080/09602011.2020.1782946] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spatial neglect has profound implications for quality of life after stroke, yet we lack consensus for screening/diagnosing this heterogeneous syndrome. Our first step in a multi-stage research programme aimed to determine which neglect tests are used (within four categories: cognitive, functional, neurological and neuroimaging/neuromodulation), by which stroke clinicians, in which countries, and whether choice is by professional autonomy or institutional policy. 454 clinicians responded to an online survey: 12 professions (e.g., 39% were occupational therapists) from 33 countries (e.g., 38% from the UK). Multifactorial logistic regression suggested inter-professional differences but fewer differences between countries (Italy was an outlier). Cognitive tests were used by 82% (particularly by psychologists, cancellation and drawing were most popular); 80% used functional assessments (physiotherapists were most likely). 20% (mainly physicians, from Italy) used neuroimaging/ neuromodulation. Professionals largely reported clinical autonomy in their choices. Respondents agreed on the need for a combined approach to screening and further training. This study raises awareness of the translation gap between theory and practice. These findings lay an important foundation to subsequent collaborative action between clinicians, researchers and stroke survivors to reach consensus on screening and diagnostic measures. The immediate next step is a review of the measures' psychometric properties.
Collapse
Affiliation(s)
- Matthew Checketts
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Mauro Mancuso
- Physical and Rehabilitative Medicine Unit, National Health Service, Grosseto, Italy
| | - Helena Fordell
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Kimberly Hreha
- Division for Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Gail A Eskes
- Department of Psychology and Neuroscience & Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neurosciences & Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Andy Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, Manchester, UK
| |
Collapse
|
13
|
Tariq U, Parker A, Saadatpour L, Doty L, Heilman KM. Posterior Cortical Atrophy with Right Lower Egocentric Quadrantic Neglect and Lower Vertical Allocentric Neglect. Arch Clin Neuropsychol 2020; 35:448-457. [PMID: 31942921 DOI: 10.1093/arclin/acz078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/01/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Whereas rare cases of hemispatial visual neglect have been reported in patients with a neurodegenerative disease, quadrantic visuospatial neglect has not been described. We report a patient with probable posterior cortical atrophy who demonstrated lower right-sided quadrantic visuospatial neglect, together with allocentric vertical neglect. METHODS/RESULTS A 68-year-old man initially noted deficits in reading and writing. Subsequently, he developed other cognitive deficits. On vertical line bisections, he deviated upward, and on horizontal line bisections, he deviated to the left. These deviations together suggest that this man's neglect might be most severe in his right (head/body-centered) lower (below eye level) visual space. When attempting to perform vertical line bisections in all four egocentric quadrants, his upward deviations were largest in the right lower quadrant. On a cancelation test, he revealed bilateral lower (ventral) allocentric neglect but not egocentric neglect. This patient's magnetic resonance imaging revealed cortical atrophy, most prominent in the left parietal lobe. DISCUSSION Previous research in stroke patients has demonstrated that the parietal lobes are important in mediating attention to contralateral and inferior visual space. The presence of left parietal atrophy may have induced this right lower (ventral) egocentric inattention as well as bilateral ventral allocentric inattention. Although to our knowledge there have been no prior reports of a patient with right lower quadrantic and lower vertical allocentric visuospatial neglect, patients are rarely tested for these forms of neglect, and this patient illustrates the importance of evaluating patients for these and other forms of neglect.
Collapse
Affiliation(s)
- Usama Tariq
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Alicia Parker
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Leila Saadatpour
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Leilani Doty
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Kenneth M Heilman
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| |
Collapse
|
14
|
Fernandez-Duque D, Black SE. Impaired perception of simultaneous stimuli in a patient with posterior cortical atrophy: an attentional account. Neurocase 2020; 26:69-78. [PMID: 32070200 DOI: 10.1080/13554794.2020.1729385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We assessed visuospatial abilities in PCA. Sequential display of two simple geometric figures enhanced detection and discrimination relative to simultaneous display (Exps 1 & 2). Comparing edges of a single object enhanced discrimination relative to comparing edges of two separate objects, consistent with object-based attention (Exp. 3). Recognition of complex line drawings was spared for a single object but disrupted by an attention-grabbing small circle (Exp. 4). A covert orienting task showed difficulty disengaging from previous locations and attentional bias toward the right visual field (Exp. 5). These findings shed light on the role of visual attention in perceptual awareness.
