“…Among the 37 papers shortlisted for full reading, 22 were considered not pertinent since they did not make use of neuroimaging or focused on neurogenerative diseases other than FTD. 15 studies met the selection criteria of this systematic review (Amanzio et al., 2016; Bastin et al., 2012; Garcia-Cordero et al., 2016; Hornberger et al., 2014; Ichikawa et al., 2013; Levy et al., 2018; Massimo et al., 2013; McMurtray et al., 2006; Mendez and Shapira, 2005; Miller et al., 1997; Rosen et al., 2010; Ruby et al., 2007; Shany-Ur et al., 2014; Sollberger et al., 2014; Zamboni et al., 2010) (Tables 2 and 3). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…(1997)30 FTD 30 ADClinical judgment Presence or absence of patients’ insight into illnessPresence of diseaseVisual inspection of SPECT imagesFairMcMurtray et al. (2006)74 bvFTDClinical judgment using Frontotemporal Dementia Inventory (degree of characterization of the object in reference ranging from 1 -not characteristic at all- to 5 -extremely characteristic-)Behavioural changeVisual rating of SPECT imagesGoodLevy et al. (2018)26 bvFTD 29 CBS 12 PPAClinical judgment on the NRS item ‘Inaccurate insight and self-appraisal’ ranging from 1 (not present) to 7 (extremely severe) Participant - informant DS on the FrSBe.Presence of disease and health status Executive dysfunctionMRI with automated parcellation of cerebral cortex into 68 regions of interest using FreeSurferGoodIchikawa et al.…”
HighlightsFractionating insight into objects aids its neuroanatomical exploration in dementia.Distinctive neural correlates seem to underpin different insight objects in FTD.Altered insight into disease/health condition mostly involves right frontal areas.Altered insight into social cognition implicates frontal, temporal and limbic areas.Frontal, medial temporal and parietal areas underpin insight into memory problems.
“…Among the 37 papers shortlisted for full reading, 22 were considered not pertinent since they did not make use of neuroimaging or focused on neurogenerative diseases other than FTD. 15 studies met the selection criteria of this systematic review (Amanzio et al., 2016; Bastin et al., 2012; Garcia-Cordero et al., 2016; Hornberger et al., 2014; Ichikawa et al., 2013; Levy et al., 2018; Massimo et al., 2013; McMurtray et al., 2006; Mendez and Shapira, 2005; Miller et al., 1997; Rosen et al., 2010; Ruby et al., 2007; Shany-Ur et al., 2014; Sollberger et al., 2014; Zamboni et al., 2010) (Tables 2 and 3). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…(1997)30 FTD 30 ADClinical judgment Presence or absence of patients’ insight into illnessPresence of diseaseVisual inspection of SPECT imagesFairMcMurtray et al. (2006)74 bvFTDClinical judgment using Frontotemporal Dementia Inventory (degree of characterization of the object in reference ranging from 1 -not characteristic at all- to 5 -extremely characteristic-)Behavioural changeVisual rating of SPECT imagesGoodLevy et al. (2018)26 bvFTD 29 CBS 12 PPAClinical judgment on the NRS item ‘Inaccurate insight and self-appraisal’ ranging from 1 (not present) to 7 (extremely severe) Participant - informant DS on the FrSBe.Presence of disease and health status Executive dysfunctionMRI with automated parcellation of cerebral cortex into 68 regions of interest using FreeSurferGoodIchikawa et al.…”
HighlightsFractionating insight into objects aids its neuroanatomical exploration in dementia.Distinctive neural correlates seem to underpin different insight objects in FTD.Altered insight into disease/health condition mostly involves right frontal areas.Altered insight into social cognition implicates frontal, temporal and limbic areas.Frontal, medial temporal and parietal areas underpin insight into memory problems.
