2,531 results on '"ANOSOGNOSIA"'
Search Results
2. Profiling self-awareness in brain injury rehabilitation: A mixed methods study.
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Sansonetti, Danielle, Fleming, Jennifer, Patterson, Freyr, and Lannin, Natasha A.
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BRAIN injuries , *MEDICAL audit , *COGNITIVE rehabilitation , *SELF-consciousness (Awareness) , *OCCUPATIONAL therapy - Abstract
Impaired self-awareness impacts outcomes for individuals with brain injury. Self-awareness is a complex construct, with little known about how its presentation differs across diagnostic groups, or how brain injury-related changes are expressed by individuals in the early phase post-brain injury. This study aims to identify differences and similarities in patterns of self-awareness between patients with different brain injury diagnoses, and provide a clinical account of how individuals with ABI describe changes to themselves arising from brain injury. This is a mixed methods retrospective cohort study involving an audit of medical files that included extraction of data from the Self-Awareness of Deficits Interview. Quantitative and qualitative techniques were used to analyse data from 173 participants. Individuals identified a range of brain injury-related impairments across domains, with greatest difficulty noted with linking impairments to functional implications and setting realistic goals. There were similarities and distinct differences in the expression of changes across diagnostic groups. Two main themes that aligned with self-awareness theory were identified from the data: 1/ Development of self-awareness; and 2/ Dimensions of self-awareness. These interrelated themes demonstrated the multifaceted nature of the clinical presentation of self-awareness, and highlight the need for an individualized approach to cognitive rehabilitation. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Anosognosia in Alzheimer's Pathology: Validation of a New Measure.
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Terry, Christian and Lecci, Len
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EXECUTIVE function , *ALZHEIMER'S disease , *COGNITIVE neuroscience , *MILD cognitive impairment , *NEUROPSYCHOLOGICAL tests - Abstract
Objective Two studies were performed to validate a brief measure of cognitive insight and compare it to an empirical model – the Cognitive Awareness Model (CAM). Method A pilot study included 31 (52% male; M age = 69.42) patients from an outpatient neuropsychological assessment clinic. Seven patients were diagnosed with likely Alzheimer's dementia (AD), 15 mild cognitive impairment (MCI), and 9 no diagnosis (i.e. cognitively normal; CN). The Cognitive Coding Form (CCF) and several other measures were administered. Study 2 entailed archival data extraction of 240 patients (80 CN, 80 MCI, and 80 AD; 53.3% female; M age = 72.8) to examine whether the CCF predicts memory (Wechsler Memory Scale – IV) and executive functioning (Trail-Making Test B). Results The pilot study found preliminary evidence of convergent and discriminant validity for the 8-item CCF. Study 2 confirmed that both patient-reported cognitive concerns (F (2,237) = 10.40, p <.001, ω2 =.07, power =.99) and, more strongly, CCF informant-patient discrepancy scores (F (2,237) = 24.52, p <.001, ω2 =.16, power =.99) can distinguish CNs from those with MCI and AD. A regression indicated that depression (5.5%; β = -.38, p <.001) and TMT-B (13%; β = -.43, p <.001), together accounted for 18.5% of the variance in insight (R2 =.19, F (2,219) = 26.10, p <.001), supporting the CAM. Conclusions These studies establish an efficient measure of insight with high clinical utility and inform the literature on the role of insight in predicting performance in those with Alzheimer's pathology. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Are subjective language complaints in memory clinic patients informative?
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Malyutina, Svetlana, Zabolotskaia, Alina, Savilov, Victor, Syunyakov, Timur, Kurmyshev, Marat, Kurmysheva, Elena, Lobanova, Irina, Osipova, Natalia, Karpenko, Olga, and Andriushchenko, Alisa
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MILD cognitive impairment , *COGNITIVE aging , *ANOSOGNOSIA , *DISEASE progression , *SELF-evaluation - Abstract
To diagnose mild cognitive impairment, it is crucial to understand whether subjective cognitive complaints reflect objective cognitive deficits. This question has mostly been investigated in the memory domain, with mixed results. Our study was one of the first to address it for language. Participants were 55-to-93-year-old memory clinic patients (n = 163). They filled in a questionnaire about subjective language and memory complaints and performed two language tasks (naming-by-definition and sentence comprehension). Greater language complaints were associated with two language measures, thus showing a moderate value in predicting language performance. Greater relative severity of language versus memory complaints was a better predictor, associated with three language performance measures. Surprisingly, greater memory complaints were associated with better naming, probably due to anosognosia in further disease progression or personality-related factors. Our findings highlight the importance of relative complaint severity across domains and, clinically, call for developing self-assessment questionnaires asking specific questions about multiple cognitive functions. [ABSTRACT FROM AUTHOR]
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- 2024
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5. A systematic literature review of the impact of impaired self-awareness on the process of rehabilitation in acquired brain injury.
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Di Somma, Rebecca and Fleming, Peter
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PATIENT compliance , *BRAIN injuries , *GOAL (Psychology) , *CINAHL database , *FUNCTIONAL status - Abstract
BackgroundMethodResultsConclusionImpaired self-awareness (ISA) is common in individuals with an acquired brain injury (ABI) and can lead to reduced awareness of one’s difficulties. Previous reviews have found that ISA impacts on functional outcomes in rehabilitation. However, to date there has not been a systematic literature review which examines how ISA impacts on the process of rehabilitation in ABI populations.A literature search was conducted using several databases in May 2024, including Academic Search Premier, CINAHL, MEDLINE, APA PsycARTICLES and APA PsycINFO. Seventeen articles were selected for the review and were analyzed using Narrative Synthesis.Four themes arose from the findings, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. ISA was found to impact on the value adult ABI participants placed in rehabilitation, which decreased treatment compliance, motivation, and engagement. ISA also impacted on goal setting and behavior and resulted in a longer length of time spent in hospital.This review emphasizes the impact of ISA on various aspects/processes of rehabilitation in ABI and provides considerations of how clinicians might adapt interventions to manage these difficulties. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Do I Have Symptoms of Dementia: A Discursive Study of Awareness and Shame Among People With Advanced Dementia.
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Kłosińska, Urszula and Leszko, Magdalena
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HEALTH literacy , *QUALITATIVE research , *TERMS & phrases , *ATTITUDES toward illness , *PSYCHOLOGICAL adaptation , *SEVERITY of illness index , *DISCOURSE analysis , *DEMENTIA , *SHAME , *VOCABULARY , *DEMENTIA patients , *SOCIAL stigma , *ANOSOGNOSIA , *PATIENTS' attitudes , *SOCIAL control , *SYMPTOMS - Abstract
Background and Objectives This study explores the narrated experiences of individuals with advanced stages of late-onset dementia, focusing on their diagnosis awareness. Such framing is motivated by 2 reasons. Firstly, there is a lack of consensus regarding the prevalence of anosognosia among people with dementia. Secondly, research on anosognosia often neglects to address the important issues of shame and stigma associated with receiving a dementia diagnosis. Research Design and Methods For this qualitative study, a total of 27 participants ranging in age from 66 to 94 were involved. The data collected were analyzed using textual-oriented discourse analysis. Results Our findings indicated that individuals with dementia struggled to comprehend the medical terminology used to describe their experiences within biomedical standards. The interviewees utilized 5 negative discourses on dementia, which shaped their attitudes toward the condition and people diagnosed with it. These discourses depicted dementia as an illness, negative aging, a devaluation, a burden, and a life tragedy. Moreover, study participants did not outright reject the diagnosis but rather negotiated its acceptance within the context of shame associated with dementia. Discussion and Implications The concept of anosognosia can serve as a mechanism of social control and stigmatization of people with dementia within the dominant biomedical discourse. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Undoubtedly unaware of homonymous hemianopia: The contribution of overconfidence to anosognosia of hemianopia.
