262:, features of the visual scene, such as color and orientation, are registered early and in parallel across the visual field. These features are represented by separate maps that are later integrated to form a master map of locations that specifies where things are but not what they are. In order to identify objects, focused attention is required to bind perceptual representations of objects being viewed with features in their proper locations. Parietal lesions damage the master map of locations, and as a result, a variety of deficits can occur, including simultanagnosia. If space is necessary to distinguish objects, then deficits in explicit access to spatial information located in the master map leads to the inability to perceive more than one object at a time.
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certain objects, which can then channel visual information to specialized systems for space and shape analysis. Deficits in the spatial indexing mechanism would result in symptoms of simultanagnosia because interpretation of a complex scene requires rapid shifting of attention to various elements, and impairments in spatial indexing lead to the inability to index multiple visual features rapidly. In addition, perception is slowed, and low-level visual processing is disrupted since the patient would not be able to extract and index salient features.
250:
shown after a long delay following the first word, identification of the second word was easier. These results indicate that patients with simultanagnosia have difficulty processing objects presented in rapid succession, and the patient is unable to shift his attention rapidly enough between successive stimuli since a certain amount of time is required for the patient to shift his attention from the first word in order to be able to identify the second word.
266:
simultanagnosic symptoms resulted. In the model simulation of simultanagnosia, the same location was assigned to all stimuli, therefore preventing the model from identifying multiple objects at once. Either the model "locked" onto the first object and was unable to disengage attention, or once recognition of the first object was completed, it "disappeared" from sight to be replaced by the second object.
220:. Because the size of the object did not affect his patient's ability to perceive an item, Bálint argued that his patient did not have a narrowing of the sensory field. Therefore, Bálint concluded that the patient's attention would always be as narrow as the size of the item being observed. In other words, the attentional window of a simultanagnosic patient is limited to one object.
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from the background; it found that processing of targets was significantly impaired even though the targets were markedly different from the background. The results suggest that impairments in parsing, such as the process by which important regions are extracted from the retinal image, or difficulty in discriminating elementary visual features led to simultanagnosia.
80:
utensils, a patient will report seeing only one item, such as a spoon. If the patient's attention is redirected to another object in the scene, such as a glass, the patient will report that they see the glass but no longer see the spoon. As a result of this impairment, simultanagnosic patients often fail to comprehend the overall meaning of a scene.
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In one study patients were required to read one word and then read a second word that followed the first in rapid succession. While individuals could identify the first word relatively quickly, they had significantly greater difficulty identifying the second word. Furthermore, if the second word was
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It is likely that damage to any of several cognitive mechanisms could result in simultanagnosia. Several theories have been proposed to account for simultanagnosic symptoms, and while some focus on the disruption of a specific process, such as the speed of attentional processing, others focus on the
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lobes. Here, perception is limited to a single object without awareness of the presence of other stimuli. Thus, being able to see only one object at a time, a patient may collide with various objects in a room being unaware of them. Additionally, objects in motion appear more difficult to perceive.
