Impact of alertness training on spatial neglect: a behavioural and fMRI study.

The effects of a 3-week computerised alertness training on chronic (>3 months) visuospatial hemineglect were investigated prospectively in seven patients by means of neuropsychological tests and functional magnetic resonance imaging (fMRI). Following the alertness training, the group showed improved alertness and a significant improvement in the performance of a neglect test battery over and above any improvement during a 3-week baseline phase. Improvements in the neglect tasks were accompanied by an increase of right hemisphere neural activity in frontal cortex, anterior cingulate cortex, precuneus, cuneus and angular gyrus. These areas have previously been associated with alertness and spatial attention. A similar pattern of increased neural activity was found for the left hemisphere. Four weeks after the end of the training, the patients' neglect test performance had mostly returned to baseline, while the increases in neural activity bilaterally in frontal areas, in the right anterior cingulate cortex, the right angular gyrus and the left temporoparietal cortex remained. The data show that a 3-week computerised alertness training can improve performance both in alertness and neglect tests and that these behavioural improvements are associated with reactivation in areas associated with alerting and visuospatial attention. The limited stability of these effects over time suggests that a 3-week alertness training alone does not result in long lasting improvements in every patient, but refining the treatment protocol may lead to a more stable amelioration of neglect symptoms.