Poster C8, Sunday, March 25, 1:00-3:00 pm, Exhibit Hall C
Same underlying neural mechanisms for spatial neglect and anosognosia for functional disability
Stephanie A. Waldman1, Peii Chen2, Meghan D. Caulfield1,2; 1Lafayette College, Easton PA, 2Kessler Foundation, West Orange, NJ
Commonly occurring after unilateral brain injury such as stroke, spatial neglect is characterized by a failure or slowness to respond, orient, or initiate action towards the side of space contralateral to the brain lesion. Spatial neglect often co-occurs with awareness deficits, demonstrated as under-reporting one’s own cognitive or motor impairment. Awareness deficits in conjunction with spatial neglect can have profound consequences for rehabilitation progress in regaining functional independence. We examined this hypothesis in 58 individuals with left-sided neglect after right brain stroke, using a secondary data analysis method. In this cohort (46.5% female; mean age=67.3 years, SD=13.3), severity of spatial neglect was determined with the Behavioral Inattention Test. Awareness of deficits was operationally defined as the over-estimation of one’s own abilities in daily activities self-rated on the Barthel Index (BI), in comparison to caregiver rated BI. Using discrepancies between the two ratings (i.e., unawareness index), two groups were created for comparative analysis: no/mild unawareness and moderate/severe unawareness. Between-group comparisons revealed significant differences in spatial neglect severity, t(56) = 2.19, p =.033, and for functional independence at rehabilitation discharge, t(52) = 3.06, p =.003, suggesting poor self-awareness is associated with both spatial neglect and disability. Lesion analysis revealed that lesion size is not responsible for observed between-group differences, p > .05. However, between-groups lesion subtractions indicate similar underlying neural mechanisms are responsible for both spatial neglect and awareness deficits (i.e. right superior temporal gyrus and right superior longitudinal fasciculus) and may play a key role in regaining functional improvement after stroke.
Topic Area: ATTENTION: Spatial