107:
Patients take a clearly piecemeal approach to interpreting the scene by reporting isolated items from the image. For instance, a patient may report seeing a "boy," "stool," and a "woman." However, when asked to interpret the overall meaning of the picture, the patient fails to comprehend the global
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to slow down; as a result, patients with simultanagnosia have difficulty discriminating among visual features. According to this theory, "feature degradation" or increased "noise" occurs in the perceptual system. One study analyzed how well patients could process targets based on a feature salient
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Finally, simultanagnosia may result from deficits in spatial indexing. Several studies have noted that a pre-attentive stage of processing exists during which visual features are obtained from the visual field in parallel. Once these features have been extracted, they can be indexed, which allows
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In contrast to Bálint's hypothesis, Thaiss and De Bleser studied a patient who had a physical restriction of her attentional window. The patient's ability to perceive multiple objects and identify global structures significantly improved as the size of the presented image decreased. Thus, complex
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at time passes, and the speed with which an individual's attention can filter percepts is much slower for a patient with simultanagnosia than a person without the disorder. People without simultanagnosia are able to perceive numerous objects at once because they can shift their attention rapidly
150:
Ventral simultanagnosia results from damage to the left inferior occipito-temporal junction. Ventral simultanagnosic patients are able to see several objects at once, but their recognition of objects is piecemeal, or limited to one object at a time. Thus, individuals with ventral simultanagnosic
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Saliency of a feature facilitates the ease with which it can be indexed. For example, the greater the difference between a specific feature and surrounding ones, the more easily it can be indexed. The indexed features, or anchor points, can serve as a "spotlight" that directs focal attention to
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Patients with simultanagnosia, a component of Bálint's syndrome, have a restricted spatial window of visual attention and cannot see more than one object at a time in a scene that contains more than one object. For instance, if presented with an image of a table containing both food and various
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Simultanagnosic patients often exhibit a phenomenon known as "local capture" where they only identify the local elements of stimuli containing local and global features. However, studies have demonstrated that implicit processing of the global structure can occur. With the appropriate stimulus
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Another theory to account for simultanagnosia involves deficits in "attentional disengaging," and this impairment affects shifts of attention in any direction. When confronted with several objects, the patient's attention becomes "locked" onto one object, and he has difficulty disengaging his
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Currently, there is no treatment available for patients with dorsal simultanagnosia, and it is likely that the bilateral lesions resulting in simultanagnosia will not heal. However, a recent study demonstrated that recovery may be related to finding ways to expand the restricted attentional
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One study developed a computer model of high-level visual processing, which contrasts with low-level visual processing in that it involves the use of previously stored information to identify objects and navigate. When the spatiotopic mapping subsystem of the model was partially damaged,
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window—their global gestalt perception—that characterizes the disorder. In another study a participant showed an improvement 18 months after stroke induced ventral simultanagnosia, this "represents the usual partial recovery from an early ventral simultanagnosia/pure alexia".
269:
Coslett and
Saffran studied one patient who was unable to maintain location information for more than one shape. Since only a single explicit binding could occur between spatial and shape information, the patient was incapable of perceiving more than one object at a time.
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There are currently no quantitative methods for diagnosing simultanagnosia. To establish the presence of simultanagnosic symptoms, patients are asked to describe complex visual displays, such as the commonly used "Boston Cookie Theft" picture, which is a component of the
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enough between stimuli so that percepts are integrated before they decay from short-term memory. However, those with simultanagnosia are incapable of shifting their attention quickly enough from one object to another, and thus, they only perceive one object at a time.
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them to function as anchor points for additional visual routines; visual routines are sequences of elemental operations, such as visual search or texture segregation, which define the spatial relationships among objects as well as their properties.
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whole. Another picture used to assess visual impairments of patients with simultanagnosia is the "Telegraph Boy" picture. Upon examination of higher nervous system functions, patients display no general intellectual impairments.
56:). The term "simultanagnosia" was first coined in 1924 by Wolpert to describe a condition where the affected individual could see individual details of a complex scene but failed to grasp the overall meaning of the image.
208:. He studied a patient who easily identified single objects, regardless of size, but claimed that he could only see one object when presented with a complex display of numerous items. This patient also exhibited ocular
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Finke, K.; Schneider, W. X.; Redel, P.; Dose, M.; Kerkhoff, G.; Muller, H. J.; et al. (2007). "The capacity of attention and simultaneous perception of objects: A group study of
Huntington's disease patients".
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circuits concerned with the perception of objects' shapes and locations, respectively. These two forms of simultanagnosia are associated with different symptoms as well as damage to separate areas of the brain.
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Other studies have proposed that simultanagnosia results from slowed attentional processing. According to this view, attention is seen as filter through which one
560:
Dalrymple, K. A.; Kingstone, A. & Barton, J. J. S. (2007). "Seeing trees OR seeing forests in simultanagnosia: Attentional capture can be local or global".
