Neuropsychological contributions to theories of part/whole organization

Recent evidence from neuropsychology has proven useful in defining neural and cognitive subsystems involved in certain cognitive processes such as spatial attention (Posner, Walker, Friedrich, & Rafal, 1984) and imagery (Farah, 1988; Kosslyn, 1986). In this article we discuss neuropsychological evidence that suggests a modular system is responsible for the organization of parts and wholes by the visual system. We review both normal and neuropsychological evidence that suggest that hierarchical organization of objects within objects involves the coordination of at least four separate subsystems, one that emphasizes the global properties of a figure (association with right posterior superior temporal-parietal regions), one that emphasizes the local properties of a figure (associated with left posterior superior temporal-parietal regions), one that controls the distribution of attentional resources to these subsystems (associated with right or left lateral parietal lobe), and one that interconnects global and local properties and relies on the integrity of posterior temporal-temporal pathways.     

Transcranial alternating brain stimulation at alpha frequency reduces hemispatial neglect symptoms in stroke patients

Background/ObjectiveNon-invasive brain stimulation techniques such as transcranial alternating current stimulation (tACS) may help alleviate attention deficits in stroke patients with hemispatial neglect by modulating oscillatory brain activity. We applied high-definition (HD)-tACS at alpha frequency over the contralesional hemisphere to support unilateral oscillatory alpha activity and correct for the pathologically altered attention bias in neglect patients.MethodsWe performed a within-subject, placebo-controlled study in which sixteen stroke patients with hemispatial neglect underwent 10 Hz (alpha) as well as sham (placebo) stimulation targeting the contralesional posterior parietal cortex. Attentional bias was measured with a computerized visual detection paradigm and two standard paper-and-pencil neglect tests.ResultsWe revealed a significant shift of attentional resources after alpha-HD-tACS, but not sham tACS, toward the ipsilateral and thus contralesional hemifield leading to a reduction in neglect symptoms, measured with a computerized visual detection paradigm and a widely used standard paper and pencil neglect tests.ConclusionsWe showed a significant alpha-HD-tACS-induced shift of attentional resources toward the contralesional hemifield, thus leading to a reduction in neglect symptoms. Importantly, HD-tACS effects persisted after the stimulation itself had ended. This tACS protocol, based on intrinsic oscillatory processes, may be an effective and well-tolerated treatment option for neglect.     

Asynchronous stimulus presentation in visual extinction: A psychophysical study

Patients showing visual extinction as a consequence of a unilateral brain lesion can correctly detect a single stimulus in either hemifield but fail to detect the contralesional stimulus (or at least process the stimulus less efficiently) when it is presented simultaneously with an ipsilesional stimulus. In an attempt to uncover the nature of the underlying deficit, some studies have manipulated the temporal characteristics of stimulus presentation. Contra- and ipsilesional stimuli with different stimulus onset asynchronies are typically used. In the present study, visual extinction was investigated in a group of left neglect patients (N=10) using a psychophysical paradigm with different stimulus onset asynchronies of target and distractor stimuli presented in different hemifields. Contrast thresholds for a target grating were determined with the target either in isolation or in the presence of an irrelevant distractor grating. When target and distractor gratings were presented simultaneously, neglect patients showed a significant extinction effect, i.e., a significant interference from the right hemifield distractor with left hemifield contrast sensitivity. When the right hemifield distractor preceded the left hemifield target stimulus by 250 ms, two different patterns of results were observed in the neglect patients. Five patients showed a significant improvement compared to the simultaneous presentation condition, five other patients showed a significant increase of the extinction effect. The results suggest that different underlying mechanisms, maybe due to different lesion locations, can cause extinction in neglect patients.     

