Unawareness of disease following lesions of the right hemisphere: Anosognosia for hemiplegia and anosognosia for hemianopia

doi:10.1016/0028-3932(86)90092-8

Neuropsychologia

Volume 24, Issue 4, 1986, Pages 471-482

https://doi.org/10.1016/0028-3932(86)90092-8 Get rights and content

Abstract

Unawareness of motor and visual-field defects was investigated in 97 right brain-damaged subjects. Both kinds of anosognosia were found to be double-dissociated from more elementary neurological disorders and from personal and extra-personal neglect. The relationships between anosognosia and unilateral neglect are discussed and allusion is made to the implications concerning the neurological organization of higher control functions.

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The ‘healthy side’ of anosognosia for hemiplegia: Increased sense of agency for the unimpaired limb or motor compensation?
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Anosognosic patients show a lack of awareness for their hemiplegia coupled with a distorted sense of agency for the actions performed by the plegic limbs. Since anosognosia is often associated with right brain damage, this hemisphere seems to play a dominant role in monitoring awareness for motor actions. Therefore, we would expect that anosognosic patients show distorted awareness and sense of agency also for actions performed with the unimpaired limb.
To test this hypothesis, we induced illusory actions that could be congruent or incongruent with a preceding verbal command. A group of 16 right brain-damaged patients performed this task and then rated i) their ability to anticipate the actions, ii) their sense of agency and iii) their sense of ownership for each limb. Measures of awareness, neglect and motor impairment were also considered for the patient group.
Following incongruent actions with the unimpaired limb, less aware patients showed a relatively mild distortion in all three aspects. In addition, we also found a crucial relationship between motor impairment (for the plegic limb) and sense of agency for both plegic and healthy limbs.
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Extending the two-component model of delusion to substance use disorder etiology and recovery
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The brain disease model (BMDA) and psychosocial models of addiction attend to phenomena at different levels of biological organization, and evidence suggests neither is sufficient to explain substance use disorder (SUD). Here, we extend a Bayesian model of the emergence and persistence of delusions to SUD etiology and recovery, building upon efforts to link lower-level impacts of psychoactive compounds to higher-level phenomena such as attitudes, beliefs, and self-control. According to the resulting two-component model of SUD, psychoactive substances interact with genetic and environmental factors to produce delusions about the biological importance of substance use and its contexts by perturbating basic human affective systems. These delusions are most often revised or rejected based on individuals’ existing belief systems. But in some individuals, factors explaining the persistence of an array of delusions (e.g., lower levels of executive functioning) prevent the evaluation and revision system from rejecting or revising beliefs that attribute high salience to substance-related stimuli. This theory provides novel hypotheses regarding the potential roles of factors such as dichotomous thinking, positive illusions and self-deception, and denial or lack of awareness in SUD etiology and recovery. Furthermore, it provides an account of SUD that may result in less stigma than the BDMA.
Awareness is in the eye of the observer: Preserved third-person awareness of deficit in anosognosia for hemiplegia
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In recent decades, the research traditions of (first-person) embodied cognition and of (third-person) social cognition have approached the study of self-awareness with relative independence. However, neurological disorders of self-awareness offer a unifying perspective to empirically investigate the contribution of embodiment and social cognition to self-awareness. This study focused on a neuropsychological disorder of bodily self-awareness following right-hemisphere damage, namely anosognosia for hemiplegia (AHP). A previous neuropsychological study has shown AHP patients, relative to neurological controls, to have a specific deficit in third-person perspective taking and allocentric stance (the other unrelated to the self) in higher order mentalizing tasks. However, no study has tested if verbal awareness of motor deficits is influenced by perspective-taking and centrism and identified the related anatomical correlates. Accordingly, two novel experiments were conducted with right-hemisphere stroke patients with (n = 17) and without AHP (n = 17) that targeted either their own (egocentric, experiment 1) or another stooge patients (allocentric, experiment 2) motor abilities from a first-or-third person perspective. In both experiments, neurological controls showed no significant difference in perspective-taking, suggesting that social cognition is not a necessary consequence of right-hemisphere damage. More specifically, experiment 1 found AHP patients more