167:. It is also possible for simultanagnosic symptoms to develop from degenerative disorders. For example, one study found that four patients with progressive
91:, which are large letters composed of smaller ones, revealed that the use of smaller and denser Navon letters biased the patient towards global processing.
104:. In the picture, the sink in the kitchen is overflowing as a boy and a girl attempt to steal cookies from the cookie jar without their mother noticing.
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attention from this object to another one. As a result of this "sticky fixation," patients with simultanagnosia can perceive only one object at a time.
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In addition, patients note that one stationary object may spontaneously disappear from view as they become aware of another object in the scene.
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Simultanagnosia results from bilateral lesions to the junction between the parietal and occipital lobes. These lesions could result from a
1247:
Riddoch, M. J. & Humphreys, G. W. (2004). "Object identification in simultanagnosia: When wholes are not the sum of their parts".
688:
Laeng, B.; Kosslyn, S. M.; Caviness, V. S. & Bates, J. (1999). "Can deficits in spatial indexing contribute to simultanagnosia?".
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more than a single object at a time. This type of visual attention problem is one of three major components (the others being
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It is also possible that impairments in mechanisms that register spatial locations lead to simultanagnosia. According to the
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52:, an uncommon and incompletely understood variety of severe neuropsychological impairments involving space representation (
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Simultanagnosia can be divided into two different types: dorsal and ventral, with each taking its name from the
1027:
Humphreys, G.W.; Price, C.J. (1994). "Visual feature discrimination in simultanagnosia. A study of two cases".
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972:"Components of high-level vision: a cognitive neuroscience analysis and accounts of neurological syndromes"
216:, or the impairment of visually guided hand movements. This collection of symptoms would later be called
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Another theory to account for simultanagnosia states that patients have difficulty analyzing shapes.
884:
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Duncan, J.; Bundesen, C.; Olson, A.; Humphreys, G.; Ward, R.; Kyllingsbaek, S.; et al. (2003).
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conditions, explicit processing of the global form may occur. For example, a study performed with
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Dalrymple, K. A.; Bischof, W. F.; Cameron, D.; Barton, J. J. S. & Kingstone, A. (2009).
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Simultanagnosia can be divided into two different categories: dorsal and ventral. Ventral
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212:, an impairment of voluntary eye movements despite intact oculomotor reflexes, and optic
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Kinsbourne, M.; Warrington, E.K. (1962). "A disorder of simultaneous form perception".
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Jackson, G. M.; Shepherd, T.; Mueller, S. C.; Husain, M. & Jackson, S. R. (2006).
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717:"Global perception in simultanagnosia is not as simple as a game of connect-the-dots"
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Treisman, A. M. & Gelade, G. (1980). "Feature-integration theory of attention".
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Coslett, H. B. & Saffran, E. (1991). "Simultanagnosia. To see but not two see".
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stimuli could be processed as wholes so long as they occupied a small visual angle.
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have been found to exhibit visual impairments similar to those of simultanagnosia.
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symptoms are capable of navigating through a room without bumping into furniture.
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Dorsal simultanagnosia results from bilateral lesions to the junction between the
925:"The interaction of spatial and object pathways: Evidence from Bálint's syndrome"
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365:"Dorsal simultanagnosia: An impairment of visual processing or visual awareness?"
1165:"Experiencing simultanagnosia through windowed viewing of complex social scenes"
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1091:"Focused attention in perception and retrieval of multidimensional stimuli"
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Julesz, B. (1984). "A brief outline of the texton theory of human-vision".
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Robertson, L.; Treisman, A.; FriedmanHill, S. & Grabowecky, M. (1997).
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Benson D.F.; Davis R.J.; Snyder B.D. (1988). "Posterior cortical atrophy".
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eventually developed symptoms of simultanagnosia as well as components of
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Jackson, G.; Swainson, R.; Mort, D.; Masud, H. & Jackson, S. (2004).
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Disorders of object recognition and what they tell us about normal vision
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1215:"Pure alexia: A nonspatial visual disorder affecting letter activation"
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Kosslyn, S. M.; Flynn, R. A.; Amsterdam, J. B. & Wang, G. (1990).
