Abstract
Background: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis.
Objective: To determine whether this wide variation might be explained by the different criteria used for diagnosing anosognosia.
Methods: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for hemiparesis using the anosognosia scale of Bisiach et al.
Results: 94% of the patients who were rated as having "mild anosognosia"—that is, they did not acknowledge their hemiparesis spontaneously following a general question about their complaints—suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. However, they immediately acknowledged their paresis when they were asked about the strength of their limbs. Their other deficits clearly had a greater impact. These patients had significantly milder paresis than those who denied their disorder even when asked directly about their limbs.
Conclusions: Patients who do not mention their paresis spontaneously but do so when questioned about it directly should not be diagnosed having "anosognosia." If this more conservative cut off criterion is applied to the data of the present as well as previous studies, a frequency of between 10% and 18% for anosognosia for hemiparesis is obtained in unselected samples of acute hemiparetic stroke patients. The incidence thus seems smaller than previously assumed.
Full Text
The Full Text of this article is available as a PDF (72.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Appelros Peter, Karlsson Gunnel M., Seiger Ake, Nydevik Ingegerd. Neglect and anosognosia after first-ever stroke: incidence and relationship to disability. J Rehabil Med. 2002 Sep;34(5):215–220. doi: 10.1080/165019702760279206. [DOI] [PubMed] [Google Scholar]
- Bisiach E., Vallar G., Perani D., Papagno C., Berti A. Unawareness of disease following lesions of the right hemisphere: anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia. 1986;24(4):471–482. doi: 10.1016/0028-3932(86)90092-8. [DOI] [PubMed] [Google Scholar]
- Cutting J. Study of anosognosia. J Neurol Neurosurg Psychiatry. 1978 Jun;41(6):548–555. doi: 10.1136/jnnp.41.6.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Feinberg T. E., Roane D. M., Kwan P. C., Schindler R. J., Haber L. D. Anosognosia and visuoverbal confabulation. Arch Neurol. 1994 May;51(5):468–473. doi: 10.1001/archneur.1994.00540170044015. [DOI] [PubMed] [Google Scholar]
- Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
- Handschu René, Poppe Reinhard, Rauss Joachim, Neundörfer Bernhard, Erbguth Frank. Emergency calls in acute stroke. Stroke. 2003 Mar 20;34(4):1005–1009. doi: 10.1161/01.STR.0000063366.98459.1F. [DOI] [PubMed] [Google Scholar]
- Jehkonen M., Ahonen J. P., Dastidar P., Laippala P., Vilkki J. Unawareness of deficits after right hemisphere stroke: double-dissociations of anosognosias. Acta Neurol Scand. 2000 Dec;102(6):378–384. doi: 10.1034/j.1600-0404.2000.102006378.x. [DOI] [PubMed] [Google Scholar]
- Maeshima S., Dohi N., Funahashi K., Nakai K., Itakura T., Komai N. Rehabilitation of patients with anosognosia for hemiplegia due to intracerebral haemorrhage. Brain Inj. 1997 Sep;11(9):691–697. doi: 10.1080/026990597123232. [DOI] [PubMed] [Google Scholar]
- NATHANSON M., BERGMAN P. S., GORDON G. G. Denial of illness; its occurrence in one hundred consecutive cases of hemiplegia. AMA Arch Neurol Psychiatry. 1952 Sep;68(3):380–387. [PubMed] [Google Scholar]
- Rathore Saif S., Hinn Albert R., Cooper Lawton S., Tyroler Herman A., Rosamond Wayne D. Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study. Stroke. 2002 Nov;33(11):2718–2721. doi: 10.1161/01.str.0000035286.87503.31. [DOI] [PubMed] [Google Scholar]
- Starkstein S. E., Fedoroff J. P., Price T. R., Leiguarda R., Robinson R. G. Anosognosia in patients with cerebrovascular lesions. A study of causative factors. Stroke. 1992 Oct;23(10):1446–1453. doi: 10.1161/01.str.23.10.1446. [DOI] [PubMed] [Google Scholar]
- Stone S. P., Halligan P. W., Greenwood R. J. The incidence of neglect phenomena and related disorders in patients with an acute right or left hemisphere stroke. Age Ageing. 1993 Jan;22(1):46–52. doi: 10.1093/ageing/22.1.46. [DOI] [PubMed] [Google Scholar]