Anosognosia

The Anosognosia is characterized by a lack of awareness of physical deficits or illnesses. Usually there is a right hemisphere parietal lobe lesion. Since there is no insight into the disease, successful therapy is very difficult to carry out.

What is anosognosia?

The stroke is the main cause of organic anosognosia. In these cases, the affected patients cannot perceive the failure of one half of the body or some sensory functions.

Anosognosia is the failure of the person concerned to recognize obvious physical disabilities. For example, the patient denies hemiplegia, blindness or deafness. Translated from the Greek, the term means the negation of a disease. Anosognosia occurs in two forms: on the one hand, it can be about not being able to recognize and, on the other hand, about not wanting to recognize the disorder.

While not being able to recognize is more likely to be caused by neurological and organically determined causes, not wanting to recognize is usually a psychopathological illness. A total of four subspecies of anosognosia are again distinguished:

• the cortical blindness

• asomatognosia (denial of one's own extremities)

• somatoparaphrenia (assignment of one's own extremity to another person)

• the anosodiaphoria - the own disease is called a trifle. The disorder is ignored and denied by the patient.

causes

Anosognosia is very often caused by a right hemisphere parietal lobe defect. This can very often be triggered by a stroke. Due to the damage to the right hemisphere, the left hemisphere dominates with its speech center. Each half of the brain coordinates the functions of the opposite half of the body. If the right hemisphere is damaged and communication between both hemispheres is interrupted at the same time, left-sided paralysis can occur, which is ignored and explained away by the affected patient.

The same applies to cortical blindness or certain forms of deafness that are based on information processing disorders in the brain. Usually only left-sided body disorders are ignored, since the intact left brain hemisphere exclusively coordinates functions of the right hemisphere. In the case of disorders in the left hemisphere, the right hemisphere dominates. The effects on anosognosia, however, are usually not so serious because the right hemisphere then partly also takes over the functions of the left hemisphere.

The stroke is the main cause of organic anosognosia. In these cases, the affected patients cannot perceive the failure of one half of the body or some sensory functions. But there are also psychopathological causes for anosognosia in the broader sense. These occur, among other things, in schizophrenia or dementia.

Schizophrenia is characterized by disorders of perception, thinking and ego function. Therefore, in the acute phase of the disease, there is no possibility of insight into the disease for these patients. In dementia, the extreme loss of memory prevents an awareness of the disease.

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Symptoms, ailments & signs

Anosognosia is not a disease in itself, but a symptom of an underlying disorder. It usually occurs as part of a stroke.

But other disease processes in the brain can also damage the right hemisphere parietal lobe. As a result, unilateral paralysis on the left side of the body is ignored by some patients. They continue to behave as if there was no restriction. The consequences are, for example, frequent falls with injuries.

The many smaller accidents are explained, among other things, by clumsiness. Blindness and deafness, which arise from disruptions in information processing, are also denied. Among other things, blindness is explained by external causes such as darkness. In some cases, mainly left-sided limbs appear alien or non-existent. The disorder known as neglect is a special form of anosognosia.

In neglect, in addition to the impairments on the left side, the entire left side of the body and all processes occurring on the left side of the body are ignored. Patients only wash the right side of their body, only shave the right side of their face, or only eat from the right side of their plate.

In psychopathological diseases such as schizophrenia or dementia, anosognosia can refer to all possible physical limitations. Here there is a lack of general insight into the underlying disease and its symptoms. In dementia the symptoms are literally forgotten and in schizophrenia they are often reinterpreted.

Diagnosis & course

Anosognosia can often be quickly diagnosed when obvious disabilities are stubbornly denied. There are several neuropsychological test procedures for diagnosing neglect. By drawing, searching, copying, and reading tasks, the doctor can quickly diagnose a neglect. For example, a clock is only drawn halfway or the words on the left are ignored when reading.

Complications

The anosognosia often leads to complications. These can vary depending on the form and severity of the anosognosia. Anosognosia is characterized or defined by the failure to recognize physical deficits and / or illnesses.

This failure to recognize and deny the obviously existing physical deficits or illnesses can lead to various problems in everyday life. A large part of this is due to the fact that the patient expects himself to do activities which he should not or cannot do due to the actual deficit or the actually existing disease.

This can result in injuries or worsening of the existing illnesses. Conveying to the patient that certain activities are not possible for him or should be avoided for health reasons is difficult or even impossible. It is clear to the patient that he himself is not ill and does not suffer from a physical deficit. It is not a question of "ignoring" the suffering, but of actually not being aware of it. This makes it difficult to make it clear that certain behaviors should be turned off.

Furthermore, so-called confabulation often occurs in the context of anosognosia. Here the patient is telling obviously untrue things that appear to him personally to be true. At the moment he tells the story, he is convinced of the truth of what has been said. This can lead to problems in the interpersonal area, which can also be seen as a "complication" in the context of anosognosia.

When should you go to the doctor?

