Disruption of large-scale electrophysiological networks in stroke patients with visuospatial neglect.

Stroke frequently produces attentional dysfunctions including symptoms of hemispatial neglect, which is characterized by a breakdown of awareness for the contralesional hemispace. Recent studies with functional MRI (fMRI) suggest that hemineglect patients display abnormal intra- and interhemispheric functional connectivity. However, since stroke is a vascular disorder and fMRI signals remain sensitive to nonneuronal (i.e., vascular) coupling, more direct demonstrations of neural network dysfunction in hemispatial neglect are warranted. Here, we utilize electroencephalogram (EEG) source imaging to uncover differences in resting-state network organization between patients with right hemispheric stroke (N = 15) and age-matched, healthy controls (N = 27), and determine the relationship between hemineglect symptoms and brain network organization. We estimated intra- and interregional differences in cortical communication by calculating the spectral power and amplitude envelope correlations of narrow-band EEG oscillations. We first observed focal frequency-slowing within the right posterior cortical regions, reflected in relative delta/theta power increases and alpha/beta/gamma decreases. Secondly, nodes within the right temporal and parietal cortex consistently displayed anomalous intra- and interhemispheric coupling, stronger in delta and gamma bands, and weaker in theta, alpha, and beta bands. Finally, a significant association was observed between the severity of left-hemispace search deficits (e.g., cancellation test omissions) and reduced functional connectivity within the alpha and beta bands. In sum, our novel results validate the hypothesis of large-scale cortical network disruption following stroke and reinforce the proposal that abnormal brain oscillations may be intimately involved in the pathophysiology of visuospatial neglect.

Disownership of body parts as revealed by a visual scale evaluation. An observational study.

The disownership of body parts, that most frequently occurs on the left side of the body, contralateral to right-hemispheric lesions, is an infrequent disorder, as usually assessed by interviews asking for dichotomic "yes/no" responses. This observational study in right-brain-damaged stroke patients investigated the efficacy of a continuous Visual Analog Scale (VAS) to detect body disownership after right brain damage, compared to dichotomic questions. Thirty-two right-handed right-brain-damaged stroke patients were given a Standardized Interview (SI), asking "Whose hand/arm/leg is this?", followed by a VAS (asking patients to mark on a vertical line their agreement with the statement that a body part belonged to them). The neural correlates of this disorder and measures of extra-personal and personal spatial neglect were also assessed. Control data were recorded from 18 neurologically unimpaired right-handed participants. During the interview, no patient showed disownership of body parts. Conversely, on the VAS eight out of 32 (25%) patients' scores, but none of the controls' scores, indicated a judgement of disownership for left body parts, with a left-right difference larger than that of control participants. VAS-detected disownership was not systematically associated with extra-personal and personal unilateral spatial neglect. Lesion sites associated with disownership of left body parts included the caudate nucleus and the anterior part of the internal capsule. To conclude, the VAS task, compared to the interview, is a novel tool to detect disownership of left body parts in right brain-damaged patients. A revised classification of body-ownership disorders is proposed. The present variant, assessed and detected by the VAS task, is termed Covert disownership and distinguished from the Overt disownership assessed by a SI.

You or me? Disentangling perspectival, perceptual, and integrative mechanisms in heterotopagnosia.

Heterotopagnosia-without-Autotopagnosia (HwA) is characterized by the incapacity to point to body parts on others, but not on one's own body. This has been classically interpreted as related to a self-other distinction, with impaired visual representations of other bodies seen in third person perspective (3PP), besides spared own body somatosensory representations in 1PP. However, HwA could be impacted by a deficit in the integration of visual and somatosensory information in space, that are spatially congruent in the case of one's own body, but not for others' body. Here, we test this hypothesis in a rare neurological patient with HwA, H+, as well as in a control patient with a comparable neuropsychological profile, but without HwA, and in age-matched healthy controls, in two experiments. First, we assessed body part recognition in a new task where somatosensory information from the participant's body and visual information from the target body shown in virtual reality was never aligned in space. Results show that, differently from the flawless performance in controls, H+ committed errors for not only the body of others in 3PP, but for all conditions where the information related to the real and the target body was not spatially congruent. Then, we tested whether the integration between these multisensory bodily cues in space, as during visuo-tactile stimulation in the full-body illusion, improves the patient's performance. Data show that after the stimulation prompting visuo-tactile integration, but not in control conditions, the patient's abilities to process body parts improved up to normal level, thus confirming and extending the first findings. Altogether, these results support a new interpretation of HwA as linked to the matching between somatosensory inputs from one's body and visual information from a body seen at a distance, and encourage the application of multisensory stimulation and virtual reality for the treatment of body-related disorders.

Dysexecutive disorders and their diagnosis: A position paper.

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

Context processing during irony comprehension in right-frontal brain-damaged individuals.

The aim of the present study was to investigate whether the degree of incongruity between contextual information and a target sentence influences the extent to which irony is understood in individuals with right-frontal-hemisphere damage (RHD). A psycholinguistic paradigm was used, allowing us to assess whether impairment in irony understanding is likely to be due to insensitivity (i.e. difficulty in capturing or detecting relevant contextual information) to relevant contextual information or to difficulties in integrating contextual information. Twenty individuals with RHD and 20 healthy control (HC) participants were tested on their understanding of a speaker's ironic intent and their executive functions. The main results revealed that individuals with RHD exhibit different patterns of performance, some of them being able to understand irony while in others this ability was impaired. The present study gives support to the hypothesis that difficulties in adequately using contextual information may account for pragmatic impairment of individuals with RHD. More importantly, the results suggested that these difficulties are related to a lack of sensitivity to contextual information instead of difficulty integrating it along with the ironic utterance. A subgroup of individuals with RHD processed the speaker's utterance without any reference to contextual information, which led them to a literal interpretation of the utterance.

