Discriminative value of different combinations of tests to detect unilateral neglect in patients with right hemisphere damage

To assess the most sensitive combination of tests to detect peri-personal unilateral neglect (UN) after stroke. The present study is a secondary analysis of a previously reported multicentric study of 203 individuals with right hemisphere damage (RHD), mainly subacute stroke, 11 weeks post onset on average, and 307 healthy controls. A battery of 7 tests, providing 19 age and education adjusted z scores were given: the bells test, line bisection, figure copying, clock drawing, overlapping figures test, reading and writing. Statistical analyses used a logistic regression and a ROC after adjustment on demographic variables. A combination of 4 z-scores based on the following three tests provided a good discrimination of patients with RHD from matched healthy controls: the starting point and the difference between the number of omissions on left and right sides from the Bells test, rightward deviation in bisection of long lines (20 cm), and left-sided omissions in a reading task. The area under the ROC curve was 0.865 (95%CI: 0.83-0.901) with a sensitivity= 0.68; a specificity = 0.95, an accuracy =0.85, a PPV= 0.90, and a NPV=0.82. The most sensitive and parsimonious combination of tests to detect UN after stroke relies on 4 scores from 3 simple tests (bells test, line bisection and reading). Future study is warranted to assess its ability to account for the functional difficulties of UN in daily life in the patient's actual environment.