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Klingbeil, Julian, Mühlig, Martin, Bahr, Emma, Welle, Florian, Ritter, Tim, Stockert, Anika, Wawrzyniak, Max, and Saur, Dorothee
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VISION disorders ,ANOSOGNOSIA ,STROKE ,CONFIDENCE ,RIDDLES - Published
- 2024
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8. Cognitive status in elderly people with alcohol dependence formed in middle and old age and complicated by secondary organic mental disorders
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Ruslan A. Kardashyan and Alexander A. Efremov
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cognitive disorders ,anosognosia ,organic mental disorders ,prevention ,alcoholism ,Internal medicine ,RC31-1245 - Abstract
One of the most common neurological symptoms is cognitive impairment. Cognitive disorders occur especially often in old age. An analysis of cognitive functions in 58 elderly patients with alcohol dependence formed in middle and old age and complicated by secondary organic mental disorders is presented. The identified neurological signs indicate the absence of severe brain lesions. Data are presented showing that the level of alcohol anosognosia for its individual components, as well as the overall score of cognitive function indicators in elderly patients with alcohol dependence, formed in middle and old age and complicated by secondary organic mental disorders, differs.
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- 2024
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9. OF TWO MINDS.
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Lilla, Mark
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NEUROLOGICAL disorders , *ANOSOGNOSIA , *PHYSICAL training & conditioning , *PHYSICIANS , *PARALYSIS - Abstract
The article titled "OF TWO MINDS" by Mark Lilla discusses the concept of self-delusion and the ways in which individuals deceive themselves. The author explores various neurological disorders that can cause individuals to have false beliefs or deny their own physical or mental conditions. The article also delves into the everyday delusions that people engage in to maintain a sense of self-ignorance. The author emphasizes the importance of self-awareness and moral responsibility, drawing on examples from religious texts and personal experiences. The article concludes by highlighting the difficulty of truly knowing oneself and the potential for divine intervention to reveal hidden aspects of one's identity. [Extracted from the article]
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- 2024
10. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort.
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Sansonetti, Danielle, Fleming, Jennifer, Patterson, Freyr, De Lacy, Laura, and Lannin, Natasha A.
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INJURY complications , *REHABILITATION for brain injury patients , *RESEARCH funding , *INTERVIEWING , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *MANN Whitney U Test , *FUNCTIONAL status , *OCCUPATIONAL therapy , *LONGITUDINAL method , *STROKE rehabilitation , *RESEARCH methodology , *COMMUNICATION , *SELF-consciousness (Awareness) , *STROKE , *DATA analysis software , *CONFIDENCE intervals , *AMNESIA , *REGRESSION analysis , *COGNITION , *ANOSOGNOSIA , *DISEASE complications , *ADULTS - Abstract
Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. Participants were 149 adults (18–70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Structural MRI Correlates of Anosognosia in Huntington's Disease.
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Hinkle, Jared T., Wildermuth, Erin, Tong, Xiao J., Ross, Christopher A., and Bang, Jee
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HUNTINGTON disease , *GLOBUS pallidus , *PARIETAL lobe , *SUBSTANTIA nigra , *ANOSOGNOSIA - Abstract
Background: Anosognosia, or unawareness of symptoms, is common in Huntington's disease (HD), but the neuroanatomical basis of this is unknown. Objective: To identify neuroanatomical correlates of HD anosognosia using structural MRI data. Methods: We leveraged a pre-processed dataset of 570 HD participants across the well-characterized PREDICT-HD and TRACK-HD cohort studies. Anosognosia index was operationalized as the score discrepancies between HD participants and their caregivers on the Frontal Systems Behavior Scale (FrSBe). Results: Univariate correlation analyses identified volumes of globus pallidus, putamen, caudate, basal forebrain, substantia nigra, angular gyrus, and cingulate cortex as significant correlates of anosognosia after correction for multiple comparisons. A multivariable model constructed with stepwise regression that included volumetric data showed globus pallidus volume alone explained more variance in anosognosia severity than motor impairment or CAP score alone. Conclusions: Anosognosia appears to be related to degeneration affecting both cortical and subcortical areas. Globus pallidus neurodegeneration in particular appears to be a key process of importance. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Resting-state networks and anosognosia in Alzheimer's disease.
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Tondelli, Manuela, Ballotta, Daniela, Maramotti, Riccardo, Carbone, Chiara, Gallingani, Chiara, MacKay, Clare, Pagnoni, Giuseppe, Chiari, Annalisa, and Zamboni, Giovanna
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RISK assessment ,NEUROLOGIC examination ,ALZHEIMER'S disease ,FUNCTIONAL connectivity ,MILD cognitive impairment ,RESEARCH funding ,QUESTIONNAIRES ,INTERVIEWING ,MAGNETIC resonance imaging ,DEFAULT mode network ,BASAL ganglia ,SEVERITY of illness index ,AGE distribution ,DESCRIPTIVE statistics ,LARGE-scale brain networks ,LIMBIC system ,NEUROPSYCHOLOGICAL tests ,AMNESIA ,NEURORADIOLOGY ,ANOSOGNOSIA ,DISEASE risk factors - Abstract
Background: Recent evidence suggests that anosognosia or unawareness of cognitive impairment in Alzheimer's Disease (AD) may be explained by a disconnection between brain regions involved in accessing and monitoring information regarding self and others. It has been demonstrated that AD patients with anosognosia have reduced connectivity within the default mode network (DMN) and that anosognosia in people with prodromal AD is positively associated with bilateral anterior cingulate cortex (ACC), suggesting a possible role of this region in mechanisms of awareness in the early phase of disease. We hypothesized that anosognosia in AD is associated with an imbalance between the activity of large-scale resting-state functional magnetic resonance imaging (fMRI) networks, in particular the DMN, the salience network (SN), and the frontoparietal network (FPN). Methods: Sixty patients with MCI and AD dementia underwent fMRI and neuropsychological assessment including the Anosognosia Questionnaire Dementia (AQ-D), a measure of anosognosia based on a discrepancy score between patient's and carer's judgments. After having applied Independent Component Analysis (ICA) to resting fMRI data we performed: (i) correlations between the AQ-D score and functional connectivity in the DMN, SN, and FPN, and (ii) comparisons between aware and unaware patients of the DMN, SN, and FPN functional connectivity. Results: We found that anosognosia was associated with (i) weak functional connectivity within the DMN, in posterior and middle cingulate cortex particularly, (ii) strong functional connectivity within the SN in ACC, and between the SN and basal ganglia, and (iii) a heterogenous effect concerning the functional connectivity of the FPN, with a weak connectivity between the FPN and PCC, and a strong connectivity between the FPN and ACC. The observed effects were controlled for differences in severity of cognitive impairment and age. Conclusion: Anosognosia in the AD continuum is associated with a dysregulation of the functional connectivity of three large-scale networks, namely the DMN, SN, and FPN. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Awareness of episodic memory and meta-cognitive profiles: associations with cerebrospinal fluid biomarkers at the preclinical stage of the Alzheimer's continuum.
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López-Martos, David, Suárez-Calvet, Marc, Milà-Alomà, Marta, Domingo Gispert, Juan, Minguillon, Carolina, Quijano-Rubio, Clara, Kollmorgen, Gwendlyn, Zetterberg, Henrik, Blennow, Kaj, Grau-Rivera, Oriol, and Sánchez-Benavides, Gonzalo
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CEREBROSPINAL fluid examination ,ALZHEIMER'S disease ,DATA analysis ,RESEARCH funding ,EPISODIC memory ,IMMUNOLOGY technique ,DESCRIPTIVE statistics ,LONGITUDINAL method ,NEUROPSYCHOLOGICAL tests ,STATISTICS ,DATA analysis software ,CONFIDENCE intervals ,BIOMARKERS ,COGNITION ,MEMORY disorders ,REGRESSION analysis ,ANOSOGNOSIA - Abstract
Introduction: The lack of cognitive awareness, anosognosia, is a clinical deficit in Alzheimer's disease (AD) dementia. However, an increased awareness of cognitive function, hypernosognosia, may serve as a marker in the preclinical stage. Subjective cognitive decline (SCD) might correspond to the initial symptom in the dynamic trajectory of awareness, but SCD might be absent along with low awareness of actual cognitive performance in the preclinical stage. We hypothesized that distinct meta-cognitive profiles, both hypernosognosia and anosognosia, might be identified in preclinical-AD. This research evaluated the association between cerebrospinal fluid (CSF) AD biomarkers and the awareness of episodic memory, further exploring dyadic (participant-partner) SCD reports, in the preclinical Alzheimer's continuum. Methods: We analyzed 314 cognitively unimpaired (CU) middle-aged individuals (mean age: 60, SD: 4) from the ALFA+ cohort study. Episodic memory was evaluated with the delayed recall from the Memory Binding Test (MBT). Awareness of episodic memory, meta-memory, was defined as the normalized discrepancy between objective and subjective performance. SCD was defined using self-report, and dyadic SCD profiles incorporated the study partner's report using parallel SCD-Questionnaires. The relationship between CSF Ab42/40 and CSF p-tau181 with meta-memory was evaluated with multivariable regression models. The role of SCD and the dyadic contingency was explored with the corresponding stratified analysis. Results: CSF Ab42/40 was non-linearly associated with meta-memory, showing an increased awareness up to Ab-positivity and a decreased awareness beyond this threshold. In the non-SCD subset, the non-linear association between CSF Ab42/40 and meta-memory persisted. In the SCD subset, higher Ab-pathology was linearly associated with increased awareness. Individuals presenting only study partner's SCD, defined as unaware decliners, exhibited higher levels of CSF p-tau181 correlated with lower meta-memory performance. Discussion: These results suggested that distinct meta-cognitive profiles can be identified in preclinical-AD. While most individuals might experience an increased awareness associated with the entrance in the AD continuum, hypernosognosia, some might be already losing insight and stepping into the anosognosic trajectory. This research reinforced that an early anosognosic profile, although at increased risk of AD-related decline, might be currently overlooked considering actual diagnostic criteria, and therefore its medical attention delayed. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Generalized anosognosia, anosodiaphoria, and visual hallucinations with bilateral enucleation after severe bifrontal brain injury: a case report describing similarities with and differences from Anton syndrome.