Collapse
Affiliation(s)
- Diego Fernandez-Duque
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, USA
| | - Sandra E Black
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| |
Collapse
|
15
|
Zebhauser PT, Vernet M, Unterburger E, Brem AK. Visuospatial Neglect - a Theory-Informed Overview of Current and Emerging Strategies and a Systematic Review on the Therapeutic Use of Non-invasive Brain Stimulation. Neuropsychol Rev 2019; 29:397-420. [PMID: 31748841 PMCID: PMC6892765 DOI: 10.1007/s11065-019-09417-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/27/2019] [Indexed: 01/12/2023]
Abstract
Visuospatial neglect constitutes a supramodal cognitive deficit characterized by reduction or loss of spatial awareness for the contralesional space. It occurs in over 40% of right- and 20% of left-brain-lesioned stroke patients with lesions located mostly in parietal, frontal and subcortical brain areas. Visuospatial neglect is a multifaceted syndrome - symptoms can be divided into sensory, motor and representational neglect - and therefore requires an individually adapted diagnostic and therapeutic approach. Several models try to explain the origins of visuospatial neglect, of which the "interhemispheric rivalry model" is strongly supported by animal and human research. This model proposes that allocation of spatial attention is balanced by transcallosal inhibition and both hemispheres compete to direct attention to the contralateral hemi-space. Accordingly, a brain lesion causes an interhemispheric imbalance, which may be re-installed by activation of lesioned, or deactivation of unlesioned (over-activated) brain areas through noninvasive brain stimulation. Research in larger patient samples is needed to confirm whether noninvasive brain stimulation can improve long-term outcomes and whether these also affect activities of daily living and discharge destination.
Collapse
Affiliation(s)
- Paul Theo Zebhauser
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany.,Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar der Technischen Universität, Munich, Germany
| | - Marine Vernet
- Section on Neurocircuitry, Laboratory of Brain and Cognition, NIMH/NIH, Bethesda, MD, USA
| | - Evelyn Unterburger
- Division of Neuropsychology, Universitätsklinik Zürich USZ, Frauenklinikstrasse 26, Zurich, Switzerland
| | - Anna-Katharine Brem
- Department of Neuropsychology, Max-Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany. .,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
16
|
Bartolomeo P, Seidel Malkinson T. Hemispheric lateralization of attention processes in the human brain. Curr Opin Psychol 2019; 29:90-96. [DOI: 10.1016/j.copsyc.2018.12.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/21/2018] [Accepted: 12/29/2018] [Indexed: 01/06/2023]
|
17
|
Abstract
Alzheimer's Disease (AD) is characteristically perceived as primarily being a disorder of episodic memory, with prominent attentional impairments more typically being associated with other neurodegenerative conditions, such as Dementia with Lewy Bodies. However, attention is also affected early on in Alzheimer's, particularly in individuals with young onset and atypical syndromes. In addition, some initial symptoms that are apparently due to episodic memory loss may be secondary to failures of attentional processes. This review delineates the various attentional impairments that can be observed in patients with AD, and addresses them through the conceptual framework of attention proposed by Posner and Petersen. It also describes how current knowledge of the development of AD has influenced our understanding of how these deficits arise. Finally, there is a brief summary of the effects of current AD treatments on attentional processes, and how future pharmacological approaches might better target these deficits.
Collapse
Affiliation(s)
- Paresh A Malhotra
- Division of Brain Sciences, Imperial College London, United Kingdom.
| |
Collapse
|
18
|
Chen Y, Liu P, Wang Y, Peng G. Neural Mechanisms of Visual Dysfunction in Posterior Cortical Atrophy. Front Neurol 2019; 10:670. [PMID: 31293507 PMCID: PMC6603128 DOI: 10.3389/fneur.2019.00670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/07/2019] [Indexed: 11/13/2022] Open
Abstract
Posterior cortical atrophy (PCA) is characterized predominantly by visual dysfunction that arises from bilateral impairments in occipital, parietal, and temporal regions of the brain. PCA is clinically identified based primarily on visual symptoms and neuroimaging findings. Region-specific gray and white matter deficits have been discussed in detail, and are associated with clinical manifestations that present with similar patterns of perfusion and metabolic findings. Here, we discuss both structural and functional changes in the ventral and dorsal visual streams along with their underlying relationships. We also discuss the most recent developments in neuroimaging characteristics and summarize correlations between distinct neuroimaging presentations.
