Dara Chinar, Bang Jee, Gottesman Rebecca F, Hillis Argye E
Departments of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Baltimore, MD, USA.
J Neurol Transl Neurosci. 2014 Jan 1;2(1):1037.
Neurologists generally consider hemispatial neglect to be the primary cognitive deficit following right hemisphere lesions. However, the right hemisphere has a critical role in many cognitive, communication and social functions; for example, in processing emotional prosody (tone of voice). We tested the hypothesis that impaired recognition of emotional prosody is a more accurate indicator of right hemisphere dysfunction than is neglect.
We tested 28 right hemisphere stroke (RHS) patients and 24 hospitalized age and education matched controls with MRI, prosody testing and a hemispatial neglect battery. Emotion categorization tasks assessed recognition of emotions from prosodic cues. Receiver operating characteristic (ROC) analyses were used to compare tests in their ability to distinguish stroke patients from controls.
ROC analyses revealed that the Prosody Score was more effective than the Neglect Battery Score in distinguishing stroke patients from controls, as measured by area under the curve (AUC); Prosody Score = 0.84; Neglect Battery Score =0. 57. The Prosody Score correctly classified 78.9%, while Neglect Score correctly classified 55.8% of participants as patients versus controls. The Prosody Score was similar to the total NIH Stroke Scale in identifying RHS patients (AUC=0.86, correctly classifying 80.1% of patients versus controls), but the tests only partially overlapped in the patients identified.
Severe prosody impairment may be a better indicator of right hemisphere dysfunction than neglect. Larger studies are needed to determine if including a bedside test of Prosody with the NIH Stroke Scale would most efficiently and reliably identify right hemisphere ischemia.
神经科医生通常认为半侧空间忽视是右半球损伤后的主要认知缺陷。然而，右半球在许多认知、交流和社会功能中起着关键作用；例如，在处理情感韵律（语调）方面。我们检验了这样一个假设，即与忽视相比，情感韵律识别受损是右半球功能障碍更准确的指标。
我们对28名右半球卒中（RHS）患者和24名年龄和教育程度匹配的住院对照者进行了MRI、韵律测试和半侧空间忽视测试。情感分类任务评估了从韵律线索中识别情感的能力。采用受试者操作特征（ROC）分析来比较各项测试区分卒中患者和对照者的能力。
ROC分析显示，在区分卒中患者和对照者方面，韵律评分比忽视测试评分更有效，以曲线下面积（AUC）衡量；韵律评分 = 0.84；忽视测试评分 = 0.57。韵律评分正确分类了78.9%的参与者，而忽视评分正确分类了55.8%的参与者为患者或对照者。韵律评分在识别RHS患者方面与美国国立卫生研究院卒中量表总分相似（AUC = 0.86，正确分类了80.1%的患者与对照者），但在识别出的患者中，这些测试仅部分重叠。
严重的韵律障碍可能比忽视更能指示右半球功能障碍。需要进行更大规模的研究来确定，将床边韵律测试与美国国立卫生研究院卒中量表结合使用是否能最有效、可靠地识别右半球缺血。