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Rodríguez, Gabriel, Azariah, Abana, Ritter, Alexandra Meurgue, Esquenazi, Yoshua, Sherer, Mark, Boake, Corwin, Fernandez, Valentina Ladera, and Garcia-Garcia, Ricardo
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BRAIN injuries , *ANOSOGNOSIA , *SPEECH therapists , *OCCIPITAL lobe , *SYMPTOMS , *CORTICAL blindness - Abstract
Visual anosognosia, associated with confabulations and cortical blindness in the context of occipital lobe injury, is known as Anton syndrome. Patients with this syndrome strongly deny their vision loss and confabulate to compensate for both visual loss and memory impairments. In this article, we present a case of a patient with some similarities to Anton syndrome, however, with several differences in clinical presentation. Bifrontal brain injury, bilateral enucleation, affective indifference (anosodiaphoria), generalized anosognosia, and the conviction that vision will resume mark clear clinical differences with Anton syndrome. Differentiating these findings from Anton syndrome will help occupational therapists, neuropsychologists, speech-language pathologists, physical therapists, and physicians when assessing frontal lobe brain injury with total and partial visual loss. This case demonstrates that visual anosognosia and confabulations can occur without occipital lobe dysfunction or cortical blindness. [ABSTRACT FROM AUTHOR]
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- 2024
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15. The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease.
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Latgé-Tovar, Sofia, Bertrand, Elodie, Piolino, Pascale, and Mograbi, Daniel C.
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EMPATHY ,SELF-evaluation ,ALZHEIMER'S disease ,PATIENT safety ,REFLECTION (Philosophy) ,VIRTUAL reality ,SELF-consciousness (Awareness) ,SEMANTICS ,ANOSOGNOSIA ,COGNITION ,PATIENTS' attitudes - Abstract
Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and selfevaluation. In addition, we suggest promising clinical implications of virtual realitybased methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Anosognosia for Motor Impairments as a Delusion: Anomalies of Experience and Belief Evaluation
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Davies, Martin, McGill, Caitlin L., Aimola Davies, Anne M., Mishara, Aaron L., editor, Moskalewicz, Marcin, editor, Schwartz, Michael A., editor, and Kranjec, Alexander, editor
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- 2024
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17. Self in Dementia
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Salmon, Eric, Feyers, Dorothée, Bastin, Christine, Genon, Sarah, Jedidi, Haroun, Bahri, Mohamed Ali, Laureys, Steven, Collette, Fabienne, Mishara, Aaron L., editor, Moskalewicz, Marcin, editor, Schwartz, Michael A., editor, and Kranjec, Alexander, editor
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- 2024
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18. Healthcare Awareness Profile Interview: Development of a new evidence-based brief clinical tool to assess awareness in people with dementia.
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Alexander, Catherine M., Martyr, Anthony, and Clare, Linda
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People with dementia vary in awareness of difficulties. Evaluating awareness could facilitate personalized care. However, current research measures are unsuitable for practical clinical application. We aimed to develop a brief multidimensional awareness interview for clinical use. Informed by available evidence about awareness of dementia, items suitable for both in-person and remote administration were modified from validated measures or developed for clinical application. The interview was administered via telephone or videoconference to 31 community-dwelling people with mild-to-moderate dementia. An informant completed a corresponding questionnaire. A multidimensional profile of awareness was created using self-report of symptoms, and discrepancies between self-rating and either informant rating or objective memory task performance. Feedback from participants and informants and discussions with clinical advisory and patient and public involvement groups helped finalize the interview. Remote administration was straightforward taking on average under 11 min. Awareness profiles showed a spectrum of awareness across domains. Feedback indicated that the items were acceptable and understandable. Certain aspects could be mildly upsetting where current difficulties were highlighted. Subject to further validation, the Healthcare Awareness Profile Interview (HAPI) shows potential as an evidence-based brief clinical tool for assessing awareness in people with mild-to-moderate dementia. [ABSTRACT FROM AUTHOR]
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- 2024
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19. The effect of offline anosognosia for hemispatial neglect on neglect rehabilitation in patients with subacute and chronic right hemispheric brain injury. A retrospective cohort study.
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Karataş, Levent, Utkan Karasu, Ayça, and Karataş, Gülçin Kaymak
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UNILATERAL neglect , *ANOSOGNOSIA , *BRAIN injuries , *FUNCTIONAL independence measure , *COHORT analysis - Abstract
We investigated the effects of offline anosognosia for hemispatial neglect on neglect severity, functional ability, mobility, and motor recovery in left hemispatial neglect (HN) patients with right hemisphere injury. Eighty-five patients were included in this retrospective study. All patients had undergone a routine neglect rehabilitation programme. Neglect and anosognosia severities were determined by the Catherine Bergego Scale. Functional Independence Measure (FIM) scores, Functional Ambulation Classification (FAC) levels, and Brunnstrom motor recovery stages were noted. The prevalence of anosognosia for HN was 81.2% (69 of 85 patients). Neglect and neglect anosognosia severities were strongly correlated (r = 0.85, p < 0.001). Patients with anosognosia had more severe hemispatial neglect. There was no difference in median FIM score between those with and without anosognosia. The severity of anosognosia negatively correlated with FIM and FAC scores. Linear mixed model analysis revealed a significant decrease in neglect scores in patients with anosognosia than in those without. Anosognosia severity also decreased through rehabilitation and the decrease in anosognosia significantly predicted neglect improvement. Our study emphasizes that neglect anosognosia is related to severe hemispatial neglect, poor functional ability, and limited mobility. Addressing neglect anosognosia may be a valuable component of neglect rehabilitation. NCT05145855. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Awareness and cognitive rehabilitation in Alzheimer's disease and frontotemporal dementia.