Collapse
Affiliation(s)
- Yi Chen
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Liu
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunyun Wang
- Department of Neurology, Shengzhou People's Hospital, Shengzhou, China
| | - Guoping Peng
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Guoping Peng
| |
Collapse
|
19
|
Bier N, El-Samra A, Bottari C, Vallet G, Carignan M, Paquette G, Brambati S, Demers L, Génier-Marchand D, Rouleau I. Posterior cortical atrophy: Impact on daily living activities and exploration of a cognitive rehabilitation approach. Cogent Psychology 2019. [DOI: 10.1080/23311908.2019.1634911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- N. Bier
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - A. El-Samra
- School of rehabilitation, Université de Montréal, Montréal, Canada
| | - C. Bottari
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - G.T. Vallet
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - M. Carignan
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
- Institut Nazareth et Louis Braille, CISSS de la Montérégie-Centre, Montreal, Canada
| | - G. Paquette
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Centre de recherche en réadaptation du Montréal Métropolitain (CRIR), Montreal, Canada
| | - S. Brambati
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Department of psychology, Université de Montréal, Montreal, Canada
| | - L. Demers
- School of rehabilitation, Université de Montréal, Montréal, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - D. Génier-Marchand
- Department of psychology, Université du Québec à Montréal, Montreal, Canada
| | - I. Rouleau
- Department of psychology, Université du Québec à Montréal, Montreal, Canada
| |
Collapse
|
20
|
Agosta F, Mandic-Stojmenovic G, Canu E, Stojkovic T, Imperiale F, Caso F, Stefanova E, Copetti M, Kostic VS, Filippi M. Functional and structural brain networks in posterior cortical atrophy: A two-centre multiparametric MRI study. Neuroimage Clin 2018; 19:901-910. [PMID: 30013929 PMCID: PMC6019262 DOI: 10.1016/j.nicl.2018.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/07/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
This study identified structural and functional brain connectivity alterations in two independent samples of patients along the posterior cortical atrophy (PCA) disease course. Twenty-one PCA patients and 44 controls were recruited from two expert centres. Microstructural damage of white matter (WM) tracts was assessed using probabilistic tractography; resting state (RS) functional connectivity of brain networks was explored using a model free approach; grey matter (GM) atrophy was investigated using voxel-based morphometry. Compared with controls, common patterns of damage across PCA patients included: GM atrophy in the occipital-temporal-parietal regions; diffusion tensor (DT) MRI alterations of the corpus callosum and superior (SLF) and inferior longitudinal fasciculi (ILF) bilaterally; and decreased functional connectivity of the occipital gyri within the visual network and the precuneus and posterior cingulum within the default mode network (DMN). In PCA patients with longer disease duration and greater disease severity, WM damage extended to the cingulum and RS functional connectivity alterations spread within the frontal, dorsal attentive and salience networks. In PCA, reduced DMN functional connectivity was associated with SLF and ILF structural alterations. PCA patients showed distributed WM damage. Altered RS functional connectivity extends with disease worsening from occipital to temporo-parietal and frontostriatal regions, and this is likely to occur through WM connections. Future longitudinal studies are needed to establish trajectories of damage spreading in PCA and whether a combined DT MRI/RS functional MRI approach is promising in monitoring the disease progression. PCA patients showed distributed WM damage. In PCA, WM damage is associated with longer disease duration ad greater severity. In PCA, altered RS functional connectivity extends with disease worsening.
Collapse
Affiliation(s)
- Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Gorana Mandic-Stojmenovic
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Clinic of Neurology, University of Belgrade, Dr Subotića 6, PO, Box 12, 11129, Belgrade 102, Serbia
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Tanja Stojkovic
- Clinic of Neurology, University of Belgrade, Dr Subotića 6, PO, Box 12, 11129, Belgrade 102, Serbia
| | - Francesca Imperiale
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Francesca Caso
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy
| | - Elka Stefanova
- Clinic of Neurology, University of Belgrade, Dr Subotića 6, PO, Box 12, 11129, Belgrade 102, Serbia
| | - Massimiliano Copetti
- Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Foggia, Italy
| | - Vladimir S Kostic
- Clinic of Neurology, University of Belgrade, Dr Subotića 6, PO, Box 12, 11129, Belgrade 102, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, via Olgettina 60, 20132 Milan, Italy.
| |
Collapse
|
21
|
Abstract
Visual neglect is a debilitating neuropsychological phenomenon that has many clinical implications and-in cognitive neuroscience-offers an important lesion deficit model. In this article, we describe a computational model of visual neglect based upon active inference. Our objective is to establish a computational and neurophysiological process theory that can be used to disambiguate among the various causes of this important syndrome; namely, a computational neuropsychology of visual neglect. We introduce a Bayes optimal model based upon Markov decision processes that reproduces the visual searches induced by the line cancellation task (used to characterize visual neglect at the bedside). We then consider 3 distinct ways in which the model could be lesioned to reproduce neuropsychological (visual search) deficits. Crucially, these 3 levels of pathology map nicely onto the neuroanatomy of saccadic eye movements and the systems implicated in visual neglect.
