Alzheimer's patients do not show left unilateral spatial neglect but exhibit peripheral inattention and simplification

Kasai, Mari; Ishizaki, Junichi; Meguro, Kenichi

doi:10.1590/S1980-57642008DN10400008

Abstract

The Rey-Osterrieth Complex Figure Test (RCFT) is widely used to measure visuoperceptual and visuoconstructional skills, while the Line Bisection (LB) test is commonly employed to assess unilateral spatial neglect (USN). Previous studies have suggested that Alzheimer's disease (AD) patients may suffer from left USN. Objectives: The purpose of this study was to clarify whether left USN occurs in AD. Methods: Forty controls, 40 very mild AD patients and 31 mild/moderate AD patients performed both the RCFT copying and the LB test. Results: The very mild AD and mild/moderate AD groups had lower total RCFT copying scores and also scored lower in the "left" and "detail" categories compared to controls. However, there were no correlations between the left-category score for RCFT and the LB score. Instead, peripheral inattention and simplification patterns were noted. Conclusions: We found that the RCFT copying test is effective for detecting early AD and suggest that AD patients manifest peripheral inattention and simplification but not left USN.

Key words:
Rey-Osterrieth complex figure test; Alzheimer's disease; visual inattention; unilateral spatial neglect

Resumo

O teste da figura complexa de Rey-Osterrieth (TFCR) é muito utilizado para avaliar habilidades vísuo-espaciais e vísuo-construtivas, enquanto o teste de Bisecção de Linhas (TBL) é usualmente empregado para avaliar a presença de negligência espacial unilateral. Estudos anteriores têm sugerido que pacientes com doença de Alzheimer (DA) podem apresentar negligência espacial unilateral esquerda. Objetivos: O propósito deste estudo foi o de verificar se negligência espacial unilateral esquerda ocorre na DA. Métodos: Quarenta controles, 40 pacientes com DA muito leve e 31 com DA leve/moderada foram avaliados mediante o TFCR e o TBL. Resultados: Os pacientes com DA muito leve e com DA leve/moderado tiveram escores mais baixos na cópia do TFCR e também nas categorias "esquerda" e "detalhe" comparados com controles. Entretanto, não houve correlação entre os escores na categoria-esquerda do TFCR e os escores no TBL. Por outro lado, foram notados padrões de inatenção periférica e simplificação. Conclusões: Nós observamos que a cópia do TFCR é eficaz para detector DA inicial e sugerimos que pacientes com DA manifestam inatenção periférica e simplificação, mas não negligência espacial unilateral esquerda.

Palavras-chave:
teste da figura complexa de Rey-Osterrieth; teste da bisseção de linhas; doença de Alzheimer; inatenção visual; negligência espacial unilateral

