[10] Because men have been shown to consistently outperform women in MR tasks,[11] tests involving the use of this particular strategy may present alternative cognitive demands and lead to inaccurate assessment of LRD performance.
[8] An extended version of the BLRD test was designed to allow for differential evaluation of LRD and MR abilities, in which subtests were created with either high or low demands on mental rotation.
[7] Scientists controlled for MR demands, potential menstrual cycle effects, and other hormone fluctuations, and determined that the neurocognitive mechanisms that support LRD are different for men and women.
[14][15] Infant ability to visually match above–below and left–right relations appears to diminish in early toddlerhood, as language acquisition may complicate verbal labeling.
One study found that neural activity patterns for left–right and above–below distinctions are represented differently in the brain, leading to the theory that these spatial judgements are supported by separate cognitive mechanisms.
This issue is of particular importance to medical students, clinicians and health care professionals, where distraction in the workplace and LRD inaccuracy can lead to severe consequences, including laterality errors and wrong-side surgeries.
[16] Additionally, in the field of health care, it has been noted that mental rotation is often involved in making left–right distinctions, such as when a medical practitioner is facing their patient and must adjust for the opposite left–right relations.