Collapse
Affiliation(s)
- Thomas Parr
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Karl J Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London WC1N 3BG, UK
| |
Collapse
|
22
|
Maia da Silva MN, Millington RS, Bridge H, James-Galton M, Plant GT. Visual Dysfunction in Posterior Cortical Atrophy. Front Neurol 2017; 8:389. [PMID: 28861031 PMCID: PMC5561011 DOI: 10.3389/fneur.2017.00389] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/21/2017] [Indexed: 01/08/2023] Open
Abstract
Posterior cortical atrophy (PCA) is a syndromic diagnosis. It is characterized by progressive impairment of higher (cortical) visual function with imaging evidence of degeneration affecting the occipital, parietal, and posterior temporal lobes bilaterally. Most cases will prove to have Alzheimer pathology. The aim of this review is to summarize the development of the concept of this disorder since it was first introduced. A critical discussion of the evolving diagnostic criteria is presented and the differential diagnosis with regard to the underlying pathology is reviewed. Emphasis is given to the visual dysfunction that defines the disorder, and the classical deficits, such as simultanagnosia and visual agnosia, as well as the more recently recognized visual field defects, are reviewed, along with the evidence on their neural correlates. The latest developments on the imaging of PCA are summarized, with special attention to its role on the differential diagnosis with related conditions.
Collapse
Affiliation(s)
- Mari N Maia da Silva
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Cognitive and Behavioural Neurology Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Rebecca S Millington
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Holly Bridge
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Merle James-Galton
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gordon T Plant
- The National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Moorfields Eye Hospital, London, United Kingdom.,St. Thomas' Hospital, London, United Kingdom
| |
Collapse
|
23
|
Lunven M, Bartolomeo P. Attention and spatial cognition: Neural and anatomical substrates of visual neglect. Ann Phys Rehabil Med 2017; 60:124-129. [DOI: 10.1016/j.rehab.2016.01.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 11/15/2022]
|
24
|
Abstract
Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
Collapse
Affiliation(s)
- Luigi Trojano
- Department of Psychology, Second University of Naples, Italy.,S. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy
| | - Guido Gainotti
- Center for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
| |
Collapse
|
25
|
Millington RS, James-Galton M, Maia Da Silva MN, Plant GT, Bridge H. Lateralized occipital degeneration in posterior cortical atrophy predicts visual field deficits. Neuroimage Clin 2017; 14:242-249. [PMID: 28180083 PMCID: PMC5288489 DOI: 10.1016/j.nicl.2017.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 01/15/2017] [Indexed: 11/21/2022]
Abstract
Background Posterior cortical atrophy (PCA), the visual variant of Alzheimer's disease, leads to high-level visual deficits such as alexia or agnosia. Visual field deficits have also been identified, but often inconsistently reported. Little is known about the pattern of visual field deficits or the underlying cortical changes leading to this visual loss. Methods Multi-modal magnetic resonance imaging was used to investigate differences in gray matter volume, cortical thickness, white matter microstructure and functional activity in patients with PCA compared to age-matched controls. Additional analyses investigated hemispheric asymmetries in these metrics according to the visual field most affected by the disease. Results Analysis of structural data indicated considerable loss of gray matter in the occipital and parietal cortices, lateralized to the hemisphere contralateral to the visual loss. This lateralized pattern of gray matter loss was also evident in the hippocampus and parahippocampal gyrus. Diffusion-weighted imaging showed considerable effects of PCA on white matter microstructure in the occipital cortex, and in the corpus callosum. The change in white matter was only lateralized in the occipital lobe, however, with greatest change in the optic radiation contralateral to the visual field deficit. Indeed, there was a significant correlation between the laterality of the optic radiation microstructure and visual field loss. Conclusions Detailed brain imaging shows that the asymmetric visual field deficits in patients with PCA reflect the pattern of degeneration of both white and gray matter in the occipital lobe. Understanding the nature of both visual field deficits and the neurodegenerative brain changes in PCA may improve diagnosis and understanding of this disease. Patients with posterior cortical atrophy show asymmetric visual field deficits manifesting as hemianopia. Both gray and white matter show lateralized degeneration corresponding to the most affected visual field. Laterality of microstructure in the optic radiation correlates with visual field loss.
