Patient assessment based on a theory of visual attention (TVA): subtle deficits after a right frontal-subcortical lesion

We report on a patient who complained of reduced awareness in the left visual field, but showed no visual neglect or extinction in clinical testing. By MR scanning, the brain damage was localized to the right basal ganglia, also involving structures in right frontal cortex. Using psychophysical testing and mathematical modeling based on Bundesen's theory of visual attention [TVA; Psychol. Rev. 97 (1990) 523], the patient's subjective experience of attentional disturbance was confirmed, and the deficit was specified into several components. At very short exposure durations, two effects were shown. The detection threshold was elevated, particularly in the left visual field, and stimuli in this side were given less attentional weight. In addition, the capacity of visual short-term memory (VSTM) was markedly reduced in both visual fields. The robustness of the test results was evaluated by bootstrap analysis. The study demonstrates the sensitivity and specificity gained by combining psychophysical testing with TVA modeling in the analysis of visual attention disorders. Extending the results of a pioneer study of parietal neglect patients by Duncan et al. [J. Exp. Psychol.: Gen. 128 (1999) 450], this study demonstrates the strength of the method in a single case, with a lesion outside parietal cortex, and only minor clinical symptoms.

[1]  George Sperling,et al.  The information available in brief visual presentations. , 1960 .

[2]  A Gorea,et al.  Failure to handle more than one internal representation in visual detection tasks. , 2000, Proceedings of the National Academy of Sciences of the United States of America.

[3]  G. Sperling,et al.  Successive approximations to a model for short term memory. , 1967, Acta psychologica.

[4]  Elisabetta Làdavas,et al.  Automatic and voluntary orienting of attention in patients with visual neglect: Horizontal and vertical dimensions , 1994, Neuropsychologia.

[5]  A. Young,et al.  Disentangling neglect and hemianopia , 1991, Neuropsychologia.

[6]  Robert L. Goldstone,et al.  Handbook of cognition , 2005 .

[7]  P. Reuter-Lorenz,et al.  Vertical orienting control: evidence for attentional bias and "neglect" in the intact brain. , 1996, Journal of experimental psychology. General.

[8]  E. Renzi,et al.  An experimental investigation on the nature of extinction , 1995, Neuropsychologia.

[9]  Charles M. Butter,et al.  Altitudinal Neglect Following Traumatic Brain Injury: A Case Report , 1989, Cortex.

[10]  Robert Tibshirani,et al.  An Introduction to the Bootstrap , 1994 .

[11]  J. Duncan,et al.  Systematic analysis of deficits in visual attention. , 1999 .

[12]  G. Sperling.  A Model for Visual Memory Tasks1 , 1963, Human factors.

[13]  D. Spinelli,et al.  Vertical Neglect: Behavioral and Electrophysiological Data , 1997, Cortex.

[14]  C. Marzi,et al.  The spatial distribution of visual attention in hemineglect and extinction patients. , 1998, Brain : a journal of neurology.

[15]  K M Heilman,et al.  Frontal lobe neglect in man , 1972, Neurology.

[16]  J. Duncan.  Converging levels of analysis in the cognitive neuroscience of visual attention. , 1998, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[17]  Dov Sagi,et al.  Natural extinction: A criterion shift phenomenon , 2002 .

[18]  Christopher Kennard,et al.  Visual neglect associated with frontal lobe infarction , 1996, Journal of Neurology.

[19]  Jon Driver,et al.  Levels of processing for visual stimuli in an “extinguished” field , 1992, Neuropsychologia.

[20]  S. Pollmann,et al.  Extinction-like Effects in Normals: Independence of Localization and Response Selection , 2000, Brain and Cognition.

[21]  G. Woodman,et al.  Storage of features, conjunctions and objects in visual working memory. , 2001, Journal of experimental psychology. Human perception and performance.

[22]  S. Ferber,et al.  Spatial awareness is a function of the temporal not the posterior parietal lobe , 2001, Nature.

[23]  Stefan Pollmann,et al.  A pop-out induced extinction-like phenomenon in neurologically intact subjects , 1996, Neuropsychologia.

