Neglect and Anosognosia After First-Ever Stroke: Incidence and Relationship to Disability

Abstract

Neglect and anosognosia are serious consequences of stroke. Authors have found great variations in their incidence and their relationship to disability has been unclear. We studied the incidence of neglect and anosognosia within the scope of a population-based stroke-incidence study, and also evaluated their impact on disability. Four tests of visuo-spatial neglect, four tests of personal neglect, and an anosognosia questionnaire were used. Sixty-two patients (23%) of the study group had visuo-spatial neglect according to our definition, 21 patients (8%) had personal neglect, and 48 (17%) showed signs of anosognosia. Using a multiple logistic regression model, we found that both neglect and anosognosia influenced disability. To ascertain the true incidence of neglect and anosognosia after stroke, it is necessary to use a community-based study design, where cases treated outside the hospital are included. Some of the variability found in previous incidence studies is likely to be explained by not using such a design.

Validation of a low-cost virtual reality system for training street-crossing. A comparative study in healthy, neglected and non-neglected stroke individuals

“…A recent evidence-based review of rehabilitation therapies for USN concluded that the effectiveness of rehabilitation for neglect remains unproven (Bowen & Lincoln, 2007). This is particularly relevant in the chronic stage of USN, which has traditionally been associated with poor functional recovery (Appelros, Karlsson, Seiger, & Nydevik, 2002;Jehkonen, Laihosalo, & Kettunen, 2006).…”

Assessing anosognosia: a critical review

“…However, reviews of the literature have shown that chronic anosognosia is not as rare as textbooks suggest (see Table 1 in Cocchini et al, 2002;Orfei et al, 2007;Jehkonen et al, 2006), and several studies have pointed out how lack of awareness can seriously interfere with functional recovery and rehabilitation training (Gialanella & Mattioli, 1992;Maeshima et al, 1997;Hartman-Maeir et al, 2001;Hartman-Maeir et al, 2002;Appelros et al, 2002;Gialanella, et al, 2005;Di Legge et al, 2005).…”

Anosognosia and neglect respond differently to the same treatments

“…Anosognosia for one's own motor deficits is often observed in association with visuo-spatial neglect (Appelros, Karlsson, Seiger, & Nydevik, 2002;Cocchini, Beschin, & Della Sala, 2002;Karnath, Baier, & Nagele, 2005;Kortte & Hillis, 2009;Jehkonen, Laithosalo, & Kettunen, 2006;Prigatano, Matthes, Hill, Wolf, & Heiserman, 2011;, and their recovery often occurs in parallel (Prigatano & Morrone-Stupinsky, 2010). Moreover, lesion sites overlap in neglect and anosognosia.…”