Abstract
In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L, -M and -NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability (τ ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity (τ = −0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and -L subtests, particularly in patients who demonstrate severe functional deficits.
Highlights
Anosognosia (α = without, νoσ oς = disease, γ νωσ ις = knowledge) was first described by Babinski (1914; see Langer and Levine, 2014) as the ‘‘denial of motor deficits contralateral to a brain lesion’’ (Canzano et al, 2014)
Even though actions were illustrated uni-manually). If instead these right brain damage due to stroke (RBD)-patients do not show difficulties to distinguish between VATA-Naturalistic Action Test—Breakfast Task (NAT) and Visual-Analogue Test assessing Anosognosia for Motor Impairment (VATA-M) demands, but Left brain damage due to stroke (LBD)-patients without motor and apraxic deficits do, it is likely that speech comprehension abilities play an important role in understanding the different VATA subtest demands
Anosognosia, for motor impairment, has been frequently observed going along with right brain damage. This predominance of patients with right brain damage in studies on anosognosia could be explained by the typically investigated subtype, namely anosognosia for hemiplegia, excluding patients with aphasia from these studies to ensure that difficulties with language will not affect the data (Morin, 2017)
Summary
Prigatano (2010) described anosognosia as ‘‘a multifaceted syndrome where patients show complete or partial lack of awareness of specific neurological or cognitive deficits’’. It was shown for patients with cortical blindness (von Monakow, 1885; Anton, 1893), hemiplegia (Anton, 1893; Pia et al, 2004; Cocchini et al, 2010a; Vocat et al, 2010), aphasia (Lebrun, 1987; Rubens and Garrett, 1991; Cocchini et al, 2010b; Kertesz, 2010), hemianopia (Celesia et al, 1997) and dementia (Schacter, 1991; Starkstein et al, 2006; Orfei et al, 2010b; Spalletta et al, 2012; Cotelli et al, 2014). Psychometric data will be analyzed with respect to interraterreliability, internal consistency, convergent and divergent validity
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