[24]  J. Marshall,et al.  Is neglect (only) lateral? A quadrant analysis of line cancellation. , 1989, Journal of clinical and experimental neuropsychology.

[25]  E. Bullmore,et al.  How Good Is Good Enough in Path Analysis of fMRI Data? , 2000, NeuroImage.

[26]  John R. Duncan,et al.  Visual search and visual attention , 1985 .

[27]  J. Marshall,et al.  Blindsight and insight in visuo-spatial neglect , 1988, Nature.

[28]  Bernhard A. Sabel,et al.  Computer-based training for the treatment of partial blindness , 1998, Nature Medicine.

[29]  H. Shibuya,et al.  Efficiency of visual selection in duplex and conjunction conditions in partial report , 1993, Perception & psychophysics.

[30]  H J Müller,et al.  Top-down controlled visual dimension weighting: an event-related fMRI study. , 2002, Cerebral cortex.

[31]  K. Heilman,et al.  Neglect and Related Disorders , 1984, Seminars in neurology.

[32]  R. Mcglinchey-Berroth.  Visual information processing in hemispatial neglect , 1997, Trends in Cognitive Sciences.

[33]  G. Mangun,et al.  The neural mechanisms of top-down attentional control , 2000, Nature Neuroscience.

[34]  C. A. Marzi,et al.  Implicit redundant-targets effect in visual extinction , 1996, Neuropsychologia.

[35]  Pierluigi Zoccolotti,et al.  Influence of the radial and vertical dimensions on lateral neglect , 2001, Experimental Brain Research.

[36]  Gordon D Logan,et al.  An instance theory of attention and memory. , 2002, Psychological review.

[37]  D. Perani,et al.  The anatomy of unilateral neglect after right-hemisphere stroke lesions. A clinical/CT-scan correlation study in man , 1986, Neuropsychologia.

[38]  G Vallar,et al.  Anatomical correlates of visual and tactile extinction in humans: a clinical CT scan study. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[39]  Claus Bundesen,et al.  Visual selective attention , 1995 .

[40]  M. Mesulam.  A cortical network for directed attention and unilateral neglect , 1981, Annals of neurology.

[41]  C. Kennard,et al.  Distractor-dependent frontal neglect , 1997, Neuropsychologia.

[42]  F. Previc.  Functional specialization in the lower and upper visual fields in humans: Its ecological origins and neurophysiological implications , 1990, Behavioral and Brain Sciences.

[43]  Claus Bundesen,et al.  Visual Selective Attention: Outlines of a Choice Model, a Race Model and a Computational Theory , 1998 .

[44]  C Bundesen,et al.  A computational theory of visual attention. , 1998, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[45]  Stephan Arndt,et al.  Normalizing Counts and Cerebral Blood Flow Intensity in Functional Imaging Studies of the Human Brain , 1996, NeuroImage.

[46]  D L Woods,et al.  Electrophysiologic evidence of increased distractibility after dorsolateral prefrontal lesions , 1986, Neurology.

[47]  T. Paus,et al.  Medial vs lateral frontal lobe lesions and differential impairment of central-gaze fixation maintenance in man. , 1991, Brain : a journal of neurology.

[48]  K. Heilman,et al.  Altitudinal neglect , 1988, Neurology.

[49]  Claus Bundesen,et al.  Single-letter recognition as a function of exposure duration , 1999 .

[50]  C Bundesen,et al.  Visual selection from multielement displays: measuring and modeling effects of exposure duration. , 1988, Journal of experimental psychology. Human perception and performance.

[51]  Stefan Pollmann,et al.  The role of the corpus callosum in visual orienting: importance of interhemispheric visual transfer , 1998, Neuropsychologia.

[52]  D. Kimura,et al.  The asymmetry of the human brain. , 1973, Scientific American.

[53]  C. Bundesen.  A theory of visual attention. , 1990, Psychological review.

[54]  K M Heilman,et al.  Peripersonal and vertical neglect. , 1990, Brain : a journal of neurology.

[55]  R. D. Gordon,et al.  Executive control of visual attention in dual-task situations. , 2001, Psychological review.

[56]  Edward K. Vogel,et al.  The capacity of visual working memory for features and conjunctions , 1997, Nature.