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Salmon, Eric, Lekeu, Françoise, Quittre, Anne, Godichard, Vinciane, Olivier, Catherine, Wojtasik, Vinciane, and Bastin, Christine
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ALZHEIMER'S disease ,FRONTOTEMPORAL dementia ,COGNITIVE rehabilitation ,BURDEN of care ,CAREGIVERS ,FRONTOTEMPORAL lobar degeneration - Abstract
INTRODUCTION: Awareness influences the evolution of neurodegenerative dementias. We gathered participants' and caregivers assessments of dependence in daily activities and we studied how each score would be related to next year participant autonomy, independently of other explicative variables. METHOD: We retrospectively analyzed data from mildly demented participants with a clinical diagnosis of Alzheimer's disease (AD, n = 186) and frontotemporal dementia (FTD, n = 29) and their relatives. A research tool was used to assess participant dependence in 98 daily activities and associated caregiver burden. A discrepancy score between the patient's and relative's judgment was calculated to evaluate awareness of dependence in activities at baseline. This dependence scores, as well as sex, age, education, and 1 year difference in Mini‐Mental State Examination were taken as possible explicative variables for dependence in activities adapted by therapists during a 1‐year cognitive rehabilitation program. RESULTS: Patients with FTD showed less awareness for daily dependence (discrepancy 20.9% vs. 11.8% in AD). Both groups benefited from cognitive rehabilitation (25% decrease in dependence) and subjective burden of relatives was decreased in both groups. In the AD group, there was a significant positive relationship between both caregiver (P < 0.001) and participant's (P < 0.02) evaluation of dependence in daily activities at inclusion and dependence of participants in adapted activities after 1 year. DISCUSSION: Awareness of impairment in daily activities is a clinical symptom that is more important at inclusion in FTD than in AD. However, in participants with AD who, as a group, significantly benefit from a cognitive rehabilitation program, not only caregiver's but also participant's assessment of dependence at baseline is correlated to subsequent, next year greater dependence in daily activities adapted by the therapists. Although discrepant, both caregiver and participant evaluations appear to be important variables to understand the evolution and the benefit of care in participants at early stages of dementia. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Anosognosia is associated with increased prevalence and faster development of neuropsychiatric symptoms in mild cognitive impairment.
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Wang, Sharon, Mimmack, Kayden, Cacciamani, Federica, Elnemais Fawzy, Michael, Munro, Catherine, Gatchel, Jennifer, Marshall, Gad A., Gagliardi, Geoffrey, and Vannini, Patrizia
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RISK assessment ,CROSS-sectional method ,DATA analysis ,RESEARCH funding ,QUESTIONNAIRES ,LONGITUDINAL method ,COGNITION disorders ,STATISTICS ,DEMENTIA ,SURVIVAL analysis (Biometry) ,COMPARATIVE studies ,CONFIDENCE intervals ,ANOSOGNOSIA ,DISEASE progression ,DISEASE risk factors ,SYMPTOMS ,OLD age - Abstract
Introduction: Both the loss of awareness for cognitive decline (a. k.a anosognosia) and neuropsychiatric symptoms (NPS) are common in patients with Alzheimer's disease (AD) dementia, even in prodromal stages, and may exacerbate functional impairment and negatively impact caregiver burden. Despite the high impact of these symptoms on patients and their caregivers, our knowledge of how they develop across the AD spectrum is limited. Here, we explored the cross-sectional and longitudinal associations between anosognosia and NPS in individuals with mild cognitive impairment (MCI). Methods: We included 237 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with a baseline clinical diagnosis of MCI. Everyday Cognition (ECog) questionnaire scores were used to measure complaints from participants and study-partners at baseline and annually over a mean of 4.29 years [standard deviation (SD) = 2.72]. Anosognosia was defined as the study- partner having an ECog score ≥2.5/4 and the participant having an ECog score <2.5/4 on their baseline measure and their last observation without more than two consecutive deviating observations during the follow-up period. The 12-item study-partner-rated Neuropsychiatric Inventory determined the presence or absence of specific NPS. Survival analyses were performed to analyze the frequency and temporal onset of NPS over time in individuals with and without anosognosia. Results: Thirty-eight out of 237 participants displayed anosognosia. Groups had similar lengths of follow-up at baseline (p > 0.9), though participants with anosognosia had lower MMSE scores (p = 0.049) and a higher proportion of amyloid-positivity using PET (p < 0.001. At baseline, the frequencies of agitation (p = 0.029) and disinhibition (p < 0.001) were higher in the anosognosia group compared to the non-anosognosia group. Survival analyses showed earlier onset of seven of the 12 NPS in the anosognosia group (p's < 0.001). Discussion: Loss of awareness for cognitive decline is associated with greater frequency and earlier onset of NPS over time in participants with MCI. These results support the hypothesis of a potential common underlying neurophysiological process for anosognosia and NPS, a finding that needs to be addressed in future studies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
22. Unilateral Spatial Neglect May Not Be Detected by Performance-Based Functional Neglect Assessment.
- Author
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Grattan, Emily S., Hounshel Smith, Brice, Mullen, Katie, and Woodbury, Michelle L.
- Subjects
SELF-evaluation ,CROSS-sectional method ,SECONDARY analysis ,RESEARCH funding ,FUNCTIONAL assessment ,DESCRIPTIVE statistics ,UNILATERAL neglect ,RESEARCH methodology ,STROKE ,DATA analysis software ,STROKE patients ,ANOSOGNOSIA ,OCCUPATIONAL therapy services ,DISEASE complications - Abstract
Importance: Unilateral spatial neglect (neglect) poststroke is disabling. It is critical that people with neglect are identified so that treatment can be provided to maximize independence. However, there is some evidence to suggest that existing assessments may not adequately measure neglect. It is unclear whether assessments also fail to identify people with neglect entirely. Objective: To determine whether there are stroke survivors who self-report neglect symptoms that are not detected by therapist-rated assessments and to compare self-report and therapist-ratings. Design: Cross-sectional study. Setting: U.S. university research center. Participants: Unilateral stroke survivors (N = 133). Intervention: Not applicable. Outcomes and Measures: The Catherine Bergego Scale (CBS) was administered to participants and scored by a trained occupational therapist. The parallel self-evaluation anosognosia form was also administered to participants to self-report and rate neglect symptoms. Results: Forty-eight participants (36.1%) were classified as without neglect on the basis of therapist-rated total CBS scores, yet 30 (62.5%) of these 48 participants reported symptoms of neglect on the CBS self-evaluation anosognosia form. There was a significant difference (p <.001) between therapist-rated and self-rated total CBS scores. Conclusions and Relevance: Our results indicate that many stroke survivors report some level of disability associated with neglect yet do not meet the criteria to be classified as having neglect according to a commonly used therapist-rated performance-based measure. Plain-Language Summary: The findings of this study contribute to the evidence that existing assessments used by occupational therapists to measure performance-based neglect may not always detect neglect symptoms comprehensively in people poststroke. The finding also suggest that we may be missing neglect symptoms entirely. Occupational therapists should consider using various methods to assess for neglect, including patient self-report and comprehensive occupational profiles. Clinicians should also thoroughly screen all clients with stroke for neglect, regardless of lesion location. The study findings contribute to the evidence that existing assessments used by occupational therapists to measure performance-based neglect may not always detect neglect symptoms comprehensively in people poststroke. The finding also suggest that we may be missing neglect symptoms entirely. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
23. Assessment of impaired self-awareness after moderate-to-severe traumatic brain injury: a comparison of assessment tools.
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Dromer, Emilie, Arnould, Annabelle, Barbot, Frédéric, and Azouvi, Philippe
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- *
TASK performance , *SELF-consciousness (Awareness) , *SEVERITY of illness index , *COMPARATIVE studies , *RESEARCH funding , *QUESTIONNAIRES , *BRAIN injuries - Abstract
To compare different assessment methods of impaired self-awareness (ISA). We included 37 patients with moderate-to-severe traumatic brain injury (TBI) at a subacute/chronic stage, and 33 healthy controls. ISA was assessed with three methods: discrepancy scores (comparison between patient and proxy ratings) on three scales (Patient Competency Rating Scale (PCRS), Awareness Questionnaire (AQ) and Dysexecutive Questionnaire (DEX)); clinician rating with the Self-Awareness of Deficits Interview (SADI); and the difference between prediction or estimation of performance and actual performance on two cognitive tasks. Clinician–patient discrepancy scores appeared more sensitive than relative–patient discrepancy. The AQ was the most sensitive. The discrepancy scores were strongly correlated one with each other. Correlations with the SADI were weaker. Patients did not overestimate their performance on cognitive tasks, and the prediction did not significantly correlate with other measures of ISA. Results support the multidimensional nature of ISA: discrepancy scores assess meta-cognitive knowledge (understanding that a function/skill is affected), while the SADI takes into account anticipatory awareness (ability to set realistic goals) and estimation of performance assesses anticipatory and situational awareness. Assessment of these different domains may provide a comprehensive overview of an individual's self-awareness. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
