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Klingbeil J, Mühlig M, Bahr E, Welle F, Ritter T, Stockert A, Wawrzyniak M, Saur D. Undoubtedly unaware of homonymous hemianopia: The contribution of overconfidence to anosognosia of hemianopia. Cortex 2024; 177:224-234. [PMID: 38875736 DOI: 10.1016/j.cortex.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 06/16/2024]
Abstract
A new functional deficit caused by a stroke can be understood as a situation of uncertainty that has to prompt deficit discovery and subsequent incorporation into an altered self-perception. Anosognosia for visual field deficits is frequent after stroke. For hemiplegia, patients' performance in a riddle test provided evidence that the inability to generate and adjust beliefs in face of uncertainty contributes to anosognosia for hemiplegia. In this prospective study, the same riddles are used in patients with homonymous hemianopia due to a first-ever stroke in the posterior cerebral artery territory and in an age-matched control cohort. The riddles create a situation of uncertainty that is resolved with five successive clues which progressively delimit the target word. After each clue, patients have to guess the target word and rate their confidence in the answer's correctness. Patients were tested once during the hospital stay. According to the Bisiach score for anosognosia, 12 out of 29 patients were unaware of their visual field deficits. All patients with anosognosia for hemianopia had right hemisphere lesions. Patients with and without anosognosia did not differ significantly in global cognitive impairment, mental flexibility or memory function. Importantly, patients with anosognosia showed higher confidence ratings than patients without anosognosia and controls in the first two clues (situations of uncertainty). This was demonstrated by a significant interaction effect in a mixed ANOVA with the factors group (anosognosia, nosognosia, controls) and riddle clues. An exploratory lesion subtraction analysis showed a high proportion of deficit unawareness in patients with lesions in the right fusiform and (para)hippocampal gyri. Our findings suggest that overconfidence in situations of uncertainty might contribute to the appearance of anosognosia for hemianopia. Because this has been demonstrated before in anosognosia for hemiplegia, we suggest that overconfidence is a supra-modal contributor to deficit unawareness.
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Affiliation(s)
- Julian Klingbeil
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
| | - Martin Mühlig
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Emma Bahr
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Welle
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Tim Ritter
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anika Stockert
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Max Wawrzyniak
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Dorothee Saur
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
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Andrade K, Guieysse T, Medani T, Koechlin E, Pantazis D, Dubois B. The dual-path hypothesis for the emergence of anosognosia in Alzheimer's disease. Front Neurol 2023; 14:1239057. [PMID: 38020610 PMCID: PMC10654627 DOI: 10.3389/fneur.2023.1239057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Although neurocognitive models have been proposed to explain anosognosia in Alzheimer's disease (AD), the neural cascade responsible for its origin in the human brain remains unknown. Here, we build on a mechanistic dual-path hypothesis that brings error-monitoring and emotional processing systems as key elements for self-awareness, with distinct impacts on the emergence of anosognosia in AD. Proceeding from the notion of anosognosia as a dimensional syndrome, varying between a lack of concern about one's own deficits (i.e., anosodiaphoria) and a complete lack of awareness of deficits, our hypothesis states that (i) unawareness of deficits would result from primary damage to the error-monitoring system, whereas (ii) anosodiaphoria would more likely result from an imbalance between emotional processing and error-monitoring. In the first case, a synaptic failure in the error-monitoring system, in which the anterior and posterior cingulate cortices play a major role, would have a negative impact on error (or deficits) awareness, preventing patients from becoming aware of their condition. In the second case, an impairment in the emotional processing system, in which the amygdala and the orbitofrontal cortex play a major role, would prevent patients from monitoring the internal milieu for relevant errors (or deficits) and assigning appropriate value to them, thus biasing their impact on the error-monitoring system. Our hypothesis stems on two scientific premises. One comes from preliminary results in AD patients showing a synaptic failure in the error-monitoring system along with a decline of awareness for cognitive difficulties at the time of diagnosis. Another comes from the somatic marker hypothesis, which proposes that emotional signals are critical to adaptive behavior. Further exploration of these premises will be of great interest to illuminate the foundations of self-awareness and improve our knowledge of the underlying paths of anosognosia in AD and other brain disorders.
