Computer-Assisted Rehabilitation Shows Greater Efficacy Than Traditional in Visuospatial Skills and Cognition in Neglect Patients.

This study is crucial for improving unilateral spatial neglect (USN) treatments, focusing on comparing the effectiveness of computer-assisted cognitive rehabilitation (CACR) against conventional rehabilitation (CR) methods. It aimed to address a significant research gap and improve patient outcomes by evaluating the impact of CACR versus CR on visuospatial perception, visual field and attention, and visual memory in patients with USN. This study was a randomized controlled trial. Forty-five consecutive patients with USN from a university rehabilitation center were divided into two groups: 22 patients received CACR with Rehacom software, focusing on saccadic eye movement, visual field, and visual-motor coordination, while 23 underwent CR that combined hemispheric activation approach, mental imagery training, and vibration therapy. Assessments included the Motor-Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Visual Span Test (VST), and Visual Recognition Test (VRT). The study employed ANCOVA and effect size calculations to evaluate the effectiveness of CACR compared to CR in treating patients with USN. Results indicated that CACR significantly outperformed CR in improving visuospatial perception, visual field, attention, and memory, showcasing its effectiveness in treating USN. These findings demonstrate the superiority of CACR over CR, particularly in enhancing visual memory and attention, as evidenced by the large effect size in VRT and moderate effects in LBT and VST. This suggests CACR's potential as a more effective approach for rehabilitation in patients with USN due to brain injuries.

Abnormal pain perception is associated with thalamo-cortico-striatal atrophy in C9orf72 expansion carriers in the GENFI cohort.

OBJECTIVE: Frontotemporal dementia (FTD) is typically associated with changes in behaviour, language and movement. However, recent studies have shown that patients can also develop an abnormal response to pain, either heightened or diminished. We aimed to investigate this symptom in mutation carriers within the Genetic FTD Initiative (GENFI). METHODS: Abnormal responsiveness to pain was measured in 462 GENFI participants: 281 mutation carriers and 181 mutation-negative controls. Changes in responsiveness to pain were scored as absent (0), questionable or very mild (0.5), mild (1), moderate (2) or severe (3). Mutation carriers were classified into C9orf72 (104), GRN (128) and MAPT (49) groups, and into presymptomatic and symptomatic stages. An ordinal logistic regression model was used to compare groups, adjusting for age and sex. Voxel-based morphometry was performed to identify neuroanatomical correlates of abnormal pain perception. RESULTS: Altered responsiveness to pain was present to a significantly greater extent in symptomatic C9orf72 expansion carriers than in controls: mean score 0.40 (SD 0.71) vs 0.00 (0.04), reported in 29% vs 1%. No significant differences were seen between the other symptomatic groups and controls, or any of the presymptomatic mutation carriers and controls. Neural correlates of altered pain perception in C9orf72 expansion carriers were the bilateral thalamus and striatum as well as a predominantly right-sided network of regions involving the orbitofrontal cortex, inferomedial temporal lobe and cerebellum. CONCLUSION: Changes in pain perception are a feature of C9orf72 expansion carriers, likely representing a disruption in somatosensory, homeostatic and semantic processing, underpinned by atrophy in a thalamo-cortico-striatal network.

Modifying the Adult Rat Tonotopic Map with Sound Exposure Produces Frequency Discrimination Deficits That Are Recovered with Training.

