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Aikaterini Fotopoulou - One of the best experts on this subject based on the ideXlab platform.
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mentalizing the body spatial and social cognition in Anosognosia for hemiplegia
Brain, 2016Co-Authors: Sahba Besharati, Stephanie J Forkel, Michael D Kopelman, Mark Solms, Paul M Jenkinson, Aikaterini FotopoulouAbstract:Following right-hemisphere damage, a specific disorder of motor awareness can occur called Anosognosia for hemiplegia, i.e. the denial of motor deficits contralateral to a brain lesion. The study of Anosognosia can offer unique insights into the neurocognitive basis of awareness. Typically, however, awareness is assessed as a first person judgement and the ability of patients to think about their bodies in more 'objective' (third person) terms is not directly assessed. This may be important as right-hemisphere spatial abilities may underlie our ability to take third person perspectives. This possibility was assessed for the first time in the present study. We investigated third person perspective taking using both visuospatial and verbal tasks in right-hemisphere stroke patients with Anosognosia (n = 15) and without Anosognosia (n = 15), as well as neurologically healthy control subjects (n = 15). The anosognosic group performed worse than both control groups when having to perform the tasks from a third versus a first person perspective. Individual analysis further revealed a classical dissociation between most anosognosic patients and control subjects in mental (but not visuospatial) third person perspective taking abilities. Finally, the severity of unawareness in Anosognosia patients was correlated to greater impairments in such third person, mental perspective taking abilities (but not visuospatial perspective taking). In voxel-based lesion mapping we also identified the lesion sites linked with such deficits, including some brain areas previously associated with inhibition, perspective taking and mentalizing, such as the inferior and middle frontal gyri, as well as the supramarginal and superior temporal gyri. These results suggest that neurocognitive deficits in mental perspective taking may contribute to Anosognosia and provide novel insights regarding the relation between self-awareness and social cognition.
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error based training and emergent awareness in Anosognosia for hemiplegia
Neuropsychological Rehabilitation, 2015Co-Authors: Valentina Moro, Michele Scandola, Cristina Bulgarelli, Renato Avesani, Aikaterini FotopoulouAbstract:Residual forms of awareness have recently been demonstrated in subjects affected by Anosognosia for hemiplegia, but their potential effects in recovery of awareness remain to date unexplored. Emergent awareness refers to a specific facet of motor unawareness in which anosognosic subjects recognise their motor deficits only when they have been requested to perform an action and they realise their errors. Four participants in the chronic phase after a stroke with Anosognosia for hemiplegia were recruited. They took part in an "error-full" or "analysis of error-based" rehabilitative training programme. They were asked to attempt to execute specific actions, analyse their own strategies and errors and discuss the reasons for their failures. Pre- and post-training and follow-up assessments showed that motor unawareness improved in all four patients. These results indicate that unsuccessful action attempts with concomitant error analysis may facilitate the recovery of emergent awareness and, sometimes, of more general aspects of awareness.
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Anosognosia as motivated unawareness the defence hypothesis revisited
Cortex, 2014Co-Authors: Oliver H. Turnbull, Aikaterini Fotopoulou, Mark SolmsAbstract:Anosognosia for hemiplegia has seen a century of almost continuous research, yet a definitive understanding of its mechanism remains elusive. Essentially, anosognosic patients hold quasi-delusional beliefs about their paralysed limbs, in spite of all the contrary evidence, repeated questioning, and logical argument. We review a range of findings suggesting that emotion and motivation play an important role in Anosognosia. We conclude that Anosognosia involves (amongst other things) a process of psychological defence. This conclusion stems from a wide variety of clinical and experimental investigations, including data on implicit awareness of deficit, fluctuations in awareness over time, and dramatic effects upon awareness of psychological interventions such as psychotherapy, reframing of the emotional consequences of the paralysis, and first versus third person perspectival manipulations. In addition, we review and refute the (eight) arguments historically raised against the 'defence' hypothesis, including the claim that a defence-based account cannot explain the lateralised nature of the disorder. We argue that damage to a well-established right-lateralised emotion regulation system, with links to psychological processes that appear to underpin allocentric spatial cognition, plays a key role in Anosognosia (at least in some patients). We conclude with a discussion of implications for clinical practice.