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Affiliation(s)
- Katia Andrade
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Etienne Koechlin
- École Normale Supérieure, Laboratoire de Neurosciences Cognitives et Computationnelles, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Bruno Dubois
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
- Frontlab, Paris Brain Institute (Institut du Cerveau, ICM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Razafimahatratra S, Guieysse T, Lejeune FX, Houot M, Medani T, Dreyfus G, Klarsfeld A, Villain N, Pereira FR, La Corte V, George N, Pantazis D, Andrade K. Can a failure in the error-monitoring system explain unawareness of memory deficits in Alzheimer's disease? Cortex 2023; 166:428-440. [PMID: 37423786 DOI: 10.1016/j.cortex.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Unawareness of memory deficits is an early manifestation in patients with Alzheimer's disease (AD), which often delays diagnosis. This intriguing behavior constitutes a form of anosognosia, whose neural mechanisms remain largely unknown. We hypothesized that anosognosia may depend on a critical synaptic failure in the error-monitoring system, which would prevent AD patients from being aware of their own memory impairment. To investigate, we measured event-related potentials (ERPs) evoked by erroneous responses during a word memory recognition task in two groups of amyloid positive individuals with only subjective memory complaints at study entry: those who progressed to AD within the five-year study period (PROG group), and those who remained cognitively normal (CTRL group). A significant reduction in the amplitude of the positivity error (Pe), an ERP related to error awareness, was observed in the PROG group at the time of AD diagnosis (vs study entry) in intra-group analysis, as well as when compared with the CTRL group in inter-group analysis, based on the last EEG acquisition for all subjects. Importantly, at the time of AD diagnosis, the PROG group exhibited clinical signs of anosognosia, overestimating their cognitive abilities, as evidenced by the discrepancy scores obtained from caregiver/informant vs participant reports on the cognitive subscale of the Healthy Aging Brain Care Monitor. To our knowledge, this is the first study to reveal the emergence of a failure in the error-monitoring system during a word memory recognition task at the early stages of AD. This finding, along with the decline of awareness for cognitive impairment observed in the PROG group, strongly suggests that a synaptic dysfunction in the error-monitoring system may be the critical neural mechanism at the origin of unawareness of deficits in AD.
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Affiliation(s)
- Solofo Razafimahatratra
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - François-Xavier Lejeune
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; Paris Brain Institute's Data and Analysis Core, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marion Houot
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA 90089, USA
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Nicolas Villain
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filipa Raposo Pereira
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Valentina La Corte
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie George
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Katia Andrade
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France; FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, 47 Bd de l'Hôpital, 75013, Paris, France.
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Serrada I, Williams L, Hordacre B, Hillier S. Key constructs of body awareness impairments post-stroke: a scoping review of assessment tools and interventions. Disabil Rehabil 2023; 45:3177-3198. [PMID: 36189909 DOI: 10.1080/09638288.2022.2123053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To summarise body awareness assessment tools and interventions relevant for stroke rehabilitation using a framework that categorises key body awareness constructs, disorders and impairments. MATERIALS AND METHODS Online electronic databases and trial registries were searched from inception until July 2021, in addition to hand searching reference lists of included studies and reviews. Study selection included any study design where the investigation involved assessing and/or intervening in body awareness following stroke. Data were extracted based on predefined criteria by two independent reviewers and mapped to the emergent framework. RESULTS The final analysis included 144 papers that reported 43 assessment tools and 8 types of interventions for body awareness. Consensus was reached on a synthesised body awareness framework. This comprised specific impairments and disorders, constructs, sub-categories and main categories leading to the overarching term of body awareness. Clinical and psychometric properties of the assessment tools were not reported or poorly evaluated, and the interventions lacked robust study designs and rigorous methods. CONCLUSIONS The framework produced will enable future research and clinical practice to be based on consistent concepts and definitions. Clinicians can also use this information to cautiously select assessment tools and/or interventions but are reminded of the limitations identified in this review.Implications for rehabilitationThere is limited understanding, compounded by inconsistent terminology and definitions regarding body awareness after stroke.A synthesized framework to define key constructs and definitions of body awareness is proposed.Assessment tools and interventions reported in the literature are mapped to the proposed framework.Psychometric properties of available tools are reported.Significant work remains to refine concepts of body awareness, develop and evaluate assessment tools and interventions.
