Hamilton R H, Coslett H B, Buxbaum L J, Whyte J, Ferraro M K
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Int Neuropsychol Soc. 2008 Jan;14(1):23-32. doi: 10.1017/S1355617708080077.
Hemispatial neglect has been conceptualized as having dissociable and potentially clinically relevant subtypes. However, the question of whether patient performance on neglect subtype measures is consistent over time remains largely unanswered. We examined changes in performance over time on measures of motor, perceptual, and personal neglect in 21 patients with neglect from acute right hemisphere stroke. Patients were assessed on three occasions, separated by at least one week, using a lateralized target test, lateralized response test, and modified fluff test. Across three testing timepoints, 18 (85.7%) patients changed subtype performance patterns at least once. In 13 (61.9%) of these patients, inconsistency between timepoints was not adequately accounted for by recovery. On initial testing, seven, patients (33.3%) demonstrated more than one neglect subtype symptom; by the third testing timepoint none of the patients demonstrated multiple symptoms. In the setting of acute stroke, performance on three measures of neglect symptoms is inconsistent across time. However, the distribution of neglect subtype symptoms appears to become more discrete over time. These findings complicate our understanding of the pathophysiology and potential prognostic value of neglect subtypes, and suggest that treatment decisions based on subtype performance assessed at a single timepoint, may be of limited utility.
半侧空间忽视已被概念化为具有可分离且可能具有临床相关性的亚型。然而，患者在忽视亚型测量中的表现是否随时间保持一致的问题在很大程度上仍未得到解答。我们研究了21例急性右半球卒中所致忽视患者在运动、感知和个人忽视测量方面随时间的表现变化。患者分别在三个时间点接受评估，间隔至少一周，使用侧化目标测试、侧化反应测试和改良绒毛测试。在三个测试时间点中，18名（85.7%）患者至少有一次改变了亚型表现模式。在其中13名（61.9%）患者中，时间点之间的不一致无法通过恢复情况得到充分解释。在初次测试时，7名患者（33.3%）表现出不止一种忽视亚型症状；到第三次测试时间点时，没有患者表现出多种症状。在急性卒中的情况下，忽视症状的三种测量表现随时间不一致。然而，忽视亚型症状的分布似乎随时间变得更加离散。这些发现使我们对半侧空间忽视亚型的病理生理学和潜在预后价值的理解变得复杂，并表明基于单个时间点评估的亚型表现做出的治疗决策可能效用有限。
