The Neural Basis of Anosognosia for Spatial Neglect After Stroke

Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Leo-Brandt-Str 5, 52425 Jülich, Germany.
Stroke (Impact Factor: 5.72). 05/2012; 43(7):1954-6. DOI: 10.1161/STROKEAHA.112.657288
Source: PubMed


The present study investigated the lesion anatomy of anosognosia for visuospatial neglect resulting from right hemispheric stroke.
In 63 patients, self-ratings of performance in paper-and-pencil tests were contrasted with external performance ratings. Lesion analysis was conducted on patient subgroups with different degrees of anosognosia but comparable visuospatial impairment.
Independent of the severity of visuospatial neglect per se, damage to the right angular and superior temporal gyrus was associated with higher levels of anosognosia.
Using a novel assessment of anosognosia for spatial neglect, the present study relates stroke-induced self-awareness deficits to inferior parietal and superior temporal brain damage.

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    • "" and if necessary, giving alternatives: left, right, both, none), and anosognosia for left hemiplegia and, more generally , for the illness. As for its neural underpinnings, unawareness of left spatial neglect, indexed by the comparison between the patients' self-rating [1 (severe) to 5 (no difficulties )] of their performance in cancellation, line bisection, drawing and text reading tasks, and that made by an external observer, was associated with lesions of the angular gyrus of the inferior parietal lobule, and the superior temporal gyrus in the right hemisphere (Vossel et al., 2012). This lesion pattern, largely overlapping with that of spatial neglect itself (review in Vallar & Bolognini, 2014), suggests a close relationship between the spatial processes dysfunctional in left neglect and their monitoring, namely the cognitive process that allow to check whether an activity or a task e here the spatial performance e is carried out correctly. "
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    ABSTRACT: Right-brain-damaged patients with unilateral spatial neglect are usually unaware (anosognosic) about their spatial deficits. However, in the scientific literature there is a lack of systematic and quantitative evaluation of this kind of unawareness, despite the negative impact of anosognosia on rehabilitation programs. This study investigated anosognosia for neglect-related impairments at different clinical tasks, by means of a quantitative assessment. Patients were tested in two different conditions (before and after execution of each task), in order to evaluate changes in the level of awareness of neglect-related behaviours triggered by task execution. Twenty-nine right-brain-damaged patients (17 with left spatial neglect) and 27 neurologically unimpaired controls entered the study. Anosognosia for spatial deficits is not pervasive, with different tasks evoking different degrees of awareness about neglect symptoms. Indeed, patients showed a largely preserved awareness about their performance in complex visuo-motor spatial and reading tasks; conversely, they were impaired in evaluating their spatial difficulties in line bisection and drawing from memory, showing over-estimation of their performance. The selectivity of the patients' unawareness of specific manifestations of spatial neglect is further supported by their preserved awareness of performance at a linguistic task, and by the absence of anosognosia for hemiplegia. This evidence indicates that discrete processes are involved in the aware monitoring of cognitive and motor performance, which can be selectively compromised by brain damage. Awareness of spatial difficulties is supported by a number of distinct components, and influenced by the specific skills required to perform a given task. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Cortex
    • "Furthermore, neglect is a multifaceted disorder and can, for example, differentially affect perceptual-attentional as well as motor-intentional functions (e.g., Bisiach et al., 1998; Vallar, 2001; Vossel et al., 2010). Right-hemispheric lesions and neglect are moreover closely associated with anosognosia for both motor impairment (Pia et al., 2004; Orfei et al., 2007) and visuospatial deficits (Vossel et al., 2012), so that the patients show reduced self-awareness for their stroke-induced functional impairments. While the cognitive processes and the underlying lesion anatomy of each of the above-mentioned symptoms and syndromes after stroke have been investigated by several studies, their functional significance for activities of daily living (ADL) to date remains less clear. "
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    ABSTRACT: Introduction: Right-hemispheric stroke can give rise to manifold neuropsychological deficits, in particular, impairments of spatial perception which are often accompanied by reduced self-awareness of these deficits (anosognosia). To date, the specific contribution of these deficits to a patient's difficulties in daily life activities remains to be elucidated. Methods: In 55 patients with right-hemispheric stroke we investigated the predictive value of different neglect-related symptoms, visual extinction and anosognosia for the performance of standardized activities of daily living (ADL). The additional impact of lesion location was examined using voxel-based lesion-symptom mapping. Results: Step-wise linear regression revealed that anosognosia for visuospatial deficits was the most important predictor for performance in standardized ADL. In addition, motor-intentional and perceptual-attentional neglect, extinction and cancellation task performance significantly predicted ADL performance. Lesions comprising the right frontal and cingulate cortex and adjacent white matter explained additional variance in the performance of standardized ADL, in that damage to these areas was related to lower performance than predicted by the regression model only. Conclusion: Our data show a decisive role of anosognosia for visuospatial deficits for impaired ADL and therefore outcome/disability after stroke. The findings further demonstrate that the severity of neglect and extinction also predicts ADL performance. Our results thus strongly suggest that right-hemispheric stroke patients should not only be routinely assessed for neglect and extinction but also for anosognosia to initiate appropriate rehabilitative treatment. The observation that right frontal lesions explain additional variance in ADL most likely reflects that dysfunction of the supervisory system also significantly impacts upon rehabilitation.
    No preview · Article · Dec 2012 · Cortex
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    ABSTRACT: The right temporo-parietal junction (TPJ) is widely considered as part of a network that reorients attention to task-relevant, but currently unattended stimuli (Corbetta and Shulman, 2002). Despite the prevalence of this theory in cognitive neuroscience, there is little direct evidence for the principal hypothesis that TPJ sends an early reorientation signal that "circuit breaks" attentional processing in regions of the dorsal attentional network (e.g., the frontal eye fields) or is completely right lateralized during attentional processing. In this review, we examine both functional neuroimaging work on TPJ in the attentional literature as well as anatomical findings. We first critically evaluate the idea that TPJ reorients attention and is right lateralized; we then suggest that TPJ signals might rather reflect post-perceptual processes involved in contextual updating and adjustments of top-down expectations; and then finally discuss how these ideas relate to the electrophysiological (P300) literature, and to TPJ findings in other cognitive and social domains. We conclude that while much work is needed to define the computational functions of regions encapsulated as TPJ, there is now substantial evidence that it is not specialized for stimulus-driven attentional reorienting.
    Full-text · Article · Aug 2013 · Neuroscience & Biobehavioral Reviews
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