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the affective modulation of motor awareness in Anosognosia for hemiplegia behavioural and lesion evidence
Cortex, 2014Co-Authors: Sahba Besharati, Stephanie J Forkel, Michael D Kopelman, Mark Solms, Paul M Jenkinson, Aikaterini FotopoulouAbstract:The possible role of emotion in Anosognosia for hemiplegia (i.e., denial of motor deficits contralateral to a brain lesion), has long been debated between psychodynamic and neurocognitive theories. However, there are only a handful of case studies focussing on this topic, and the precise role of emotion in Anosognosia for hemiplegia requires empirical investigation. In the present study, we aimed to investigate how negative and positive emotions influence motor awareness in Anosognosia. Positive and negative emotions were induced under carefully-controlled experimental conditions in right-hemisphere stroke patients with Anosognosia for hemiplegia (n = 11) and controls with clinically normal awareness (n = 10). Only the negative, emotion induction condition resulted in a significant improvement of motor awareness in anosognosic patients compared to controls; the positive emotion induction did not. Using lesion overlay and voxel-based lesion-symptom mapping approaches, we also investigated the brain lesions associated with the diagnosis of Anosognosia, as well as with performance on the experimental task. Anatomical areas that are commonly damaged in AHP included the right-hemisphere motor and sensory cortices, the inferior frontal cortex, and the insula. Additionally, the insula, putamen and anterior periventricular white matter were associated with less awareness change following the negative emotion induction. This study suggests that motor unawareness and the observed lack of negative emotions about one's disabilities cannot be adequately explained by either purely motivational or neurocognitive accounts. Instead, we propose an integrative account in which insular and striatal lesions result in weak interoceptive and motivational signals. These deficits lead to faulty inferences about the self, involving a difficulty to personalise new sensorimotor information, and an abnormal adherence to premorbid beliefs about the body.
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implicit awareness in Anosognosia for hemiplegia unconscious interference without conscious re representation
Brain, 2010Co-Authors: Simone Pernigo, Aikaterini Fotopoulou, Rino Maeda, Anthony Rudd, Michael D KopelmanAbstract:Some patients with Anosognosia for hemiplegia, i.e. apparent unawareness of hemiplegia, have been clinically observed to show 'tacit' or 'implicit' awareness of their deficits. Here we have experimentally examined whether implicit and explicit responses to the same deficit-related material can dissociate. Fourteen stroke patients with right hemisphere lesions and contralesional paralysis were tested for implicit and explicit responses to brief sentences with deficit-related themes. These responses were elicited using: (i) a verbal inhibition test in which patients had to inhibit completing each sentence with an automatic response (implicit task) and (ii) a rating procedure in which patients rated the self-relevance of the same sentences (explicit task). A group of anosognosic hemiplegic patients was significantly slower than a control group of aware hemiplegic patients in performing the inhibition task with deficit-related sentences than with other emotionally negative themes (relative to neutral themes). This occurred despite their explicit denial of the self-relevance of the former sentences. Individual patient analysis showed that six of the seven anosognosic patients significantly differed from the control group in this dissociation. Using lesion mapping procedures, we found that the lesions of the anosognosic patients differed from those of the 'aware' controls mainly by involving the anterior parts of the insula, inferior motor areas, basal ganglia structures, limbic structures and deep white matter. In contrast, the anosognosic patient without implicit awareness had more cortical lesions, mostly in frontal areas, including lateral premotor regions, and also in the parietal and occipital lobes. These results provide strong experimental support for a specific dissociation between implicit and explicit awareness of deficits. More generally, the combination of our behavioural and neural findings suggests that an explicit, affectively personalized sensorimotor awareness requires the re-representation of sensorimotor information in the insular cortex, with possible involvement of limbic areas and basal ganglia circuits. The delusional features of Anosognosia for hemiplegia can be explained as a failure of this re-representation.