Spatial maps of directed visual attention

Simple reaction times (RTs) to a visual target are facilitated when the target occurs at a location expected by an observer, and are slowed when the target occurs at the mirror-symmetric location contralateral to the expectancy (e.g., Posner, 1978; Posner, Snyder, & Davidson, 1980). The spatial extent of this attention effect was examined by inducing subjects to expect the target at one location and introducing occasional probe flashes at other locations throughout the visual field. The results indicated that RTs to these probes were equivalent to those obtained at the expected location so long as the probe was in the same hemifield as the subject's expectancy. Conversely, RTs to probes in the hemifield opposite the expectancy generated uniformly slower response times. These results were obtained when the expected location varied in eccentricity from 2 degrees to 16 degrees along the horizontal meridian. In addition, when the expected and unexpected locations were within the same hemifield, no expectancy effects were observed. Under these conditions, the frequently used metaphor that directed visual attention operates like a spatially restricted "beam" appears inaccurate. The implications of these findings for current views of directed attention are considered.     

Impaired initiation but not execution of contralesional saccades in hemispatial neglect

Patients with unilateral neglect are impaired at making saccades to contralesional targets. Whether this problem arises from a deficit in perception, in planning the saccade or in executing the eye movement or some combination thereof remains unclear. We measured several variables related to the initiation and execution of saccades in an experiment which crossed two factors: target side (left, right) and direction of saccade (leftwards, rightwards). Relative to control subjects, patients with left-sided neglect were impaired in planning but not executing the contralesional saccade; while the latency to move their eyes following the onset of the target was increased, the duration and velocity to reach the target were normal. In addition, there were also no directional differences for saccades that were hypometric or inaccurate in the patients, further ruling out an execution impairment. Interestingly, this directional initiation deficit was exaggerated for leftward saccades to left targets, compared with all other conditions. We suggest that the disadvantage for contralesional saccades in neglect patients is attributable to a deficit not only in perceiving contralateral targets but also in planning leftward saccades. Once the saccade is initiated, however, execution apparently proceeds unimpaired.     

发展性阅读障碍的视觉空间注意加工能力

鉴于阅读起始于基础视觉加工阶段, 越来越多的研究者开始关注阅读障碍者的视觉空间注意加工能力。视觉空间注意是指个体对视觉刺激的空间位置的注意, 可通过线索提示、视觉搜索和视觉注意广度等视觉任务来考察。大量国内外研究发现, 发展性阅读障碍者在视觉空间注意任务下表现出行为和神经活动方面的异常。其中的神经机制问题不仅反映在与视觉空间注意有关的顶叶区域激活异常, 还存在于脑区间功能连接异常(如顶叶区域与字形加工区的功能连接)。未来研究还需利用横断和追踪研究探讨阅读障碍与视觉空间注意能力发展关系的内在机制, 以及探究语言特性对阅读障碍者视觉空间注意缺陷的可能调节作用。     

Response Channel Activation and the Temporoparietal Junction

When we learn to make one motor response to one visual stimulus and a different motor response to another, representations of these stimulus–response associations must be maintained to efficiently transduce perception into action. When an irrelevant distractor is presented adjacent to a target stimulus, interference is observed when the two stimuli are associated with conflicting responses, presumably due to response channel activation by the incompatible information. We have explored the neural bases of these interference effects. In a previous study, patients with hemispatial neglect showed normal interference from contralesional flankers. In another study, patients with lesions of the lateral prefrontal cortex were found not to show interference from distractors presented in the contralesional hemifield. The current study provided a more anatomically detailed investigation of the effects of posterior association cortex lesions on flanker interference. Patients with chronic, unilateral lesions involving the temporoparietal junction (TPJ), two of whom had hemispatial neglect, were compared with patients with lesions of the posterior association cortex not involving the TPJ. All patients performed a color discrimination task at fixation while a congruent or incongruent colored flanker was briefly presented (16.7 ms) in the adjacent contralesional or ipsilesional hemifield. Patients with TPJ lesions showed no interference effects from the contralesional flankers. These results suggest that the TPJ, in combination with the dorsolateral prefrontal cortex, is involved in transducing perception into action.     

