Italian standardization of the Apples Cancellation Test.

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect).

The relationship between specific cognitive impairment and behaviour in Prader-Willi syndrome.

BACKGROUND: Individuals with Prader-Willi syndrome (PWS) have been shown to demonstrate a particular cognitive deficit in attention switching and high levels of preference for routine and temper outbursts. This study assesses whether a specific pathway between a cognitive deficit and behaviour via environmental interaction can exist in individuals with PWS. METHODS: Four individuals with PWS participated in a series of three single-case experiments including laboratory-based and natural environment designs. Cognitive (computer-based) challenges placed varying demands on attention switching or controlled for the cognitive demands of the tasks while placing no demands on switching. Unexpected changes to routines or expectations were presented in controlled games, or imposed on participants' natural environments and compared with control conditions during which no unexpected changes occurred. Behaviour was observed and heart rate was measured. RESULTS: Participants showed significantly increased temper outburst related behaviours during cognitive challenges that placed demands on attention switching, relative to the control cognitive challenges. Participants showed significantly increased temper outburst related behaviours when unexpected changes occurred in an experimental or the natural environment compared with when no changes occurred. CONCLUSIONS: Difficult behaviours that could be triggered reliably in an individual by a specific cognitive demand could also be triggered via manipulation of the environment. Results suggest that a directional relationship between a specific cognitive deficit and behaviour, via environmental interaction, can exist in individuals with PWS.

A specific pathway can be identified between genetic characteristics and behaviour profiles in Prader-Willi syndrome via cognitive, environmental and physiological mechanisms.

BACKGROUND: Behavioural phenotypes associated with genetic syndromes have been extensively investigated in order to generate rich descriptions of phenomenology, determine the degree of specificity of behaviours for a particular syndrome, and examine potential interactions between genetic predispositions for behaviour and environmental influences. However, relationships between different aspects of behavioural phenotypes have been less frequently researched and although recent interest in potential cognitive phenotypes or endophenotypes has increased, these are frequently studied independently of the behavioural phenotypes. METHOD: Taking Prader-Willi syndrome (PWS) as an example, we discuss evidence suggesting specific relationships between apparently distinct aspects of the PWS behavioural phenotype and relate these to specific endophenotypic characteristics. RESULTS: The framework we describe progresses through biological, cognitive, physiological and behavioural levels to develop a pathway from genetic characteristics to behaviour with scope for interaction with the environment at any stage. CONCLUSIONS: We propose this multilevel approach as useful in setting out hypotheses in order to structure research that can more rapidly advance theory.

From both sides now: crossover effects influence navigation in patients with unilateral neglect.

Unilateral neglect is a challenging disorder that pervades a range of behaviours following stroke and hampers recovery. Although a preponderance of clinical studies measure performance on a range of bedside assessments, including line bisection and cancellation tasks, there have been calls for studies to embrace more relevant functional measures. Here, for the first time, we present data from two separate tasks that characterise the performance of seven patients with unilateral neglect when navigating a power wheelchair. The tasks involved negotiating an obstacle course and steering a central path between gaps of different sizes. Results from the obstacle course confirmed the clinical observation and predicted bias of contralesional errors. However, the second task revealed a robust "crossover" effect. Patients deviated to the ipsilesional side for large gaps but deviated increasingly contralesionally when steering through small gaps in behaviour that was analogous to that previously shown on line bisection tasks. Contrary to being seen as an unintuitive finding, further analysis of these errors suggests that patients are giving disproportionate weight to the location of the ipsilesional object when plotting a midline course between two objects. Our results provide a platform for further studies to investigate the modulation and rehabilitation of this important skill.

Comparing action disorganization syndrome and dual-task load on normal performance in everyday action tasks.

The term 'action disorganization syndrome' has been used to describe patients with selective impairments in carrying out multi-step everyday tasks, which are not linked to motor deficits. We used a range of everyday life tasks to examine the effects on a patient with ADS of having related distractors present during task performance. The presence of related distractors increased omission errors in the patient. In a second experiment we assessed whether we could mimic this pattern of deficit when normal participants carried out the everyday tasks and a secondary task was imposed to place demands on executive processes. Secondary task load produced a general increase in errors in the controls and reduced the number of self-correcting responses, but there were no proportional increases in omission errors. Control participants and patients with ADS may suffer from demands on different processes involved in the performance of everyday actions. We discuss the implications for understanding everyday actions.

