Rapid Screening for Neglect Following Stroke: A Systematic Search and European Academy of Neurology Recommendations
European Journal of Neurology
Moore, M., Milosevich, E., et al. (2022).
European Journal of Neurology, 29(9), 2596-2606.
This consensus statement provides recommendations about the screening and assessment of post-stroke spatial neglect for patients in time-limited clinical settings.
European Academy of Neurology Scientific Panel for Higher Cortical Functions
Whenever possible, clinicians should utilize multiple neglect tests. The literature suggests that single screening tests cannot sufficiently rule out post-stroke spatial neglect.
If there is only time to administer one screening test, a cancellation task should be the primary test for post-stroke neglect. If available, the following screeners are recommended: <br />
<ul>
<li><span style="color: #333333;">the Behavioral Inattention Test (BIT) Star Cancellation Task; </span></li>
<li><span style="color: #333333;">the Bells Cancellation Test; </span></li>
<li><span style="color: #333333;">the Oxford Cognitive Screen (OCS) Hearts Cancellation Test (open acess); and </span></li>
<li><span style="color: #333333;">the Birmingham Cognitive Screen (BCoS) Apples Cancellation Task (open access).</span></li>
</ul>
The following tasks should not be utilized as primary screening tests for post-stroke neglect for the following reasons: <br />
<ul>
<li><span style="color: #333333;">cancellation tasks with low stimulus density (e.g., Albert’s Test, Coin Selection): may have a lower probably of detecting neglect;</span></li>
<li><span style="color: #333333;"> cancellation tasks with high complexity (e.g., Mesulam Shape Cancellation): may prove to be too difficult for patients with acute stroke; </span></li>
<li><span style="color: #333333;"> language-based cancellation tasks (i.e., Letter Cancellation Tests): may be confounded by letter and word-level deficits; </span></li>
<li><span style="color: #333333;">reading- and writing-based neglect assessments: may be confounded by language and fine-motor deficits; </span></li>
<li><span style="color: #333333;">screening tests based on behavioral observation: may be confounded by expectation biases and are not rapid to administer;</span></li>
<li><span style="color: #333333;">line bisection tasks: lacks validity for detecting neglect in isolation; </span></li>
<li><span style="color: #333333;">copying tasks: may be confounded by comorbid motor and cognitive deficits; and</span></li>
<li><span style="color: #333333;">the National Institutes of Health Stroke Scale: highly susceptible to clinician bias, less sensitive than cancellation tasks, and misdiagnoses visual field deficits as neglect.</span></li>
</ul>
If time permits, clinicians should consider administering one or more of the following as secondary screening tests for post-stroke neglect: <br />
<ul>
<li><span style="color: #333333;">figure copying tasks that display multiple stimuli on the horizontal plane (e.g., scene copying task); </span></li>
<li><span style="color: #333333;"> line bisection tasks with standardized manual bisection and published normative data; and </span></li>
<li><span style="color: #333333;">baking tray tasks where patients are asked to arrange items evenly across a baking tray.</span></li>
</ul>
Clinicians should perform a functional/ecological evaluation of post-stroke neglect and conduct longer assessment of everyday activities as the patient's condition allows. The Catherine Bergego Scale is recommended for naturalistic assessment of neglect in the context of everyday tasks. <br /><br />The Dublin Extrapersonal Neglect Assessment (DENA) may also provide a naturalistic and informative assessment. However, because this assessment has not yet been extensively deployed in clinical settings, the routine use of this assessment is not recommended. Additionally, it requires patients to mobilize down a hallway, which may not be possible in the hyper-acute stage of stroke recovery.
