Gender Comparisons of Asymmetric Lateralization in Neurodegenerative Disorder Patients via E-Pen Based Cognitive Assessment System

  • Haemi JEE Department of Sports and Health Care, Namseoul University, Cheonan-si, Korea
  • Jaehyun PARK Department of Information and Communication, Inha University, Incheon, Korea
Keywords: Line bisection test; Asymmetric neglect; Visuospatial neglect; Parkinson’s disease


Abstract Background: The clinical gender-dependent characteristics of visuospatial neglect between men and women have not been elucidated in Korean patients with cognitive impairment. The goal of this study was to observe the asymmetric lateralization in patients using a novel e-pen based cognitive assessment system. Methods: A total of 31 patients, 16 men and 15 women, with early stage hemispheric cerebral dysfunction were recruited for the assessment of unilateral neglect suing a novice paper-and-pencil based electronic evaluation system from a rehabilitation center of Inha University hospital in 2016. Results were assessed for degrees of deviations, and numbers of neglected lines. Degree of deviation was assessed using the positions and distances from the horizontal line centers. Effect sizes were calculated to assess proximities between the assessed results. Results: Comparatively greater left and rightward biasness for the right-sided and left-sided horizontal lines were observed for the male patients, respectively. Moreover, greater degree of left to rightward biasness was observed as the horizontal lines shortened in both groups. However, the magnitude of biasness in female patients showed comparatively less directional bias, indicating greater prevalence for the center of mass effect in male patients. Conclusion: Gender difference in visuospatial neglect seems to exist with less accuracy in recognition for the bisecting center for the female and asymmetrical lateralization and magnitude of deviation for the male patients.  


1. Ham TE, Bonnelle V, Hellyer P, et al (2013). The neural basis of impaired self-awareness after traumatic brain injury. Brain, 137(2):586-597.
2. Foster ER, Black KJ, Antenor-Dorsey JA, et al (2008). Motor asymmetry and substantia nigra volume are related to spatial delayed response performance in Parkinson disease. Brain Cogn, 67(1):1-10.
3. Verreyt N, Nys GM, Santens P, et al (2011). Cognitive differences between patients with left-sided and right-sided Parkinson's disease. A review. Neuropsychol Rev, 21(4):405-424.
4. Cools R (2006). Dopaminergic modulation of cognitive function-implications for L-DOPA treatment in Parkinson's disease. Neurosci Biobehav Rev, 30(1):1-23.
5. Unsworth CA (2007). Cognitive and Perceptual Dysfunction. Davis Company.
6. Committeri G, Pitzalis S, Galati G, et al (2007). Neural bases of personal and extrapersonal neglect in humans. Brain, 130(2):431-441.
7. Schenkenberg T, Bradford DC, Ajax ET (1980). Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology, 30(5):509-517.
8. Ferber S, Karnath HO (2001). How to assess spatial neglect--line bisection or cancellation tasks? J Clin Exp Neuropsychol, 23(5):599-607.
9. Molenberghs P, Sale MV (2011). Testing for spatial neglect with line bisection and target cancellation: are both tasks really unrelated? PLoS One, 6(7):e23017.
10. Pavon JM, Whitson HE, Okun MS (2010). Parkinson's disease in women: a call for improved clinical studies and for comparative effectiveness research. Maturitas, 65(4):352-358.
11. Ting DS, Pollock A, Dutton GN, et al (2011). Visual neglect following stroke: current concepts and future focus. Surv Ophthalmol, 56(2):114-134.
12. Erez AB, Katz N, Ring H, et al (2009). Assessment of spatial neglect using computerised feature and conjunction visual search tasks. Neuropsychol Rehabil, 19(5):677-695.
13. Villardita C, Smirni P, Zappala G (1983). Visual neglect in Parkinson's disease. Arch Neurol, 40(12):737-739.
14. Falchook AD, Salazar L, Neal D, et al (2015). Global attentional neglect of segmented lines in Parkinson's disease. Neurocase, 21(4):501-508.
15. Oh YS, Kim JS, Park IS, et al (2015). Prevalence and treatment pattern of Parkinson's disease dementia in Korea. Geriatr Gerontol Int, 30:S440
16. Roland KP, Jones GR, Jakobi JM (2013). Parkinson's disease and sex-related differences in electromyography during daily life. J Electromyogr Kinesiol, 23(4):958-965.
17. Smith KM, Dahodwala N (2014). Sex differences in Parkinson's disease and other movement disorders. Exp Neurol, 259:44-56.
18. Albert ML (1973). A simple test of visual neglect. Neurology, 23(6):658-664.
19. Jee H, Kim J, Kim C, et al (2015). Feasibility of a Semi-computerized Line Bisection Test for Unilateral Visual Neglect Assessment. Appl Clin Inform, 6(2):400-417.
20. Ku J, Lee JH, Han K, et al (2009). Validity and reliability of cognitive assessment using virtual environment technology in patients with stroke. Am J Phys Med Rehabil, 88(9):702-710.
21. Rolfe MH, Hamm JP, Waldie KE (2008). Differences in paper-and-pencil versus computerized line bisection according to ADHD subtype and hand-use. Brain Cogn, 66(2):188-195.
22. McGrath RE, Meyer GJ (2006). When effect sizes disagree: the case of r and d. Psychol Methods, 11(4):386-401.
23. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Lawrence Erlbaum Associates.
24. Mungas D (1991). In-office mental status testing: a practical guide. Geriatrics, 46(7):54-58, 63, 66.
25. Tuijl JP, Scholte EM, de Craen AJ, et al (2012). Screening for cognitive impairment in older general hospital patients: comparison of the Six-Item Cognitive Impairment Test with the Mini-Mental State Examination. Int J Geriatr Psychiatry, 27(7):755-762.
26. Ducharme S, Dickerson BC (2015). The neuropsychiatric examination of the young-onset dementias. Psychiatr Clin North Am, 38(2):249-264.
27. Jewell G, McCourt ME (2000). Pseudoneglect: a review and meta-analysis of performance factors in line bisection tasks. Neuropsychologia, 38(1):93-110.
28. Shuren JE, Jacobs DH, Heilman KM (1997). The influence of center of mass effect on the distribution of spatial attention in the vertical and horizontal dimensions. Brain Cogn, 34(2):293-300.
29. Delis DC, Robertson LC, Efron R (1986). Hemispheric specialization of memory for visual hierarchical stimuli. Neuropsychologia, 24(2):205-214.
30. Doricchi F, Guariglia P, Figliozzi F, et al (2005). Causes of cross-over in unilateral neglect: between-group comparisons, within-patient dissociations and eye movements. Brain, 128(6):1386-1406.
How to Cite
JEE H, PARK J. Gender Comparisons of Asymmetric Lateralization in Neurodegenerative Disorder Patients via E-Pen Based Cognitive Assessment System. Iran J Public Health. 48(2):289-98.
Original Article(s)