Detection by action: neuropsychological evidence for action-defined templates in search.

How do we detect a target in a cluttered environment? Here we present neuropsychological evidence that detection can be based on the action afforded by a target. A patient showing symptoms of unilateral neglect following damage to the right fronto-temporal-parietal region was slow and sometimes unable to find targets when they were defined by their name or even by a salient visual property (such as their color). In contrast, he was relatively efficient at finding a target defined by the action it afforded. Two other patients with neglect showed an opposite pattern; they were better at finding a target defined by its name. The data suggest that affordances can be effective even when a brain lesion limits the use of other properties in search tasks. The findings give evidence for a direct pragmatic route from vision to action in the brain.

Preliminary validation study of the Russian Birmingham Cognitive Screen.

INTRODUCTION: The Birmingham Cognitive Screen (BCoS) is designed for use with individuals who have acquired language impairment following stroke. Our goal was to develop a Russian version of the BCoS (Rus-BCoS) by translating the battery following cultural and linguistic adaptations and establishing preliminary data on its psychometric properties. METHOD: Fifty patients with left-hemisphere stroke were recruited, of whom 98% were diagnosed with mild to moderate aphasia. To check whether the Rus-BCoS provides stable and consistent scores, internal consistency, test-retest, and interrater types of reliability were determined. Eight participants with stroke and 20 neurologically intact participants were assessed twice. To inspect the discriminative power of the battery, 63 participants without brain impairment were tested with the Rus-BCoS. Additionally, the Russian version of the Montreal Cognitive Assessment (MoCA), Quantitative Assessment of Speech in Aphasia, and Luria's Neuropsychological Assessment Battery were used to examine convergent validity, sensitivity, and specificity of the Rus-BCoS. RESULTS: The internal consistency as well as test-retest and interrater reliability of the Rus-BCoS satisfied criteria for the research use. Performance on a majority of tasks in the battery correlated significantly with independently validated tests that putatively measure similar cognitive processes. Critically, all patients with aphasia returned nonzero scores in at least one task in all the Rus-BCoS sections, with the exception of the Controlled Attention section where two patients with severe executive control deficits could not perform. CONCLUSIONS: The Rus-BCoS shows promise as a comprehensive cognitive screening tool that can be used by clinicians working with Russian-speaking persons experiencing poststroke aphasia after much further validation and development of reliable normative standards. Given a lack of quantitative neuropsychological assessment tools in Russia, however, we contend the Rus-BCoS offers potential benefits to clinicians and patients. However, data from research studies with a broader sample of Russian speakers are needed.

Object recognition: the man who mistook his dog for a cat.

Neuropsychological studies of people with specific brain lesions have led to the theory that different parts of the brain are responsible for recognizing living and non-living objects. Now there is direct evidence from activity measurements that this is the case.

Previewing distracters reduces their effective contrast.

In a visual search task, when half the distracters are presented earlier than the remainder ('previewed'), observers find the target item more efficiently than when all the items are presented together -- the preview benefit. We measured psychometric functions for contrast increments on Gabors that were presented as a valid preview for subsequent search, and when they were a non-predictive (dummy) preview. Sensitivity to contrast increments was lower (rightwards shift of the psychometric function) on valid, compared to dummy previews. This is consistent with an account of the preview benefit in terms of active inhibition, equivalent to lowering the contrast of previewed items that are being actively ignored.

A psychophysical investigation into the preview benefit in visual search.

In preview search, half of the distracters are presented ahead of the remaining distracters and the target. Search under these conditions is more efficient than when all the items appear together (Watson & Humphreys, 1997). We investigated the mechanisms contributing to this preview benefit using an orientation discrimination task. In a display of vertical Gabors (all equidistant from fixation) one Gabor (chosen at random) was tilted (left or right). When half the non-tilted Gabors were previewed, thresholds increased less with the number of Gabors, relative to when all the Gabors appeared together (a preview benefit). In a further experiment, orientation noise was added to some of the Gabors. When all Gabors were presented simultaneously, orientation thresholds for the target increased. The effects of noise on thresholds was reduced, however, when the noisy Gabors were presented as a preview. Furthermore, there was less effect of noise in the preview condition than when observers were cued to a subset of Gabors (with a cue presented prior to the Gabors, adjacent to their positions). Visual information can be effectively excluded from the previewed locations to a greater degree than when attention is directed to a subset of display items. The implications for understanding the mechanisms involved in preview search are discussed.

