Anosognosia: inability to realize disability

Anosognosia: inability to realize disability

Anosognosia appears when a person is not aware that he has suffered neurological damage and suffers from some type of deficit. In these cases, the treatment always involves making the patient see the reality of his situation.

Anosognosia is a neurological pathology. It appears when a person is not able to identify their own limitations or dysfunctions, being something 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 following an injury to primary visual areas. What stood out from this diagnosis was the lack of awareness about such a deficit. Nothing can be as flashy as a blind person who is not able to admit their own deficiency.

Later, in 1914, Joseph Babinski presented in the Neurology Society of Paris 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 to the disease.

According to the clinical and statistical data, 1 in 3 people with Alzheimer's suffer from anosognosia

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:

It is a clinical phenomenon whereby a patient with a cerebral dysfunction is not aware of the deterioration of neurological and/or neuropsychological function, which is evident to the doctor and others.

This lack of awareness cannot be explained by a generalized cognitive impairment. Nor by a patient's own denial mechanism. The causality of the lesion is indifferent to the possibility of showing anosognosia during the course of the disorder.

Types of anosognosia

The loss of the ability to perceive the consequences associated with this cerebral dysfunction (either because of an injury or a neurodegenerative disease) translates into 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.

What would be the origin?

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

The first is that various brain regions related to awareness are affected anatomically, resulting in an alteration in the ability to recognize or appreciate the severity of deficits.

The second is that our I, understood as the conscience about ourselves, is relegated and cannot integrate the information referring to the injury as part of us; In fact, it is as if it did not exist.

It should also be noted that anosognosia is also related to schizophrenia and dementia.

Diagnostic criteria and cormobility

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

Impaired 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 deficit, evidenced in statements such as "I do not know why I am here", "I do not know what is happening to me", "I have never been good at these exercises, it is normal that I do not do well" "It is the others who say that I am wrong"

Evidence of deficits through assessment instruments.

Recognition of the alteration by relatives or acquaintances.

Negative influence on the activities of daily life.

The alteration does not appear in the context of confusional states or states of altered consciousness.

This alteration tends to be comorbid with disorders of two types:

Neurological: neurovascular disorders, Alzheimer's dementia, mild cognitive impairment, tumors, frontotemporal 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 heminegligence, prosopagnosia, amnesia, Korsakov syndrome, Anton syndrome, hemiplegia, dysexecutive syndrome, constructive apraxia, Wernicke aphasia ...

Treatment and consequences of anosognosia

At present, the treatment for anosognosia remains very complex. The priority is to treat what has caused the psychological condition itself, that is, to give support and rehabilitation for that brain damage or that disease.

Also, the second step will be to confront the person with the reality of his state. 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 (think that this pathology is common in people with Alzheimer's disease) the most important thing is to support the family environment and offer resources for that day to day often so complicated.

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

Among other symptoms and signs, people who suffer from it may have:

Difficulties regarding adherence to treatment.

Bad prognosis regarding the evolution and rehabilitation of the disorder.

Risk of falling or injury due to lack of awareness.

Mood alterations gave the confrontation of information: irritation, anger, depression ...

Lack of follow-up of pharmacological and medical treatments.

Lack of social understanding of their status and illness.

Little social and community support ...

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