anosodiaphoria
{{Infobox medical condition (new)
| name = Anosodiaphoria
| field = Neurology
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Anosodiaphoria is the inability to recognize the full importance of a neurological disability brought on by a brain lesion.{{cite book | last=Mendoza | first=John E. | title=Encyclopedia of Clinical Neuropsychology | chapter=Anosodiaphoria | publisher=Springer New York | publication-place=New York, NY | date=2011 | isbn=978-0-387-79947-6 | doi=10.1007/978-0-387-79948-3_702 | page=179–179}} It might be specifically associated with defective functioning of the frontal lobe of the right hemisphere.{{Cite book |last=Prigatano |first=George P. |url=https://books.google.com/books?id=d4S-T0NboMQC&pg=PA89 |title=The Study of Anosognosia |date=2010-04-21 |publisher=Oxford University Press |isbn=978-0-19-970244-2 |language=en |access-date=2017-08-27 |archive-date=2022-07-24 |archive-url=https://web.archive.org/web/20220724193944/https://books.google.com/books?id=d4S-T0NboMQC&pg=PA89 |url-status=live }}
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. 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.{{cite book | last=Prigatano | first=G.P. | title=The Study of Anosognosia | publisher=Oxford University Press, USA | year=2010 | isbn=978-0-19-537909-9 |url=https://books.google.com/books?id=nyxnDAAAQBAJ | access-date=2024-07-22 | page=}}
Signs and symptoms
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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.{{Cite book |last1=Prigatano |first1=George P. |url=https://books.google.com/books?id=xze89PCLaWMC |title=Awareness of Deficit after Brain Injury: Clinical and Theoretical Issues |last2=Schacter |first2=Daniel L. |date=1991-01-24 |publisher=Oxford University Press |isbn=978-0-19-802257-2 |language=en}}
Other explanations include reduced emotional experience, impaired emotional communication, alexithymia, behavioral abnormalities, dysexecutive syndrome, and the frontal lobes.
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.{{cite journal | last1=STONE | first1=S. P. | last2=HALLIGAN | first2=P. W. | last3=GREENWOOD | first3=R. J. | title=The Incidence of Neglect Phenomena and Related Disorders in Patients with an Acute Right or Left Hemisphere Stroke | journal=Age and Ageing | publisher=Oxford University Press (OUP) | volume=22 | issue=1 | year=1993 | issn=0002-0729 | doi=10.1093/ageing/22.1.46 | pages=46–52| pmid=8438666 }}
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.{{cite journal | last1=Mendez | first1=Mario F. | last2=Shapira | first2=Jill S. | title=Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria" | journal=Consciousness and Cognition | publisher=Elsevier BV | volume=20 | issue=4 | year=2011 | issn=1053-8100 | doi=10.1016/j.concog.2011.09.005 | pages=1690–1696| pmid=21959203 | pmc=3199289 }}
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.{{cite journal | last1=Barrett | first1=Anna M. | last2=Buxbaum | first2=Laurel J. | last3=Coslett | first3=H. Branch | last4=Edwards | first4=Emmeline | last5=Heilman | first5=Kenneth M. | last6=Hillis | first6=Argye E. | last7=Milberg | first7=William P. | last8=Robertson | first8=Ian H. | title=Cognitive Rehabilitation Interventions for Neglect and Related Disorders: Moving from Bench to Bedside in Stroke Patients | journal=Journal of Cognitive Neuroscience | publisher=MIT Press - Journals | volume=18 | issue=7 | date=2006-07-01 | issn=0898-929X | doi=10.1162/jocn.2006.18.7.1223 | pages=1223–1236| pmid=16839294 | hdl=2262/35966 | hdl-access=free }}