Collapse
Affiliation(s)
- Rebecca S Millington
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Gordon T Plant
- National Hospital for Neurology and Neurosurgery, London, UK; Moorfields Eye Hospital, London, UK
| | - Holly Bridge
- Oxford Centre for fMRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
26
|
Neitzel J, Ortner M, Haupt M, Redel P, Grimmer T, Yakushev I, Drzezga A, Bublak P, Preul C, Sorg C, Finke K. Neuro-cognitive mechanisms of simultanagnosia in patients with posterior cortical atrophy. Brain 2016; 139:3267-3280. [DOI: 10.1093/brain/aww235] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/01/2016] [Accepted: 07/31/2016] [Indexed: 11/13/2022] Open
|
27
|
Migliaccio R, Gallea C, Kas A, Perlbarg V, Samri D, Trotta L, Michon A, Lacomblez L, Dubois B, Lehericy S, Bartolomeo P. Functional Connectivity of Ventral and Dorsal Visual Streams in Posterior Cortical Atrophy. J Alzheimers Dis 2016; 51:1119-30. [DOI: 10.3233/jad-150934] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Raffaella Migliaccio
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Department of Neurology, Institut de la mémoire et de la maladie d’Alzheimer, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Cécile Gallea
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR) de l’Institut du Cerveau et de la Moelle Epiniere (ICM), Hôpital de la Pitié-Salpêtrière, Paris, France
- Equipe “Mouvements Anormaux et Ganglions de la Base”, Institut du Cerveau et de la Moëlle Epinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Aurélie Kas
- Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- INSERM U1146, CNRS UMR7371, laboratoire d’imagerie biomédicale, Sorbonne université, UPMC université, Paris 60 UMCR2, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Vincent Perlbarg
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- INSERM U1146, CNRS UMR7371, laboratoire d’imagerie biomédicale, Sorbonne université, UPMC université, Paris 60 UMCR2, Hôpital de la Pitié-Salpêtrière, Paris, France
- IHU-A-ICM, Bioinformatics/Biostatistis Plateform, Paris, France
| | - Dalila Samri
- Department of Neurology, Institut de la mémoire et de la maladie d’Alzheimer, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Laura Trotta
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Department of Neurology, Institut de la mémoire et de la maladie d’Alzheimer, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Agnès Michon
- Department of Neurology, Institut de la mémoire et de la maladie d’Alzheimer, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Lucette Lacomblez
- INSERM U1146, CNRS UMR7371, laboratoire d’imagerie biomédicale, Sorbonne université, UPMC université, Paris 60 UMCR2, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department des maladies du système nerveux, CIC-CET, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
- Service de pharmacologie, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bruno Dubois
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Department of Neurology, Institut de la mémoire et de la maladie d’Alzheimer, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stéphane Lehericy
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR) de l’Institut du Cerveau et de la Moelle Epiniere (ICM), Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Paolo Bartolomeo
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, and Université Pierre et Marie Curie-Paris 6, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), F-75013 Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| |
Collapse
|
28
|
Abstract
The syndrome of posterior cortical atrophy (PCA) is a rare clinical manifestation of several neurodegenerative diseases which affect the parieto-occipital cortex. The most frequent underlying pathology is Alzheimer's disease but some cases are caused by Lewy body disease, progressive subcortical gliosis, corticobasal degeneration or prion diseases. The most prominent clinical feature of PCA is complex visual disturbances including object agnosia, simultanagnosia, optical ataxia and oculomotor apraxia while basic visual functions remain intact. These deficits lead to multiple impairments in activities of daily living that require visual control. On progression of the disease amnestic, apraxic and dysexecutive symptoms occur so that a global dementia gradually emerges. At the core of the diagnostic work-up are a detailed patient history, accurate analysis of behavior and neuropsychological testing. Structural and functional brain imaging are suitable to demonstrate the localization of the disease process. Measurement of cerebrospinal fluid proteins (e.g. beta amyloid, tau, phospho-tau and 14-3-3) serves to confirm or exclude Alzheimer's disease or prion diseases. The mainstay of treatment are non-pharmacological interventions to support activities of daily living and personal independence. These treatments include cognitive training and compensatory strategies which can be prescribed as neuropsychological treatment or occupational therapy. If Alzheimer's disease or Lewy body disease is the likely cause, a treatment with cholinesterase inhibitor may be tried. Caregiver education and support are another essential part of the treatment regimen as with all forms of dementia.