Spatiotemporal segregation in visual search: evidence from parietal lesions

The mechanisms underlying segmentation and selection of visual stimuli over time were investigated in patients with posterior parietal damage. In a modified visual search task, a preview of old objects preceded search of a new set for a target while the old items remained. In Experiment 1, control participants ignored old and prioritized new items, but patients had severe difficulties finding the target (especially on the contralesional side). In Experiment 2, simplified displays yielded analogous results, ruling out search ease as a crucial factor in poor preview search. In Experiment 3, outlines around distractor groups (to aid segmentation) improved conjunction but not preview search, suggesting a specific deficit in spatiotemporal segmentation. Experiment 4 ruled out spatial disengagement problems as a factor. The data emphasize the role of spatiotemporal segmentation cues in preview search and the parietal lobe in the role of these cues to prioritize search of new stimuli.     

Perception of visual letter strings in a case of left neglect: Manipulation of the word form

Patients with lesions in the right parietal lobe neglect the left side of nonwords much more than the left side of words. This has been interpreted in terms of a more automatic process in reading words. The case of a patient with left visual neglect after a vascular right parietooccipital lesion is presented. He showed the phenomenon of a word superiority effect over nonword in reading at the beginning in a clinical test with static cards; 6 months later, after some recovery, the same phenomenon could be demonstrated only with tachistoscopic presentation, and it occurred even inside the good right visual hemifield. The word form of visually presented stimuli was manipulated, showing that there was a striking effect particularly when spacing the letters of words in a task that requires naming the stimulus. The patient's performance is interpreted in terms of an attentional deficit occurring at an early level of spatial information processing.     

Misprojection of landmarks onto the spatial map

It has been suggested that neglect patients misrepresent the metric spatial relations along the horizontal axis (anisometry). The "fabric" of their internal spatial medium would be distorted in such a way that physically equal distances appear relatively shorter on the contralesional side (canonical anisometry). The case of GL, a 76-year-old lady with left neglect on visual search tasks, is presented. GL showed severe relative overestimation on the left (contralesional) side on two independent tasks evaluating the metrics of her internal representation. A qualitatively similar pattern was found in two out of 10 other neglect patients who performed the second task. This behavior cannot be accounted for by the canonical anisometry hypothesis. Nevertheless, GL produced a relative left overextension (underestimation) when trying to set the endpoints of a virtual line given its midpoint (Endpoints Task). An interpretation of these results is offered in terms of a misprojection of relevant landmarks onto the internal representation without assuming distortion of its "fabric."     

Horizontal and vertical attentional orienting in Parkinson’s disease

Patients with Parkinson’s disease (PD) typically suffer from an asymmetric degeneration of dopaminergic cells in the substantia nigra, resulting in right-sided (RPD) or left-sided (LPD) predominance of motor symptomatology. As the dopaminergic system is also involved in attention, we examined horizontal and vertical orienting of attention in LPD (N = 10), RPD (N = 9) and controls (N = 10). Four LPD patients demonstrated left neglect and three LPD patients demonstrated neglect for the upper visual field. LPD patients demonstrated a slower performance in detecting targets in the left hemifield and did not demonstrate a validity effect, unlike RPD patients and controls. RPD patients performed similar to controls, with the exception of one patient showing left and another showing right neglect, and two RPD patients demonstrated lower neglect. In sum, horizontal and vertical orienting of attention can be affected in Parkinson’s disease – particularly in LPD – from very subtle slowing to clinically detectable horizontal and/or vertical neglect.     

Asymmetrical brain activity induced by voluntary spatial attention depends on the visual hemifield: a functional near-infrared spectroscopy study

The effect of the visual hemifield to which spatial attention was oriented on the activities of the posterior parietal and occipital visual cortices was examined using functional near-infrared spectroscopy in order to investigate the neural substrates of voluntary visuospatial attention. Our brain imaging data support the theory put forth in a previous psychophysical study, namely, the attentional resources for the left and right visual hemifields are distinct. Increasing the attentional load asymmetrically increased the brain activity. Increase in attentional load produced a greater increase in brain activity in the case of the left visual hemifield than in the case of the right visual hemifield. This asymmetry was observed in all the examined brain areas, including the right and left occipital and parietal cortices. These results suggest the existence of asymmetrical inhibitory interactions between the hemispheres and the presence of an extensive inhibitory network.     

