Medicine:Anosodiaphoria
| Anosodiaphoria | |
|---|---|
| Specialty | Neurology |
Anosodiaphoria is a condition in which a person who has a brain injury seems indifferent to the existence of their impairment. Anosodiaphoria is specifically used in association with indifference to paralysis. It is a somatosensory agnosia, or a sign of neglect syndrome.[1] It might be specifically associated with defective functioning of the frontal lobe of the right hemisphere.[2]
Joseph Babinski first used the term anosodiaphoria in 1914 to describe a disorder of the body schema in which patients verbally acknowledge a clinical problem (such as hemiparesis) but fail to be concerned about it.[3] Anosodiaphoria follows a stage of anosognosia, in which there may be verbal, explicit denial of the illness, and after several days to weeks, develop the lack of emotional response.[4] Indifference is different from denial because it implies a lack of caring on the part of the patient, who otherwise acknowledges his or her deficit.[citation needed]
Signs and symptoms
Causes
A few possible explanations for anosodiaphoria exist:
- The patient is aware of the deficit but does not fully comprehend it or its significance for functioning
- May be related to an affective communication disorder and defective arousal. These emotional disorders cannot account for the verbal explicit denial of illness of anosognosia.[5]
Other explanations include reduced emotional experience, impaired emotional communication, alexithymia, behavioral abnormalities, dysexecutive syndrome, and the frontal lobes.[6]
Neurology
Anosodiaphoria occurs after stroke of the brain. 27% of patients with an acute hemispheric stroke had the stroke in the right hemisphere, while 2% have it in their left.[7]
Anosodiaphoria is thought to be related to unilateral neglect, a condition often found after damage to the non-dominant (usually the right) hemisphere of the cerebral cortex in which patients seem unable to attend to, or sometimes comprehend, anything on a certain side of their body (usually the left).[citation needed]
The frontal lobe is thought to be the primary area for the lack of emotional insight seen in anosodiaphoria, such as in frontotemporal dementia. A recent 2011 study done by Mendez and Shapira found that people with frontotemporal dementia also had a loss of insight more properly described at "frontal anosodiaphoria", a lack of concern for proper self-appraisal. Patients were found to have a lack of emotional updating, or concern for having an illness; an absence of an emotional self-referent tagging of information on their disorder, which they think is possibly from disease in the ventromedial prefrontal cortex, anterior cingulate-anterior insula area, especially on the right.[8]
Treatment
Indifference to illness may have an adverse impact on a patient's engagement in neurological rehabilitation, cognitive rehabilitation and physical rehabilitation. Patients are not likely to implement rehabilitation for a condition about which they are indifferent. Although anosognosia often resolves in days to weeks after stroke, anosodiaphoria often persists.[9] Therefore, the therapist has to be creative in their rehabilitation approach in order to maintain the interest of the patient.[citation needed]
See also
- Anosognosia
- Body schema
- Brain damage
- Frontotemporal dementia
- Indifference
- Oliver Sacks
- Unilateral neglect
References
- ↑ "Anosodiaphoria." http://cancerweb.ncl.ac.uk/cgi-bin/omd?anosodiaphoria. Online Medical Dictionary[|permanent dead link|dead link}}]
- ↑ Prigatano, George P. (2010-04-21) (in en). The Study of Anosognosia. Oxford University Press. ISBN 978-0-19-970244-2. https://books.google.com/books?id=d4S-T0NboMQC&pg=PA89.
- ↑ Prigatano, G. (1991). Awareness of deficit after brain injury: clinical and theoretical issues. New York, New York: Oxford University Press.
- ↑ Prigatano, G. (2010). The study of anosognosia. New York, New York: Oxford University Press.
- ↑ Prigatano, George P.; Schacter, Daniel L. (1991-01-24) (in en). Awareness of Deficit after Brain Injury: Clinical and Theoretical Issues. Oxford University Press. ISBN 978-0-19-802257-2. https://books.google.com/books?id=xze89PCLaWMC.
- ↑ Prigatano, G. (2010). The study of anosognosia. New York, New York: Oxford University Press.
- ↑ Stone, S.P. Halligan, P.W., and Greenwood, R.J. (1993). The incidence of neglect phenomenon and related disorders in patients with an acute right or left hemisphere stroke. Age and Aging, 22, 46-52.
- ↑ Mendez, M.F. & Shapira, J.S. (2011). Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria".Consciousness and Cognition, 20(4), 1690-1696.
- ↑ Barrett, A.M., Buxbaum, L.J., Coslett, H.B., Edwards, E., Heilman, K.M., Hillis, A.E., Milberg, W.P., and Robertson, I.H. (2006). Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. Journal of Cognitive Neuroscience, 18(7), 1223-1236.
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