The Study of Anosognosia 1st Edition

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To Dagmar, Laura, and Katie
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 Preface

The study of anosognosia is important for several reasons:

1. Patients with identifiable brain disorders (e.g., cerebrovascular accident
[CVA], severe traumatic brain injury [TBI], etc.) may have reduced self-aware-
ness of residual neurological or neuropsychological impairments that nega-
tively impact their clinical care.
2. Understanding the biological and neuropsychological mechanisms responsible
for anosognosia in its various forms may reveal important insights into brain
organization and how human consciousness (subjective awareness of the self
and the environment) is possible.
3. The comparative study of anosognosia in patients with identifiable brain
disorders in comparison to patients with psychiatric disorders (e.g., hysterical,
conversion disorder) may provide rich insights into the ‘‘body–mind’’ problem.
4. Understanding the basis of how anosognosia changes with time (i.e.,
‘‘recovers’’ or ‘‘worsens’’) may provide important insights into mechanisms of
‘‘recovery’’ and ‘‘deterioration’’ after various brain disorders. This has clear
implications for treatment and patient management.

It is, therefore, with considerable pleasure that this volume has become a
reality. Hopefully, it will encourage clinicians and researchers to continue
creative work in this area of investigation. This text is the direct result of a
conference held in Phoenix, Arizona, at the Arizona Biltmore Hotel between
October 24 and 27, 2008. Prominent clinicians and researchers who have
studied anosognosia were willing to prepare chapters prior to meeting at the
conference. During the conference they presented their ideas to the various
participants. The authors then modified their chapters after the meeting con-
cluded, to help clarify the new findings and review present and old theoretical
perspectives. Additional chapters were added after the conference to cover topics
not addressed at that time. The expressed goal of the conference and of this book
was to summarize advances in the study of anosognosia. It is hopeful that readers
and reviewers of this edited text will conclude that this has been achieved.
The text does not cover all possible studies relevant to understanding anosog-
nosia, but it does provide a summary of hundreds of studies that have bearing on
this topic. I am indebted to the various authors who have taken seriously the need

vii
viii PREFACE

to summarize important findings relevant to the study of anosognosia. Chapter

lengths within this volume vary, but they do so primarily because of the databases
that presently exist. Clearly, there is more to say in some areas than in others.
In the initial section of this book, chapters are devoted to the study of
anosognosia for hemiplegia (AHP). These chapters repeat certain historical
observations and models that have helped explain this phenomenon. This is
necessary because each set of authors needed to set the stage for their particular
approach to the study of AHP. Repetition can also be valuable insofar as it helps
reveal how the same historical observations have impacted individual investiga-
tors differentially, thus modifying their focus of attention when conducting
research. As is true in all of science, advances represent the unique interests of
investigators and the body of research knowledge that they find most relevant.
Other sections of this text have described how the study of anosognosia has
expanded over the last several years. This expansion may, in part, have been
stimulated by the first book that emanated from a similar conference on ano-
sognosia that was held in Phoenix, Arizona, in October of 1988. That conference
resulted in the edited text Awareness of Deficit after Brain Injury: Clinical and
Theoretical Issues (Prigatano & Schacter, 1991).
Both conferences were made possible by the generous support of the Barrow
Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix,
Arizona. I have had the good fortune of being affiliated with the Barrow
Neurological Institute (BNI) since 1985, and wish to express to hospital admin-
istrators, including Phil Pomeroy, Vice President of Neuroscience and
Dr. Robert F. Spetzler, Director of the BNI, my gratitude for their continued
support and encouragement. I would also like to explicitly recognize Dr. Spetzler
for his continued efforts in providing support to carry out such an important
meeting during difficult financial times. Funding from the Barrow Neurological
Foundation (BNF) and the Newsome Foundation made this conference possible.
Special recognition and thanks also goes to Lindsey Kerby, conference plan-
ning manager for the BNI, and to Mary Henry, administrative assistant in the
Department of Clinical Neuropsychology. Ms. Henry’s work in preparing this
manuscript is especially appreciated. Jennifer Gray, Ph.D., was invaluable in her
help editing the chapters of this book.
The continued goal of the Department of Clinical Neuropsychology within
the Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center is
to provide patient care based on our most recent scientific understanding of how
various brain disorders affect psychological functioning. This needs to be done,
however, in a manner that is sensitive to each individual’s personal reaction to
his or her neurological and neuropsychological disturbances. This book repre-
sents our most recent efforts in this regard.

