Left-right confusion in psychiatric, neurodevelopmental and neurological disorders: A systematic review

• Published in: Brain research bulletin Vol. 229; p. 111435
• Main Authors: Thaler, Moritz, Ocklenburg, Sebastian
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2025; Elsevier
• Subjects: Brain - physiopathology; Confusion - physiopathology; Functional Laterality - physiology; Gyrus angularis; Humans; Left-right confusion; Left-right discrimination; Mental Disorders - complications; Mental Disorders - physiopathology; Nervous System Diseases - complications; Nervous System Diseases - physiopathology; Neurodevelopmental Disorders - complications; Neurodevelopmental Disorders - physiopathology; Pathologies; PRISMA guidelines; Systematic review; Gyrus angularis; Systematic review; Pathologies; Left-right confusion; Left-right discrimination; PRISMA guidelines
• ISSN: 0361-9230; 1873-2747; 1873-2747
• DOI: 10.1016/j.brainresbull.2025.111435

Left-right confusion is common in healthy individuals, but increased prevalence has been reported in several psychiatric, neurodevelopmental, and neurological disorders. The present systematic review aimed to identify disorders in which the prevalence of left-right confusion is higher than in the general population. For this purpose, a systematic review following PRISMA guidelines was conducted using the databases Google Scholar, PubMed, and Mendeley. A total of 20 quantitative case-control studies were included. Lesions in parietal brain areas and damage to temporal-parietal-occipital brain areas because of Alzheimer's disease were associated with severe impairments in left-right orientation. Furthermore, evidence for developmental impairments in direction assignment was provided by studies on developmental topographical disorientation (DTD). These DTD-related impairments are associated with low functional connectivity between the hippocampus and the right prefrontal cortex. Individuals with DTD show significantly poorer performance in direction discrimination compared to healthy subjects. In addition, the review highlights that, despite previous research, there remains a substantial need for further studies and for the development of a uniform definition and operationalization of left-right confusion in clinical populations. •Systematic review of left-right confusion in neurological and psychiatric disorders, including Alzheimer's disease.•Left-right confusion is often associated with damage to parietal structures.•Left-right confusion can also occur developmental as an isolated symptom.•A uniform definition and operationalization of left-right confusion is needed.