Collapse
Affiliation(s)
- M Ortner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
| | | |
Collapse
|
29
|
|
30
|
Solyga VM, Western E, Solheim H, Hassel B, Kerty E. [Posterior cortical atrophy]. Tidsskr Nor Laegeforen 2015; 135:949-52. [PMID: 26037756 DOI: 10.4045/tidsskr.14.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Posterior cortical atrophy is a neurodegenerative condition with atrophy of posterior parts of the cerebral cortex, including the visual cortex and parts of the parietal and temporal cortices. It presents early, in the 50s or 60s, with nonspecific visual disturbances that are often misinterpreted as ophthalmological, which can delay the diagnosis. The purpose of this article is to present current knowledge about symptoms, diagnostics and treatment of this condition. METHOD The review is based on a selection of relevant articles in PubMed and on the authors' own experience with the patient group. RESULTS Posterior cortical atrophy causes gradually increasing impairment in reading, distance judgement, and the ability to perceive complex images. Examination of higher visual functions, neuropsychological testing, and neuroimaging contribute to diagnosis. In the early stages, patients do not have problems with memory or insight, but cognitive impairment and dementia can develop. It is unclear whether the condition is a variant of Alzheimer's disease, or whether it is a separate disease entity. There is no established treatment, but practical measures such as the aid of social care workers, telephones with large keypads, computers with voice recognition software and audiobooks can be useful. INTERPRETATION Currently available treatment has very limited effect on the disease itself. Nevertheless it is important to identify and diagnose the condition in its early stages in order to be able to offer patients practical assistance in their daily lives.
Collapse
Affiliation(s)
| | - Elin Western
- Psykosomatisk avdeling Oslo universitetssykehus, Rikshospitalet
| | - Hanne Solheim
- Nukleærmedisinsk avdeling Oslo universitetssykehus, Radiumhospitalet
| | - Bjørnar Hassel
- Nevrologisk avdeling Oslo universitetssykehus, Rikshospitalet og Forsvarets forskningsinstitutt Kjeller
| | - Emilia Kerty
- Nevrologisk avdeling Oslo universitetssykehus, Rikshospitalet og Det medisinske fakultet Universitetet i Oslo
| |
Collapse
|
31
|
Abstract
The syndrome of visuospatial neglect is a common consequence of unilateral brain injury. It is most often associated with stroke and is more severe and persistent following right hemisphere damage, with reported frequencies in the acute stage of up to 80%. Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to report or to respond to stimuli located on the contralesional side. Neglect is usually caused by large strokes in the middle cerebral artery territory and is heterogeneous, such that most patients do not manifest every feature of the syndrome. A number of treatments may improve neglect, but there is no widely accepted universal approach to therapy. Although most patients recover spontaneously, the evidence suggests that they continue to have significant cognitive impairments, particularly relating to attention.
Collapse
Affiliation(s)
- Korina Li
- Centre for Restorative Neuroscience, Division of Brain Sciences, Imperial College London, London, UK Department of Neurology, University Hospital Coventry, Coventry, West Midlands, UK
| | - Paresh A Malhotra
- Centre for Restorative Neuroscience, Division of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
32
|
Abstract
Patients with posterior cortical atrophy (PCA) have been reported to have neglect in the egocentric/ body-centered reference frame. This report describes a woman with PCA who had a right-sided stimulus-based form of allocentric visual neglect on cancellation, reading, and drawing tests. Her brain imaging revealed left parietal atrophy. The pathophysiology of this disorder may be related to an impairment of the ventral "what" stream's ability to interact with the dorsal "where" stream that mediates the allocation of spatial attention, or a deficit in the systems that allocate contralateral focal attention. Further research is needed to better understand the mechanisms of this disorder and to optimally treat it.