Self-bias modulates saccadic control.

We present novel data on the role of attention in eliciting enhanced processing of stimuli associated with self. Participants were required to make pro- or anti-saccades according to whether learned shape-label pairings matched or mismatched. When stimuli matched participants were required to make an anti-saccade, and when the stimuli mismatched a pro-saccade was required. We found that anti-saccades were difficult to make to stimuli associated with self when compared to stimuli associated with a friend and a stranger. In contrast, anti-saccades to friend-stimuli were easier to make than anti-saccades to stranger-stimuli. In addition, a correct anti-saccade to a self-associated stimulus disrupted subsequent pro-saccade trials, relative to when the preceding anti-saccade was made to other stimuli. The data indicate that self-associated stimuli provide a strong cue for explicit shifts of attention to them, and that correct anti-saccades to such stimuli demand high levels of inhibition (which carries over to subsequent pro-saccade trials). The self exerts an automatic draw on attention.

Domain-specific versus generalized cognitive screening in acute stroke.

Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76% of patients were impaired on MoCA, and 86% demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78% sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.

Don't think twice, it's all right--contralesional dependency for bimanual prehension movements.

In bimanual coordination when moving the hands to two separate objects, subjects tend to initiate and terminate the movements together, even when the targets are at different distances or are of a different size. Additionally, each hand tends to scale its grasp independently to the object to be grasped. Here, we report the performance of a patient, who had previously shown signs of motor neglect, on two experiments investigating coupling and independence in bimanual coordination. The patient showed relatively normal bimanual behaviour for the transport phase of prehension when objects were placed at different distances (Experiment 1), but abnormal behaviour for the grasp component when objects were of different sizes (Experiment 2). Moreover, the contralesional limb demonstrated a dependency of grasp that was related to the object grasped by the ipsilesional limb. We discuss the possible underlying mechanisms of this dependency in relation to competitive motor programming and attentional bias. The results also reinforce the view that the transport and grasp components of prehension are distinct processes.

Connectionist models of neuropsychological disorders.

Artificial neural networks ('connectionist models') embody aspects of real neuronal systems. But does studying the breakdown of performance in such models help us to understand cognitive impairments in humans following brain damage? Here we review recent attempts to capture different neuropsychological disorders using connectionist models with simulated lesions. We show how such lesion studies can be used to evaluate some of the standard assumptions made in neuropsychological research, concerning both double dissociations and associations between patterns of impairment. We also illustrate how lesioned models, like humans, can sometimes be more impaired on the easier of two tasks and demonstrate that connectionist models can incorporate forms of internal structure. Finally we discuss the utility of the models for understanding and predicting the effectiveness of different rehabilitation strategies. Future questions concern the role and possible development of internal structure within these models, whether the models can be generalized to larger-scale simulations, and whether they can accommodate higher-order linguistic disorders.

The effect of target foreknowledge on visual search for categorically separable orientation targets.

This research note assesses the role of target foreknowledge in visual search for categorically defined orientation targets, as first described by Wolfe et al. [Wolfe, J. M., Friedman-Hill, S. R., Stewart, M. I., & O'Connell, K. M. (1992). The role of categorisation in visual search for orientation. Journal of Experimental Psychology: Human Perception and Performance, 18, 34-49]. We compared search with known versus unknown (respond to the odd item) targets. An RT advantage for categorical search only emerged with known targets. The evidence points to an important role for top-down processes in search for categorically--defined orientation targets.

The computation of perceptual structure from collinearity and closure: normality and pathology.

