Anosognosia: inability to realize disability

Anosognosia is a neurological pathology. It appears when a person is not able to identify their own limitations or dysfunctions, being especially common in schizophrenic patients or with various personality disorders, as well as in people with Alzheimer’s, brain tumors or other problems of neurological origin.

It was in 1895 when the neuropathologist Constantin Von Monakov described the case of a patient with cortical blindness as a result of a lesion in primary visual areas. What stood out from this diagnosis was the lack of awareness about such a deficit. Nothing can be as striking as a blind person who is unable to admit his own deficiency.

Later, and in 1914, Joseph Babinski presented at the Paris Neurological Society the case of two patients with left hemiplegia and a total absence of awareness of their motor defect. In turn, the famous Polish neurologist introduced another term: anosodiaphoria, referring to cases in which there is total indifference towards the disease.

Definition of anosognosia

The neurologist George Prigatano, President of the National Academy of Neuropsychology, delved into the definition of anosognosia. Thus, among his studies and analysis, he ended up defining the following characteristics:

This is a clinical phenomenon by which A patient with brain dysfunction is unaware of the deterioration in neurological and/or neuropsychological function, which is evident to the physician and others.This lack of awareness cannot be explained by generalized cognitive impairment. Nor due to the patient’s own denial mechanism.The The causality of the lesion is indifferent to the possibility of showing anosognosia during the evolution of the disorder.

This is a total denial of symptoms in which the patient is not aware of the deterioration of their functions., even though it is evident to health professionals and people around them. This denial means that the person sees himself as capable of completing tasks on his behalf when he clearly cannot do so, putting himself in danger.

Types of anosognosia

The loss of the ability to perceive the consequences associated with this brain dysfunction (whether due to an injury or a neurodegenerative disease) results in different deficits that can cover the following areas:

Deficits in the perception of physical limitations.Deficits in the perception of cognitive limitations.Deficits in the perception of behavioral limitations.

Causes of anosognosia

Dr. Patrik Vuilleumier, from the Neurology Laboratory of the University of Geneva, explains to us in a study that this psychological condition of neurological origin is very complex. However, there are several common points that could explain the origin of anosognosia.

The first is that Various brain regions related to awareness are anatomically affected (whether by injury or disease).leading to an alteration in the ability to recognize or appreciate the severity of the deficits. The second is that our I, understood as awareness about ourselves, is relegated and cannot integrate the information related to the injury as part of us; In fact, it is as if it did not exist.

Diagnostic criteria and comorbidity

Although there are no specific criteria for its diagnosis, The Clinical Neuropsychology Consortium (2010) published the following criteria, in order to help their identification and classification:

Alteration of awareness of suffering from a deficit, whether physical, neurocognitive and/or psychological or suffering from a disease.Alteration in the form of denial of the deficitevidenced in statements such as “I don’t know why I’m here”, “I don’t know what’s wrong with me”, “I’ve never been good at these exercises, it’s normal that I don’t do them well”, “it’s the others who “They say I’m bad.”Evidence of deficits through evaluation instruments.Recognition of the alteration by family or acquaintances.Negative influence on the activities of daily living. The alteration does not appear in the context of confusional states or states of altered consciousness.

This alteration tends to occur comorbidly with disorders of two types:

Neurological: neurovascular disorders, Alzheimer’s type dementia, mild cognitive impairment, tumors, fronto-temporal dementia, head trauma, cortical blindness, epilepsy and posterior cortical atrophy.Psychiatric: schizophrenia and personality disorders. From a symptomatic point of view, anosognosia can appear in cases of hemineglect, prosopagnosia, amnesia, Korsakoff syndrome, Anton syndrome, hemiplegia, dysexecutive syndrome, constructive apraxia, Wernicke’s aphasia…

Symptoms

Among other symptoms and signs, people who suffer from anosognosia can present:

Difficulties regarding adherence to treatment.Bad prognosis regarding the evolution and rehabilitation of the disorder. Risk of suffering falls or injuries due to lack of awareness.Mood disturbances given the confrontation of information: irritation, anger, depression, etc. Lack of monitoring of pharmacological and medical treatments.Lack of social understanding of his condition and his illness. Little social and community support.

Treatment and consequences of anosognosia

Currently, the treatment for anosognosia remains very complex. The priority is to treat what has caused the psychological condition itself, that is, to provide support and rehabilitation for that brain damage or illness.

Likewise, the second step will be to confront the person with the reality of their condition. It is a delicate fact and not without difficulties where the maximum objective is to always give the best quality of life to the patient. However, and since this is not always possible (let’s think that this pathology is common in people with Alzheimer’s)More importantly, it is to support the family environment and offer them resources for that often complicated day-to-day life.

Likewise, anosognosia often occurs with multiple neurological pathologies. and it seems to be specific for each deficit. Given the practical implications in daily life for people who suffer from it, it is relevant to carry out early identification of it.

How to help a person with anosognosia

Observing that a person flatly denies clearly visible symptoms can be shocking to the observer. Additionally, a person with anosognosia will also not report that he has anosognosia. Therefore, awareness and an action plan are very necessary to guarantee the patient’s quality of life. Here are some tips for this:

Educate yourself about the topic.Share day-to-day tasks with the patient: this way they will accept help more easily.Express your concerns delicately: it is better “I like to go shopping with you” than “you know you forget half of it” off the list, don’t go.”Go to a professional.

We therefore need multidisciplinary assistance, there where social services, health professionals and the family itself always act together.

Image courtesy of Patrick Hoesly

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