Impaired orienting of attention in left unilateral neglect: a componential analysis

Twenty-six patients suffering from damage to the right side of the brain, 19 of whom exhibited signs of left neglect, as well as 32 matched controls, ran 3 spatial cuing tasks. Patients were also tested with 2 cancellation tests, a line-bisection test, the copy of a complex drawing, and a visual extinction procedure. Results first showed correlations between extinction and cancellation tests performance on one hand, and between line bisection and copy on the other hand. Second, results demonstrated that an engagement deficit toward contralesional targets appeared to be the most striking feature of neglect, and the engagement score was correlated with the cancellation score and extinction. Most patients with neglect also presented a deficit in disengagement, a deficit of inhibition of return, and probably a deficit of alertness. Deficits in engagement and in disengagement, as well as poor scores in cancellation tests, seemed to be related with posterior cortical and subcortical lesions. Most important, even if an endogenous deficit (frequently related with a thalamic lesion) could aggravate the neglect behavior, neglect syndrome was mainly explained by a deficit of exogenous attention.