Frequency discrimination learning is often accompanied by an expansion of the functional region corresponding to the target frequency within the auditory cortex. Although the perceptual significance of this plastic functional reorganization remains debated, greater cortical representation is generally thought to improve perception for a stimulus. Recently, the ability to expand functional representations through passive sound experience has been demonstrated in adult rats, suggesting that it may be possible to design passive sound exposures to enhance specific perceptual abilities in adulthood. To test this hypothesis, we exposed adult female Long-Evans rats to 2 weeks of moderate-intensity broadband white noise followed by 1 week of 7 kHz tone pips, a paradigm that results in the functional over-representation of 7 kHz within the adult tonotopic map. We then tested the ability of exposed rats to identify 7 kHz among distractor tones on an adaptive tone discrimination task. Contrary to our expectations, we found that map expansion impaired frequency discrimination and delayed perceptual learning. Rats exposed to noise followed by 15 kHz tone pips were not impaired at the same task. Exposed rats also exhibited changes in auditory cortical responses consistent with reduced discriminability of the exposure tone. Encouragingly, these deficits were completely recovered with training. Our results provide strong evidence that map expansion alone does not imply improved perception. Rather, plastic changes in frequency representation induced by bottom-up processes can worsen perceptual faculties, but because of the very nature of plasticity these changes are inherently reversible.SIGNIFICANCE STATEMENT The potent ability of our acoustic environment to shape cortical sensory representations throughout life has led to a growing interest in harnessing both passive sound experience and operant perceptual learning to enhance mature cortical function. We use sound exposure to induce targeted expansions in the adult rat tonotopic map and find that these bottom-up changes unexpectedly impair performance on an adaptive tone discrimination task. Encouragingly, however, we also show that training promotes the recovery of electrophysiological measures of reduced neural discriminability following sound exposure. These results provide support for future neuroplasticity-based treatments that take into account both the sensory statistics of our external environment and perceptual training strategies to improve learning and memory in the adult auditory system.

Association between prism adaptation and auditory cues on spatial navigation in individuals with unilateral neglect.

BACKGROUND: Unilateral neglect is common among right-hemispheric stroke individuals and also concerns the auditory modality. Prism adaptation can improve auditory extinction during a dichotic listening task, but its effect during an ecological task has not been studied. OBJECTIVE: The main objective was to evaluate whether lateralized cueing before and after prism adaptation improved virtual spatial navigation of stroke individuals with visual and auditory unilateral neglect. Secondary objectives were to assess spatial memory and obtain a better understanding of the mechanism of the cueing treatment by using an eye-tracker. METHODS: We included 22 stroke individuals with left visual and auditory neglect, 14 individuals without neglect, and 12 healthy controls. After a familiarization task, participants underwent 3 evaluation sessions. Participants were first passively shown a path that they had then to actively reproduce by using a joystick. A path with lateralized beeping sounds indicating direction and a path without any sounds were followed in a randomized order. After prism adaptation, the participants followed a third path with lateralized beeping sounds. The time of navigation and number of trajectory mistakes were recorded. After navigation, spatial memory was assessed. Additionally, an eye-tracker was used during the navigation period. RESULTS: The navigational performance of participants with neglect was significantly better with than without auditory cues, especially after prism adaptation. With auditory cues, participants without neglect reached the navigational performance of healthy controls. The spatial memory of individuals with neglect was significantly lower with auditory cues. Eye-tracking analyses showed that participants with neglect made more saccades and looked longer at the right-square angles in the absence of auditory cues. CONCLUSIONS: This study demonstrates the positive effect of auditory cues in virtual spatial navigation of individuals with visual and auditory neglect and the potentiation of the help of cues after prism adaptation.

Influence of Motor Deficiency and Spatial Neglect on the Contralesional Posterior Parietal Cortex Functional and Structural Connectivity in Stroke Patients.

The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those existing for the contralesional PPC. In this study, we aimed at mapping the functional (using resting state fMRI) and structural (using diffusion tensor imagery) networks from 3 subparts of the PPC of the contralesional hemisphere (the anterior intraparietal sulcus), the posterior intraparietal sulcus and the superior parieto-occipital cortex to bilateral frontal areas and ipsilesional homologous PPC parts in 11 chronic stroke patients compared to 13 healthy controls. We also aimed at assessing the relationship between connectivity and the severity of visuospatial and motor deficiencies. We showed that interhemispheric functional and structural connectivity between PPCs was altered in stroke patients compared to controls, without any specificity among seeds. Alterations of parieto-frontal intra- and interhemispheric connectivity were less observed. Neglect severity was associated with several alterations in intra- and interhemispheric connectivity, whereas we did not find any behavioral/connectivity correlations for motor deficiency. The results of this exploratory study shed a new light on the influence of the contralesional PPC in post-stroke patients, they have to be confirmed and refined in further larger studies.

Mapping the anatomy of perceptual pseudoneglect. A multivariate approach.