Peter P. Deyn - One of the best experts on this subject based on the ideXlab platform.
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Functional Neural Correlates of Anosognosia in Mild Cognitive Impairment and Alzheimer’s Disease: a Systematic Review
Neuropsychology Review, 2019Co-Authors: Jaime D. Mondragón, Natasha M. Maurits, Peter P. DeynAbstract:Functional neuroimaging techniques (i.e. single photon emission computed tomography, positron emission tomography, and functional magnetic resonance imaging) have been used to assess the neural correlates of Anosognosia in mild cognitive impairment (MCI) and Alzheimer’s disease (AD). A systematic review of this literature was performed, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, on PubMed, EMBASE, and PsycINFO databases. Twenty-five articles met all inclusion criteria. Specifically, four brain connectivity and 21 brain perfusion, metabolism, and activation articles. Anosognosia is associated in MCI with frontal lobe and cortical midline regional dysfunction (reduced perfusion and activation), and with reduced parietotemporal metabolism. Reduced within and between network connectivity is observed in the default mode network regions of AD patients with Anosognosia compared to AD patients without Anosognosia and controls. During initial stages of cognitive decline in Anosognosia, reduced indirect neural activity (i.e. perfusion, metabolism, and activation) is associated with the cortical midline regions, followed by the parietotemporal structures in later stages and culminating in frontotemporal dysfunction. Although the current evidence suggests differences in activation between AD or MCI patients with Anosognosia and healthy controls, more evidence is needed exploring the differences between MCI and AD patients with and without Anosognosia using resting state and task related paradigms.
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functional neural correlates of Anosognosia in mild cognitive impairment and alzheimer s disease a systematic review
Neuropsychology Review, 2019Co-Authors: Jaime D. Mondragón, Natasha M. Maurits, Peter P. DeynAbstract:Functional neuroimaging techniques (i.e. single photon emission computed tomography, positron emission tomography, and functional magnetic resonance imaging) have been used to assess the neural correlates of Anosognosia in mild cognitive impairment (MCI) and Alzheimer's disease (AD). A systematic review of this literature was performed, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, on PubMed, EMBASE, and PsycINFO databases. Twenty-five articles met all inclusion criteria. Specifically, four brain connectivity and 21 brain perfusion, metabolism, and activation articles. Anosognosia is associated in MCI with frontal lobe and cortical midline regional dysfunction (reduced perfusion and activation), and with reduced parietotemporal metabolism. Reduced within and between network connectivity is observed in the default mode network regions of AD patients with Anosognosia compared to AD patients without Anosognosia and controls. During initial stages of cognitive decline in Anosognosia, reduced indirect neural activity (i.e. perfusion, metabolism, and activation) is associated with the cortical midline regions, followed by the parietotemporal structures in later stages and culminating in frontotemporal dysfunction. Although the current evidence suggests differences in activation between AD or MCI patients with Anosognosia and healthy controls, more evidence is needed exploring the differences between MCI and AD patients with and without Anosognosia using resting state and task related paradigms.
Sahba Besharati - One of the best experts on this subject based on the ideXlab platform.