Horizontal and vertical attentional orienting in Parkinson’s disease

Patients with Parkinson’s disease (PD) typically suffer from an asymmetric degeneration of dopaminergic cells in the substantia nigra, resulting in right-sided (RPD) or left-sided (LPD) predominance of motor symptomatology. As the dopaminergic system is also involved in attention, we examined horizontal and vertical orienting of attention in LPD (N = 10), RPD (N = 9) and controls (N = 10). Four LPD patients demonstrated left neglect and three LPD patients demonstrated neglect for the upper visual field. LPD patients demonstrated a slower performance in detecting targets in the left hemifield and did not demonstrate a validity effect, unlike RPD patients and controls. RPD patients performed similar to controls, with the exception of one patient showing left and another showing right neglect, and two RPD patients demonstrated lower neglect. In sum, horizontal and vertical orienting of attention can be affected in Parkinson’s disease – particularly in LPD – from very subtle slowing to clinically detectable horizontal and/or vertical neglect.     

Visual extinction and awareness: The importance of binding dorsal and ventral pathways

Patients with visual extinction were tested on three tasks involving stimulus identification and localization. In the first experiment, in which patients were to identify and localize stimuli, they demonstrated high levels of contralesional omissions. This primarily occurred under conditions of double simultaneous stimulation (DSS), consistent with the character of extinction. In contrast, when patients had to simply localize or count stimuli in Experiment 2, their contralesional omissions were very low. Similarly, when patients were to identify stimuli without localizing them (Experiment 3) they again showed very low contralesional error rates. These results support the view (Baylis, Driver, & Rafal, 1993) that visual extinction may be greatest when information about location cannot be bound to information about identity.     

Auditory and multisensory aspects of visuospatial neglect

Spatial neglect is a common neurological syndrome in which awareness of contralesional space is disrupted after unilateral (typically right) stroke. Although most research has focused on visual aspects of neglect, there is increasing evidence that neglect can often be multisensory. Here we focus on auditory disturbances that can co-occur with visual neglect. Patients selected for showing visual neglect often also show deficits in localization of single sounds; and also in the detection or identification of contralesional sounds, particularly in the presence of an ipsilesional competitor. Moreover, auditory and visual aspects of neglect often correlate in their severity across patients. These results are considered in relation to recent neuroimaging findings in the normal brain, showing that the brain regions typically damaged in neglect patients might contain multimodal representations of space.     

Spatial neglect, Balint-Homes' and Gerstmann's syndrome, and other spatial disorders

Brain-damaged patients with lesion or dysfunction involving the parietal cortex may show a variety of neuropsychological impairments involving spatial cognition. The more frequent and disabling deficit is the syndrome of unilateral spatial neglect that, in a nutshell, consists in a bias of spatial representation and attention ipsilateral to of extrapersonal, personal (ie, the body) space, or both, toward the side of the hemispheric lesion. The deficit is more frequent and severe after damage to the right hemisphere, involving particularly the posterior-inferior parietal cortex at the temporo-parietal junction. Damage to these posterior parietal regions may also impair visuospatial short-term memory, which may be associated with and worsen spatial neglect. The neural network supporting spatial representation, attention and short-term memory is, however, more extensive, including the right premotor cortex. Also disorders of drawing and building objects (traditionally termed constructional apraxia) are a frequent indicator of posterior parietal damage in the left and in the right hemispheres. Other less frequent deficits, which, however, have a relevant localizing value, include optic ataxia (namely, the defective reaching of visual objects, in the absence of elementary visuo-motor impairments), which is typically brought about by damage to the superior parietal lobule. Optic ataxia, together with deficits of visual attention, of estimating distances and depth, and with apraxia of gaze, constitutes the severely disabling Balint-Holmes' syndrome, which is typically associated with bilateral posterior parietal and occipital damage. Finally, lesions of the posterior parietal lobule (angular gyrus) in the left hemisphere may bring about a tetrad of symptoms (left-right disorientation, acalculia, finger agnosia, and agraphia) termed Gerstmann's syndrome, that also exists in a developmental form.     

