Anosognosia in patients with cerebrovascular lesions. A study of causative factors.

Abstract

Background and Purpose: Psychological and biological hypotheses have been proposed to explain anosognosia. We correlated the presence of anosognosia with the presence and severity of psychiatric disturbances, neglect, intellectual impairments, and computed tomographic evidence of lesion size, location, and measurements of brain atrophy.Methods: A series of 80 patients with acute stroke were assessed using a battery of psychiatric and neuropsychological tests and computed tomography.Results: There were five main findings. First, 27 (28%) of the 96 patients originally screened showed anosognosia. Second, patients with anosognosia had significantly higher frequencies of hemispatial neglect and related phenomena, as well as deficits in recognizing facial emotions and in receptive prosody. Third, depression was equally frequent among patients with and without anosognosia. Fourth, patients with anosognosia had a significantly higher frequency of right hemisphere lesions, primarily involving the temporoparietal junction, thalamus, and basal ganglia. Fifth, patients with anosognosia showed significantly more subcortical brain atrophy, primarily involving the frontal white matter and diencephalic areas.Conclusions: The present study demonstrates that anosognosia does not "protect" stroke patients from depressive feelings; rather, it represents arousal-attentional disorders after lesions in specific areas of the right hemisphere in nonaphasic patients with preexisting subcortical atrophy.

Functional Recovery After Hemiplegia in Patients With Neglect

“…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.…”

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…14,15 Second, PSD has been observed in individuals with anosognosia. 16 Third, late-onset depression has been associated with white matter disease and small silent infarcts. 12,17,18 Fourth, poststroke depressive-like symptoms have been noted in several animal models.…”

A Systematic Evaluation of the Adaptation of Depression Diagnostic Methods for Stroke Survivors Who Have Aphasia

“…22,26,38,39 Reding et al 26 also indicated using participants' gestures as responses. A noncompletion rate of 14 from at least 46 attempts was achieved (based on 3 studies that reported numbers of individuals with aphasia that did not complete 26,38,39 and 2 studies that reported the number that did.…”

“…22,26,38,39 Reding et al 26 also indicated using participants' gestures as responses. A noncompletion rate of 14 from at least 46 attempts was achieved (based on 3 studies that reported numbers of individuals with aphasia that did not complete 26,38,39 and 2 studies that reported the number that did. 38,39 Two studies 22,40 (both with 'limited' aphasia) reported using response cards as a supplementary method: as part of the interview assessment with the SADBD 22 ; and to aid administration of the SDS questionnaire.…”