title: Differences between left- and right-sided neglect revisited: A large cohort study across multiple domains.
abstract: Unilateral spatial neglect (USN) is a syndrome that can occur after right- and left-hemisphere damage. It is generally accepted that left-sided USN is more severe than right-sided USN. Evidence for such a difference in other domains is lacking. Primary aims were to compare frequency, severity, region specificity, cognition, physical functioning, and physical independence between left and right USN. Secondary aims were to compare lesion characteristics. A total of 335 stroke patients admitted for inpatient rehabilitation were included. The severity of the lateralized attentional deficit was measured with a shape cancellation and line bisection test (in peripersonal and extrapersonal space) and the Catherine Bergego scale. The Mini-Mental State Examination, Stichting Afasie Nederland score, search organization (i.e., best R and intersections rate), Motricity Index, balance, mobility, and self-care were assessed. Measures were statistically compared between left, right, and no USN patients. Lesion overlay plots were compared with lesion subtraction analyses.
  
  
  RESULTS
  Left USN (15.82%) was more frequent than right USN (9.25%). Demographic and stroke characteristics were comparable between groups. The lateralized attentional deficit was most severe in left USN. USN in both peripersonal and extrapersonal space was more frequently left-sided in nature. Search efficiency was lower in left USN. Balance was poorer in right USN. No differences between left and right USN were found for cognitive ability, communication, motor strength, mobility, and self-care. Most patients with left USN had right-hemispheric lesions, whereas patients with right USN could have lesions in either the left or the right hemisphere. To conclude, left and right USN are both common after stroke. Although the lateralized attention deficit is worse in left than in right USN, consequences at the level of physical functioning and physical independence are largely comparable. From a clinical perspective, it is important to systematically screen for USN, both after right- and after left-hemisphere damage.
authors.affiliation: a Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus , University Medical Center Utrecht, and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.
authors.forename: Antonia F
authors.identifier: http://orcid.org/0000-0001-7634-0819
authors.initials: AF
authors.lastname: Ten Brink
authors.affiliation: b Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Jurre H
authors.identifier: http://orcid.org/0000-0002-6842-8586
authors.initials: JH
authors.lastname: Verwer
authors.affiliation: b Department of Neurology, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: J Matthijs
authors.identifier: http://orcid.org/0000-0001-7017-2148
authors.initials: JM
authors.lastname: Biesbroek
authors.affiliation: a Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus , University Medical Center Utrecht, and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.|c Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: Johanna M A
authors.initials: JMA
authors.lastname: Visser-Meily
authors.affiliation: a Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus , University Medical Center Utrecht, and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.|c Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus , University Medical Center Utrecht , Utrecht , The Netherlands.|d Department of Experimental Psychology, Helmholtz Institute , Utrecht University , Utrecht , The Netherlands.
authors.forename: Tanja C W
authors.identifier: http://orcid.org/0000-0001-6683-0267
authors.initials: TCW
authors.lastname: Nijboer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000209:etiology / Q000503:physiopathology*; D013028:Space Perception / Q000502:physiology*; D020521:Stroke / Q000150:complications / Q000503:physiopathology*
keywords: Cognition; Functional impairment; Lateralized attentional deficit; Stroke; Unilateral spatial neglect