Anosognosia for limb and bucco‐facial apraxia as inferred from the recognition of gestural errors

Abstract

Anosognosia is a multifaceted syndrome characterized by a lack of awareness of motor, cognitive, or emotional deficits. While most studies have focused on basic motor disorders such as hemiplegia, only recently, the issue of whether anosognosia also concerns higher-order motor disorders like apraxia has been addressed. Here, we explore the existence of a specific form of anosognosia for apraxia in forty patients with uni-hemispheric vascular lesions. The patients were requested to imitate actions involving upper limb or bucco-facial body parts and then judge their performance. Successively, they were also asked to observe video recordings of the same actions performed by themselves or by other patients and judge the accuracy of the displayed actions. The comparison of participants versus examiner judgement and between error recognition of others' versus self's actions was considered as an index of awareness deficit for the online and offline conditions, respectively. Evidence was found that awareness deficits occurred both immediately after action execution (online anosognosia) and in the video recording task (offline anosognosia). Moreover, bucco-facial and limb apraxic patients were specifically unaware of their errors in bucco-facial and limb actions, respectively, indicating for the first time a topographical organization of the syndrome. Our approach allowed us to distinguish awareness deficits from more general disorders in error recognition; indeed, anosognosic patients were able to identify errors when the same action was executed by another patient but not when the video showed their own actions. Finally, we provide evidence that anosognosia for apraxia might be associated with frontal cortical and subcortical networks.

Brain Dynamics of Action Monitoring in Higher-Order Motor Control Disorders: The Case of Apraxia

“…Capitalizing on previous similar reports (Spinelli et al, 2018;Pezzetta et al, 2018;Pavone et al, 2016), we recorded EEG in left-brain damaged individuals with and without limb apraxia and in a control group who observed through immersive virtual-reality an avatar performing correct or incorrect actions. In line with previous studies on error monitoring, 6 awareness, and gesture recognition in patients with apraxia (Canzano et al, 2014;Canzano et al, 2016;Candidi et al, 2016;Scandola et al, 2021), we expected an impairment in patients with LA when the error monitoring system is called into play, that is when a mismatch between predicted and observed action goal occurs. Acquiring EEG signatures of performance monitoring during the observation of correct and incorrect actions provided novel information upon the integrity of the error detection system in LA.…”

Mapping the human praxis network: an investigation of white matter disconnection in limb apraxia of gesture production

“…Involvement of the temporal lobe has also been found to be relevant in the context of anosognosia for limb apraxia. 74 …”

Anosognosia for theory of mind deficits: A single case study and a review of the literature

“…There is a heated debate on whether awareness is a specific function or may have some domain-specific components (Vallar and Ronchi, 2006;Mograbi and Morris, 2013;Fotopolou, 2014). Selective lack of awareness has been demonstrated in syndromes such as anosognosia for hemiplegia (Babinski, 1914), apraxia (Canzano et al, 2014;Scandola et al, 2020), amnesia (Mograbi and Morris, 2013) and aphasia (Cocchini et al, 2010a(Cocchini et al, , 2010b, thus supporting the hypothesis of at least a partial specificity. However, neuro-anatomical data indicate that there may be a number of general processes relating to awareness, which would be associated with the neural networks involved in self-referred processes, the updating of self-referred beliefs and general behaviour monitoring and error processing (Pacella et al, 2019).…”