title: Anosognosia, neglect, extinction and lesion site predict impairment of daily living after right-hemispheric stroke.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: Cognitive Neuroscience, Institute of Neuroscience & Medicine (INM-3), Research Centre Jülich, Jülich, Germany. s.vossel@fz-juelich.de
authors: Simone
authors: S
authors: Vossel
authors: Peter H
authors: PH
authors: Weiss
authors: Philipp
authors: P
authors: Eschenbeck
authors: Gereon R
authors: GR
authors: Fink
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000209:etiology* / Q000523:psychology*; D001364:Awareness; D001931:Brain Mapping; D003627:Data Interpretation, Statistical; D005108:Extinction, Psychological / Q000502:physiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D010468:Perceptual Disorders / Q000209:etiology* / Q000523:psychology*; D012044:Regression Analysis; D012649:Self Concept; D020521:Stroke / Q000473:pathology* / Q000523:psychology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult