Neglect in elderly stroke patients: A comparison of five tests

Abstract  Neglect is a disabling state in stroke patients. Five tests for visuo-spatial neglect, star cancellation, line crossing, line bisection, draw a clock and copy a cross, were compared in 57 elderly patients. Sensitivity and intercorrelations between the tests were determined. Patients with neglect were studied as regards their activities of daily living, motor activity and cognition. Left-hemisphere neglect in patients with right-hemisphere lesions was more severe than right-sided neglect in patients with left-sided lesions in the star cancellation test. Sensitivity of the tests was moderate for star cancellation, line bisection and draw a clock, and low for line crossing and copy a cross. Significant correlations existed between the tests and cognitive and functional ability. Intercorrelations between the tests were moderate. Neglect patients showed a slower recovery after 6 and 12 months. Draw a clock and copy a cross displayed no sensitivity for neglect in patients with hemianopia, which may be due to the fact that these tests also evaluate constructional apraxia. The cancellation tests were influenced by hemianopia and there is evidence that hemianopia exacerbates neglect. This study shows that a battery of neglect tests is required to diagnose the neglect syndrome.