Following the gold trail: Reward influences on spatial exploration in neglect.

Spatial attention is guided by the perceived salience and relevance of objects in the environment, a process considered to depend on a broad parieto-frontal cortical network. Signals arising from the limbic and nigrostriatal pathways conveying affective and motivational cues are also known to modulate visual selection, but the nature of this contribution and its relation to spatial attention remain unclear. We investigated the role of reward information in 15 patients with left hemispatial neglect and 15 control subjects playing multiple rounds of a virtual foraging game. Participants' exploration tracked dynamically adjusted underlying reward distributions, largely unbeknownst to them. Both control and neglect participants showed typical exploration/exploitation balance, dependent on abundance or scarcity of rewards. De-reinforcing previously favored, mostly right, regions of space attenuated left space under-exploration in patients. Multiple regression analysis indicates that such reward-based training may benefit mostly patients early after lesion onset, with mild neglect and small lesions sparing subcortical regions. Our findings support the view that spatial exploration recruits heavily right hemispheric visuospatial attentional mechanisms as well as reward signals processed by basal ganglia and prefrontal cortical circuits, which serve to learn about the motivational relevance of environmental stimuli and help prioritize attention and motor response selection.