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References

¹
Ishiai S, Okiyama R, Koyama Y, et al. Unilateral spatial neglect in Alzheimer's disease: a line bisection study. Acta Neurol Scand 1996;93:219-224.
²
Mendez MF, Cherrier MM, Cymerman JS. Hemispatial neglect on visual search tasks in Alzheimer's disease. Neuropsychiatry Neuropsychol Behav Neurol 1997;10:203-208.
³
Cherrier MM, Mendez MF, Dave M, et al. Performance on the Rey-Osterrieth Complex Figure Test in Alzheimer disease and vascular dementia. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:95-101.
⁴
Lezak MD. Neuropsychological Assessment, 3rd ed. New York: Oxford University Press; 1995.
⁵
Meyers JE, Meyers KR. Rey. Complex Figure Test and Recognition Trial. Odessa: Psychological Assessment Resources; 1995.
⁶
Spreen O, Strauss E. A compendium of neuropsychological tests. 2nd ed. New York: Oxford University Press; 1998.
⁷
Venneri A, Pentore R, Cotticelli B, et al. Unilateral spatial neglect in the late stage of Alzheimer's disease. Cortex 1998;34:743-752.
⁸
Ishiai S, Koyama Y, Seki K, et al. Unilateral spatial neglect in AD: significance of line bisection performance. Neurology 2000;55:364-370.
⁹
Schenkenberg T, Bradford DC, Ajax ET. Line bisection and unilateral visual neglect in patients with neurologic impairments. Neurology 1980;30:509-517.
¹⁰
Park RW, Zec RF, Wilson RS. Neuropsychology of Alzheimer's disease and other dementias. New York: Oxford University Press; 1993.
¹¹
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease: a clinical review. Brain 1999;122:383-404.
¹²
Kaskie B, Storandt M. Visuospatial deficit in dementia of the Alzheimer Type. Arch Neurol 1995;52:422-425.
¹³
Benton AL, Sivan AB, Hamsher K, et al. Contributions to neuropsychological assessment: a clinical manual. 2nd ed. New York: Oxford University Press; 1994:65-72.
¹⁴
Meguro K, Ishii, H, Yamaguchi S, et al. Prevalence of dementia and dementing diseases in Japan: the Tajiri Project. Arch Neurol 2002;59:1109-1114.
¹⁵
Meguro K, Ishii, H, Yamaguchi S , et al. Prevalence and cognitive performances of Clinical Dementia Rating 0.5 and Mild Cognitive Impairment in Japan. The Tajiri Project. Alzheimer Dis Assoc Disord 2004;18:3-10.
¹⁶
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
¹⁷
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
¹⁸
Otoyama W, Niina R, Homma A, et al. Inter-rater reliability of the Japanese version of Clinical Dementia Rating (CDR). Jap J Geriatr Psychiatry. 2000;11:521-527.
¹⁹
American Psychiatric Association. DSM-4: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association; 1994.
²⁰
Morris JC, McKeel DW, Storandt M, et al. Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology 1991;41:469-478.
²¹
Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.
²²
McKhann G, David D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34: 939-944.
²³
Kasai M, Meguro K, Hashimoto R, et al. Non-verbal learning is impaired in very mild Alzheimer's disease (CDR 0.5): "Normative" data of the Rey-Osterrieth Complex Figure Test learning version. Psychiatry Clin Neurosci 2006;60:139-146.
²⁴
Fujii T, Fukatsu R, Yamadori A, et al. Effect of age on the line bisection test. J Clin Exp Neuropsychol 1995;17:941-944.
²⁵
McCourt ME, Jewell G. Visual attention in line bisection: stimulus modulation of pseudoneglect. Neuropsychology 1999;37:843-855.
²⁶
Chatterjee A. Cross-over, completion and confabulation in unilateral spatial neglect. Brain 1995;118:455-465.
²⁷
Monaghan P, Shillcock R. The cross-over effect in unilateral neglect: modeling detailed data in the line-bisection task. Brain 1998;121:907-921.
²⁸
Kirk A, Kertesz A. On drawing impairment in Alzheimer's disease. Arch Neurol 1991;48:73-77.
²⁹
Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropsychologia 1991;82:239-259.
³⁰
Arnaiz E, Jelic V, Almkvist O et al. Impaired cerebral glucose metabolism and cognitive functioning predict deterioration in mild cognitive impairment. Neuroreport 2001;12:851-855.
³¹
Chetelat G, Desgranges B, de la Sayette V, et al. Mild cognitive impairment. Can FDG-PET predict who is to rapidly convert to Alzheimer's disease? Neurology 2003:60:1374-1377.
³²
Meguro K, Blaizot X, Kondoh Y, et al. Neocortical and hippocampal glucose hypometabolism following neurotoxic lesions of the entorhinal and perirhinal cortices in the non-human primate as shown by PET implications for Alzheimer's disease. Brain 1999;122:1519-1531.

Publication Dates

Publication in this collection
Oct-Dec 2007

History

Received
08 Aug 2007
Reviewed
01 Sept 2007
Accepted
30 Oct 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Ishiai S, Okiyama R, Koyama Y, et al. Unilateral spatial neglect in Alzheimer's disease: a line bisection study. Acta Neurol Scand 1996;93:219-224.

[2] ²
Mendez MF, Cherrier MM, Cymerman JS. Hemispatial neglect on visual search tasks in Alzheimer's disease. Neuropsychiatry Neuropsychol Behav Neurol 1997;10:203-208.

[3] ³
Cherrier MM, Mendez MF, Dave M, et al. Performance on the Rey-Osterrieth Complex Figure Test in Alzheimer disease and vascular dementia. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:95-101.

[4] ⁴
Lezak MD. Neuropsychological Assessment, 3rd ed. New York: Oxford University Press; 1995.

[5] ⁵
Meyers JE, Meyers KR. Rey. Complex Figure Test and Recognition Trial. Odessa: Psychological Assessment Resources; 1995.