Fundamental to the understanding of the functions of spatial cognition and attention is to clarify the underlying neural mechanisms. It is clear that relatively right-dominant activity in ventral and dorsal parieto-frontal cortex is associated with attentional reorienting, certain forms of mental imagery and spatial working memory for higher loads, while lesions mostly to right ventral areas cause spatial neglect with pathological attentional biases to the right side. In contrast, complementary leftward biases in healthy people, called pseudoneglect, have been associated with varying patterns of cortical activity. Notably, this inconsistency may be explained, at least in part, by the fact that pseudoneglect studies have often employed experimental paradigms that do not control sufficiently for cognitive processes unrelated to pseudoneglect. To address this issue, here we administered a carefully designed continuum of pseudoneglect and control tasks in healthy adults while using functional magnetic resonance imaging (fMRI). Data submitted to partial least square (PLS) imaging analysis yielded a significant latent variable that identified a right-dominant network of brain regions along the intra-occipital and -parietal sulci, frontal eye fields and right ventral cortex in association with perceptual pseudoneglect. Our results shed new light on the interplay of attentional and cognitive systems in pseudoneglect.

Differential Patterns of Visual Sensory Alteration Underlying Face Emotion Recognition Impairment and Motion Perception Deficits in Schizophrenia and Autism Spectrum Disorder.

BACKGROUND: Impaired face emotion recognition (FER) and abnormal motion processing are core features in schizophrenia (SZ) and autism spectrum disorder (ASD) that have been linked to atypical activity within the visual cortex. Despite overlaps, only a few studies have directly explored convergent versus divergent neural mechanisms of altered visual processing in ASD and SZ. We employed a multimodal imaging approach to evaluate FER and motion perception in relation to functioning of subcortical and cortical visual regions. METHODS: Subjects were 20 high-functioning adults with ASD, 19 patients with SZ, and 17 control participants. Behavioral measures of coherent motion sensitivity and FER along with electrophysiological and functional magnetic resonance imaging measures of visual pattern and motion processing were obtained. Resting-state functional magnetic resonance imaging was used to assess the relationship between corticocortical and thalamocortical connectivity and atypical visual processing. RESULTS: SZ and ASD participants had intercorrelated deficits in FER and motion sensitivity. In both groups, reduced motion sensitivity was associated with reduced functional magnetic resonance imaging activation in the occipitotemporal cortex and lower delta-band electroencephalogram power. In ASD, FER deficits correlated with hyperactivation of dorsal stream regions and increased evoked theta power. Activation of the pulvinar correlated with abnormal alpha-band modulation in SZ and ASD with under- and overmodulation, respectively, predicting increased clinical symptoms in both groups. CONCLUSIONS: SZ and ASD participants showed equivalent deficits in FER and motion sensitivity but markedly different profiles of physiological dysfunction. The specific pattern of deficits observed in each group may help guide development of treatments designed to downregulate versus upregulate visual processing within the respective clinical groups.

An Active Inference Approach to Interoceptive Psychopathology.

Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.

Issues in the future development of new analgesic drugs.

PURPOSE OF REVIEW: There is a clear unmet need for either the development of new drugs for the treatment of painful pathologies or the better use of the existing agents denoted by the lack of efficacy of many existing drugs in a number of patients, limitations of their use due to severity of side effects, and by the high number of drugs that fail to reach clinical efficacy from preclinical development. This account considers the efforts being made to better validate new analgesic components and to improve translational efficacy of existing drugs. RECENT FINDINGS: A better use of the available models and tools can improve the predictive validity of new analgesic drugs, as well as using intermediate steps when translating drugs to clinical context such as characterizing drugs using stem cell-sensory derived neurones. Profiling patient sensory phenotypes can decrease the number of failed clinical trials and improve patient outcome. SUMMARY: An integrative approach, comprising the use of complementary techniques to fully characterize drug profiles, is necessary to improve translational success of new analgesics.

Dissociable Contributions of Precuneus and Cerebellum to Subjective and Objective Neuropathy in HIV.

