A disengagement deficit in representational space.

Some patients with hemispatial neglect show a deficit of "disengagement", i.e., their left-sided inattention is largely a consequence of an inability to move the spotlight of attention away from right-sided stimuli. We report a neglect patient with a failure of disengagement in imagined space, a feature not previously described. The patient was repeatedly moved along a hallway and had to memorize 20 objects placed alongside the walls (alternating starting points). Each learning run was followed by a recall run, in which objects had to be named in their correct sequence from one imaginary starting point. Initially, when performance was still poor, only right-sided items were named, a response pattern mimicking a neglect of representational space. However, as recall improved over successive runs, left-sided objects were as well memorized as right-sided, but the latter were named before the former. By contrast, if photographs of single objects were presented in the center of a screen for laterality decisions, neither accuracy nor latency of the patient's decisions differentiated between left-sided and right-sided items. We interpret the sticking to the right side during initial periods of free recall, in the absence of side-differences during cued recognition, as a failure to disengage from the right side of a mental image. In view of the extensive cortical and subcortical lesions in our patient the current debate about the functional neuroanatomy of this deficit cannot be resolved. However, the present report adds to our understanding of the heterogeneous nature of deficiencies in the representation of space.