Sperber Christoph, Wiesen Daniel, Karnath Hans-Otto, de Haan Bianca
Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland.
Hum Brain Mapp. 2024 Mar;45(4):e26639. doi: 10.1002/hbm.26639.
Multi-target attention, that is, the ability to attend and respond to multiple visual targets presented simultaneously on the horizontal meridian across both visual fields, is essential for everyday real-world behaviour. Given the close link between the neuropsychological deficit of extinction and attentional limits in healthy subjects, investigating the anatomy that underlies extinction is uniquely capable of providing important insights concerning the anatomy critical for normal multi-target attention. Previous studies into the brain areas critical for multi-target attention and its failure in extinction patients have, however, produced heterogeneous results. In the current study, we used multivariate and Bayesian lesion analysis approaches to investigate the anatomical substrate of visual extinction in a large sample of 108 acute right hemisphere stroke patients. The use of acute stroke patient data and multivariate/Bayesian lesion analysis approaches allowed us to address limitations associated with previous studies and so obtain a more complete picture of the functional network associated with visual extinction. Our results demonstrate that the right temporo-parietal junction (TPJ) is critically associated with visual extinction. The Bayesian lesion analysis additionally implicated the right intraparietal sulcus (IPS), in line with the results of studies in neurologically healthy participants that highlighted the IPS as the area critical for multi-target attention. Our findings resolve the seemingly conflicting previous findings, and emphasise the urgent need for further research to clarify the precise cognitive role of the right TPJ in multi-target attention and its failure in extinction patients.
多目标注意力，即关注并对同时出现在双眼视野水平子午线上的多个视觉目标做出反应的能力，对于日常现实世界中的行为至关重要。鉴于健康受试者中消退这一神经心理缺陷与注意力限制之间的紧密联系，研究消退背后的解剖结构能够独特地提供有关正常多目标注意力关键解剖结构的重要见解。然而，先前关于对多目标注意力至关重要的脑区及其在消退患者中失效的研究产生了不一致的结果。在当前研究中，我们使用多变量和贝叶斯损伤分析方法，对108名急性右半球中风患者的大样本进行视觉消退的解剖学基础研究。使用急性中风患者数据以及多变量/贝叶斯损伤分析方法使我们能够解决与先前研究相关的局限性，从而更全面地了解与视觉消退相关的功能网络。我们的结果表明，右侧颞顶联合区（TPJ）与视觉消退密切相关。贝叶斯损伤分析还表明右侧顶内沟（IPS）也有影响，这与对神经健康参与者的研究结果一致，这些研究强调IPS是多目标注意力的关键区域。我们的发现解决了先前看似相互矛盾的研究结果，并强调迫切需要进一步研究以阐明右侧TPJ在多目标注意力中的确切认知作用及其在消退患者中的失效情况。
