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Italian standardization of the Apples Cancellation Test

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Abstract

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect).

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References

  1. Jehkonen M, Ahonen JP, Dastidar P, Koivisto AM, Laippala P, Vilkki J, Molnar G (2000) Visual neglect as a predictor of functional outcome one year after stroke. Acta Neurol Scand 101(3):195–201

    Article  CAS  PubMed  Google Scholar 

  2. Paolucci S, Antonucci G, Grasso MG, Pizzamiglio L (2001) The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischaemic strple patients: a matched comparison. Arch Phys Med Rehab 82:743–749

    Article  CAS  Google Scholar 

  3. Nijober TCW, Kollen BJ, Kwakkel G (2013) Time course of visuospatial neglect early after stroke: a longitudinal cohort study. Cortex 49:2021–2027

    Article  Google Scholar 

  4. Bowen A, McKenna K, Tallis RC (1999) Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke 30:1196–1202

    Article  CAS  PubMed  Google Scholar 

  5. Milner DA, McIntosh RD (2005) The neurological basis of visual neglect. Curr Opin Neurol 18:748–753

    Article  PubMed  Google Scholar 

  6. Bartolomeo P (2007) Visual neglect. Curr Opin Neurol 20:381–386

    Article  PubMed  Google Scholar 

  7. Chechlacz M, Rotshtein P, Roberts KL, Bickerton W-L, Lau JKL, Humphreys GW (2012) The prognosis of allocentric and egocentric neglect: evidence from clinical scans. PLoS One 7(11):e47821. doi:10.1371/journal.pone.0047821

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Grimsen C, Hildebrandt H, Fahle M (2008) Dissociation of egocentric and allocentric coding of space in visual search after right middle cerebral artery stroke. Neuropsychologia 46:902–914

    Article  PubMed  Google Scholar 

  9. Ota H, Fujii T, Suzuki K, Fukatsu R, Yamadori A (2001) Dissociation of body centered and stimulus centered representation in unilateral neglect. Neurology 57:2064–2069

    Article  CAS  PubMed  Google Scholar 

  10. Rorden C, Hjaltason H, Fillmore P, Fridriksson J, Kjartansson O, Magnusdottir S, Karnath HO (2012) Allocentric neglect strongly associated with egocentric neglect. Neuropsychologia 50:1151–1157

    Article  PubMed Central  PubMed  Google Scholar 

  11. Yue Y, Song W, Huo S, Wang M (2012) Study on the occurrence and neural bases of hemispatial neglect with different reference frames. Arch Phys Med Rehabil 93:156–162

    Article  PubMed  Google Scholar 

  12. Stone SP, Wilson B, Wroot A, Halligan PW, Lange LS, Marshall JC, Greenwood RJ (1991) The assessment of visuo-spatial neglect after acute stroke. J Neurol Neurosurg Psychiat 54:345–350

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Bickerton WL, Samson D, Williamson J, Humphreys GW (2011) Separating forms of neglect using the Apple Test: validation and functional predicting in chronic and acute stroke. Neuropsychology 25:567–580

    Article  PubMed  Google Scholar 

  14. Wilson B, Cockburn J, Halligan P (1987) Development of a behavioural test of visuospatial neglect. Arch Phys Med Rehabil 68:98–102

    CAS  PubMed  Google Scholar 

  15. Humphreys G, Bickerton WL, Samson D, Riddoch M (2012) BCoS cognition screen. Psychology Press, Hove

    Google Scholar 

  16. Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9:97–113

    Article  CAS  PubMed  Google Scholar 

  17. Magni E, Binetti G, Bianchetti R, Rozzini R, Trabucchi M (1996) Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol 3:198–202

    Article  CAS  PubMed  Google Scholar 

  18. Bamford J, Sandercock P, Dennis M, Warlow C, Burn J (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. The Lancet 337:1521–1526

    Article  CAS  Google Scholar 

  19. Collin C, Wade DT (1990) Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiat 53:576–579

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Denes G, Semenza C, Stoppa E, Lis A (1982) Unilateral spatial neglect and recovery from hemiplegia a follow-up study. Brain 105(3):543–552

    Article  PubMed  Google Scholar 

  21. Chechlacz M, Rotshtein P, Bickerton WL, Hansen PC, Deb S, Humphreys GW (2010) Separating neural correlates of allocentric and egocentric neglect: distinct cortical sites and common white matter disconnections. Cogn Neuropsychol 27:277–303

    Article  PubMed  Google Scholar 

  22. Medina J, Kannan V, Pawlak MA, Kleinman JT, Newhart M, Davis C, Heidler-Gary JE, Herskovits EH, Hillis AE (2009) Neural substrates of visuospatial processing in distinct reference frames: evidence from unilateral spatial neglect. J Cogn Neurosci 21:2073–2084

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

We would like to especially thank M. Pacini, B. Basagni, E. Todeschini, R. Moretti, S. Prestigiacomo, M.A. D’angelo, A. Lazzarini, C. Zucchella, M.E. Girò, F. Cellamare, E.Conti, M. Marchetti and G. Alla for their contribution in collecting the data.

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The authors declare that they have no conflicts of interest.

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Correspondence to Mauro Mancuso.

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Appendix

Appendix

See Table 2.

Table 2 Number of healthy subjects who were part of the stratification sample as a function of age, gender and education

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Mancuso, M., Rosadoni, S., Capitani, D. et al. Italian standardization of the Apples Cancellation Test. Neurol Sci 36, 1233–1240 (2015). https://doi.org/10.1007/s10072-015-2088-2

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