“…Furthermore, neuropsychological testing is lacking in the assessment of social skills, which are often affected by anosognosia, especially in bvFTD, in which these deficits are among the first to appear (Eslinger et al, 2005). Despite this, according to the study conducted by Levy et al (2018), the methodology based on evaluation by a clinician is more associated with brain areas and with executive dysfunction evaluations, both theoretically associated with self-awareness. Furthermore, it is more associated with neuropsychological test performance than the discrepancy method used with the Frontal Systems Behavioral Scale (Levy et al, 2018).…”
Section: Self-awareness In Neurodegenerative Disordersmentioning
confidence: 98%
“…Despite this, according to the study conducted by Levy et al (2018), the methodology based on evaluation by a clinician is more associated with brain areas and with executive dysfunction evaluations, both theoretically associated with self-awareness. Furthermore, it is more associated with neuropsychological test performance than the discrepancy method used with the Frontal Systems Behavioral Scale (Levy et al, 2018). In the next section, the properties and technical features of VR will be described and proposed as a method for assessing self-awareness that could compensate for the limitations of the traditional ways above described, integrating their points of strength.…”
Section: Self-awareness In Neurodegenerative Disordersmentioning
The absence of self-awareness is a crucial aspect in the symptomatology of various neurodegenerative disorders. This characteristic becomes relevant due to the strong implications it has on the patient’s quality of life, on the effects that functional dependence has on the caregiver and on the efficacy of the therapy. Faced with a construct as complex as self-awareness, there are in the literature investigations on different aspects of this phenomenon, such as the creation of cognitive models, the study of the neural substrate and the research of appropriate assessment methods that can reliably detect this function. With regard to the assessment methods, there are methodologies in the literature that provide complementary information. The first modality is a quantitatively online measurement based on the discrepancy between the estimate of the patient of his performance and his actual performance, but often neglecting the ecological validity and the real functioning of the subject. The second kind collecting subjective information on the actual daily functioning of the patient resulting from clinical observation or interviews with the subject and caregivers, but obtaining offline information on the functioning of the subject, liable to bias that may imply an overestimation or underestimation of subject’s ability. The absence of acknowledged metacognitive functional assessment with normative data to evaluate awareness winks at the emerging and increasingly consistent use of virtual reality (VR) also in the context of cognitive research and clinical assessment. This article aims to make a theoretical proposal regarding the use of this innovative and promising tool as a supplement to the assessment methods of self-awareness.
“…Thus, in ABI patients, a reduction of awareness might be considered as a damage in self-monitoring ( Stuss and Benson, 1984 ). This mechanism also occurs in patients with neurodegenerative disorders, such as frontotemporal dementia (FTD) ( O’Keeffe et al, 2007 ; Amanzio et al, 2016 ; Levy et al, 2018 ), Alzheimer ( Amanzio et al, 2010 , 2011 , 2013 ) and Parkinson ( Amanzio et al, 2014 ; Palermo et al, 2017 ) diseases. Moreover, deficits in basic executive functions, i.e., cognitive set-shifting, response inhibition, and self-monitoring, have been previously proposed as possible mechanisms of reduced self-awareness in patients with a selective anterior cingulate cortex ABI ( Palermo et al, 2014 ).…”
Reduced self-awareness is a well-known phenomenon investigated in patients with vascular disease; however, its impact on neuropsychological functions remains to be clarified. Importantly, selective vascular lesions provide an opportunity to investigate the key neuropsychological features of reduced self-awareness in neurocognitive disorders. Because of its rarity, we present an unusual case of a woman affected by a combined polar and paramedian bilateral thalamic infarction. The patient underwent an extensive neuropsychological evaluation to assess cognitive, behavioral, and functional domains, with a focus on executive functions. She was assessed clinically in the acute phase and after 6 months from the stroke, both clinically and by magnetic resonance imaging. The patient developed a cognitive impairment, characterised by prevalent executive dysfunction associated with reduced self-awareness and mood changes, in terms of apathy and depression. Such condition persisted after 6 months. In May 2020, the patient underwent the serology test in chemiluminescence to detect IgG antibodies against SARS-CoV-2. The result of the quantitative test highlighted a high probability of previous contact with the virus. We suggest that reduced self-awareness related to executive dysfunction and behavioral changes may be due to combined polar and paramedian bilateral thalamic lesion. Metacognitive–executive dysfunction affecting the instrumental abilities of everyday life might make people less able to take appropriate precautions, facilitating the risk of SARS-CoV-2 contagion.
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