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mentalizing the body spatial and social cognition in Anosognosia for hemiplegia
Brain, 2016Co-Authors: Sahba Besharati, Stephanie J Forkel, Michael D Kopelman, Mark Solms, Paul M Jenkinson, Aikaterini FotopoulouAbstract:Following right-hemisphere damage, a specific disorder of motor awareness can occur called Anosognosia for hemiplegia, i.e. the denial of motor deficits contralateral to a brain lesion. The study of Anosognosia can offer unique insights into the neurocognitive basis of awareness. Typically, however, awareness is assessed as a first person judgement and the ability of patients to think about their bodies in more 'objective' (third person) terms is not directly assessed. This may be important as right-hemisphere spatial abilities may underlie our ability to take third person perspectives. This possibility was assessed for the first time in the present study. We investigated third person perspective taking using both visuospatial and verbal tasks in right-hemisphere stroke patients with Anosognosia (n = 15) and without Anosognosia (n = 15), as well as neurologically healthy control subjects (n = 15). The anosognosic group performed worse than both control groups when having to perform the tasks from a third versus a first person perspective. Individual analysis further revealed a classical dissociation between most anosognosic patients and control subjects in mental (but not visuospatial) third person perspective taking abilities. Finally, the severity of unawareness in Anosognosia patients was correlated to greater impairments in such third person, mental perspective taking abilities (but not visuospatial perspective taking). In voxel-based lesion mapping we also identified the lesion sites linked with such deficits, including some brain areas previously associated with inhibition, perspective taking and mentalizing, such as the inferior and middle frontal gyri, as well as the supramarginal and superior temporal gyri. These results suggest that neurocognitive deficits in mental perspective taking may contribute to Anosognosia and provide novel insights regarding the relation between self-awareness and social cognition.
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the affective modulation of motor awareness in Anosognosia for hemiplegia behavioural and lesion evidence
Cortex, 2014Co-Authors: Sahba Besharati, Stephanie J Forkel, Michael D Kopelman, Mark Solms, Paul M Jenkinson, Aikaterini FotopoulouAbstract:The possible role of emotion in Anosognosia for hemiplegia (i.e., denial of motor deficits contralateral to a brain lesion), has long been debated between psychodynamic and neurocognitive theories. However, there are only a handful of case studies focussing on this topic, and the precise role of emotion in Anosognosia for hemiplegia requires empirical investigation. In the present study, we aimed to investigate how negative and positive emotions influence motor awareness in Anosognosia. Positive and negative emotions were induced under carefully-controlled experimental conditions in right-hemisphere stroke patients with Anosognosia for hemiplegia (n = 11) and controls with clinically normal awareness (n = 10). Only the negative, emotion induction condition resulted in a significant improvement of motor awareness in anosognosic patients compared to controls; the positive emotion induction did not. Using lesion overlay and voxel-based lesion-symptom mapping approaches, we also investigated the brain lesions associated with the diagnosis of Anosognosia, as well as with performance on the experimental task. Anatomical areas that are commonly damaged in AHP included the right-hemisphere motor and sensory cortices, the inferior frontal cortex, and the insula. Additionally, the insula, putamen and anterior periventricular white matter were associated with less awareness change following the negative emotion induction. This study suggests that motor unawareness and the observed lack of negative emotions about one's disabilities cannot be adequately explained by either purely motivational or neurocognitive accounts. Instead, we propose an integrative account in which insular and striatal lesions result in weak interoceptive and motivational signals. These deficits lead to faulty inferences about the self, involving a difficulty to personalise new sensorimotor information, and an abnormal adherence to premorbid beliefs about the body.
Anna Berti - One of the best experts on this subject based on the ideXlab platform.
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Invisible grasps: Grip interference in Anosognosia for hemiplegia.
Neuropsychology, 2015Co-Authors: Alessandro Piedimonte, Francesca Garbarini, Marco Rabuffetti, Lorenzo Pia, Angelo Montesano, Maurizio Ferrarin, Anna BertiAbstract:OBJECTIVES Previous findings suggest that, in anosognosic patients, their illusory motor experience is based on a "normal" motor intention and planning for the paralyzed limbs. However, these studies involved proximal muscles (shoulder) that can be mediated by the ipsilateral (intact) cortex more than distal muscles (fingers). In the present study, we asked whether, in anosognosic patients, the spared motor intention for the paralyzed limb can go as far as to influence kinematic parameters of distal movements. METHOD Six hemiplegic patients (1 with and 5 without Anosognosia) were required to reach and grasp with both hands targets of the same or different size, attached to a plinth. Maximum grip aperture of the right (intact) hand was recorded using an infrared motion capture system. All patients were evaluated with a specific battery for Anosognosia and different neurpsychological test. RESULTS In the patient affected by Anosognosia for hemiplegia, the grip aperture of the healthy hand was influenced by the intended (but not executed) movement of the plegic hand when the patient was trying to reach to grasp targets of different size, F(2, 14) = 11.87, p < .001. Patients affected by hemiplegia (without Anosognosia) didn't show any interference effect between the plegic and healthy hand even when they were asked to reach to grasp targets of different size. CONCLUSIONS Our results confirm the hypothesis that a spared intention-programming system within the contralateral (damaged) cortex can go as far as to influence distal kinematic parameters of the healthy hand of patients affected by Anosognosia for hemiplegia.