[6] ⁶
Spreen O, Strauss E. A compendium of neuropsychological tests. 2nd ed. New York: Oxford University Press; 1998.

[7] ⁷
Venneri A, Pentore R, Cotticelli B, et al. Unilateral spatial neglect in the late stage of Alzheimer's disease. Cortex 1998;34:743-752.

[8] ⁸
Ishiai S, Koyama Y, Seki K, et al. Unilateral spatial neglect in AD: significance of line bisection performance. Neurology 2000;55:364-370.

[9] ⁹
Schenkenberg T, Bradford DC, Ajax ET. Line bisection and unilateral visual neglect in patients with neurologic impairments. Neurology 1980;30:509-517.

[10] ¹⁰
Park RW, Zec RF, Wilson RS. Neuropsychology of Alzheimer's disease and other dementias. New York: Oxford University Press; 1993.

[11] ¹¹
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease: a clinical review. Brain 1999;122:383-404.

[12] ¹²
Kaskie B, Storandt M. Visuospatial deficit in dementia of the Alzheimer Type. Arch Neurol 1995;52:422-425.

[13] ¹³
Benton AL, Sivan AB, Hamsher K, et al. Contributions to neuropsychological assessment: a clinical manual. 2nd ed. New York: Oxford University Press; 1994:65-72.

[14] ¹⁴
Meguro K, Ishii, H, Yamaguchi S, et al. Prevalence of dementia and dementing diseases in Japan: the Tajiri Project. Arch Neurol 2002;59:1109-1114.

[15] ¹⁵
Meguro K, Ishii, H, Yamaguchi S , et al. Prevalence and cognitive performances of Clinical Dementia Rating 0.5 and Mild Cognitive Impairment in Japan. The Tajiri Project. Alzheimer Dis Assoc Disord 2004;18:3-10.

[16] ¹⁶
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[17] ¹⁷
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[18] ¹⁸
Otoyama W, Niina R, Homma A, et al. Inter-rater reliability of the Japanese version of Clinical Dementia Rating (CDR). Jap J Geriatr Psychiatry. 2000;11:521-527.

[19] ¹⁹
American Psychiatric Association. DSM-4: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association; 1994.

[20] ²⁰
Morris JC, McKeel DW, Storandt M, et al. Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology 1991;41:469-478.

[21] ²¹
Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.

[22] ²²
McKhann G, David D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34: 939-944.

[23] ²³
Kasai M, Meguro K, Hashimoto R, et al. Non-verbal learning is impaired in very mild Alzheimer's disease (CDR 0.5): "Normative" data of the Rey-Osterrieth Complex Figure Test learning version. Psychiatry Clin Neurosci 2006;60:139-146.

[24] ²⁴
Fujii T, Fukatsu R, Yamadori A, et al. Effect of age on the line bisection test. J Clin Exp Neuropsychol 1995;17:941-944.

[25] ²⁵
McCourt ME, Jewell G. Visual attention in line bisection: stimulus modulation of pseudoneglect. Neuropsychology 1999;37:843-855.

[26] ²⁶
Chatterjee A. Cross-over, completion and confabulation in unilateral spatial neglect. Brain 1995;118:455-465.

[27] ²⁷
Monaghan P, Shillcock R. The cross-over effect in unilateral neglect: modeling detailed data in the line-bisection task. Brain 1998;121:907-921.

[28] ²⁸
Kirk A, Kertesz A. On drawing impairment in Alzheimer's disease. Arch Neurol 1991;48:73-77.

[29] ²⁹
Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropsychologia 1991;82:239-259.

[30] ³⁰
Arnaiz E, Jelic V, Almkvist O et al. Impaired cerebral glucose metabolism and cognitive functioning predict deterioration in mild cognitive impairment. Neuroreport 2001;12:851-855.

[31] ³¹
Chetelat G, Desgranges B, de la Sayette V, et al. Mild cognitive impairment. Can FDG-PET predict who is to rapidly convert to Alzheimer's disease? Neurology 2003:60:1374-1377.

[32] ³²
Meguro K, Blaizot X, Kondoh Y, et al. Neocortical and hippocampal glucose hypometabolism following neurotoxic lesions of the entorhinal and perirhinal cortices in the non-human primate as shown by PET implications for Alzheimer's disease. Brain 1999;122:1519-1531.

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