George P. Prigatano, Ph.D.,

Newsome Chair, Clinical Neuropsychology
 Contents

Contributors xiii

Part I
Historical Overview and 1. Historical Observations Relevant
Introduction 1 to the Study of Anosognosia 3
George P. Prigatano

Part II
Anosognosia of Motor and Language 2. Anosognosia for Hemiplegia and
Impairments 15 Models of Motor Control: Insights
from Lesional Data 17
Gabriella Bottini, Eraldo Paulesu,
Martina Gandola, Lorenzo Pia,
Paola Invernizzi, and Anna Berti

3. Anosognosia for Hemiparesis and

Hemiplegia: Disturbed Sense of
Agency and Body Ownership 39
Hans-Otto Karnath and
Bernhard Baier

4. The Insular Cortex and

Subjective Awareness 63
A. D. (Bud) Craig

5. Anosognosia and Anosodiaphoria

of Weakness 89
Kenneth M. Heilman and
Michal Harciarek

ix
x CONTENTS

6. Anosognosia in Aphasia 113

Andrew Kertesz

7. Assessing Anosognosia for

Motor and Language
Impairments 123
Gianna Cocchini and
Sergio Della Sala

Part III
Anosognosia Observed in Various Brain 8. Anosognosia in Huntington’s
Disorders 145 Disease 147
Daniel Tranel, Jane S. Paulsen,
and Karin F. Hoth

9. Anosognosia and Parkinson’s

Disease 159
George P. Prigatano,
Franziska Maier, and
Richard S. Burns

10. Anosognosia in Alzheimer’s

Disease: Neuroimaging
Correlates 171
Sergio E. Starkstein and
Brian D. Power

11. Anosognosia and Alzheimer’s

Disease: Behavioral Studies 189
Alfred W. Kaszniak and
Emily C. Edmonds

12. Anosognosia after Traumatic

Brain Injury 229
George P. Prigatano

13. Anosognosia in Schizophrenia

and Other Neuropsychiatric
Disorders: Similarities and
Differences 255
James Gilleen,
Kathryn Greenwood, and
Anthony S. David
 CONTENTS xi

Part IV
Anosognosia and Specific Cognitive and 14. Anosognosia and Personality
Affective Disturbances 291 Change in Neurodegenerative
Disease 293
Katherine P. Rankin

15. Anosognosia and Error

Processing in Various Clinical
Disorders 321
Ian H. Robertson

16. Emotional Awareness

among Brain-Damaged
Patients 333
Ricardo E. Jorge

Part V
Anosognosia and Hysteria 357 17. Neuroanatomy of Impaired Body
Awareness in Anosognosia and
Hysteria: A Multicomponent
Account 359
Roland Vocat and
Patrik Vuilleumier

Part VI
Measurement Issues and 18. Functional Imaging of
Technology 405 Self-Appraisal 407
Sterling C. Johnson and
Michele L. Ries

19. The Behavioral Measurement of

Anosognosia as a Multifaceted
Phenomenon 429
M. Donata Orfei,
Carlo Caltagirone, and
Gianfranco Spalletta

Part VII
Anosognosia and Visual Loss 453 20. Anton’s Syndrome and
Unawareness of Partial or
Complete Blindness 455
George P. Prigatano and
Thomas R. Wolf
xii CONTENTS

Part VIII
Advances in the Study of 21. A Progress Report on the Study of
Anosognosia 469 Anosognosia 471
George P. Prigatano

22. Management and Rehabilitation of

Persons with Anosognosia and
Impaired Self-Awareness 495
George P. Prigatano and
Jeannine Morrone-Strupinsky

Author Index 517

Subject Index 525
 Contributors

Bernhard Baier, M.D.

Department of Neurology
University of Mainz
Mainz, Germany
Anna Berti, M.D., Ph.D.
Department of Psychology
Neuropsychology Research Group
University of Turin
Turin, Italy
Gabriella Bottini, M.D., Ph.D.
Psychology Department
University of Pavia
Pavia, Italy
Richard S. Burns, M.D.
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona
Carlo Caltagirone, M.D.
Department of Clinical and Behavioural Neurology
IRCCS S. Lucia Foundation
Rome, Italy
Gianna Cocchini, Ph.D.
Psychology Department
Goldsmiths University of London
London, England
A. D. (Bud) Craig, Ph.D.
Atkinson Research Lab
Barrow Neurological Institute
Phoenix, Arizona

xiii
xiv CONTRIBUTORS

Anthony S. David, M.D.