Grounding spatial language in the motor system: Reciprocal interactions between spatial semantics and orienting

Shifts of attention that are directed by spatial words are thought to be mediated by a spatial frame of reference. Previous studies have documented a selection cost when visual attention is directed along the left/right axis relative to the above/below axis due to the greater ambiguity of the horizontal endpoints. The present study investigated whether the horizontal endpoints may be more fully disambiguated when “left/right” cues are first enacted by nondivisible, more discrete, modes of orienting such as directional motor responses. This issue was investigated using a repetition priming paradigm in which the effects of prior enactments were measured on the subsequent conceptual control of visual attention. The results of four experiments showed that grounding spatial language in the motor system can enhance the focus of visual attention by disambiguating the endpoints of the horizontal axis. In so doing, the present study extends previous research demonstrating that spatial concepts can influence the spatial distribution of attention by demonstrating that different modes of orienting can also influence the semantics of space. Implications for the premotor theory of attention and grounded theories of cognition are also discussed.     

Impaired shifting of attention in Balint's syndrome

We assessed the efficiency of attentional shifts across the horizontal and vertical axes of the visual field in a patient with Balint's syndrome caused by bilateral parieto-occipital infarctions. This was performed using an adaptation of Posner's peripheral cueing paradigm. In contrast to normal controls and patients with unilateral parietal lesions previously reported, this patient did not benefit from cues directing attention to the left or right visual field. She appeared to benefit only when the cues directed attention to the upper visual field. This suggests a defect in shifting attention that may occur following bilateral parietal lesions. We discuss the implications of these findings for the role of the parietal lobes in attentional processes and for our understanding of the behavioral abnormalities observed in Balint's syndrome.     

Suppression of extinction with TMS in humans: from healthy controls to patients

We review a series of studies exemplifying some applications of single-pulse and paired-transcranial magnetic stimulation (TMS) in the study of spatial attention and of its deficits. We will focus primarily on sensory extinction, the failure to consciously perceive a contralesional sensory stimulus only during bilateral stimulation of homologous surfaces. TMS studies in healthy controls show that it is possible either to interfere or modulate the excitability of the parietal cortex during sensory (i.e. tactile and visual) attentional tasks, thus reproducing a condition of virtual extinction. TMS studies in patients with unilateral (mainly right) brain damage show that the modulation of the unbalance in cortical excitability between the two cerebral hemispheres transiently improves contralesional sensory extinction. These studies show the possible application of TMS not only as a research method in healthy subjects, but also as a tool for inducing brain excitability changes in patients with sensory extinction, which could be useful for supporting the rehabilitation of this deficit.     

Attentional disengagement deficit in nondemented elderly over 75 years of age

Healthy older adults in the age range of 60-75 years are moderately deficient in visuospatial attention when central location cues are used to shift attention, but not when peripheral cues are used. In contrast, older adults with dementia of the Alzheimer's type (DAT) exhibit an attention shifting (disengagement) deficit for both central and peripheral cues. If the effects of dementia and normal aging on visuospatial attention differ qualitatively, then peripherally cued shifts of attention should be unaffected even in very old nondemented persons. to examine this possibility, subjects in six age groups (17-24, 35-44, 45-54, 55-64, 65-74, and 75-85 years) were tested on a visuospatial attention task. Valid, invalid and neutral location cues preceded a letter target requiring, in separate conditions, either speeded detection or discrimination. Combined costs and benefits of cue validity on reaction time (RT) increased with age in the discrimination but not in the detection task. the oldest group (75-85) showed significantly larger RT costs and benefits than the next oldest group (65-74), for both central and peripheral cues. the 75-85 year-olds were significantly slower than the 65-75 year-olds on invalid trials (costs) but not on valid trials (benefits), pointing to a disengagement deficit, as reported previously for patients with either parietal lobe damage or DAT. the results suggest that in healthy nondemented subjects of advanced age (over 75 years), visuospatial attention is affected similarly to younger patients in the early, mild stages of Alzheimer's disease.