Three experiments tested how structural information affects the processing of fragmented forms, using evidence from both normal subjects and an agnosic patient. The stimuli were either (a) outline drawings of objects; (b) "well" or "poorly" structured fragmented forms derived from outline drawings (Experiments 1 and 2) or (c) "well" or "poorly" structured fragmented forms derived from outline drawings of meaningless forms (Experiment 3). "Well" and "poorly" structured forms varied on the properties of collinearity and closure of the elements. Subjects decided if two simultaneously presented forms had the same orientation or were mirror-reversed. Three levels of discriminability were examined: (a) for "symmetrical" forms the decision had to be based on the detection of a small feature appearing on the same or the opposite side in the two forms; (b) for "asymmetrical" forms the decision had to be based on a large part located on the same or the opposite side of each object; and (c) for "oblique" forms, matching could be based on the global orientation of the shapes. Normal subjects performed equivalently on outline drawings and "well" structured fragmented forms and worse on "poorly" structured forms. This effect was strongest on "asymmetrical" stimuli, both with meaningful (Experiments 1 and 2) and meaningless forms (Experiment 3). This indicates that the segmentation of forms into parts, for judgements with "asymmetrical" stimuli, is affected by the structural properties of collinearity and closure. For the agnosic patient, performance was similar for "well" and "poorly" structured forms, and there was better performance in the "oblique" condition. This suggests that the patient could use global shape information, but that this coexists with a selective deficit in computing local perceptual structure, based on collinearity and closure between form elements. The implications of the results for understanding form perception and the clinical use of fragmented forms, are discussed.

Task-specific effects of orientation information: neuropsychological evidence.

The deficits underlying orientation agnosia in a patient (MB) with a right fronto-temporo-parietal lesion were examined. Like similar patients in the literature, MB was impaired at discriminating whether objects were upright or not and, in copying, she tended to re-represent stimuli as upright. In addition, MB failed to show the normal effects of rotation on object identification; her naming of objects rotated 45 degrees from upright was no slower than her naming of upright items. Effects of the degree of rotation did emerge, however, when she had to perform a matching task that required mental rotation. The evidence suggests that orientation may be coded in several ways (e.g. separately between objects and relative to the viewer), and that brain-damage can selectively affect the use of some but not all types of orientation information.

Coding space within but not between objects: evidence from Balint's syndrome.

The ability to make spatial judgements was examined in a patient demonstrating poor perception of multiple objects following bilateral parietal lesions, under conditions in which the presence of the stimuli to which judgements were made could be detected. The tasks required judgements of spatial length or the position of coloured parts of stimuli. We manipulated the degree to which two uprights in a display could be encoded into a single perceptual object using either stored knowledge or bottom-up cues based on 2D or 3D image relations. Performance was dependent on the presence of both bottom-up grouping and familiarity. However, connectedness in the image was not sufficient to benefit performance, when stimuli were separate objects in 3D space. This deficit in spatial judgements, arising following detection of the relevant stimulus elements, is attributed to an impairment in coding the spatial relations between separate perceptual objects. This deficit could be overcome if stimuli could be grouped in 3D, using bottom-up cues and top-down knowledge.

Axis-based grouping reduces visual extinction.

We examined the effects on extinction of grouping by collinearity of edges and grouping by alignment of internal axes of shapes, in a patient (GK) with simultanagnosia following bilateral parietal brain damage. GK's visual extinction was reduced when items (equilateral triangles and angles) could be grouped by base alignment (i.e., collinearity) or by axis alignment, relative to a condition in which items were ungrouped. These grouping effects disappeared when inter-item spacing was increased, though factors such as display symmetry remained constant. Overall, the results suggest that, under some conditions, grouping by alignment of axes of symmetry can have an equal beneficial effect on visual extinction as edge-based grouping; thus, in the extinguished field, there is derivation of axis-based representations from the contours present.

The effect of cueing on unilateral neglect.

Heilman and Valenstein recently failed to reduce unilateral neglect, assessed by a line bisection task, by cueing patients to attend to their neglected field. Cueing was accomplished by placing letters at both ends of the line and instructing subjects to identify either the right or left hand letter prior to bisecting the line. The present experiments tested whether this failure to improve neglect occurred because patients were presented with competing stimuli in their neglected and non-neglected fields. Five patients with unilateral neglect and hemianopia took part in two experiments. The results showed a marked decrease in neglect when subjects were cued and forced to report stimuli in their neglected field. This occurred even when there was a competing stimulus in the non-neglected field. However, in the absence of forced report requirements, patients oriented to stimuli in the non-neglected field. The results are interpreted as a failure of patients with unilateral neglect to orient automatically to the side of space contralateral to the lesion, though processes governing the conscious orienting of attention are intact.