title: Unawareness of motor impairment and emotions in right hemispheric stroke: a preliminary investigation.
abstract: BACKGROUND
  Awareness may lack in some stroke patients who are not capable of evaluating the nature and severity of illness. Thus, unawareness may have different forms such as anosognosia, neglect, and alexithymia or unawareness of emotions. In this study we investigated the relationship among anosognosia, neglect, alexithymia, and cognition.
  
  
  METHODS
  Fifty consecutive right stroke inpatients were approached within the first 3 months from the acute event. Anosognosia was measured with the Bisiach scale, alexithymia with the TAS-20 scale and neglect with line crossing, letter cancellation, figure and shape copying, and line bisection tests. A neuropsychological test battery was used to measure different areas of cognition.
  
  
  RESULTS
  despite the strong comorbidity rate among the different forms of unawareness, there are patients who suffer from pure forms of these types of lack of awareness. A multivariate logistic regression model evidenced that presence of neglect (OR = 10.3; 95% CI = 1.4-76.3; p = 0.023) and more difficulty in describing feelings (TAS-20 F2 subscore; OR = 1.3; 95% CI = 1.1-1.7; p = 0.014) were the only predictors of anosognosia. In addition, anosognosics with alexithymia performed worst in a frontal task such as the verbal fluency task (p = 0.042) and in the verbal span forward task (p = 0.026) than pure anosognosics.
  
  
  CONCLUSIONS
  Anosognosia for motor impairment is strictly associated with a specific form of unawareness of emotions. Future studies have to clarify if frontal cognitive impairment previously described in anosognosics is a manifestation of unawareness of emotions or anosognosia for motor impairment.
authors.affiliation: IRCCS Fondazione Santa Lucia, Rome, Italy. g.spalletta@hsantalucia.it
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Spalletta
authors.forename: Laura
authors.initials: L
authors.lastname: Serra
authors.forename: Lucia
authors.initials: L
authors.lastname: Fadda
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ripa
authors.forename: Pietro
authors.initials: P
authors.lastname: Bria
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D001364:Awareness; D004644:Emotions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000175:diagnosis / Q000209:etiology*; D020521:Stroke / Q000523:psychology*