24. Neural correlates of impaired cognitive processes underlying self-unawareness in Alzheimer's disease.
- Author
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Salmon, Eric, Meyer, François, Genon, Sarah, Collette, Fabienne, and Bastin, Christine
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ALZHEIMER'S disease ,COGNITIVE ability ,SELF-consciousness (Awareness) ,COGNITIVE development ,COGNITIVE processing speed - Published
- 2024
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25. Resting-state networks and anosognosia in Alzheimer’s disease
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Manuela Tondelli, Daniela Ballotta, Riccardo Maramotti, Chiara Carbone, Chiara Gallingani, Clare MacKay, Giuseppe Pagnoni, Annalisa Chiari, and Giovanna Zamboni
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anosognosia ,unawareness ,Alzheimer ,dementia ,mild cognitive impairment ,salience ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
BackgroundRecent evidence suggests that anosognosia or unawareness of cognitive impairment in Alzheimer’s Disease (AD) may be explained by a disconnection between brain regions involved in accessing and monitoring information regarding self and others. It has been demonstrated that AD patients with anosognosia have reduced connectivity within the default mode network (DMN) and that anosognosia in people with prodromal AD is positively associated with bilateral anterior cingulate cortex (ACC), suggesting a possible role of this region in mechanisms of awareness in the early phase of disease. We hypothesized that anosognosia in AD is associated with an imbalance between the activity of large-scale resting-state functional magnetic resonance imaging (fMRI) networks, in particular the DMN, the salience network (SN), and the frontoparietal network (FPN).MethodsSixty patients with MCI and AD dementia underwent fMRI and neuropsychological assessment including the Anosognosia Questionnaire Dementia (AQ-D), a measure of anosognosia based on a discrepancy score between patient’s and carer’s judgments. After having applied Independent Component Analysis (ICA) to resting fMRI data we performed: (i) correlations between the AQ-D score and functional connectivity in the DMN, SN, and FPN, and (ii) comparisons between aware and unaware patients of the DMN, SN, and FPN functional connectivity.ResultsWe found that anosognosia was associated with (i) weak functional connectivity within the DMN, in posterior and middle cingulate cortex particularly, (ii) strong functional connectivity within the SN in ACC, and between the SN and basal ganglia, and (iii) a heterogenous effect concerning the functional connectivity of the FPN, with a weak connectivity between the FPN and PCC, and a strong connectivity between the FPN and ACC. The observed effects were controlled for differences in severity of cognitive impairment and age.ConclusionAnosognosia in the AD continuum is associated with a dysregulation of the functional connectivity of three large-scale networks, namely the DMN, SN, and FPN.
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- 2024
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26. Studying lack of awareness of cognitive decline in neurodegenerative diseases requires measures of both anosognosia and denial.
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Prigatano, George P., Russell, Sydney, and Meites, Tiffany M.
- Subjects
PHYSICAL diagnosis ,REPORT writing ,MILD cognitive impairment ,DENIAL (Psychology) ,FUNCTIONAL status ,TASK performance ,ANOSOGNOSIA ,NEUROPSYCHOLOGICAL tests ,MEMORY disorders ,COGNITIVE testing ,ANXIETY ,DIAGNOSIS - Abstract
The cause(s) of lack of awareness of cognitive decline in neurodegenerative diseases can be multifactorial. Yet neurologically oriented research on anosognosia of cognitive decline almost exclusively assumes that the underlying disturbance of neuro-networks that support various cognitive functions accounts for the reduced self-awareness. Cultural and psychosocial factors, including the person's emotional state, however, can contribute to the underreporting or avoidance of admitting to cognitive impairments in neurodegenerative diseases. Research on the causes of lack of awareness of cognitive decline in neurodegenerative disorders needs to include these variables. We briefly present two case examples of underreporting or "unawareness" of memory difficulties in persons with mild cognitive impairment (MCI) (or minor neurocognitive disorder). One presented with classic anosognosia for memory impairment, while the other initially reported no memory impairment but later admitted to "denying" her memory difficulties secondary to anxiety. Based on these patients' clinical presentations and available research, we suggest three potential screening items that may help identify probable denial of memory impairments when studying anosognosia in MCI. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. Components of self-awareness affecting caregiver burden: a long-term follow-up study.
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Cheng, Wen-Yu, Klonoff, Pamela S., and Perumparaichallai, Ramaswamy Kavitha
- Subjects
- *
STATISTICS , *FUNCTIONAL status , *BURDEN of care , *REGRESSION analysis , *SELF-consciousness (Awareness) , *T-test (Statistics) , *PSYCHOLOGY of caregivers , *SOCIAL status , *RESEARCH funding , *DESCRIPTIVE statistics , *CHI-squared test , *BRAIN injuries , *EMOTIONS , *DATA analysis software , *DATA analysis - Abstract
Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 =.33) for caregiver burden. Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Is Anosognosia for Left-Sided Hemiplegia Due to a Specific Self-Awareness Defect or to a Poorly Conscious Working Mode Typical of the Right Hemisphere?
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Gainotti, Guido
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- *
ANOSOGNOSIA , *UNILATERAL neglect , *SELF-consciousness (Awareness) , *BRAIN damage , *BRAIN function localization , *HEMIPLEGIA - Abstract
This review aimed to evaluate whether the association between 'anosognosia for hemiplegia' and lesions of the right hemisphere points to a special self-awareness role of the right side of the brain, or could instead be due to a working mode typical of the right hemisphere. This latter viewpoint is consistent with a recently proposed model of human brain asymmetries that assumes that language lateralization in the left hemisphere might have increased the left hemisphere's level of consciousness and intentionality in comparison with the right hemisphere's less conscious and more automatic functioning. To assess these alternatives, I tried to ascertain whether anosognosia is greater for left-sided hemiplegia than for other disorders provoked by right brain lesions, or whether unawareness prevails in tasks more clearly related to the disruption of the right hemisphere's more automatic (and less conscious) functioning. Data consistent with the first alternative would support the existence of a specific link between anosognosia for hemiplegia and self-awareness, whereas data supporting the second option would confirm the model linking anosognosia to a poorly conscious working mode typical of the right hemisphere. Analysis results showed that the incidence of anosognosia of the highly automatic syndrome of unilateral neglect was greater than that concerning the unawareness of left hemiplegia, suggesting that anosognosia for left-sided hemiplegia might be due to the poorly conscious working mode typical of the right hemisphere. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
29. The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease.
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Andrade, Katia, Guieysse, Thomas, Medani, Takfarinas, Koechlin, Etienne, Pantazis, Dimitrios, and Dubois, Bruno
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ALZHEIMER'S disease ,ANOSOGNOSIA ,PREFRONTAL cortex ,SYSTEM failures ,HUMAN origins - Abstract
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer's disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one's own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
30. Illusory hand movements in the absence of asomatognosia, spatial neglect and anosognosia for hemiplegia.
- Author
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Beccherle, Maddalena, Gobbetto, Valeria, Bertagnoli, Sara, Bulgarelli, Cristina, Rossato, Elena, and Moro, Valentina
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ANOSOGNOSIA ,HEMIPLEGIA ,MEDICAL care ,BRAIN imaging ,MEDICAL personnel - Published
