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Non-Spatial Impairments Affect False-Positive Neglect Diagnosis Based on Cancellation Tasks

Published online by Cambridge University Press:  30 March 2020

Hanne Huygelier Open the ORCID record for Hanne Huygelier [Opens in a new window] ,
Margaret Jane Moore ,
Nele Demeyere Open the ORCID record for Nele Demeyere [Opens in a new window]  and
Céline R. Gillebert
Hanne Huygelier
Affiliation:
Department of Brain and Cognition, KU Leuven, Leuven, Belgium
Margaret Jane Moore
Affiliation:
Department of Experimental Psychology, University of Oxford, Oxford, UK
Nele Demeyere
Affiliation:
Department of Experimental Psychology, University of Oxford, Oxford, UK
Céline R. Gillebert*
Affiliation:
Department of Brain and Cognition, KU Leuven, Leuven, Belgium Department of Experimental Psychology, University of Oxford, Oxford, UK
*
*Correspondence and reprint requests to: Céline R. Gillebert, Department of Brain and Cognition, KU Leuven, Tiensestraat 102, Box 3711, Leuven3000, Belgium. E-mail: celine.gillebert@kuleuven.be
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Abstract

Objective:

To diagnose egocentric neglect after stroke, the spatial bias of performance on cancellation tasks is typically compared to a single cutoff. This standard procedure relies on the assumption that the measurement error of cancellation performance does not depend on non-spatial impairments affecting the total number of cancelled targets. Here we assessed the impact of this assumption on false-positive diagnoses.

Method:

We estimated false positives by simulating cancellation data using a binomial model. Performance was summarised by the difference in left and right cancelled targets (R-L) and the Centre of Cancellation (CoC). Diagnosis was based on a fixed cutoff versus cutoffs adjusted for the total number of cancelled targets and on single test performance versus unanimous or proportional agreement across multiple tests. Finally, we compared the simulation findings to empirical cancellation data acquired from 651 stroke patients.

Results:

Using a fixed cutoff, the rate of false positives depended on the total number of cancelled targets and ranged from 10% to 30% for R-L scores and from 10% to 90% for CoC scores. The rate of false positives increased even further when diagnosis was based on proportional agreement across multiple tests. Adjusted cutoffs and unanimous agreement across multiple tests were effective at controlling false positives. For empirical data, fixed versus adjusted cutoffs differ in estimation of neglect prevalence by 13%, and this difference was largest for patients with non-spatial impairments.

Conclusions:

Our findings demonstrate the importance of considering non-spatial impairments when diagnosing neglect based on cancellation performance.

Keywords

Perceptual disorderstask performance and analysispsychometricsstrokeclinical decision makingneuropsychology
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Issue 7 , August 2020 , pp. 668 - 678
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

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