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Anosognosia in patients with acute hemispheric ischemic stroke

https://doi.org/10.14412/2074-2711-2016-2-31-35

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Abstract

Objective: to investigate the frequency of anosognosia (a deficit of self-awareness), its anatomic correlates associated with other neuropsychological and neurological disorders in acute hemispheric ischemic stroke (IS).

Patients and methods 150 patients (83 men and 67 women; mean age, 63.0±9.3 years) with acute hemispheric IS were examined. All the patients underwent neurological, neuroimaging, and neuropsychological (by the procedure described by A.R. Luria) examinations. neuropsychological investigations. Anosognosia was diagnosed using the Dysexecutive Questionnaire (DEX) and the authors' procedure involving a scale to measure impaired self-rating of motor abilities and a scale to measure impaired self-rating of cognitive abilities in everyday life.

Results and discussion. In the acute period of hemispheric IS, reduced self-awareness of motor and cognitive abilities was noted in 14% of the patients and unawareness of only cognitive abilities was recorded in 15%. Patients with anosognosia and cognitive dysfunction (ACD) and those with anosognosia and motor dysfunction (AMD) had right-sided hemispheric IS more frequently (76%) while this was not found in patients with isolated ACD. The development of anosognosia for paralysis and paresis was favored by the large sizes of an ischemic focus that involved a few lobes in the posterior regions of the brain although no lesions were found in the anosognosia-specific anatomical regions. ACD and AMD proved to be associated with unilateral spatial and tactile neglect and obvious regulatory dysfunction. 

About the Authors

V. N. Grigoryeva
Nizhny Novgorod State Medical Academy, Ministry of Health of Russia, Nizhny Novgorod
Russian Federation
Department of Neurology, Neurosurgery, and Medical Genetics


T. A. Sorokina
Nizhny Novgorod State Medical Academy, Ministry of Health of Russia, Nizhny Novgorod
Russian Federation
Department of Neurology, Neurosurgery, and Medical Genetics


References

1. Гусев ЕИ. Проблема инсульта в России. Журнал неврологии и психиатрии им. С.С. Корсакова. 2003;(9):32-41. [Gusev EI. The problem of stroke in Russia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2003;(9):32-41. (In Russ.)].

2. Скворцова ВИ, Кольцова ЕА, Кимельфельд ЕИ. Ишемический инсульт у больных молодого возраста. Журнал неврологии и психиатрии им. С.С. Корсакова. 2009;109(10): 3-14. [Skvortsova VI, Kol'tsova EA, Kimel'fel'd EI. Ischemic stroke in young patients. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2009;109(10):3-14. (In Russ.)].

3. Starkstein SE, Jorge RE, Robinson RG. The frequency, clinical correlates, and mechanism of anosognosia after stroke. Can J Psychiatry. 2010 Jun;55(6):355-61.

4. Weinstein EA. Anosognosia and denial of illness. In: Prigatano GP, Schacter DL, editors. Awareness deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press; 1991. P. 240–57.

5. Hartman-Maeir A, Soroker N, Oman SD, Katz N. Awareness of disabilities in stroke rehabilitation—a clinical trial. Disabil Rehabil. 2003 Jan 7;25(1):35-44.

6. Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th edition. New York: Oxford University Press; 2004. 1016 p.

7. Kortte K, Hillis AE. Recent Advances in the understanding of neglect and anosognosia following right hemisphere stroke. Curr Neurol Neurosci Rep. 2009 Nov;9(6):459-65.

8. Vocat R, Saj A, Vuilleumier P. The riddle of anosognosia: does unawareness of hemiplegia involve a failure to update beliefs? Cortex. 2013 Jul-Aug;49(7):1771-81. doi: 10.1016/j.cortex.2012.10.009. Epub 2012 Nov 27.

9. Harold P, Adams Jr, Birgitte H, et al. Classification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial. Stroke. 1993 Jan;24(1):35-41.

10. Яхно НН, Захаров ВВ, Локшина АБ и др. Деменции: руководство для врачей. Москва: МЕДпресс-информ; 2010. 272 с. [Yakhno NN, Zakharov VV, Lokshina A, et al. Dementsii: rukovodstvo dlya vrachei [Dementia: a guide for physicians]. Moscow: MEDpress-inform; 2010. 272 p.]

11. Kimura D, Archibald Y. Motor functions of the left hemisphere. Brain. 1974 Jun;97(2):337-50. 12. Wilson BA, Alderman N, Burgess P, et al. Behavioural Assessment of the Dysexecutive Syndrome (BADS). London, UK: Pearson, Clinical Assessment. 1996.

12. Nurmi ME, Jehkonen M. Recognition and rehabilitation of impaired awareness of illness, i.e. anosognosia in a patient with cerebrovascular disease. Duodecim. 2015;131(3):228-34.

13. Лурия АР. Высшие корковые функции человека и их нарушение при локальных пора- жениях мозга. 2-е изд. Москва: Издательство Московского университета; 1969. 504 с. [Luriya AR. Vysshie korkovye funktsii cheloveka i ikh narushenie pri lokal'nykh porazheniyakh mozga [Higher cortical functions in man and their impairment in local lesions of the brain]. 2nd edition. Moscow: Izdatel'stvo Moskovskogo universiteta; 1969. 504 p.]

14. Vossel S, Weiss PH, Eschenbeck P, Fink GR. Anosognosia, neglect, extinction and lesion site predict impairment of daily living after righthemispheric stroke. Cortex. 2013 Jul-Aug; 49(7):1782-9. doi: 10.1016/j.cortex.2012.12.011. Epub 2012 Dec 19.

15. Notturno F, Sepe R, Caulo M, et al. Pseudocortical and dissociate discriminative sensory dysfunction in a thalamic stroke. Cortex. 2013 Jan;49(1):336-9. doi: 10.1016/j.cortex.2012.07.002. Epub 2012 Aug 14.

16. Heilman KM, Barrett AM, Adair JC. Possible mechanisms of anosognosia: a defect in selfawareness. Philos Trans R Soc Lond B Biol Sci. 1998 Nov 29;353(1377):1903-9.


For citation:


Grigoryeva V.N., Sorokina T.A. Anosognosia in patients with acute hemispheric ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):31-35. (In Russ.) https://doi.org/10.14412/2074-2711-2016-2-31-35

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)