Collapse
Affiliation(s)
- Eduardo M Zilli
- a Department of Neurology and Center for Neuropsychological Studies , University of Florida College of Medicine , Gainesville , FL 32610-023 , USA
| | | |
Collapse
|
33
|
Cappa A, Ciccarelli N, Baldonero E, Martelli M, Silveri MC. Posterior AD-type pathology: cognitive subtypes emerging from a cluster analysis. Behav Neurol 2014; 2014:259358. [PMID: 24994944 DOI: 10.1155/2014/259358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/18/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND "Posterior shift" of the neuropathological changes of Alzheimer's disease (AD) produces a syndrome (posterior cortical atrophy) (PCA) dominated by high-level visual deficits. OBJECTIVE To explore in patients with AD-type pathology whether a data-driven analysis (cluster analysis) based on neuropsychological findings resulted in the emergence of different subgroups of patients; in particular to find out whether it was possible to identify patients with visuospatial deficits consistent with the hypothesis that PCA is a "dorsal stream" syndrome or, rather, whether there were subgroups of patients with different types of impairment within the high-level visual domain. METHODS 23 PCA and 16 DAT patients were studied. By a principal component analysis performed on a wide range of neuropsychological tasks, 15 variables were obtained that loaded onto five main factors (memory, language, perceptual, visuospatial, and calculation) which entered a hierarchical cluster analysis. RESULTS Four clusters of cognitive impairment emerged: visuospatial/perceptual, memory, perceptual/calculation, and language. Only in the first cluster a visuospatial deficit clearly emerged. conclusions: AD pathology produces not only variants dominated by memory (DAT) and, to a lesser extent, visuospatial deficit (PCA), but also other distinct syndromic subtypes with disorders in visual perception and language which reflect a different vulnerability of specific functional networks.
Collapse
|
34
|
|
35
|
Andrade K, Kas A, Samri D, Sarazin M, Dubois B, Habert MO, Bartolomeo P. Visuospatial deficits and hemispheric perfusion asymmetries in posterior cortical atrophy. Cortex 2013; 49:940-7. [DOI: 10.1016/j.cortex.2012.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/09/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
|
36
|
Migliaccio R, Agosta F, Scola E, Magnani G, Cappa SF, Pagani E, Canu E, Comi G, Falini A, Gorno-Tempini ML, Bartolomeo P, Filippi M. Ventral and dorsal visual streams in posterior cortical atrophy: a DT MRI study. Neurobiol Aging 2012; 33:2572-84. [PMID: 22277261 PMCID: PMC4827710 DOI: 10.1016/j.neurobiolaging.2011.12.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/15/2011] [Accepted: 12/20/2011] [Indexed: 12/20/2022]
Abstract
Using diffusion tensor magnetic resonance imaging tractography, ventral (inferior longitudinal fasciculus) and fronto-occipital (inferior fronto-occipital fasciculus) and dorsal (fronto-parietal superior longitudinal fasciculus) visual pathways were assessed in 7 patients with posterior cortical atrophy (PCA), showing either predominantly ventral or additional dorsal cognitive deficits. Corpus callosum and corticospinal tracts were also studied. Gray and white matter atrophy was assessed using voxel-based morphometry. In all PCA patients, abnormal diffusivity indexes were found in bilateral inferior longitudinal fasciculus and inferior fronto-occipital fasciculus, with a left-side predominance. Patients also had mild microstructural damage to the corpus callosum. The 2 patients with more dorsal symptoms also showed right fronto-parietal superior longitudinal fasciculus abnormalities. Corticospinal tracts were normal, bilaterally. When studied separately, patients with ventral clinical impairment showed a pattern of atrophy mainly located in the ventral occipitotemporal regions, bilaterally; patients with both ventral and dorsal clinical deficits showed additional atrophy of the bilateral inferior parietal lobe. Magnetic resonance imaging patterns of abnormalities mirror closely the clinical phenotypes and could provide reliable ante mortem markers of tissue damage in PCA.