- 2023
- Full Text
- View/download PDF
31. Continuing Education Module. Rebalancing Perspectives: Anosognosia.
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McCarthy, Lise and Canick, Jonathan
- Subjects
NOSOLOGY ,SELF-evaluation ,GAIT in humans ,POSTURAL balance ,COGNITION ,ACTIVITIES of daily living ,CONTINUING education ,ANOSOGNOSIA ,FUNCTIONAL assessment ,ACCIDENTAL falls ,DIAGNOSIS ,MUSCLE strength ,REHABILITATION ,ALLIED health personnel ,PATIENT safety ,SYMPTOMS - Published
- 2023
32. Identifying and addressing difficulties with awareness in early-stage dementia
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Alexander, C., Clare, Linda, and Martyr, Anthony
- Subjects
Alzheimer's disease ,anosognosia ,awareness ,insight ,metacognition ,person-centred care - Abstract
Background People with early-stage dementia show varying degrees of awareness about their condition and difficulties. This has implications for their welfare, and for carers, and health professionals involved in their care. Understanding more about awareness could facilitate person-centred care. In this thesis I aimed to explore awareness of condition, review existing measures of awareness, and develop and test a new clinical tool for assessing awareness in dementia. Methods Using data from the national IDEAL cohort, a cross-sectional study explored factors associated with awareness of condition. A longitudinal study investigated changes in awareness using case-matched comparisons of people with ongoing low awareness and those who gained awareness over time. A scoping review investigated existing measures of awareness. Using findings from the scoping review and evidence from previous awareness research I developed a new clinical interview to assess awareness, named the Healthcare Awareness Profile Interview (HAPI). This multi-dimensional structured interview was tested for feasibility and acceptability in a small pilot study conducted by telephone or video call. The interview was finalised after consultation with clinical advisory and patient and public involvement groups. Results In the IDEAL cohort, awareness of condition was negatively associated with mood and perceived ability to 'live well'. Changes in awareness were seen over a two-year period, with most people showing awareness at some timepoint. Gains in awareness of condition occurred despite the progression of cognitiveand/or functional impairment. The pilot study showed that HAPI could be administered remotely and was generally acceptable to people with dementia and carers. Resulting awareness profiles demonstrated the heterogeneity of awareness across different domains of cognitive, functional and socioemotional activities. Conclusions The new clinical tool HAPI shows potential for evaluating awareness in dementia. Greater understanding of variations in awareness would be valuable in supporting person-centred care for people with dementia and carers.
- Published
- 2022
33. Awareness and cognitive rehabilitation in Alzheimer's disease and frontotemporal dementia
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Eric Salmon, Françoise Lekeu, Anne Quittre, Vinciane Godichard, Catherine Olivier, Vinciane Wojtasik, and Christine Bastin
- Subjects
Alzheimer's disease ,anosognosia ,autonomy ,awareness ,burden ,cognitive rehabilitation ,Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Abstract
Abstract INTRODUCTION Awareness influences the evolution of neurodegenerative dementias. We gathered participants’ and caregivers assessments of dependence in daily activities and we studied how each score would be related to next year participant autonomy, independently of other explicative variables. METHOD We retrospectively analyzed data from mildly demented participants with a clinical diagnosis of Alzheimer's disease (AD, n = 186) and frontotemporal dementia (FTD, n = 29) and their relatives. A research tool was used to assess participant dependence in 98 daily activities and associated caregiver burden. A discrepancy score between the patient's and relative's judgment was calculated to evaluate awareness of dependence in activities at baseline. This dependence scores, as well as sex, age, education, and 1 year difference in Mini‐Mental State Examination were taken as possible explicative variables for dependence in activities adapted by therapists during a 1‐year cognitive rehabilitation program. RESULTS Patients with FTD showed less awareness for daily dependence (discrepancy 20.9% vs. 11.8% in AD). Both groups benefited from cognitive rehabilitation (25% decrease in dependence) and subjective burden of relatives was decreased in both groups. In the AD group, there was a significant positive relationship between both caregiver (P < 0.001) and participant's (P < 0.02) evaluation of dependence in daily activities at inclusion and dependence of participants in adapted activities after 1 year. DISCUSSION Awareness of impairment in daily activities is a clinical symptom that is more important at inclusion in FTD than in AD. However, in participants with AD who, as a group, significantly benefit from a cognitive rehabilitation program, not only caregiver's but also participant's assessment of dependence at baseline is correlated to subsequent, next year greater dependence in daily activities adapted by the therapists. Although discrepant, both caregiver and participant evaluations appear to be important variables to understand the evolution and the benefit of care in participants at early stages of dementia.
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- 2024
- Full Text
- View/download PDF
34. The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer’s disease
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Sofia Latgé-Tovar, Elodie Bertrand, Pascale Piolino, and Daniel C. Mograbi
- Subjects
Alzheimer’s disease ,anosognosia ,perspective-taking ,self-awareness ,virtual reality ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer’s Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject’s viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects’ life and possible improvements in their awareness.
- Published
- 2024
- Full Text
- View/download PDF
35. Anosognosia is associated with increased prevalence and faster development of neuropsychiatric symptoms in mild cognitive impairment
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Sharon Wang, Kayden Mimmack, Federica Cacciamani, Michael Elnemais Fawzy, Catherine Munro, Jennifer Gatchel, Gad A. Marshall, Geoffroy Gagliardi, and Patrizia Vannini
- Subjects
awareness ,Alzheimer's disease ,mild cognitive impairment ,neuropsychiatric symptoms ,anosognosia ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
IntroductionBoth the loss of awareness for cognitive decline (a. k.a anosognosia) and neuropsychiatric symptoms (NPS) are common in patients with Alzheimer's disease (AD) dementia, even in prodromal stages, and may exacerbate functional impairment and negatively impact caregiver burden. Despite the high impact of these symptoms on patients and their caregivers, our knowledge of how they develop across the AD spectrum is limited. Here, we explored the cross-sectional and longitudinal associations between anosognosia and NPS in individuals with mild cognitive impairment (MCI).MethodsWe included 237 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with a baseline clinical diagnosis of MCI. Everyday Cognition (ECog) questionnaire scores were used to measure complaints from participants and study-partners at baseline and annually over a mean of 4.29 years [standard deviation (SD) = 2.72]. Anosognosia was defined as the study-partner having an ECog score ≥2.5/4 and the participant having an ECog score < 2.5/4 on their baseline measure and their last observation without more than two consecutive deviating observations during the follow-up period. The 12-item study-partner-rated Neuropsychiatric Inventory determined the presence or absence of specific NPS. Survival analyses were performed to analyze the frequency and temporal onset of NPS over time in individuals with and without anosognosia.ResultsThirty-eight out of 237 participants displayed anosognosia. Groups had similar lengths of follow-up at baseline (p > 0.9), though participants with anosognosia had lower MMSE scores (p = 0.049) and a higher proportion of amyloid-positivity using PET (p < 0.001. At baseline, the frequencies of agitation (p = 0.029) and disinhibition (p < 0.001) were higher in the anosognosia group compared to the non-anosognosia group. Survival analyses showed earlier onset of seven of the 12 NPS in the anosognosia group (p's < 0.001).DiscussionLoss of awareness for cognitive decline is associated with greater frequency and earlier onset of NPS over time in participants with MCI. These results support the hypothesis of a potential common underlying neurophysiological process for anosognosia and NPS, a finding that needs to be addressed in future studies.
- Published
- 2024
- Full Text
- View/download PDF
36. Research
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Heilman, Kenneth M. and Heilman, Kenneth M.
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- 2023
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37. Psychological Aspects of Recovery After Brain Injury: A Focus on Psychodynamic Factors
- Author
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Costa, Alberto, Gullo, Salvatore, Bivona, Umberto, Caltagirone, Carlo, Manto, Mario, Series Editor, and Petrosini, Laura, editor
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- 2023
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38. Studying lack of awareness of cognitive decline in neurodegenerative diseases requires measures of both anosognosia and denial
- Author
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George P. Prigatano, Sydney Russell, and Tiffany M. Meites
- Subjects
mild cognitive impairment ,early Alzheimer’s dementia ,anosognosia ,denial ,case examples ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
The cause(s) of lack of awareness of cognitive decline in neurodegenerative diseases can be multifactorial. Yet neurologically oriented research on anosognosia of cognitive decline almost exclusively assumes that the underlying disturbance of neuro-networks that support various cognitive functions accounts for the reduced self-awareness. Cultural and psychosocial factors, including the person’s emotional state, however, can contribute to the underreporting or avoidance of admitting to cognitive impairments in neurodegenerative diseases. Research on the causes of lack of awareness of cognitive decline in neurodegenerative disorders needs to include these variables. We briefly present two case examples of underreporting or “unawareness” of memory difficulties in persons with mild cognitive impairment (MCI) (or minor neurocognitive disorder). One presented with classic anosognosia for memory impairment, while the other initially reported no memory impairment but later admitted to “denying” her memory difficulties secondary to anxiety. Based on these patients’ clinical presentations and available research, we suggest three potential screening items that may help identify probable denial of memory impairments when studying anosognosia in MCI.