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Anosognosia for hemianaesthesia: a voxel-based lesion-symptom mapping study.
Cortex, 2014Co-Authors: Lorenzo Pia, Alessandro Piedimonte, Francesca Garbarini, L Spinazzola, Giulia Bellan, Carlotta Fossataro, A Livelli, Dalila Burin, Anna BertiAbstract:Brain-damaged patients affected by hemianaesthesia (i.e., the loss of tactile sensibility on the contralesional side of the body) may deny their deficits (i.e., Anosognosia for tactile deficits) even reporting tactile experience when stimuli are delivered on the impaired side. So far, descriptive analysis on small samples of patients reported that the insular cortex, the internal/external capsule, the basal ganglia and the periventricular white matter would subserve Anosognosia for hemianaesthesia. Here, we aimed at examining in depth the anatomo-functional nature of Anosognosia for hemianaesthesia by means of a voxelwise statistical analysis. We compared two groups of left hemiplegic patients due to right brain damages differing only for the presence/absence of Anosognosia for left hemianaesthesia. Our findings showed a lesional cluster confined mainly to the anterior part of the putamen. According to the current anatomical evidence on the neural basis of sensory expectancies, we suggested that Anosognosia for hemianaesthesia might be explained as a failure to detect the mismatch between expected and actual tactile stimulation.
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temporal coupling due to illusory movements in bimanual actions evidence from Anosognosia for hemiplegia
Cortex, 2013Co-Authors: Lorenzo Pia, Alessandro Piedimonte, Francesca Garbarini, M Rabuffetti, M Ferrarin, Jon Driver, L Spinazzola, Anna BertiAbstract:Abstract In Anosognosia for hemiplegia, patients may claim having performed willed actions with the paralyzed limb despite unambiguous evidence to the contrary. Does this false belief of having moved reflect the functioning of the same mechanisms that govern normal motor performance? Here, we examined whether anosognosics show the same temporal constraints known to exist during bimanual movements in healthy subjects. In these paradigms, when participants simultaneously reach for two targets of different difficulties, the motor programs of one hand affect the execution of the other. In detail, the movement time of the hand going to an easy target (i.e., near and large), while the other is going to a difficult target (i.e., far and small), is slowed with respect to unimanual movements (temporal coupling effect). One right-brain-damaged patient with left hemiplegia and Anosognosia, six right-brain-damaged patients with left hemiplegia without Anosognosia, and twenty healthy subjects were administered such a bimanual task. We recorded the movement times for easy and difficult targets, both in unimanual (one target) and bimanual (two targets) conditions. We found that, as healthy subjects, the anosognosic patient showed coupling effect. In bimanual asymmetric conditions (when one hand went to the easy target and the other went to the difficult target), the movement time of the non-paralyzed hand going to the easy target was slowed by the ‘pretended’ movement of the paralyzed hand going to the difficult target. This effect was not present in patients without Anosognosia. We concluded that in anosognosic patients, the illusory movements of the paralyzed hand impose to the non-paralyzed hand the same motor constraints that emerge during the actual movements. Our data also support the view that coupling relies on central operations (i.e., activation of intention/programming system), rather than on online information from the periphery.
