半側無視の評価であるCatherine Bergego Scaleの臨床的意義の再検討─半側無視に対する机上検査と行動評価との関連性の検討から

Rethinking the clinical significance of the Catherine Bergego Scale in the assessment of unilateral neglect: Correlating unilateral neglect in behavioral assessment and neuropsychological tests

要旨：本研究の目的は，半側無視（以下，UN）に対する机上検査とCatherine Bergego Scale（以下，CBS）による行動評価の関連性，そして両者間でUNの乖離が起こる要因を検討しCBSの臨床的意義を再検討することである．脳卒中右半球損傷患者44名に机上検査と行動評価を実施し，UNにおける両者の関連性を後方視的に調査した結果，29.5％の対象者で机上検査と行動評価の間でUNの乖離がみられた．UNの乖離がみられた群では，ADLで自己身体空間や遠位空間のUNが目立っていた．さらに乖離の要因として無視空間の違い，認知機能によるUNの代償可能性が考えられ，UNに対しては机上検査だけでなくCBSによるADLでの行動評価を並行して実施する必要がある．

　The objective of this retrospective study was to rethink the clinical significance of the Catherine Bergego Scale (CBS), to correlate behavioral assessments and a neuropsychological test battery consisting of paper-and-pencil tests of unilateral neglect (UN), and to determine the factors that contribute to the discrepancy between the two UN tests in right-hemisphere stroke patients. We assessed 44 right-hemisphere stroke patients with unilateral neglect; the Catherine Bergego Scale (CBS) and neuropsychological tests battery consisting of 5 paper-and-pencil tests were used to evaluate neglect in spontaneous behavior in natural daily activities. As a result, 29.5％ of patients presented discrepancies of UN between behavioral assessments and paper-and-pencil tests. The UN discrepancy patients showed personal and extra-personal neglect, semi-independent distinct regions of space, and compensatory ability to overcome UN by cognitive function. These were factors that contributed to a discrepancy of UN between behavioral assessments and paper-and-pencil tests. In conclusion, we propose that clinicians use not only paper-and-pencil tests but also behavioral assessments in natural daily activities by using CBS in the assessment of UN patients.