Department of Psychiatry
Section of Cognitive Neuropsychiatry
Institute of Psychiatry
King’s College
London, England
Sergio Della Sala, M.D., Ph.D.
Human Cognitive Neuroscience, Psychology
University of Edinburgh
Edinburgh, Scotland
Emily C. Edmonds, M.A.
Department of Psychology
University of Arizona
Tucson, Arizona
Martina Gandola, M.A., Ph.D.
Psychology Department
University of Pavia
Pavia, Italy
James Gilleen, Ph.D.
Department of Psychiatry
Section of Cognitive Neuropsychiatry
Institute of Psychiatry
King’s College
London, England
Kathryn Greenwood, Ph.D.
Department of Psychology
Institute of Psychiatry
King’s College London
London, England
Michal Harciarek, Ph.D.
Institute of Psychology
University of Gda
nsk
Gda
nsk, Poland
Kenneth M. Heilman, M.D.
Department of Neurology
College of Medicine
University of Florida
Veteran’s Affairs Medical Center
Gainesville, Florida
 CONTRIBUTORS xv

Karin F. Hoth, Ph.D.

Division of Psychosocial Medicine
Department of Medicine
National Jewish Health
Department of Psychiatry
University of Colorado Denver
Denver, Colorado
Paola Invernizzi, M.A.
Psychology Department
Univeristy of Milano-Bicocca
Milano, Italy
Sterling C. Johnson, Ph.D.
Geriatric Research Education and Clinical Center
Wm. S. Middleton Memorial Veteran’s Hospital
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Ricardo E. Jorge, M.D.
Department of Psychiatry
University of Iowa Hospitals and Clinics
Iowa City, Iowa
Hans-Otto Karnath, M.D., Ph.D.
Section of Neuropsychology
Center of Neurology
Hertie-Institute for Clinical Brain Research
University of T€ubingen,
ubingen, Germany
T€
Alfred W. Kaszniak, Ph.D.
Department of Psychology
University of Arizona
Tucson, Arizona
Andrew Kertesz, M.D., FRCP (C)
Department of Neurology
University of Western Ontario
St. Joseph’s Health Center
London, Ontario, Canada
Franziska Maier, M.A.
Movement Disorders and Deep Brain Stimulation
Department of Neurology
University Hospital Cologne
Cologne, Germany
xvi CONTRIBUTORS

Jeannine Morrone-Strupinsky, Ph.D.

Department of Clinical Neuropsychology
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona
M. Donata Orfei, M.A.
Department of Clinical and Behavioural Neurology
IRCCS S. Lucia Foundation
Rome, Italy
Eraldo Paulesu, M.D.
Psychology Department
Univeristy of Milano-Bicocca
Milano, Italy
Jane S. Paulsen, Ph.D.
Departments of Psychiatry, Neurology, and Psychology
College of Medicine
University of Iowa
Iowa City, Iowa
Lorenzo Pia, Ph.D.
Department of Psychology
Neuropsychology Research Group
University of Turin
Turin, Italy
Brian D. Power, M.D.
Lecturer, School of Psychiatry and Neurosciences
University of Western Australia
Fremantle, Australia
George P. Prigatano, Ph.D.
Department of Clinical Neuropsychology
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona
Katherine P. Rankin, Ph.D.
Memory and Aging Center
Department of Neurology
University of California San Francisco
San Francisco, California
Michele L. Ries, Ph.D.
Geriatric Research Education and Clinical Center
 CONTRIBUTORS xvii

Wm. S. Middleton Memorial Veteran’s Hospital

University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Ian H. Robertson, Ph.D., MRIA
School of Psychology and Institute of Neuroscience
Trinity College Dublin
Dublin, Ireland
Gianfranco Spalletta, M.D., Ph.D.
Department of Clinical and Behavioural Neurology
IRCCS S. Lucia Foundation
Rome, Italy
Sergio E. Starkstein, M.D., Ph.D.
School of Psychiatry and Neurosciences
University of Western Australia
Fremantle, Australia
Daniel Tranel, Ph.D.
Departments of Neurology and Psychology
Division of Behavioral Neurology and Cognitive Neuroscience
College of Medicine
University of Iowa
Iowa City, Iowa
Roland Vocat, Ph.D.
Laboratory for Behavioral Neurology and Imaging of Cognition
Department of Neuroscience
University Medical Center & Department of Neurology
University Hospital
Geneva, Switzerland
Patrik Vuilleumier, M.D.
Laboratory for Behavioral Neurology and Imaging of Cognition
Department of Neuroscience
University Medical Center & Department of Neurology
University Hospital
Geneva, Switzerland
Thomas R. Wolf, M.D.
Consultant, Clinical Neuro-ophthalmology
Instructor in Neurology and Visiting Research Scientist in
Aerospace Medicine
Mayo Clinic Arizona
Phoenix, Arizona
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 I

Historical Overview and

Introduction