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Bilateral lesions to the parieto-occipital junction may cause the
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lesions cause a mild form of the disorder, while dorsal occipito-
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512:"Implicit processing of global information in Bálint's syndrome"
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462:"Attentional functions in dorsal and ventral simultanagnosia"
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Inability to visually perceive more than one object at a time
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Roelfsema, P. R.; Lamme, V. A. F.; Spekreijse, H. (2000).
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K. Dalrymple. Personal interview. 21 September 2009.
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36:characterized by the inability of an individual to
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71:lesions cause a more severe form of the disorder.
1163:Dalrymple K A; Birmingham E; et al. (2011).
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412:"Simultanagnosia: When a rose is not red"
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1124:"The implementation of visual routines"
260:feature-integration theory of attention
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806:10.1016/j.neuropsychologia.2007.06.006
574:10.1016/j.neuropsychologia.2006.07.013
345:Farah, M.J. (1990). "Visual agnosia".
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1016:from the original on August 16, 2016.
410:Coslett, H. B. & Lie, G. (2008).
102:Boston Diagnostic Aphasia Examination
1284:Xu, Y. D. & Chun, M. M. (2009).
770:10.1001/archneur.1988.00520310107024
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179:. In addition, patients with
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254:Spatial mapping deficits
228:Disengagement difficulty
1056:Trends in Neurosciences
702:10.1080/026432999380915
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237:Slowed visual attention
146:Ventral simultanagnosia
54:visuospatial processing
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1337:Dorsal Simultanagnosia
849:10.1093/brain/85.3.461
165:traumatic brain injury
129:Dorsal simultanagnosia
1089:Treisman, A. (1977).
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173:Gerstmann's syndrome
1357:Medical terminology
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202:Rezső Bálint
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42:optic ataxia
32:) is a rare
29:
25:
24:
1251:(Article).
1101:(1): 1–11.
1031:(Article).
839:(Article).
796:(Article).
760:(Article).
634:(Article).
564:(Article).
518:(Article).
471:(Article).
418:(Article).
371:(Article).
75:Description
1295:(Review).
1178:: 265–77.
583:2429/17890
324:References
19:See also:
1172:Brain Res
979:Cognition
880:CiteSeerX
303:Treatment
200:In 1909,
139:occipital
95:Diagnosis
1351:Category
1323:19269882
1277:42936948
1269:21038214
1192:20950591
1150:10788648
1076:53151601
1011:Archived
957:27076617
949:23965009
857:14032918
822:14541572
814:17681560
743:19460397
592:16973181
536:15174462
497:17788279
489:20957589
436:17919075
397:34698303
389:16909634
312:See also
169:dementia
135:parietal
69:parietal
65:temporal
61:occipito
1314:3213861
1200:9857024
1007:9706913
999:2183962
902:7351125
778:3390033
652:1884165
600:1573520
544:4481532
444:1256738
318:Agnosia
243:percept
210:apraxia
122:ventral
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516:Cortex
495:
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369:Cortex
214:ataxia
161:stroke
155:Causes
118:dorsal
1289:(PDF)
1273:S2CID
1196:S2CID
1168:(PDF)
1072:S2CID
1014:(PDF)
1003:S2CID
975:(PDF)
953:S2CID
906:S2CID
837:Brain
818:S2CID
632:Brain
596:S2CID
540:S2CID
493:S2CID
465:(PDF)
440:S2CID
393:S2CID
48:) of
1319:PMID
1265:PMID
1188:PMID
1176:1367
1146:PMID
995:PMID
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898:PMID
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810:PMID
774:PMID
739:PMID
648:PMID
588:PMID
532:PMID
485:PMID
432:PMID
385:PMID
175:and
137:and
120:and
44:and
28:(or
1309:PMC
1301:doi
1257:doi
1227:doi
1180:doi
1136:doi
1103:doi
1064:doi
1037:doi
987:doi
937:doi
890:doi
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636:114
578:hdl
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163:or
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