title: Mentalizing the body: spatial and social cognition in anosognosia for hemiplegia.
abstract: Following right-hemisphere damage, a specific disorder of motor awareness can occur called anosognosia for hemiplegia, i.e. the denial of motor deficits contralateral to a brain lesion. The study of anosognosia can offer unique insights into the neurocognitive basis of awareness. Typically, however, awareness is assessed as a first person judgement and the ability of patients to think about their bodies in more 'objective' (third person) terms is not directly assessed. This may be important as right-hemisphere spatial abilities may underlie our ability to take third person perspectives. This possibility was assessed for the first time in the present study. We investigated third person perspective taking using both visuospatial and verbal tasks in right-hemisphere stroke patients with anosognosia (n = 15) and without anosognosia (n = 15), as well as neurologically healthy control subjects (n = 15). The anosognosic group performed worse than both control groups when having to perform the tasks from a third versus a first person perspective. Individual analysis further revealed a classical dissociation between most anosognosic patients and control subjects in mental (but not visuospatial) third person perspective taking abilities. Finally, the severity of unawareness in anosognosia patients was correlated to greater impairments in such third person, mental perspective taking abilities (but not visuospatial perspective taking). In voxel-based lesion mapping we also identified the lesion sites linked with such deficits, including some brain areas previously associated with inhibition, perspective taking and mentalizing, such as the inferior and middle frontal gyri, as well as the supramarginal and superior temporal gyri. These results suggest that neurocognitive deficits in mental perspective taking may contribute to anosognosia and provide novel insights regarding the relation between self-awareness and social cognition.
authors.affiliation: 1 Department of Psychology, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, UK 2 Department of Psychology, University of Cape Town, South Africa 3 Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK.
authors.forename: Sahba
authors.initials: S
authors.lastname: Besharati
authors.affiliation: 3 Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK 4 Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Forkel
authors.affiliation: 5 Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Kopelman
authors.affiliation: 2 Department of Psychology, University of Cape Town, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Solms
authors.affiliation: 6 Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, UK.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Jenkinson
authors.affiliation: 3 Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK a.fotopoulou@ucl.ac.uk.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Fotopoulou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D005260:Female; D006429:Hemiplegia / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010468:Perceptual Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D010775:Photic Stimulation / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology; D013028:Space Perception / Q000502:physiology*; D056345:Theory of Mind / Q000502:physiology*
keywords: Theory of Mind; anosognosia; awareness; mentalizing; self
references.citation: Neuropsychologia. 2006;44(3):374-83
references.pmid: 16112148
references.citation: Monogr Soc Res Child Dev. 1986;51(1):i-v, 1-87
references.pmid: 3807927
references.citation: Neuropsychologia. 2011 Sep;49(11):2971-84
references.pmid: 21803062
references.citation: Brain. 2010 Dec;133(Pt 12):3564-77
references.pmid: 20823084
references.citation: J Neurosci. 2005 Aug 3;25(31):7134-8
references.pmid: 16079395
references.citation: Behav Res Ther. 2006 May;44(5):699-713
references.pmid: 16038873
references.citation: Science. 2005 Jul 15;309(5733):488-91
references.pmid: 16020740
references.citation: Neuropsychology. 2015 May;29(3):421-32
references.pmid: 25133319
references.citation: Neuroimage Clin. 2012 Aug 30;1(1):37-47
references.pmid: 24179735
references.citation: Neuroimage. 2005 Apr 15;25(3):926-35
references.pmid: 15808992
references.citation: Cereb Cortex. 2012 Oct;22(10):2428-40