Neuropathy, typically diagnosed by the presence of either symptoms or signs of peripheral nerve dysfunction, remains a frequently reported complication in the antiretroviral (ART)-treated HIV population. This study was conducted in 109 healthy controls and 57 HIV-infected individuals to investigate CNS regions associated with neuropathy. An index of objective neuropathy was computed based on 4 measures: deep tendon ankle reflex, vibration sense (great toes), position sense (great toes), and 2-point discrimination (feet). Subjective neuropathy (self-report of pain, aching, or burning; pins and needles; or numbness in legs or feet) was also evaluated. Structural MRI data were available for 126/166 cases. The HIV relative to the healthy control group was impaired on all 4 signs of neuropathy. Within the HIV group, an objective neuropathy index of 1 (bilateral impairment on 1 measure) or 2 (bilateral impairment on at least 2/4 measures) was associated with older age and a smaller volume of the cerebellar vermis. Moderate to severe symptoms of neuropathy were associated with more depressive symptoms, reduced quality of life, and a smaller volume of the parietal precuneus. This study is consistent with the recent contention that ART-treated HIV-related neuropathy has a CNS component. Distinguishing subjective symptoms from objective signs of neuropathy allowed for a dissociation between the precuneus, a brain region involved in conscious information processing and the vermis, involved in fine tuning of limb movements. Graphical Abstract In HIV patients, objective signs of neuropathy correlated with smaller cerebellar vermis (red) volumes whereas subjective symptoms of neuropathy were associated with smaller precuneus (blue) volumes.

Using real-time fMRI neurofeedback to restore right occipital cortex activity in patients with left visuo-spatial neglect: proof-of-principle and preliminary results.

Hemineglect is common after right parietal stroke, characterised by impaired awareness for stimuli in left visual space, with suppressed neural activity in the right visual cortex due to losses in top-down attention signals. Here we sought to assess whether hemineglect patients are able to up-regulate their right visual cortex activity using auditory real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback. We also examined any effect of this training procedure on neglect severity. Two different neurofeedback methods were used. A first group of six patients was trained to up-regulate their right visual cortex activity and a second group of three patients was trained to control interhemispheric balance between their right and left visual cortices. Over three sessions, we found that the first group successfully learned to control visual cortex activity and showed mild reduction in neglect severity, whereas the second group failed to control the feedback and showed no benefit. Whole brain analysis further indicated that successful up-regulation was associated with a recruitment of bilateral fronto-parietal areas. These findings provide a proof of concept that rt-fMRI neurofeedback may offer a new approach to the rehabilitation of hemineglect symptoms, but further studies are needed to identify effective regulation protocols and determine any reliable impact on clinical symptoms.

Motor imagery in chronic neglect: An fMRI pilot study.

AIM: Previous studies indicate the effectiveness of motor imagery training in stroke patients. To determine whether patients showing chronic visuospatial neglect symptoms may profit from motor imagery training, it is important to assess how the brain implements motor imagery when cortical systems involved in attentional control are impaired. METHOD: Therefore, in this pilot study, nine chronic neglect patients with right-hemispheric stroke performed motor imagery of a finger opposition task during functional magnetic resonance imaging (fMRI). RESULTS: Imagery of unaffected hand movements was related to activations in the left primary somatosensory and premotor cortices as well as in the left supplementary motor area. During the imagery of the affected hand, patients displayed activations in the left premotor cortex and supplementary motor area as well as left dorsolateral prefrontal cortex. Furthermore, time since onset and visual imagery capacity were negatively related to activation in the supplementary motor area during the imagery of the affected hand. CONCLUSIONS: These initial results demonstrate motor imagery capacity in patients with chronic neglect via compensatory neural processing during motor imagery of the affected hand in ipsilateral brain regions, since we found that the supplementary motor area appears to be specifically related to neglect severity. Although our results must be treated with caution due to the small sample size and missing control group, they indicate that neglect is not necessarily an exclusion criterion for motor imagery training per se.

Sounds from seeing silent motion: Who hears them, and what looks loudest?

Some people hear what they see: car indicator lights, flashing neon shop signs, and people's movements as they walk may all trigger an auditory sensation, which we call the visual-evoked auditory response (vEAR or 'visual ear'). We have conducted the first large-scale online survey (N > 4000) of this little-known phenomenon. We analysed the prevalence of vEAR, what induces it, and what other traits are associated with it. We assessed prevalence by asking whether respondents had previously experienced vEAR. Participants then rated silent videos for vividness of evoked auditory sensations, and answered additional trait questions. Prevalence appeared higher relative to other typical synaesthesias. Prior awareness and video ratings were associated with greater frequency of other synaesthesias, including flashes evoked by sounds, and musical imagery. Higher-rated videos often depicted meaningful events that predicted sounds (e.g., collisions). However, even videos containing abstract flickering or moving patterns could also elicit higher ratings, despite having no predictable association with sounds. Such videos had higher levels of raw 'motion energy' (ME), which we quantified using a simple computational model of motion processing in early visual cortex. Critically, only respondents reporting prior awareness of vEAR tended to show a positive correlation between video ratings and ME. This specific sensitivity to ME suggests that in vEAR, signals from visual motion processing may affect audition relatively directly without requiring higher-level interpretative processes. Our other findings challenge the popular assumption that individuals with synaesthesia are rare and have ideosyncratic patterns of brain hyper-connectivity. Instead, our findings of apparently high prevalence and broad associations with other synaesthesias and traits are jointly consistent with a common dependence on normal variations in physiological mechanisms of disinhibition or excitability of sensory brain areas and their functional connectivity. The prevalence of vEAR makes it easier to test such hypotheses further, and makes the results more relevant to understanding not only synaesthetic anomalies but also normal perception.

Effects of spatial attention on mental time travel in patients with neglect.

Numerous studies agree that time is represented in spatial terms in the brain. Here we investigate how a deficit in orienting attention in space influences the ability to mentally travel in time, that is to recall the past and anticipate the future. Right brain-damaged patients, with (RBD-N+) and without neglect (RBD-N-), and healthy controls (HC) were subjected to a Mental Time Travel (MTT) task. Participants were asked to project themselves in time to past, present or future (i.e., self-projection) and, for each self-projection, to judge whether events were located relatively in the past or the future (i.e., self-reference). The MTT-task was performed before and after a manipulation, through prismatic adaptation (PA), inducing a leftward shift of spatial attention. Before PA, RBD-N+ were slower for future than for past events, whereas RBD-N- and HC responded similarly to past and future events. A leftward shift of spatial attention by PA reduced the difference in past/future processing in RBD-N+ and fastened RBD-N- and HC's response to past events. Assuming that time concepts, such as past/future, are coded with a left-to-right order on a mental time line (MTL), a recursive search of future-events can explain neglect patients' performance. Improvement of the spatial deficit following PA reduces the recursive search of future events on the rightmost part of the MTL, facilitating exploration of past events on the leftmost part of the MTL, finally favoring the correct location of past and future events. In addition, the study of the anatomical correlates of the temporal deficit in mental time travel through voxel-based lesion-symptom mapping showed a correlation with a lesion located in the insula and in the thalamus. These findings provide new insights about the inter-relations of space and time, and can pave the way to a procedure to rehabilitate a deficit in these cognitive domains.

Cotard Syndrome.

Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusions and claims of immortality and enormity, feelings of damnation, and illusions of bodily dissolution and transformation. Alternatively conceived as an extreme case of depression, hypochondria, or psychosis, the condition is considered rare and remains poorly understood. Cotard himself provided a taxonomy and several explanations for the condition, focusing on its distinction from classical persecutory delusions and suggesting that it could be a kind of reversed grandiosity. He proposed a psychosensory basis in the dissolution of mental imagery, which he then extended to a more general psychomotor impairment of volition. Other early authors highlighted a disorder of the bodily self, and more recent theories postulated an impairment of right hemispheric functions, leading to perceptual and somatosensory feelings of unreality, which coupled with reasoning impairments and an internalized attributional style led in turn to beliefs of non-existence. However, despite its striking presentation and its relevance to our understanding of self-awareness, Cotard's syndrome remains an elusive condition, rarely reported and poorly researched.

