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首页> 外文期刊>Cortex: A Journal Devoted to the Study of the Nervous System and Behavior >Cingulate neglect in humans: Disruption of contralesional reward learning in right brain damage
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Cingulate neglect in humans: Disruption of contralesional reward learning in right brain damage

机译：在人类中忽略忽视：在右脑损伤中扰乱对侧奖励学习

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摘要

Motivational valence plays a key role in orienting spatial attention. Nonetheless, clinical documentation and understanding of motivationally based deficits of spatial orienting in the human is limited. Here in a series of one group-study and two single-case studies, we have examined right brain damaged patients (RBD) with and without left spatial neglect in a spatial reward-learning task, in which the motivational valence of the left contralesional and the right ipsilesional space was contrasted. In each trial two visual boxes were presented, one to the left and one to the right of central fixation. In one session monetary rewards were released more frequently in the box on the left side (75% of trials) whereas in another session they were released more frequently on the right side. In each trial patients were required to: 1) point to each one of the two boxes; 2) choose one of the boxes for obtaining monetary reward; 3) report explicitly the position of reward and whether this position matched or not the original choice. Despite defective spontaneous allocation of attention toward the contralesional space, RBD patients with left spatial neglect showed preserved contralesional reward learning, i.e., comparable to ipsilesional learning and to reward learning displayed by patients without neglect. A notable exception in the group of neglect patients was L.R., who showed no sign of contralesional reward learning in a series of 120 consecutive trials despite being able of reaching learning criterion in only 20 trials in the ipsilesional space. L.R. suffered a cortical-subcortical brain damage affecting the anterior components of the parietal-frontal attentional network and, compared with all other neglect and non-neglect patients, had additional lesion involvement of the medial anterior cingulate cortex (ACC) and of the adjacent sectors of the corpus callosum. In contrast to his lateralized motivational learning deficit, L.R. had no lateral bias in the early phases of attentional processing as he suffered no contralesional visual or auditory extinction on double simultaneous tachistoscopic and dichotic stimulation and detected, with no exception, single contralesional visual and auditory stimuli. In a separate study, we were able to compare L.R. with another RBD patient, G.P., who had a selective lesion in the right ACC, in the adjacent callosal connections and the medial-basal prefrontal cortex. G.P. had no contralesional neglect and displayed normal reward learning both in the left and right side of space. These findings show that contralesional reward learning is generally preserved in RBD patients with left spatial neglect and that this can be exploited in rehabilitation protocols. Contralesional reward learning is severely disrupted in neglect patients when an additional lesion of the ACC is present: however, as demonstrated by the comparison between L.R. and G.P. cases, selective unilateral lesion of the right ACC does not produce motivational neglect for the contralesional space. (C) 2014 Elsevier Ltd. All rights reserved.
机译：励志价值在定向空间关注方面发挥着关键作用。尽管如此，临床文件和对人类空间定向的动机缺陷的理解是有限的。这里在一系列一组研究和两个单案研究中，我们检查了右脑受损的患者（RBD），在空间奖励学习任务中没有留下空间忽视，其中左侧和左侧的动机价值右侧的iPsiles空间形成对比。在每次试验中，向左侧和中央固定右侧提供两个视觉盒子。在一个会议中，货币奖励在左侧的盒子里更频繁地释放（75％的试验），而在另一个会议中，他们在右侧更频繁地释放。在每次试验患者中需要：1）指向两个盒子中的每一个; 2）选择其中一个盒子以获得货币奖励; 3）明确报告奖励的位置以及该职位是否匹配或不是原始选择。尽管有缺陷的自发分配对违背空间，但左侧空间忽视的患者显示了保留的对立奖励学习，即，与IPSILESION学习相当，与患者显示的奖励没有忽视。忽视患者组中的一个显着例外是L.R.，尽管能够在IPsilesional空间中只有20个试验中达到学习标准，但在120个连续的两项试验中没有举行令人瞩目的奖励学习。 L.R.遭受了皮质脑面波动损伤，影响了椎管前额前关注网络的前部件，与所有其他忽视和非忽视患者相比，内侧前型铰接皮质（ACC）和相邻部门的额外病变涉及语料库胼callosum。与他侧向化的励志学习赤字相比，L.R.由于他在双重同步的高奇阶段和Dichototic刺激和检测到的情况下，没有横向偏见，因为他在双重同时同时进行视觉或听觉灭绝并检测到，没有例外，单一对立视觉和听觉刺激。在一个单独的研究中，我们能够比较L.R.与另一名RBD患者G.P.，在邻近召集的调用连接和内侧基础前额外皮质中有一个选择性病变。 G.P.在空间的左侧和右侧，无违反忽视并显示正常奖励学习。这些调查结果表明，在左空间疏忽的RBD患者中通常保留了对照奖励学习，并且可以在康复协议中利用这一点。当存在ACC的额外病变时，在忽视患者时，忽视奖励学习被严重破坏：但是，如L.R.之间的比较所示和G.P.案例，正确ACC的选择性单侧病变不会为违规空间产生诱导忽视。 （c）2014年elestvier有限公司保留所有权利。

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