- Published
- 2024
- Full Text
- View/download PDF
39. Evaluation of upper limb perception after stroke with the new Affected Limb Perception Questionnaire (ALPQ): a study protocol
- Author
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Konik, Stéphanie, Beaud, Valérie, Fellrath, Julia, Martinelli, Isabella, Guanziroli, Eleonora, Molteni, Franco, Bassolino, Michela, and Serino, Andrea
- Published
- 2024
- Full Text
- View/download PDF
40. The dual-path hypothesis for the emergence of anosognosia in Alzheimer’s disease
- Author
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Katia Andrade, Thomas Guieysse, Takfarinas Medani, Etienne Koechlin, Dimitrios Pantazis, and Bruno Dubois
- Subjects
anosognosia ,Alzheimer’s disease ,error-monitoring system ,emotional processing ,neural mechanism ,synaptic failure ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer’s disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one’s own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders.
- Published
- 2023
- Full Text
- View/download PDF
41. Detecting Anosognosia from the Prodromal Stage of Alzheimer's Disease.
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Guieysse, Thomas, Lamothe, Roxane, Houot, Marion, Razafimahatratra, Solofo, Medani, Takfarinas, Lejeune, François-Xavier, Dreyfus, Gérard, Klarsfeld, André, Pantazis, Dimitrios, Koechlin, Etienne, and Andrade, Katia
- Subjects
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ALZHEIMER'S disease , *ANOSOGNOSIA , *SERVICES for caregivers , *BURDEN of care - Abstract
Background: Though not originally developed for this purpose, the Healthy Aging Brain Care Monitor (HABC-M) seems a valuable instrument for assessing anosognosia in Alzheimer's disease (AD). Objectives: Our study aimed at 1) investigating the validity of the HABC-M (31 items), and its cognitive, psychological, and functional subscales, in discriminating AD patients from controls; 2) exploring whether the HABC-M discrepancy scores between the self-reports of patients/controls in these different domains and the respective ratings provided by their caregivers/informants correlate with an online measure of self-awareness; 3) determining whether the caregiver burden level, also derived from the HABC-M, could add additional support for detecting anosognosia. Methods: The HABC-M was administered to 30 AD patients and 30 healthy controls, and to their caregivers/informants. A measure of online awareness was established from subjects' estimation of their performances in a computerized experiment. Results: The HABC-M discrepancy scores distinguished AD patients from controls. The cognitive subscale discriminated the two groups from the prodromal AD stage, with an AUC of 0.88 [95% CI: 0.78;0.97]. Adding the caregiver burden level raised it to 0.94 [0.86;0.99]. Significant correlations between the HABC-M and online discrepancy scores were observed in the patients group, providing convergent validity of these methods. Conclusions: The cognitive HABC-M (six items) can detect anosognosia across the AD spectrum. The caregiver burden (four items) may corroborate the suspicion of anosognosia. The short-hybrid scale, built from these 10 items instead of the usual 31, showed the highest sensitivity for detecting anosognosia from the prodromal AD stage, which may further help with timely diagnosis. [ABSTRACT FROM AUTHOR]
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- 2023
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42. Network Localization of Awareness in Visual and Motor Anosognosia.
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Kletenik, Isaiah, Gaudet, Kyla, Prasad, Sashank, Cohen, Alexander L., and Fox, Michael D.
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ANOSOGNOSIA , *MOTOR cortex , *FALSE discovery rate , *CINGULATE cortex , *VISUAL cortex , *MOTOR imagery (Cognition) - Abstract
Objective: Unawareness of a deficit, anosognosia, can occur for visual or motor deficits and lends insight into awareness itself; however, lesions associated with anosognosia occur in many different brain locations. Methods: We analyzed 267 lesion locations associated with either vision loss (with and without awareness) or weakness (with and without awareness). The network of brain regions connected to each lesion location was computed using resting‐state functional connectivity from 1,000 healthy subjects. Both domain specific and cross‐modal associations with awareness were identified. Results: The domain‐specific network for visual anosognosia demonstrated connectivity to visual association cortex and posterior cingulate while motor anosognosia was defined by insula, supplementary motor area, and anterior cingulate connectivity. A cross‐modal anosognosia network was defined by connectivity to the hippocampus and precuneus (false discovery rate p < 0.05). Interpretation: Our results identify distinct network connections associated with visual and motor anosognosia and a shared, cross‐modal network for awareness of deficits centered on memory‐related brain structures. ANN NEUROL 2023;94:434–441 [ABSTRACT FROM AUTHOR]
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- 2023
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43. Can a failure in the error-monitoring system explain unawareness of memory deficits in Alzheimer's disease?
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Razafimahatratra, Solofo, Guieysse, Thomas, Lejeune, François-Xavier, Houot, Marion, Medani, Takfarinas, Dreyfus, Gérard, Klarsfeld, André, Villain, Nicolas, Pereira, Filipa Raposo, La Corte, Valentina, George, Nathalie, Pantazis, Dimitrios, and Andrade, Katia
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ALZHEIMER'S disease ,HEALTH outcome assessment ,NEUROPSYCHOLOGY ,MEDICAL care ,ANOSOGNOSIA - Published
- 2023
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44. Volonté de rester à domicile et anosognosie des risques associés à la maladie neurodégénérative de type Alzheimer.
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Compagne, Charline, Trimaille, Hélène, Bonnet, Magalie, Ferrero, Lénaïc, Magnin, Éloi, and Tannou, Thomas
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ANOSOGNOSIA ,DEMENTIA ,AGING ,DECISION making - Abstract
Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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45. Upper extremity self-efficacy correlates with daily hand-use of individuals with high functional capacity post-stroke.
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Goldman-Gerber, Vered, Schwartz, Isabella, and Rand, Debbie
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HAND physiology , *STATISTICS , *UNILATERAL neglect , *CONFIDENCE intervals , *CEREBRAL dominance , *FUNCTIONAL status , *CROSS-sectional method , *ACTIVITIES of daily living , *ARM , *SELF-efficacy , *ANOSOGNOSIA , *NEUROPSYCHOLOGICAL tests , *PSYCHOSOCIAL factors , *STROKE patients , *STROKE rehabilitation , *DESCRIPTIVE statistics , *QUESTIONNAIRES , *DATA analysis , *HEMIPLEGIA , *MOTOR ability - Abstract
To understand the role of affected upper extremity (UE) self-efficacy for explaining daily-hand-use in individuals post-stroke. Specifically, to describe UE self-efficacy and to assess the associations between UE self-efficacy to UE motor and functional capacity and daily hand-use. This cross-sectional study included individuals post-stroke receiving rehabilitation with high UE functional capacity [Action Research Arm Test (ARAT) > 50]. The Rating of Everyday Arm-Use in the Community and Home (REACH) assessed perceived UE daily use and the Confidence in Arm and Hand Movement scale (CAHM) assessed UE self-efficacy. Functional capacity was assessed by the ARAT and the Fugl-Meyer-motor-assessment assessed motor impairment. Correlations between measures were assessed. Twenty-two individuals, aged 19–80, with high UE functional capacity [median (IQR) ARAT-56.5 (54–57)] and varying UE self-efficacy [median (IQR) CAHM-76.7 (58–84.4)], were included. UE self-efficacy was significantly correlated with the ARAT (rs = 0.53, p < 0.01) and REACH (rs = 0.51, p < 0.01) but ARAT was not significantly correlated with REACH. UE self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity. Further research and a deeper understanding of the clinical implications of UE self-efficacy are warranted. UE self-efficacy should perhaps be assessed during rehabilitation. Individuals with stroke with high affected upper extremity functional capacity do not necessarily use this hand for daily living. Upper extremity self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity; participants with higher upper extremity self-efficacy also reported more daily hand-use. Upper extremity self-efficacy seems to be upper extremity task or situation-specific. Upper extremity self-efficacy should be assessed during rehabilitation and the clinical implications of (low) upper extremity self-efficacy should be further researched. [ABSTRACT FROM AUTHOR]
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- 2023
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46. Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer's disease.
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Fischer, Anna, Dourado, Marcia Cristina Nascimento, Laks, Jerson, Landeira-Fernandez, Jesus, Morris, Robin G., and Mograbi, Daniel C.
