The frequency, clinical correlates, and mechanism of anosognosia after stroke.
OBJECTIVE
To review the frequency, clinical correlates, and mechanism of anosognosia after stroke.


METHODS
We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings.


RESULTS
Anosognosia is present in about 10% of acute stroke patients and its diagnosis is relatively simple. Nevertheless, a valid and reliable standardization of diagnostic instruments and criteria for research purposes is more difficult to achieve. This limitation may partially account for various instruments available to assess anosognosia and the different strategies used to diagnose this phenomenon. Anosognosia is a fleeting phenomenon and chronic cases are infrequent. There is a robust association between anosognosia and right-hemisphere lesions involving cortical (insular, temporal, and parietal lobes) and subcortical structures (thalamus and basal ganglia). The main clinical correlates of anosognosia are the presence of neglect, cognitive deficits, previous strokes, and older age. Anosognosia has a negative impact on the rehabilitation of stroke patients. The mechanism of anosognosia remains unknown but was explained as owing to psychological denial, disconnection between left and right hemispheres, and dysfunction of a system that monitors the intention to move and actual movements.


CONCLUSIONS
Anosognosia is a relatively frequent complication of acute stroke and may become an excellent model to understand the mechanism of human awareness.
Starkstein
Sergio E
SE
The University of Western Australia, Perth, Australia. ses@cyllene.uwa.edu.au <ses@cyllene.uwa.edu.au>
Jorge
Ricardo E
RE
Robinson
Robert G
RG
D000203:Activities of Daily Living / Q000523:psychology; D000377:Agnosia / Q000175:diagnosis* / Q000503:physiopathology; D001364:Awareness / Q000502:physiology; D001479:Basal Ganglia / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D003717:Denial, Psychological; D004292:Dominance, Cerebral / Q000502:physiology; D056344:Executive Function / Q000502:physiology; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology; D009460:Neurologic Examination; D010468:Perceptual Disorders / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013788:Thalamus / Q000503:physiopathology