Synaesthesia-type associations and perceptual changes induced by hypnotic suggestion.

Are synaesthetic experiences congenital and so hard-wired, or can a functional analogue be created? We induced an equivalent of form-colour synaesthesia using hypnotic suggestions in which symbols in an array (circles, crosses, squares) were suggested always to have a certain colour. In a Stroop type-naming task, three of the four highly hypnotizable participants showed a strong synaesthesia-type association between symbol and colour. This was verified both by their subjective reports and objective eye-movement behaviour. Two resembled a projector- and one an associator-type synaesthete. Participant interviews revealed that subjective experiences differed somewhat from typical (congenital) synaesthesia. Control participants who mimicked the task using cognitive strategies showed a very different response pattern. Overall, the results show that the targeted, preconsciously triggered associations and perceptual changes seen in association with congenital synaesthesia can rapidly be induced by hypnosis. They suggest that each participant's subjective experience of the task should be carefully evaluated, especially when studying hypnotic hallucinations. Studying such experiences can increase understanding of perception, automaticity, and awareness and open unique opportunities in cognitive neuroscience and consciousness research.

Cortico-thalamic disconnection in a patient with supernumerary phantom limb.

Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse. Here, we tested this hypothesis by studying an extremely rare patient with chronic SPL, still present 3 years after a vascular stroke affecting cortical and subcortical right-hemisphere structures. Anatomical analysis included an advanced in vivo reconstruction of white matter tracts using diffusion-based spherical deconvolution. This reconstruction demonstrated a massive and relatively selective disconnection between anatomically preserved SMA/PMC and the thalamus. Our results provide strong anatomical support for the hypothesis that cortico-thalamic loops involving motor-related circuits are crucial to integrate sensorimotor processing with bodily self-awareness.

Left Spatial Neglect Evoked by Electrostimulation of the Right Inferior Fronto-occipital Fasciculus.

Left spatial neglect is a debilitating condition that may occur after lesion of many cortical territories in the right hemisphere. At the subcortical level, the second and third branches of the right superior longitudinal fasciculus has emerged as strong candidates in conveying information exchanges within the attention networks as their damage has been repeatedly associated to spatial neglect in neuromodulation and neuropsychological studies. Yet, a few cases of spatial neglect have also been observed after damage to the right inferior fronto-occipital fasciculus (IFOF), suggesting an involvement of this associative connectivity in spatial attention. Here we report three rare cases of patients having undergone a wide-awake craniotomy with direct electrostimulation for right temporal glioma. An intraoperative monitoring of spatial cognition was performed using a standard line bisection task. Responsive cortical sites were observed in the supramarginal gyrus and the posterior part of both the middle and superior temporal gyri. Critically, in all patients, significant rightward deviations were observed by the stimulation of the white matter deep in the temporal lobe, along the roof of the inferior horn of the lateral ventricle-a well-known anatomical landmark to identify the IFOF. Disconnection analyses confirmed the high probability of IFOF disconnection during neglect-related stimulations. Taken together, our findings provide support for a role of the right IFOF in spatial cognition. We discuss these results in the light of the newly discovered fronto-parietal connections of the IFOF and suggest that some subcomponents of this tract might be involved in between-system integration within the attention network.

Representational pseudoneglect for detecting changes to Rey-Osterrieth figures.

When dividing attention between the left and right sides of physical space, most individuals pay slightly more attention to the left side. This phenomenon, known as pseudoneglect, may also occur for the left and right sides of mental representations of stimuli. Representational pseudoneglect has been shown for the recall of real-world scenes and for simple, briefly presented stimuli. The current study sought to investigate the effect of exposure duration and complexity using adaptations of the Rey-Osterrieth figures. Undergraduates (n = 97) were shown a stimulus for 20 s and asked to remember it. Participants were then shown a probe and indicated whether it was the same or different. Results showed that, irrespective of whether an element was added or subtracted, changes on the left side of the remembered image were better detected. These results are consistent with representational pseudoneglect and demonstrate that this effect occurs for complex stimuli when presented for an extended period of time. Representation neglect is therefore unlikely to be the result of an initial saccade to the left-but could be related to the formation or recall of the representation.