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Objectives: To investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness in a non-clinically depressed sample of participants with mild to moderate Alzheimer's disease (AD) in Brazil. Methods: People with AD (PwAD) aged 60 years or older were recruited from an outpatient unit at the Center of AD of the Federal University of Rio de Janeiro, Brazil. Measures of awareness of condition (Assessment Scale of the Psychosocial Impact of the Diagnosis of Dementia), cognitive function (Mini-Mental State Examination), mood state (Cornell Scale for Depression in Dementia), and functionality (Pfeffer Functional Activities Questionnaire) were applied to 264 people with mild to moderate AD and their caregivers. Hypotheses were tested statistically using SEM approach. Three competing models were compared. Results: The first model, in which the influence of mood state and cognitive function on awareness was mediated by functionality, showed a very good fit to the data and a medium effect size. The competing models, in which the mediating variables were mood state and cognitive function, respectively, only showed poor model fit. Conclusion: Our model supports the notion that the relationship between different factors and awareness in AD is mediated by functionality and not by depressive mood state or cognitive level. The proposed direct and indirect effects on awareness are discussed, as well as the missing direct influence of mood state on awareness. The understanding of awareness in dementia is crucial and our model gives one possible explanation of its underlying structure in AD. [ABSTRACT FROM AUTHOR]
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- 2023
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47. Unawareness of Apathy in Parkinson's Disease: The Role of Executive Dysfunction on Symptom Recognition.
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Maggi, Gianpaolo, Vitale, Carmine, Delle Curti, Alessia, Amboni, Marianna, and Santangelo, Gabriella
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PARKINSON'S disease , *EXECUTIVE function , *APATHY , *BASAL ganglia diseases , *DELAYED diagnosis , *PREFRONTAL cortex , *MOVEMENT disorders - Abstract
Altered self-awareness or anosognosia may impact patients' everyday life by interfering with their safe and independent functioning. Symptom awareness has been linked to executive dysfunctions caused by damage to frontal regions. Apathy is a frequent neuropsychiatric manifestation of Parkinson's disease (PD) and is considered a consequence of altered functioning of cortico-subcortical circuitries connecting the prefrontal cortex (PFC) with the basal ganglia. Thus, apathetic PD patients may be not be fully aware of their condition due to shared neuropathophysiological mechanisms. The present study aimed to explore the awareness of apathy in PD patients by comparing the self-reported evaluations with their caregivers' ratings. Moreover, we explored the clinical predictors of possible discrepancies and their consequences on patients' self-reported evaluation of quality of life (QoL). We found a fair agreement between patients' self-reports and caregivers' ratings on apathy scores, with patients reporting less severe apathetic symptoms, especially those related to executive and auto-activation processing, compared to their caregivers' reports. Executive functioning was found to mediate the relationship between disease stage and awareness of the apathetic state. Awareness of executive apathy impacted patients' self-reported QoL. Therefore, PD patients might be unaware of their apathetic symptoms, especially those with worse executive functioning, which plays a key role in metacognitive processes such as self-monitoring and error detection. Anosognosia for apathy in PD patients may affect their QoL perception and leads to misleading self-report evaluations that delay diagnosis and treatment. [ABSTRACT FROM AUTHOR]
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- 2023
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48. Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff's Syndrome: A Network Analysis.
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Fidder, Hester, Veenhuizen, Ruth B., Gerridzen, Ineke J., van Wieringen, Wessel N., Smalbrugge, Martin, Hertogh, Cees M. P. M., and van Loon, Anouk M.
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SOCIAL participation , *LONG-term care facilities , *AWARENESS , *ANTIPSYCHOTIC agents , *SOCIAL skills - Abstract
Background: Impaired awareness of one's own functioning is highly common in people with Korsakoff's syndrome (KS). However, it is currently unclear how awareness relates to impairments in daily functioning and quality of life (QoL). Methods: We assessed how impaired awareness relates to cognitive, behavioral, physical, and social functioning and QoL by applying a network analysis. We used cross-sectional data from 215 patients with KS or other severe alcohol-related cognitive deficits living in Dutch long-term care facilities (LTCFs). Results: Apathy has the most central position in the network. Higher apathy scores relate positively to reduced cognition and to a greater decline in activities of daily living and negatively to social participation and the use of antipsychotic drugs. Impaired awareness is also a central node. It is positively related to a higher perceived QoL, reduced cognition and apathy, and negatively to social participation and length of stay in the LTCF. Mediated through apathy and social participation, impaired awareness is indirectly related to other neuropsychiatric symptoms. Conclusions: Impaired awareness is closely related to other domains of daily functioning and QoL of people with KS or other severe alcohol-related cognitive deficits living in LTCFs. Apathy plays a central role. Network analysis offers interesting insights to evaluate the interconnection of different symptoms and impairments in brain disorders such as KS. [ABSTRACT FROM AUTHOR]
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- 2023
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49. Type of attitude to the disease in patients with epilepsy and suicidal ideation
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N. I. Shova, V. A. Mikhailov, E. A. Granovskaya, and V. V. Bocharov
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suicidal behavior ,epilepsy ,attitude to the disease ,risk factors ,anosognosia ,Psychiatry ,RC435-571 - Abstract
Suicidal behavior is characterized by the response of the individual to the conditions of the crisis situation experienced. The unrelenting interest of researchers around the world is aimed at studying the factors that determine the risk of suicidal intentions in patients with epilepsy.Purposal. To determine the main types of attitude to the disease in patients with epilepsy and suicidal thoughts.Materials and methods. 112 patients with epilepsy were examined and divided into 2 groups depending on the presence of suicidal thoughts at the time of the study: 1st group – with suicidal intentions, 2nd group – without it. The method «Type of attitude to the disease» were used.Results. Thus, among the clinical factors of suicidal risk in patients with epilepsy, severe course of the underlying disease is the most significant, which is manifested by frequent seizures, serial course, and drug resistance form. It was revealed that patients with epilepsy with suicidal thoughts are characterized by the presence of «mixed» and «diffuse» types of attitude to the disease, with a predominance of maladaptive forms. The analysis of «pure» types of attitude towards the disease in two groups showed that there are fewer respondents with a «pure» type of attitude towards the disease in the group of patients with suicidal thoughts than in the group of patients without it. Along with the ergopathic and sensitive types, in the 2nd group of patients, the anosognosic type of attitude to the disease is also quite pronounced, and in the 1st group, patients with anosognosic, anxious and hypochondriacal types of attitude to the disease were identified.Conclusion. Consequently, patients with epilepsy are characterized by: vulnerability, vulnerability, concern about possible adverse impressions that they can make on others with information about their illness; the desire, despite the severity of the disease, to continue working; lack of criticality to their own disease, which can lead to destabilization of the underlying disease and the formation of suicidal behavior.
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- 2022
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50. Effects of visual-motor illusion in stroke hemiplegic patients with left-side personal neglect: A report of two cases.
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Tanabe, Junpei, Amimoto, Kazu, Sakai, Katsuya, Morishita, Motoyoshi, Fukata, Kazuhiro, Osaki, Shinpei, and Yoshihiro, Nao
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HEMIPLEGICS , *STROKE patients , *CEREBRAL infarction , *FUNCTIONAL independence measure , *CEREBRAL arteries , *PHYSICAL therapy - Abstract
Personal neglect is the neglect of self-body space, which often occurs in patients with unilateral spatial neglect (USN), but lacks a dedicated rehabilitation. The purpose of this study was to investigate the effects of visual-motor illusion (VMI) on two-stroke hemiplegic patients with left-side personal neglect. Case 1 was a 53-year-old man diagnosed with a right lenticulostriate artery infarction. Case 2 was a 76-year-old woman diagnosed with a right middle cerebral artery infarction. USN symptoms were not observed in either patient in the desk USN assessment, but personal neglect and USN symptoms in daily life were observed in both patients. Intervention effects were verified using an ABA design, comprising a 5-day three-phase (A1, B, A2). In phase B, VMI was performed on the paralyzed upper limb for 10 min in addition to conventional physical therapy. Outcomes measures were the Fluff test, Catherine Bergego Scale (CBS), Fugl-Meyer Assessment (FMA), and Functional Independence Measure (FIM). In both patients, no improvements were noted in FMA, but improvements were observed in the Fluff test, CBS, and FIM in phase B; these effects were retained in phase A2. Therefore, VMI may have contributed to improvements in Personal neglect and USN symptoms in daily life. [ABSTRACT FROM AUTHOR]
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- 2023
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