references.pmid: 22095216
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Laterality. 2006 May;11(3):195-225
references.pmid: 16644560
references.citation: Neuroimage. 2008 May 1;40(4):1902-11
references.pmid: 18325789
references.citation: Nat Neurosci. 2003 May;6(5):448-50
references.pmid: 12704393
references.citation: Neuropsychologia. 2013 Jul;51(8):1453-62
references.pmid: 23603022
references.citation: Brain. 2012 May;135(Pt 5):1486-97
references.pmid: 22374937
references.citation: Dev Psychopathol. 1997 Fall;9(4):679-700
references.pmid: 9449001
references.citation: J Cogn Neurosci. 2009 Jun;21(6):1179-92
references.pmid: 18702587
references.citation: Cortex. 2004 Feb;40(1):19-40
references.pmid: 15070001
references.citation: Cognition. 2015 May;138:21-34
references.pmid: 25704580
references.citation: Percept Mot Skills. 1978 Oct;47(2):599-604
references.pmid: 724398
references.citation: Cortex. 2003 Apr;39(2):357-70
references.pmid: 12784893
references.citation: Neuropsychologia. 2009 Apr;47(5):1256-60
references.pmid: 19428388
references.citation: Cogn Neuropsychol. 2010 May;27(3):245-60
references.pmid: 20936548
references.citation: Brain. 2005 May;128(Pt 5):1102-11
references.pmid: 15774506
references.citation: J Cogn Neurosci. 2007 Jul;19(7):1081-8
references.pmid: 17583985
references.citation: Neuropsychologia. 1986;24(4):471-82
references.pmid: 3774133
references.citation: Nature. 2002 Sep 19;419(6904):269-70
references.pmid: 12239558
references.citation: Trends Cogn Sci. 2003 Feb;7(2):77-83
references.pmid: 12584026
references.citation: Child Dev. 1988 Feb;59(1):26-37
references.pmid: 3342716
references.citation: Nat Rev Neurosci. 2004 Oct;5(10):813-9
references.pmid: 15378041
references.citation: Neurology. 2000 Dec 12;55(11):1621-6
references.pmid: 11113214
references.citation: Trends Cogn Sci. 2007 Apr;11(4):153-7
references.pmid: 17300981
references.citation: Neuron. 2013 Sep 4;79(5):836-48
references.pmid: 24012000
references.citation: Nat Rev Neurosci. 2002 Jun;3(6):463-71
references.pmid: 12042881
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Cortex. 2014 Dec;61:127-40
references.pmid: 25481471
references.citation: Psychiatry Res. 2009 Aug 15;168(3):181-5
references.pmid: 19467562
references.citation: Conscious Cogn. 2015 May;33:500-10
references.pmid: 25459651
references.citation: J Cogn Neurosci. 2004 Jun;16(5):817-27
references.pmid: 15200709
references.citation: J Neurol Neurosurg Psychiatry. 2000 Apr;68(4):511-3
references.pmid: 10727491
references.citation: Neuroimage. 2007 Jul 1;36(3):511-21
references.pmid: 17499520
references.citation: Brain. 2010 Dec;133(Pt 12):3578-97
references.pmid: 21126995
references.citation: J Comput Assist Tomogr. 1998 Mar-Apr;22(2):324-33
references.pmid: 9530404
references.citation: J Am Geriatr Soc. 2005 Apr;53(4):695-9
references.pmid: 15817019
references.citation: Curr Biol. 2007 Aug 21;17(16):R724-32
references.pmid: 17714666
references.citation: Neuropsychologia. 2008 Apr;46(5):1429-41
references.pmid: 18304591
references.citation: Nat Neurosci. 2001 May;4(5):546-50
references.pmid: 11319565
references.citation: Behav Brain Res. 2011 Nov 20;225(1):259-69
references.pmid: 21777624
references.citation: Front Hum Neurosci. 2013 Aug 12;7:455
references.pmid: 23964228
references.citation: Cortex. 2000 Apr;36(2):289-92
references.pmid: 10815712
references.citation: Cognition. 2001 Nov;82(1):1-26
references.pmid: 11672703
references.citation: Neuropsychology. 2005 May;19(3):318-31
references.pmid: 15910118
references.citation: Neuropsychol Rehabil. 2015;25(3):319-52
references.pmid: 24958030
references.citation: Brain. 2004 Feb;127(Pt 2):243-58
references.pmid: 14662516
references.citation: Psychol Sci. 2006 Jan;17(1):74-81
references.pmid: 16371147
references.citation: Front Hum Neurosci. 2013 Oct 08;7:652
references.pmid: 24115930
references.citation: Annu Rev Psychol. 2007;58:259-89
references.pmid: 17002553
references.citation: Cognition. 1985 Oct;21(1):37-46
references.pmid: 2934210
references.citation: Conscious Cogn. 1995 Mar;4(1):22-51
references.pmid: 7497101
references.citation: Neuroimage. 2001 Jul;14(1 Pt 1):170-81
references.pmid: 11525326
references.citation: Cortex. 1978 Jun;14(2):294-303
references.pmid: 679710
references.citation: J Int Neuropsychol Soc. 1996 Sep;2(5):426-40
references.pmid: 9375168