title: Right hemisphere dysfunction is better predicted by emotional prosody impairments as compared to neglect.
abstract: BACKGROUND
  Neurologists generally consider hemispatial neglect to be the primary cognitive deficit following right hemisphere lesions. However, the right hemisphere has a critical role in many cognitive, communication and social functions; for example, in processing emotional prosody (tone of voice). We tested the hypothesis that impaired recognition of emotional prosody is a more accurate indicator of right hemisphere dysfunction than is neglect.
  
  
  METHODS
  We tested 28 right hemisphere stroke (RHS) patients and 24 hospitalized age and education matched controls with MRI, prosody testing and a hemispatial neglect battery. Emotion categorization tasks assessed recognition of emotions from prosodic cues. Receiver operating characteristic (ROC) analyses were used to compare tests in their ability to distinguish stroke patients from controls.
  
  
  RESULTS
  ROC analyses revealed that the Prosody Score was more effective than the Neglect Battery Score in distinguishing stroke patients from controls, as measured by area under the curve (AUC); Prosody Score = 0.84; Neglect Battery Score =0. 57. The Prosody Score correctly classified 78.9%, while Neglect Score correctly classified 55.8% of participants as patients versus controls. The Prosody Score was similar to the total NIH Stroke Scale in identifying RHS patients (AUC=0.86, correctly classifying 80.1% of patients versus controls), but the tests only partially overlapped in the patients identified.
  
  
  CONCLUSIONS
  Severe prosody impairment may be a better indicator of right hemisphere dysfunction than neglect. Larger studies are needed to determine if including a bedside test of Prosody with the NIH Stroke Scale would most efficiently and reliably identify right hemisphere ischemia.
authors.affiliation: Departments of Neurology Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Chinar
authors.initials: C
authors.lastname: Dara
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Baltimore, MD, USA.
authors.forename: Jee
authors.initials: J
authors.lastname: Bang
authors.affiliation: Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.affiliation: Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
keywords: communication; emotions; neglect; prosody; right hemisphere; stroke