Clinical presentation and neural correlates of stroke-associated spatial delusions

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Spatial delusions, or reduplicative paramnesias, involve mislocation beliefs, often following right hemisphere brain injury.
• These delusions significantly impact patient behavior, but their clinical characteristics are not well-documented.

Purpose of the Study:

• To prospectively identify and characterize spatial delusions in acute right-hemisphere stroke patients.
• To analyze the relationship between delusion duration and structural disruption of belief-associated functional networks.
• To describe syndrome subtypes and evaluate their prediction by functional network disruption.

Main Methods:

• Screened 504 acute right-hemisphere stroke patients for spatial delusions.
• Systematically assessed behavioral and clinical features of affected patients.
• Analyzed correlations between delusion duration, structural disruption, and network connectivity using statistical modeling and k-means clustering.

Main Results:

• Identified 60 patients with spatial delusions; 93% mislocalized places closer to home.
• Delusion duration (median 3 days) moderately correlated with structural-functional decoupling of belief networks (r=0.39, p=0.02).
• Clinical subtypes showed distinct patterns; clustering based on network disruption poorly matched clinical categorization.

Conclusions:

• Systematic characterization of spatial delusions improves diagnosis and clinical management.
• New insights into neural correlates clarify the pathophysiology of delusional misidentifications.