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moving a paralysed hand bimanual coupling effect in patients with Anosognosia for hemiplegia
Brain, 2012Co-Authors: Francesca Garbarini, Alessandro Piedimonte, Lorenzo Pia, M Rabuffetti, M Ferrarin, Francesca Frassinetti, Patrizia Gindri, Anna Cantagallo, Jon Driver, Anna BertiAbstract:Selective neurological impairments can shed light on different aspects of motor cognition. Brain-damaged patients with Anosognosia for hemiplegia deny their motor deficit and believe they can still move the paralysed limb. Here we study, for the first time, if the anomalous subjective experience that their affected hand can still move, may have objective consequences that constrain movement execution with the opposite, intact hand. Using a bimanual motor task, in which anosognosic patients were asked to simultaneously trace out lines with their unaffected hand and circles with their paralysed hand, we found that the trajectories of the intact hand were influenced by the requested movement of the paralysed hand, with the intact hand tending to assume an oval trajectory (bimanual coupling effect). This effect was comparable to that of a group of healthy subjects who actually moved both hands. By contrast, brain-damaged patients with motor neglect or actual hemiplegia but no Anosognosia did not show this bimanual constraint. We suggest that anosognosic patients may have intact motor intentionality and planning for the plegic hand. Rather than being merely an inexplicable confabulation, Anosognosia for the plegic hand can produce objective constraints on what the intact hand does.
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Modular structure of awareness for sensorimotor disorders: evidence from Anosognosia for hemiplegia and Anosognosia for hemianaesthesia.
Neuropsychologia, 2008Co-Authors: L Spinazzola, Lorenzo Pia, Alessia Folegatti, C Marchetti, Anna BertiAbstract:In the present paper, we shall review clinical evidence and theoretical models related to Anosognosia for sensorimotor impairments that may help in understanding the normal processing underlying conscious self-awareness. The dissociations between Anosognosia for hemiplegia and Anosognosia for hemianaesthesia are considered to give important clinical evidence supporting the hypothesis that awareness of sensory and motor deficits depends on the functioning of discrete self-monitoring processes. We shall also present clinical and anatomical data on four single case reports of patients selectively affected by Anosognosia for hemianaesthesia. The differences in the anatomical localization of lesions causing Anosognosia for hemiplegia and Anosognosia for hemianaesthesia are taken as evidence that cerebral circuits subserving these monitoring processes are located in separate brain areas, which may be involved both in the execution of primary functions and the emergence of awareness related to the monitoring of the same functions. The implications of these findings for the structure of conscious processes shall be also discussed.
Sergio Della Sala - One of the best experts on this subject based on the ideXlab platform.
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Anosognosia and neglect respond differently to the same treatments
Neuropsychological Rehabilitation, 2012Co-Authors: Nicolletta Beschin, Gianna Cocchini, Rory Allen, Sergio Della SalaAbstract:Different techniques, such as optokinetic stimulation, adaptation to prismatic shift of the visual field to the right, or transcutaneous electrical nerve stimulation (TENS), have been shown to alleviate neglect, at least temporarily. We assessed the effect of these techniques on Anosognosia and whether their therapeutic effect, if any, matches that on neglect. The effect of the three types of treatment on Anosognosia and neglect was investigated in five patients presenting with both severe Anosognosia and neglect. Patient 1 was treatment responsive to Anosognosia but not to neglect, whereas patients 4 and 5 showed the reverse pattern, i.e., they were treatment responsive to neglect but not to Anosognosia. This “treatment response bias” proved to be a valid means to investigate different effects of treatments in the same patient.
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explicit and implicit Anosognosia or upper limb motor impairment
Neuropsychologia, 2010Co-Authors: Gianna Cocchini, Nicoletta Beschin, Aikaterini Fotopoulou, Sergio Della SalaAbstract:If asked directly, anosognosic patients deny or seriously underestimate their motor difficulties. However explicit denial of hemiplegia does not necessarily imply a lack of insight of the deficit. In this study we explored explicit and implicit awareness for upper limb motor impairment in a group of 30 right-brain damaged patients. Explicit awareness was assessed using a questionnaire (the VATAm) in which patients are asked to rate their motor abilities, whereas implicit awareness was assessed by means of a newly developed test (BMT - bimanual task). This test requires the performance of a series of bimanual tasks that can be better performed using two hands, but could also be performed using one hand only. With the BMT, patients' performance rather than their verbal reports is evaluated and scored as an index of awareness. Paretic patients with Anosognosia tend to approach these tasks as if they could use both hands. Our findings showed that explicit and implicit awareness for motor deficits can be dissociated, and they may be differently affected by feedback suggesting that different underlying mechanisms may account for the multi-factorial phenomenon of Anosognosia.