Executive Functions Deficits After Severe Traumatic Brain Injury: The GREFEX Study.

OBJECTIVE: To assess the sensitivity of traditional neuropsychological tests and of a behavioral inventory of executive disorders in a large sample of patients with chronic severe traumatic brain injury. METHODS: A total of 112 patients were compared with 780 healthy controls from a larger database. The GREFEX battery included 7 widely used tests and the Behavioral Dysexecutive Syndrome Inventory (proxy rating). A previously described statistical methodology was used, controlling for age, education, and gender. Summary scores were computed and performance was dichotomized on the basis of 5th percentile cutoffs from controls' z scores. RESULTS: The frequency of cognitive impairment was high (55.4%) but lower than that of behavioral changes (81.5%). Double dissociations were observed between cognitive and behavioral assessments. Behavioral changes exhibited larger effect-sizes as compared with cognitive impairments. Logistic regression analysis showed that 3 cognitive tests (verbal fluency, Stroop reading, and Trail Making Test-B) and 3 behavior z scores (hypoactivity, anticipation, and hyperactivity) best discriminated patients from controls. CONCLUSION: Behavioral changes were more frequent and severe than cognitive deficits, at least as assessed with traditional testing. The present results also suggest that a shortened battery may provide a rapid screening method with reasonable sensitivity to detect deficits of executive functions in patients with severe traumatic brain injury.

Assessment of Topographical Disorientation: First Application of New Tests and Case Report.

A right posterior cerebral lesion can lead to an inability to orient and can consequently interfere with daily-life autonomy. Despite the wide literature about navigation abilities, it is still difficult to assess topographical disorientation (TD) because of the interindividual specificity of spatial knowledge and the diversity of symptoms. We describe here a set of new tests evaluating spatial cognition in a patient with TD presenting difficulties in navigating inside the hospital and in his hometown more than 3 years after his diffuse ischemic right Sylvian stroke. These tests assess mental imagery (global and specifically spatial imagery), perspective change, and the ability to recall spatial relations in familiar environments. The evaluation revealed difficulties with all the tests (but not in global mental imagery) in this patient when compared with matched controls. Hence, these new tests seem specific and affected by a right hemispheric lesion. The observed deficits can explain, at least partially, the spatial orientation difficulties experienced by this patient in the hospital and familiar environments. In conclusion, these tests could be appropriate tools for the assessment of visuospatial and spatial processes.

Unilateral hemispheric lesions disrupt parallel processing within the contralateral intact hemisphere: an auditory fMRI study.

Evidence from activation studies suggests that sound recognition and localization are processed in two distinct cortical networks that are each present in both hemispheres. Sound recognition and/or localization may, however, be disrupted by purely unilateral damage, suggesting that processing within one hemisphere may not be sufficient or may be disturbed by the contralateral lesion. Sound recognition and localization were investigated psychophysically and using fMRI in patients with unilateral right hemisphere lesions. Two patients had a combined deficit in sound recognition and sound localization, two a selective deficit in sound localization, one a selective deficit in sound recognition, and two normal performance in both tasks. The overall level of activation in the intact left hemisphere of the patients was smaller than in normal control subjects, irrespective of whether the patient's performance in the psychophysical tasks was impaired. Despite this overall decrease in activation strength, patients with normal performance still exhibited activation patterns similar to those of the control subjects in the recognition and localization tasks, indicating that the specialized brain networks subserving sound recognition and sound localization in normal subjects were also activated in the patients with normal performance, albeit to an altogether lesser degree. In patients with deficient performance, on the other hand, the activation patterns during the sound recognition and localization tasks were severely reduced, comprising fewer and partly atypical activation foci compared to the normal subjects. This indicates that impaired psychophysical performance correlates with a breakdown of parallel processing within specialized networks in the contralesional hemisphere.

Segregated processing of auditory motion and auditory location: an ERP mapping study.

Recent studies have revealed a distinct cortical network activated during the analysis of sounds' spatial properties. Whether common brain regions in this auditory where pathway are involved in both auditory motion and location processing is unresolved. We investigated this question with multichannel auditory evoked potentials (AEPs) in 11 subjects. Stimuli were binaural 500-ms white noise bursts. Interaural time differences (ITD) created the sensation of moving or stationary sounds within each auditory hemifield, and subjects discriminated either their position or direction of motion in a blocked design. Scalp potential distributions (AEP maps) differentiated electric field configurations across stimulus classes. The initial approximately 250-ms poststimulus yielded common topographies for both stimulus classes and hemifields. After approximately 250-ms, moving and stationary sounds engaged distinct cortical networks at two time periods, again with no differences observed between hemifields. The first ( approximately 250- to 350-ms poststimulus onset) was during stimulus presentation, and the second ( approximately 550- to 900-ms poststimulus onset) occurred after stimulus offset. Distributed linear inverse solutions of the maps over the 250- to 350-ms time period revealed not only bilateral inferior frontal activation for both types of auditory spatial processing, but also strong right inferior parietal activation in the case of auditory motion discrimination. During the later 550-to 900-ms time period, right inferior parietal and bilateral inferior frontal activity was again observed for moving sounds, whereas strong bilateral superior frontal activity was seen in the case of stationary sounds. Collectively, the evidence supports the existence of partly segregated networks within the auditory where pathway for auditory location and auditory motion processing.