Neglect impairs explicit processing of the mental number line

Converging evidence suggests that visuospatial attention plays a pivotal role in numerical processing, especially when the task involves the manipulation of numerical magnitudes. Visuospatial neglect impairs contralesional attentional orienting not only in perceptual but also in numerical space. Indeed, patients with left neglect show a bias toward larger numbers when mentally bisecting a numerical interval, as if they were neglecting its leftmost part. In contrast, their performance in parity judgments is unbiased, suggesting a dissociation between explicit and implicit processing of numerical magnitude. Here we further investigate the consequences of these visuospatial attention impairments on numerical processing and their interaction with task demands. Patients with right hemisphere damage, with and without left neglect, were administered both a number comparison and a parity judgment task that had identical stimuli and response requirements. Neglect patients' performance was normal in the parity task, when processing of numerical magnitude was implicit, whereas they showed characteristic biases in the number comparison task, when access to numerical magnitude was explicit. Compared to patients without neglect, they showed an asymmetric distance effect, with slowing of the number immediately smaller than (i.e., to the left of) the reference and a stronger SNARC effect, particularly for large numbers. The latter might index an exaggerated effect of number-space compatibility after ipsilesional (i.e., rightward) orienting in number space.Thus, the effect of neglect on the explicit processing of numerical magnitude can be understood in terms of both a failure to orient to smaller (i.e., contralesional) magnitudes and a difficulty to disengage from larger (i.e., ipsilesional) magnitudes on the number line, which resembles the disrupted pattern of attention orienting in visual space