The behavioural assessment of visual neglect

Abstract

Unilateral visual neglect is among the most striking consequences of right-sided brain damage and is characterised by the patient's failure to respond to stimuli on the side contralateral to the lesion. Visual neglect disrupts many aspects of daily living such as mobility, dressing, and reading, yet the underlying mechanisms remain poorly understood.

This paper describes the development, standardisation and validation of a test battery designed to identify a wide variety of visual neglect behaviours observed in clinical practice. The Behavioural Inattention Test (B.I.T.), which was standardised on a large stroke population (n = 80), is described. Unlike existing studies of visual neglect, the B.I.T. relates test results to functional assessment and rehabilitation. Using the test battery and normative data from 50 age-matched controls, 30 patients (37.5%) were classified as demonstrating neglect. Neglect is more frequent and severe following right-rather than left-sided lesions. Inter-rater, test-retest, and parallel forms of the test show the neglect battery to be a reliable measure of patient performance. Correlations with ‘conventional’ and clinical judgements demonstrate the underlying validity of the battery.

The B.I.T. thus provides a conceptual framework within which to investigate and characterise visual neglect in a manner that is useful to rehabilitation.     

Reliability of the pattern hair loss classifications: A comparison of the basic and specific and Norwood–Hamilton classifications

Pattern hair loss (PHL) is the most common form of baldness in both sexes. The Norwood–Hamilton classification is the most commonly used classification worldwide, but it has many limitations. The basic and specific (BASP) classification was introduced as an improvement over the Norwood–Hamilton classification. Previous research was done to estimate the reliability of the Norwood–Hamilton classification and the result was unsatisfactory. However, the reliability of the BASP and Norwood–Hamilton classifications has not yet been compared. Eight dermatological specialists, 17 dermatological residents and 15 general physicians classified PHL in 100 sets of photographs using both the BASP and Norwood–Hamilton classifications. Intergroup reproducibility was evaluated by examining the match rate of the individual data in each group and the match rate between hair specialist and the other examiners. Intragroup repeatability was determined by calculating the match rate between the first and second studies. In terms of intergroup reproducibility of the match rate for individual data in each group, the basic type had the best agreement, the specific type had the second best, and the Norwood–Hamilton classification had the lowest match rate. In comparison, hair specialist and intragroup repeatability showed the same patterns. The BASP classification not only distinguishes all kinds of hair loss patterns, but also has better reproducibility and repeatability than the Norwood–Hamilton classification.     

Response to pretransplant hypomethylating agents influences the outcome of allogeneic hematopoietic stem cell transplantation in adults with myelodysplastic syndromes

This study describes a retrospective analysis on the transplant outcome of 56 consecutive patients with myelodysplastic syndrome (MDS) according to their response to hypomethylating agents (HMA). While 2‐yr disease‐free survival (DFS) of patients who transformed to acute myeloid leukemia (n = 12) was 25%, that of the remaining patients with MDS according to response to HMA was 73.1%, 68.1%, 50.0%, and 20.8% in G‐COR (group of continuous response, n = 19), G‐NoC (group of no change, n = 15), G‐LOR (group of loss of response, n = 6), and G‐DP (group of disease progression, n = 4), respectively. When dichotomized as G‐COR/G‐NoC versus G‐LOR/G‐DP, significantly different 2‐yr DFS (71.0% vs. 33.3%; P = 0.004) and relapse (14.1% vs. 46.7%; P = 0.016) were demonstrated. On multivariate analysis, G‐LOR/G‐DP [hazard ratio (HR), 3.91; P = 0.008] and poor karyotype at transplantation (HR, 2.69; P = 0.017) were the significant predictors for poor DFS, as G‐LOR/G‐DP was for relapse (HR, 6.28; P = 0.011). DFS was significantly poor in patients with any of the two predictors in all MDS (81.5% vs. 34.9%; P = 0.001) or higher‐risk MDS (HrMDS) at the time of HMA (80.7% vs. 29.2%; P = 0.005). G‐COR showed a trend of better DFS compared with G‐NoC among HrMDS (74.6% vs. 36.5%; P = 0.090). These results implicate the significance of response to HMA on hematopoietic stem cell transplantation (HSCT) outcomes and support the need for future study to verify the suggested strategy of proceeding to transplantation before LOR or DP, especially for HrMDS.