-
Continuum (Minneapolis, Minn.) Dec 2021Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive... (Review)
Review
PURPOSE OF REVIEW
Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke.
RECENT FINDINGS
Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available.
SUMMARY
This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
Topics: Agnosia; Brain; Humans; Perceptual Disorders; Stroke; Stroke Rehabilitation
PubMed: 34881729
DOI: 10.1212/CON.0000000000001076 -
Revista de Neurologia Feb 2020Hemineglect produces a lower capacity for recovery after the stroke and so far there are no rehabilitation techniques that have proven to be effective at functional... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Hemineglect produces a lower capacity for recovery after the stroke and so far there are no rehabilitation techniques that have proven to be effective at functional level.
AIMS
The main objective of this work was to assess whether the modified constraint-induced movement therapy (mCIMT)for hemineglect produces greater benefits than conventional therapy on functional hemineglect. Secondary objectives were to assess whether mCIMT produces greater benefits on upper and lower limb function as well as on the degree of autonomy and disability of patients with in relation to conventional therapy.
PATIENTS AND METHODS
We have recruited 30 patients with ischemic stroke and diagnosis of hemineglect randomly assigned to mCIMT group (n = 15) or conventional therapy group (n = 15). We used the Catherine Bergego Scale (CBS) for assessment hemineglect; Fugl-Meyer tests for the motor function of lower and upper limb, and Barthel index and modified Rankin scale for the rest of objectives.
RESULTS
We have found significant differences in favour of mCIMT group in the CBS after treatment and three months later once finished. We have not found differences between groups for the rest of variables.
CONCLUSIONS
mCIMT could be a more effective therapy than conventional therapy to improve the symptoms of hemineglect in the acute stroke. However, it may be clinically more recommended in patients with a certain motor function after stroke.
Topics: Aged; Aged, 80 and over; Agnosia; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 32043533
DOI: 10.33588/rn.7004.2019330 -
Tidsskrift For Den Norske Laegeforening... Nov 2023Neurological disorders can present with a vast array of visual disturbances. The constellation of symptoms and findings in this patient prompted workup for unusual...
BACKGROUND
Neurological disorders can present with a vast array of visual disturbances. The constellation of symptoms and findings in this patient prompted workup for unusual causes of both stroke and neurodegenerative disorder.
CASE PRESENTATION
A woman in her sixties presented with visual disturbances, followed by weakness in her right arm and aphasia three days later. Her close acquaintances had suspected progressive cognitive decline during the previous year. CT and MRI showed an occluded left posterior cerebral artery with a subacute occipito-temporal infarction. The finding of extensive white matter lesions and segmental arterial vasoconstriction necessitated further workup of vasculitis and hereditary small vessel disease, which were ruled out. The stroke aetiology was considered to be atherosclerotic intracranial large vessel disease. FDG-PET scan revealed decreased metabolism in the left hemisphere, and cerebrospinal biomarkers had slightly decreased beta-amyloid. The findings were suggestive of early Alzheimer's disease or primary progressive aphasia, but currently inconclusive.
INTERPRETATION
Based on clinical-anatomical correlation, the patient's visual disturbances, in this case right hemianopsia and object agnosia, were solely related to the stroke and not to a neurodegenerative disorder. Knowledge and interpretation of visual agnosias can in many cases be clinically valuable.
Topics: Female; Humans; Agnosia; Magnetic Resonance Imaging; Neurodegenerative Diseases; Positron-Emission Tomography; Stroke; Vision Disorders; Aged
PubMed: 37938009
DOI: 10.4045/tidsskr.23.0198 -
European Neurology 2020Anosognosia and hemineglect are among the most startling neurological phenomena identified during the 20th century. Though both are associated with right hemisphere...
Anosognosia and hemineglect are among the most startling neurological phenomena identified during the 20th century. Though both are associated with right hemisphere cerebral dysfunction, notably stroke, each disorder had its own distinct literature. Anosognosia, as coined by Babinski in 1914, describes patients who seem to have no idea of their paralysis, despite general cognitive preservation. Certain patients seem more than unaware, with apparent resistance to awareness. More extreme, and qualitatively distinct, is denial of hemiplegia. Various interpretations of pathogenesis are still deliberated. As accounts of its captivating manifestations grew, anosognosia was established as a prominent symbol of neurological and psychic disturbance accompanying (right-hemisphere) stroke. Although reports of specific neglect-related symptomatology appeared earlier, not until nearly 2 decades after anosognosia's inaugural definition was neglect formally defined by Brain, paving a path spanning some years, to depict a class of disorder with heterogeneous variants. Disordered awareness of body and extrapersonal space with right parietal lesions, and other symptom variations, were gathered under the canopy of neglect. Viewed as a disorder of corporeal awareness, explanatory interpretations involve mechanisms of extinction and perceptual processing, disturbance of spatial attention, and others. Odd alterations involving apparent concern, attitudes, or belief characterize many right hemisphere conditions. Anosognosia and neglect are re-examined, from the perspective of unawareness, the nature of belief, and its baffling distortions. Conceptual parallels between these 2 distinct disorders emerge, as the major role of the right hemisphere in mental representation of self is highlighted by its most fascinating syndromes of altered awareness.
