How reliable is repeated testing for hemispatial neglect? Implications for clinical follow-up and treatment trials

Patients with hemispatial neglect following right hemisphere brain damage fail to spontaneously orient towards or respond to contralesional stimuli.1 The diagnosis and longitudinal assessment of the syndrome is not always straightforward. This is mainly due to two reasons: the heterogeneity of the syndrome and inter-individual differences in the time course of recovery from the disorder.

The neglect syndrome affects various cognitive components across patients, and one patient may show neglect on certain tasks but not on others.1 ,2 Because there is no single test able to detect neglect in all patients, a battery of several paper-and-pencil tests is usually required.1 ,3 However, little is known about their use as a tool for longitudinal assessments. This is of high clinical importance as repeat assessments are necessary to monitor changes in neglect severity related to spontaneous remission or a specific treatment. If a test per se is not ‘stable’, the variation in test results over repeated sessions may simply reflect low test–retest reliability and not the actual change of the underlying disorder.
We therefore investigated the test–retest reliability of three of the most commonly used paper-and-pencil tests for hemispatial neglect over several daily test repetitions in chronic neglect patients.