Unawareness of deficits after right hemisphere stroke: double-dissociationsof anosognosias

Abstract

Double-dissociations demonstrate that anosognosias for different defects are independent and specific impairments of awareness, although general cognitive disorder may also reduce awareness of defects. Unawareness of illness and anosognosia for hemiparesis disappear rapidly and can hardly be direct causes of poor long-term recovery. However, transient anosognosia may be associated with persistent disorders which result in poor outcome.

Functional Recovery After Hemiplegia in Patients With Neglect

“…First, the study brings forth other data on the functional recovery of patients with N. Second, the study shows that patients with A have more severe cognitive disturbances than those of subjects with N. This is in line with data by Feinberg et al, 3 Stone et al, 23 and Jehkonen et al, 24 which underline that A is an indicator of more severe neglect. Finally, it increases the knowledge on the factors affecting the rehabilitative outcome of subjects with N. There are few studies on this topic.…”

“…First, the cognitive disturbances found in subjects with NϩA pertain to A itself. 3,24,25 In fact, Jehkonen et al 24 found that patients with A had poorer orientation and verbal memory, and Feinberg et al 3 observed verbal confabulation in subjects with A. Starkstein et al 25 found significantly higher frequencies of hemispatial neglect and related phenomena, as well as deficits in recognizing facial emotions and in receptive prosody in patients with A. Second, in our study we wanted to take more into consideration the motor FIM score, which assesses self-sufficiency in the activities of daily living.…”

Unawareness of motor impairment and emotions in right hemispheric stroke: a preliminary investigation

“…To confirm the clinical diagnosis, in patients with neglect we administered four tests: line crossing, letter cancellation, figure and shape copying, and line bisection (Jehkonen et al, 2000). All patients with neglect scored pathologically in at least 2 of these tests.…”

“…Only patients within the first 3 months from the acute stroke were included because it is well established that unawareness phenomena are not stable and may have a progressive recovery within the first months, so that it is much more evident in the acute phase than in the following period (Jehkonen et al, 2000;Marcel et al, 2004). The diagnosis of stroke was based on the clinical history and magnetic resonance (MR) findings.…”

“…However, the fact that anosognosia and neglect may also be present individually (Orfei et al, in press) suggests partially independent pathogenetic mechanisms (Jehkonen et al, 2000;Berti et al, 2005). Also, cerebral mechanisms for individual unawareness phenomenon, such as anosognosia, may be different in some way.…”