aware of their own motor paralysis (egocentric stance) when asked from a third compared to a first-person perspective, using both group level and individual level analysis. In experiment 2, AHP patients were less accurate than controls in making allocentric judgements about the stooge patient, but with only a trend towards significance and with no difference between perspectives. As predicted, deficits in egocentric and allocentric third-person perspective taking were associated with lesions in the middle frontal gyrus, superior temporal and supramarginal gyri, and white matter disconnections were more prominent with deficits in allocentricity. Behavioural and neuroimaging results demonstrate the intersecting relationship between bodily self-awareness and self-and-other-directed metacognition or mentalisation.
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In healthy subjects, the transient perturbation of body part ownership is accompanied by regional skin temperature decrease. This observation leaves an open question about a possible body part-specific thermoregulatory response in pathological conditions, in which the sense of ownership over that body part is altered. For instance, Body Integrity Dysphoria (BID), a poorly understood neuropsychiatric disorder, is characterised by the non-acceptance of one or more of one's extremities. This unsettling feeling pervasively captures the individuals' attention towards the unwanted limb. Previous studies characterised BID in terms of absent ownership feeling with preserved ownership judgment. We explored for the first time whether this altered feeling is also associated with a specific thermoregulatory response. We recorded thermal image sequences of circumscribed regions of the limbs' skin in seven individuals with BID desiring to remove one leg while they were invited to focus their attention toward one particular limb (arm or leg). Their event-related thermoregulatory pattern was compared to a group of healthy matched controls. In individuals with BID but not in control persons, we found a bilateral decrease in leg temperature when focusing their attention on either the unwanted or accepted leg. The event-related thermoregulatory response for both upper limbs was similar between individuals with BID and healthy controls. Our results suggest that the alteration of the sense of body ownership in neuropsychiatric conditions such as BID may critically rest on specific event-related thermoregulatory patterns in response to modulation of attention to body parts.
Where in the Brain is “the Other's” Hand? Mapping Dysfunctional Neural Networks in Somatoparaphrenia
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Somatoparaphrenia refers to the delusional belief, typically observed in right brain-damaged patients, that the contralesional limbs belong to someone else. Here, we aimed to uncover the neural activity associated with this productive, i.e. confabulatory, component in a patient, S.P.P., with a large right-sided lesion of both cortical and subcortical gray and white matter. He claimed that his left paralyzed hand belonged to his mother. In a block-design functional magnetic resonance (fMRI) experiment, S.P.P. imagined that the mother would move her (i.e. his left) hand (condition “mother”). Subtraction of the activity elicited by control conditions (imagery of self-generated movement of either left or right hand) from that in the “mother” condition resulted in the focal activation of the pars opercularis of the right inferior frontal gyrus (rIFG). In a separate, resting-state fMRI experiment with S.P.P. and 21 healthy controls, we examined the functional connectivity of the rIFG and the affected hand somatosensory network to the rest of the brain. We found a negative correlation between the activity in the rIFG and that of Broca area and the temporo-parietal junction in the left hemisphere. Furthermore, the affected hand somatosensory network was disconnected from the left secondary somatosensory cortex. Our results link the productive component of somatoparaphrenia to the activity of crucial hubs for integrating the multimodal signals of the affected hand. Furthermore, they provide the first direct evidence supporting the “left narrator model”, proposed by Halligan et al. (1995), according to which the confabulations of somatoparaphrenia are due to a disconnection of left hemisphere language areas from right hemisphere parieto-temporal cortex.

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^∗: Present address: Dipartimento di Tecnologie Biomediche dell'Università di Milano.

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Unawareness of disease following lesions of the right hemisphere: Anosognosia for hemiplegia and anosognosia for hemianopia

Abstract

Cortex

Brain

de Le jargon des aphasiques, désintégration anosognosique des valeurs sémantiques du langage

J. Psychol.

de Le jargon des aphasiques, désintégration anosognosique des valeurs sémantiques du langage

J. Psychol.

Ueber die Selbstwahrnehmung der Herderkrankungen des Gehirns durch den Kranken bei Rindenblindheit und Rindentaubheit

Arch. Psychiat. Nervenkrankh.

Contribution à l'étude des troubles mentaux dans l'hémiplégie organique cérébrale (anosognosie)

Revue. neurol.

Anosognosie

Revue neurol.

Neglect dysgraphia

J. Neurol. Neurosurg. Psychiat.