The way to the doctor in the event of anosognosia is basically to be classified as immediate. The problem, however, is that this disease is a kind of paradox. Usually the diagnosis of an existing underlying disease has already been made and the patient is fully informed.

In addition, there is anosognosia and thus the misjudgment. Despite sufficient symptoms, the person concerned has a different assessment of the situation and often does not follow the advice of the specialist. If there is enough trust in relatives and other caregivers in the social environment, a patient with anosognosia may regularly consult a doctor. This would be optimal, as it can be used to influence. Nevertheless, it is to be expected that the patient will not stick to medical advice due to the selectivity of his own perception and will not seek the way to the doctor.

For this reason, it is recommended that relatives consult with the doctor, inform them comprehensively about the patient's state of health and gently try to exert influence. Repeatedly showing comparative cases or test results from imaging procedures as well as clinical studies can be helpful in order to activate awareness of one's own illness again and again. It is helpful if relatives succeed in helping the person concerned immediately in situations of overestimation.

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Treatment & Therapy

Fortunately, lengthy treatment for anosognosia is usually not necessary. In most cases, it disappears on its own after a few days to a few weeks. It is generally difficult to treat patients with anosognosia because of the lack of insight into the disease. The therapy naturally also includes the patient taking part voluntarily. In severe cases, in which the anosognosia persists for a long time, insight into the disease must first be generated through psychotherapeutic treatments.

There are a number of therapeutic methods, especially for a neglect. Among other things, the damaged hemisphere can be temporarily activated by caloric stimulation, whereby either cold or warm water is flushed into the ear canal. Patients with schizophrenia require medicinal medication, which may be forcibly applied. Afterwards, the insight into the disease usually increases again, which then moves the patient to voluntary medication.

Outlook & forecast

The disease is based on damage to specific cortical areas on the right side of the hemispheres. According to the current state of science, the human brain areas can only be cured insufficiently or not at all. Therefore, the existing impairments remain constant or can progress further.

A deterioration in the state of health depends on the cause of the anosognosia. In most cases, the disease is suddenly caused by having suffered a stroke. It can be assumed here that there will be no changes in the existing symptoms for a long time.

The complaints remain constant, as the patient's lack of insight into the disease means that there are few options for effective therapy or medical care. Many patients refuse medical care because they are not aware of their physical symptoms. If there is an underlying psychopathological disease, there may be a further deterioration in health and an increase in symptoms.

In dementia, the functional ability of the brain areas gradually deteriorates, usually over several years. This leads to an expansion of the damaged tissue while at the same time reducing the mental possibilities. Not knowing and not remembering are increasing. In the further course, in addition to orientation problems and the loss of knowledge, there are further motor restrictions.

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prevention

Anosognosia cannot be prevented. It occurs in the context of strokes and psychopathological diseases. Only the best possible treatment and follow-up for these conditions can reduce the risk of recurrence of the anosognosia.

Aftercare

After an anosognosia, the regular follow-up check-ups must be taken. Usually, follow-up care focuses on providing the patient with appropriate therapy by identifying any triggers. The patient should see a neurologist every six months.

In addition, follow-up checks must be carried out at regular intervals by the ophthalmologist, ear specialist or orthopedic surgeon, depending on the disease that the patient refuses to recognize and the associated symptoms. Aftercare includes psychological counseling. If the patient agrees to continue the therapy, further measures can be initiated.

Behavioral therapies and cognitive training can be used to reduce the risk of recurrent anosognosia. Follow-up care includes an anamnesis in which the patient intensively deals with the patient's fears. If the outcome is positive, if the patient acknowledges the disease and has it treated, no further medical consultations are necessary.

If the patient does not recognize the disease, further therapies can be considered. In older patients, psychological treatment is eventually discontinued if there is no improvement in cognitive ability. Nevertheless, an attempt must be made to convince the patient that the original condition should be treated.

You can do that yourself

Since the patient with anosognosia either cannot recognize or does not want to recognize the disorder he is suffering from, self-help is generally excluded. Supportive measures beyond medical care must be provided by the patient's social environment.

What is required for this depends on the type of underlying disease that the patient is suppressing. If it is a question of blindness or deafness on one side only, measures that serve to prevent accidents are usually sufficient. As a rule, patients are no longer able to drive a motor vehicle independently. If the person concerned has no insight into this, the car or bicycle must be seized against his will if necessary.

Patients should not use public transport alone, as the unconscious loss of a sensory organ increases the risk of accidents.Hazardous areas should also be secured in the residential area. These include, for example, pointed-edged pieces of furniture, open fires, hot stovetops and all kinds of steps.

It is usually also beneficial if the social environment shows the patient his repressed suffering with the necessary subtlety. In the case of visible disturbances, an effective method of confrontation is to take a photo of the patient and then show him the photo immediately afterwards. Visible deformations can then no longer simply be rationalized away by the person concerned. The patient is thus forced to deal with his or her suffering.