Anosognosia in patients with acute hemispheric ischemic stroke

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.