The strange role of brain lesion size in cognitive neuropsychology. (January 2022)

• Record Type: Journal Article
• Authors: Sperber, Christoph
• Is Part Of: Cortex. Volume 146(2022)
• Page Start: 216
• Page End: 226
• Publication Date: 2022-01
• Subjects: Lesion volume -- Stroke -- Covariate control -- Lesion–deficit prediction -- Voxel-based lesion symptom mapping; Neuropsychology -- Periodicals; Nervous system -- Periodicals; Neurology -- Periodicals; Psychophysiology -- Periodicals; Behavior -- Periodicals; Neurology -- Periodicals; 612.825
• DOI: 10.1016/j.cortex.2021.11.005
• Languages: English
• ISSNs: 0010-9452

Abstract

Abstract: The size of brain lesions is a variable that is frequently considered in cognitive neuropsychology. In particular, lesion-deficit inference studies often control for lesion size, and the association of lesion size with post-stroke cognitive deficits and its predictive value are studied. In the present article, the role of lesion size in cognitive deficits and its computational or design-wise consideration is discussed and questioned. First, I argue that the commonly discussed role or effect of lesion size in cognitive deficits eludes us. A generally valid understanding of the causal relation of lesion size, lesion location, and cognitive deficits is unachievable. Second, founded on the theory of causal inference, I argue that lesion size control is no generally appropriate covariate control. Instead, it is identified as a procedure with only situational benefits, which is supported by empirical data. This theoretical background is used to suggest possible research practices in lesion-deficit inference, post-stroke outcome prediction, and behavioural studies. Last, control for lesion size is put into a bigger historical context – it is identified to relate to a long-known association problem in neuropsychology, which was previously discussed from the perspectives of a mislocalisation in lesion-deficit mapping and the symptom complex approach.