Visuospatial neglect: Recovery & Functional outcome after 6 months.
Abstract: Background/Objective: This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes. Methods: This study presents a secondary cohort study of acute and 6 month follow up data from 400 stroke survivors who completed the Oxford Cognitive Screen Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results: Overall, 98/142(69%) neglect cases recovered by follow-up and there was no significant difference in the persistence of egocentric/allocentric (X2(1)=0.66, p=0.418) or left/right neglect (X2(2)=0.781, p= 0.677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F(9,383)=3.96, p<0.001, R2=0.066). Conclusions: Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes.