Anosodiaphoria

Anosodiaphoria
Anosodiaphoria
Specialty	Neurology

Anosodiaphoria is the inability to recognize the full importance of a neurological disability brought on by a brain lesion.^[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]

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.^[3]

Other explanations include reduced emotional experience, impaired emotional communication, alexithymia, behavioral abnormalities, dysexecutive syndrome, and the frontal lobes.^[4]

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.^[5]

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.^[6]

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.^[7]

References

^ Mendoza, John E. (2011). "Anosodiaphoria". Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York. p. 179–179. doi:10.1007/978-0-387-79948-3_702. ISBN 978-0-387-79947-6.
^ Prigatano, George P. (2010-04-21). The Study of Anosognosia. Oxford University Press. ISBN 978-0-19-970244-2. Archived from the original on 2022-07-24. Retrieved 2017-08-27.
^ ^a ^b Prigatano, George P.; Schacter, Daniel L. (1991-01-24). Awareness of Deficit after Brain Injury: Clinical and Theoretical Issues. Oxford University Press. ISBN 978-0-19-802257-2.
^ ^a ^b Prigatano, G.P. (2010). The Study of Anosognosia. Oxford University Press, USA. ISBN 978-0-19-537909-9. Retrieved 2024-07-22.
^ STONE, S. P.; HALLIGAN, P. W.; GREENWOOD, R. J. (1993). "The Incidence of Neglect Phenomena and Related Disorders in Patients with an Acute Right or Left Hemisphere Stroke". Age and Ageing. 22 (1). Oxford University Press (OUP): 46–52. doi:10.1093/ageing/22.1.46. ISSN 0002-0729. PMID 8438666.
^ Mendez, Mario F.; Shapira, Jill S. (2011). "Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria"". Consciousness and Cognition. 20 (4). Elsevier BV: 1690–1696. doi:10.1016/j.concog.2011.09.005. ISSN 1053-8100. PMC 3199289. PMID 21959203.
^ Barrett, Anna M.; Buxbaum, Laurel J.; Coslett, H. Branch; Edwards, Emmeline; Heilman, Kenneth M.; Hillis, Argye E.; Milberg, William P.; Robertson, Ian H. (2006-07-01). "Cognitive Rehabilitation Interventions for Neglect and Related Disorders: Moving from Bench to Bedside in Stroke Patients". Journal of Cognitive Neuroscience. 18 (7). MIT Press - Journals: 1223–1236. doi:10.1162/jocn.2006.18.7.1223. hdl:2262/35966. ISSN 0898-929X. PMID 16839294.

[v371-1] Mendoza, John E. (2011). "Anosodiaphoria". Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York. p. 179–179. doi:10.1007/978-0-387-79948-3_702. ISBN 978-0-387-79947-6.

[2] Prigatano, George P. (2010-04-21). The Study of Anosognosia. Oxford University Press. ISBN 978-0-19-970244-2. Archived from the original on 2022-07-24. Retrieved 2017-08-27.

[d622-3] Prigatano, George P.; Schacter, Daniel L. (1991-01-24). Awareness of Deficit after Brain Injury: Clinical and Theoretical Issues. Oxford University Press. ISBN 978-0-19-802257-2.

[Prigatano-4] Prigatano, G.P. (2010). The Study of Anosognosia. Oxford University Press, USA. ISBN 978-0-19-537909-9. Retrieved 2024-07-22.

[f822-5] STONE, S. P.; HALLIGAN, P. W.; GREENWOOD, R. J. (1993). "The Incidence of Neglect Phenomena and Related Disorders in Patients with an Acute Right or Left Hemisphere Stroke". Age and Ageing. 22 (1). Oxford University Press (OUP): 46–52. doi:10.1093/ageing/22.1.46. ISSN 0002-0729. PMID 8438666.

[q191-6] Mendez, Mario F.; Shapira, Jill S. (2011). "Loss of emotional insight in behavioral variant frontotemporal dementia or "frontal anosodiaphoria"". Consciousness and Cognition. 20 (4). Elsevier BV: 1690–1696. doi:10.1016/j.concog.2011.09.005. ISSN 1053-8100. PMC 3199289. PMID 21959203.

[x202-7] Barrett, Anna M.; Buxbaum, Laurel J.; Coslett, H. Branch; Edwards, Emmeline; Heilman, Kenneth M.; Hillis, Argye E.; Milberg, William P.; Robertson, Ian H. (2006-07-01). "Cognitive Rehabilitation Interventions for Neglect and Related Disorders: Moving from Bench to Bedside in Stroke Patients". Journal of Cognitive Neuroscience. 18 (7). MIT Press - Journals: 1223–1236. doi:10.1162/jocn.2006.18.7.1223. hdl:2262/35966. ISSN 0898-929X. PMID 16839294.

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