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Vata-L: Visual-Analogue Test Assessing Anosognosia for Language Impairment
The Clinical Neuropsychologist, 2010Co-Authors: Gianna Cocchini, Nicoletta Beschin, Nicola Gregg, Michael P. Dean, Sergio Della SalaAbstract:Lack of awareness (Anosognosia) for one's own language impairments has rarely been investigated, despite hampering language rehabilitation. Assessment of Anosognosia by means of self-report is particularly complex, as a patient's language difficulties may seriously prevent or bias the assessment. Other methods, such as measures of self-correction and error detection, have provided valuable information, although they are an indirect form of assessment of Anosognosia and are not exempt from methodological criticisms. In this study we report on a new tool, the VATA-L (Visual-Analogue Test for Anosognosia for Language impairment), geared at assessing explicit Anosognosia for aphasia. The VATA-L compares the patient's self-evaluation with caregivers' evaluations of the patient's verbal communication abilities in a series of common situations. By means of non-verbal support and a system of check questions, this test minimizes some of the methodological limitations of existing diagnostic tools (e.g., structured interviews), enhancing reliability, and enabling assessment of patients with aphasia. Finally, normative data provided in the study allow a clearer interpretation of the patient's performance and facilitate assessment of Anosognosia.
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Anosognosia for Motor Impairment Following Left Brain Damage
Neuropsychology, 2009Co-Authors: Gianna Cocchini, Nicoletta Beschin, Aikaterini Fotopoulou, A. Cameron, Sergio Della SalaAbstract:Anosognosia for motor impairment has been linked to lesions of the right hemisphere. However, left hemisphere damaged patients have often been excluded from investigation because of their associated language deficits. In this study we assessed Anosognosia for motor disorders in a group of left hemisphere damaged patients using 2 tools that assess the presence of unawareness—a structured interview that is a common method of assessment of Anosognosia in clinical settings, and a new tool, the Visual-Analogue Test for Anosognosia for Motor Impairment (VATAm; Della Sala, Cocchini, Beschin, & Cameron, in press). The structured interview relies heavily on language and enquires about general motor ability whereas the VATAm is less dependent on language abilities and enquires about specific motor tasks. Results suggest that the frequency of Anosognosia in left brain damaged patients may have been underestimated due to methodological reasons, and that Anosognosia for motor impairment can also be associated with lesions of the left hemisphere.
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Chronic Anosognosia: a case report and theoretical account
Neuropsychologia, 2002Co-Authors: Gianna Cocchini, Nicoletta Beschin, Sergio Della SalaAbstract:Unawareness of motor disorders (Anosognosia) has often been reported after brain lesions, and it has been considered a temporary condition common in the acute and post-acute phases. The presence of Anosognosia in a chronic phase (i.e. lasting more than few weeks) is a rare occurrence, thought to be the result of reasoning deficits which prevent patients from performing an adequate check of reality. Although this assumption is widely shared amongst researchers, only a few studies have actually addressed this issue. We report on the case of a patient (NS) who was still showing Anosognosia for hemiplegia 1 year after a traumatic brain–head injury, while his reasoning abilities were well preserved. By means of a series of tests and experiments, we evaluated the main theoretical approaches. NS’s long-lasting Anosognosia is discussed in terms of a combination of clinical manifestations, whereby personal neglect and motor–sensory information play a key role in preventing awareness, whereas memory difficulties in updating pre-existing personal schema may be crucial in maintaining NS’s anosognosic status.