Collapse
Affiliation(s)
- Raffaella Migliaccio
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- INSERM, U975 Centre de Recherche de l’Institut du Cerveau et de la Moëlle Epinière (CRICM), Hôpital de la Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Scola
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano F. Cappa
- Department of Clinical Neurosciences, San Raffaele Turro Hospital, Milan, Italy
- Vita-Salute San Raffaele University and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF, 350 Parnassus Avenue, San Francisco, CA, USA
| | - Paolo Bartolomeo
- INSERM, U975 Centre de Recherche de l’Institut du Cerveau et de la Moëlle Epinière (CRICM), Hôpital de la Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
37
|
Migliaccio R, Agosta F, Toba MN, Samri D, Corlier F, de Souza LC, Chupin M, Sharman M, Gorno-Tempini ML, Dubois B, Filippi M, Bartolomeo P. Brain networks in posterior cortical atrophy: a single case tractography study and literature review. Cortex 2012; 48:1298-309. [PMID: 22099855 PMCID: PMC4813795 DOI: 10.1016/j.cortex.2011.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/01/2011] [Accepted: 10/05/2011] [Indexed: 02/07/2023]
Abstract
Posterior cortical atrophy (PCA) is rare neurodegenerative dementia, clinically characterized by a progressive decline in higher-visual object and space processing. After a brief review of the literature on the neuroimaging in PCA, here we present a study of the brain structural connectivity in a patient with PCA and progressive isolated visual and visuo-motor signs. Clinical and cognitive data were acquired in a 58-years-old patient (woman, right-handed, disease duration 18 months). Brain structural and diffusion tensor (DT) magnetic resonance imaging (MRI) were obtained. A voxel-based morphometry (VBM) study was performed to explore the pattern of gray matter (GM) atrophy, and a fully automatic segmentation was assessed to obtain the hippocampal volumes. DT MRI-based tractography was used to assess the integrity of long-range white matter (WM) pathways in the patient and in six sex- and age-matched healthy subjects. This PCA patient had a clinical syndrome characterized by left visual neglect, optic ataxia, and left limb apraxia, as well as mild visuo-spatial episodic memory impairment. VBM study showed bilateral posterior GM atrophy with right predominance; DT MRI tractography demonstrated WM damage to the right hemisphere only, including the superior and inferior longitudinal fasciculi and the inferior fronto-occipital fasciculus, as compared to age-matched controls. The homologous left-hemisphere tracts were spared. No difference was found between left and right hippocampal volumes. These data suggest that selective visuo-spatial deficits typical of PCA might not result from cortical damage alone, but by a right-lateralized network-level dysfunction including WM damage along the major visual pathways.
Collapse
Affiliation(s)
- Raffaella Migliaccio
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | - Monica N. Toba
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Dalila Samri
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Fabian Corlier
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Leonardo C. de Souza
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Marie Chupin
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- CNRS, UMR-S7225, Paris, France
| | - Michael Sharman
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- CENIR, Centre de Neuroimagerie de Recherche, Paris, France
| | | | - Bruno Dubois
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Massimo Filippi
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | - Paolo Bartolomeo
- Inserm-UPMC UMRS 975, CR-ICM, Centre de Recherche de l’Institut du Cerveau et de la Moelle épinière, Hôpital de la Pitié-Salpêtrière, Paris, France
- Department of Psychology, Catholic University, Milan, Italy
| |
Collapse
|
38
|
Bartolomeo P, Thiebaut de Schotten M, Chica AB. Brain networks of visuospatial attention and their disruption in visual neglect. Front Hum Neurosci 2012; 6:110. [PMID: 22586384 PMCID: PMC3343690 DOI: 10.3389/fnhum.2012.00110] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/11/2012] [Indexed: 11/13/2022] Open
Abstract
Visual neglect is a multi-component syndrome including prominent attentional disorders. Research on the functional mechanisms of neglect is now moving from the description of dissociations in patients' performance to the identification of the possible component deficits and of their interaction with compensatory strategies. In recent years, the dissection of attentional deficits in neglect has progressed in parallel with increasing comprehension of the anatomy and function of large-scale brain networks implicated in attentional processes. This review focuses on the anatomy and putative functions of attentional circuits in the brain, mainly subserved by fronto-parietal networks, with a peculiar although not yet completely elucidated role for the right hemisphere. Recent results are discussed concerning the influence of a non-spatial attentional function, phasic alertness, on conscious perception in normal participants and on conflict resolution in neglect patients. The rapid rate of expansion of our knowledge of these systems raises hopes for the development of effective strategies to improve the functioning of the attentional networks in brain-damaged patients.
Collapse
Affiliation(s)
- Paolo Bartolomeo
- INSERM - UPMC UMRS 975, Brain and Spine Institute, Groupe Hospitalier Pitié-Salpêtrière Paris, France
| | | | | |
Collapse
|
39
|
Abstract
Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterised by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer's disease in most patients. However, alternative underlying causes, including dementia with Lewy bodies, corticobasal degeneration, and prion disease, have also been identified, and not all patients with PCA have atrophy on clinical imaging. This heterogeneity has led to inconsistencies in diagnosis and terminology and difficulties in comparing studies from different centres, and has restricted the generalisability of findings from clinical trials and investigations of factors that drive phenotypic variability. Important challenges remain, including the identification of factors associated not only with the selective vulnerability of posterior cortical regions but also with the young age of onset of PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-level and disease-level classifications are needed to improve diagnostic accuracy, clinical management, and the design of research studies.
Collapse
Affiliation(s)
- Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK.
| | | | | | | | | | | |
Collapse
|