An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury

Abstract

Considerable emphasis has been placed upon cognitive neuropsychological explanations of awareness disorders in brain injury and Alzheimer's disease (AD), with relatively few models acknowledging the role of psychosocial factors. The present paper explores clinical presentations of unawareness in brain injury and AD, reviews the evidence for the influence of psychosocial factors alongside neuropsychological changes, and considers a number of key issues that theoretical models need to address, before going on to discuss some recently-developed models that offer the potential for developing a comprehensive biopsychosocial account. Building on these developments, we present a framework designed to assist clinicians to identify the specific factors contributing to an individual's presentation of unawareness, and illustrate its application with a case example.

Another perspective on anosognosia: Self-observation in video replay improves motor awareness

“…Whether these awareness-related emotions are a primary manifestation of the disorder itself, or a secondary consequence of other primary causes has long being debated in the literature (see Bisiach & Geminiani, 1991;Fotopoulou, 2013;Solms, 1995;Turnbull et al, 2005;Weinstein and Khan, 1950). This study cannot directly address such debates, but it nevertheless suggests that taking patients' emotions into account may be an important component of any successful intervention for AHP (see also Prigatano, 2005), as has also been shown in similar syndromes such as confabulation following acute frontal damage (see Fotopoulou et al, 2008) and unawareness in generalised and neurodegenerative disorders such as dementia (Ownsworth, Clare, & Morris, 2006).…”

Knowledge and use of memory strategies in amnestic mild cognitive impairment.

“…Comprehensive neurocognitive and biopsychosocial models (cf. Agnew & Morris, 1998;Ownsworth, Clare, & Morris, 2006) and brain metabolic correlates of awareness in aMCI (Nobili et al, 2010) provide some explanation for this variability. However, methodological factors, particularly how awareness is measured, are also relevant.…”

Emotional distress and awareness following acquired brain injury: An exploratory analysis

“…Impaired awareness can be observed when a patient does not report, denies or minimizes difficulties that are readily detectable by an observer. To date, models of awareness have focused on both the neurological and psychological aspects of the phenomenon [10]. Psychological models of awareness focus on the role of denial of disabilities as a protection against the impact of the reality of disability and loss of pre-injury status [11].…”