Article

Historically, anosognosia referred to under-report of striking symptoms of
acquired brain injury (e.g., hemiplegia) with debilitating functional
consequences and was linked with anosodiaphoria, an emotional reaction of
indifference. It was later extended to include under-report of all manner of
symptoms of acquired brain injury by the patient compared to clinicians, family
members, or functional performance. Anosognosia is related to time since onset of
brain injury but not consistently to demographic variables, lesion location
(except that it is more common after unilateral right than left hemispheric
injury), or specific neuropsychological test scores. This review considers all
manifestations of anosognosia as a unitary phenomenon with differing clinical
characteristics dictated by variability in linked cognitive impairments. It is
concluded that anosognosia has three chief contributing factors: (1) procedural :
measurement differences across studies in terms of symptom selection and the
designation of a "gold standard" of patient symptomatology ;
(2) psychological : a
tendency towards positive self-evaluation and the avoidance of adverse
information, that also occurs in neurologically intact individuals; and (3) neuropathological :
an increased likelihood of error recognition failure from
disconnections that disrupt feedback between injured brain regions governing
specific behaviours (symptoms) and anterior cingulate /insular cortex.
Anosodiaphoria is considered as an associated symptom, resulting from the same
psychological and neuropathological factors.

Langue : ANGLAIS