Topics: Agnosia; History, 19th Century; History, 20th Century; Humans; Neurology; Perceptual Disorders
PubMed: 32927461
DOI: 10.1159/000510397 -
Current Neurology and Neuroscience... Mar 2017The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the... (Review)
Review
The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness and summarize both traditional and emerging approaches to assessing awareness from clinical and meta-cognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and meta-cognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying meta-cognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.
Topics: Aged; Agnosia; Alzheimer Disease; Awareness; Frontotemporal Dementia; Humans; Metacognition; Models, Psychological; Neuropsychological Tests
PubMed: 28283961
DOI: 10.1007/s11910-017-0734-1 -
Experimental Brain Research Sep 2013Neurological disorders of volition may be characterized by deficits in willing and/or agency. When we move our bodies through space, it is the sense that we intended to... (Review)
Review
Neurological disorders of volition may be characterized by deficits in willing and/or agency. When we move our bodies through space, it is the sense that we intended to move (willing) and that our actions were a consequence of this intention (self-agency) that gives us the sense of voluntariness and a general feeling of being "in control." While it is possible to have movements that share executive machinery ordinarily used for voluntary movement but lack a sense of voluntariness, such as psychogenic movement disorders, it is also possible to claim volition for presumed involuntary movements (early chorea) or even when no movement is produced (anosognosia). The study of such patients should enlighten traditional models of how the percepts of volition are generated in the brain with regard to movement. We discuss volition and its components as multi-leveled processes with feedforward and feedback information flow, and dependence on prior expectations as well as external and internal cues.
Topics: Agnosia; Brain; Humans; Intention; Movement; Volition
PubMed: 23329204
DOI: 10.1007/s00221-013-3399-2 -
OTJR : Occupation, Participation and... Apr 2018Unilateral neglect (neglect) and anosognosia often co-occur post stroke. It is unknown whether anosognosia of neglect varies for different types of daily activities. The...
Unilateral neglect (neglect) and anosognosia often co-occur post stroke. It is unknown whether anosognosia of neglect varies for different types of daily activities. The objective is to examine the frequency of anosognosia of neglect for items on the Catherine Bergego Scale (CBS) and to determine the level of agreement between participant/assessor item ratings and total scores. Secondary analysis of data was carried out. We conducted descriptive analyses and interrater reliability analyses (Cohen's kappa) to determine the level of agreement between assessor and participant item ratings. A paired t test was conducted to compare assessor and participant total scores. The frequency of anosognosia among items varied (29.2%-83.3%) and Kappa statistics ranged from -0.07 (no agreement) to 0.23 (fair agreement) for item ratings. There was a significant difference- t(36) = 3.02, p ≤ .01)-between assessor ( M = 8.0, SD = 5.2) and participant-rated ( M = 5.3, SD = 4.5) total CBS scores. Anosognosia is prevalent among those with neglect. Findings highlight the importance of assessing for anosognosia.
Topics: Aged; Agnosia; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Observer Variation; Perceptual Disorders; Prevalence; Psychometrics; Reproducibility of Results; Stroke
PubMed: 29251546
DOI: 10.1177/1539449217747586 -
Journal of Neurology, Neurosurgery, and... May 1959"And what is the nature of this knowledge or recollection? I mean to ask, Whether a person, who having seen or heard or in any way perceived anything, knows not only...
"And what is the nature of this knowledge or recollection? I mean to ask, Whether a person, who having seen or heard or in any way perceived anything, knows not only that, but has a conception of something else which is the subject, not of the same but of some other kind of knowledge, may not be fairly said to recollect that of which he has the conception?""And when the recollection is derived from like things, then another consideration is sure to arise, which is, Whether the likeness in any degree falls short or not of that which is recollected?" "The Philosophy of Plato" Phaedo (the Jowett translation).
Topics: Agnosia; Humans; Male; Philosophy; Prosopagnosia
PubMed: 13655102
DOI: 10.1136/jnnp.22.2.124 -
Current Biology : CB Jan 2007
Topics: Cerebral Cortex; Humans; Prosopagnosia; Visual Perception
PubMed: 17208177
DOI: 10.1016/j.cub.2006.11.043 -
The Permanente Journal 2016
Topics: Adult; Agnosia; Anomia; Color Perception; Dyslexia; Female; Humans
PubMed: 27352419
DOI: 10.7812/TPP/15-165