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Affiliation(s)
- Ines Serrada
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Lindy Williams
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Brenton Hordacre
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, Adelaide, SA, Australia
| | - Susan Hillier
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, Adelaide, SA, Australia
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Cocchini G, Scandola M, Gobbetto V, Cioffi MC, Bartolo A, Moore J, Moro V. The 'healthy side' of anosognosia for hemiplegia: Increased sense of agency for the unimpaired limb or motor compensation? Neuropsychologia 2022; 177:108421. [PMID: 36370826 DOI: 10.1016/j.neuropsychologia.2022.108421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/28/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Anosognosic patients show a lack of awareness for their hemiplegia coupled with a distorted sense of agency for the actions performed by the plegic limbs. Since anosognosia is often associated with right brain damage, this hemisphere seems to play a dominant role in monitoring awareness for motor actions. Therefore, we would expect that anosognosic patients show distorted awareness and sense of agency also for actions performed with the unimpaired limb. METHOD To test this hypothesis, we induced illusory actions that could be congruent or incongruent with a preceding verbal command. A group of 16 right brain-damaged patients performed this task and then rated i) their ability to anticipate the actions, ii) their sense of agency and iii) their sense of ownership for each limb. Measures of awareness, neglect and motor impairment were also considered for the patient group. RESULTS Following incongruent actions with the unimpaired limb, less aware patients showed a relatively mild distortion in all three aspects. In addition, we also found a crucial relationship between motor impairment (for the plegic limb) and sense of agency for both plegic and healthy limbs. CONCLUSION Although the distortion linked to both limbs supports the initial hypothesis that the right hemisphere is responsible for monitoring awareness for action for the whole body, our data also suggest that the observed distortion may be linked to a motor compensatory phenomenon, not necessarily related to awareness processes.
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Affiliation(s)
| | | | - Valeria Gobbetto
- Department of Human Sciences, Verona University, Italy; IRCSS Sacro Cuore Don Calabria, Negrar Verona, Italy
| | | | - Angela Bartolo
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; Institut Universitaire de France (IUF), France
| | - James Moore
- Psychology Department, Goldsmiths University of London, UK
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Pyasik M, Scandola M, Moro V. Electrophysiological correlates of action monitoring in brain-damaged patients: A systematic review. Neuropsychologia 2022; 174:108333. [PMID: 35842019 DOI: 10.1016/j.neuropsychologia.2022.108333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/19/2022]
Abstract
Action monitoring is crucial to the successful execution of an action and understanding the actions of others. It is often impaired due to brain lesions, in particular after stroke. This systematic review aims to map the literature on the neurophysiological correlates of action monitoring in patients with brain lesions. Eighteen studies were identified and divided into two groups: studies on monitoring of one's own actions and studies on monitoring of the actions of others. The first group included EEG studies on monitoring of self-performed erroneous and correct actions. Impaired error detection (decreased error-related negativity) was observed in patients with lesions in the performance-monitoring network, as compared to healthy controls. Less consistent results were shown for error positivity and behavioral error monitoring performance. The second group of studies on monitoring of others' actions reported decreased mu frequency suppression, impaired readiness potential in the affected hemisphere and decreased EEG indices of error observation (observed error positivity and theta power) in stroke patients. As a whole, these results indicate distinct patterns of impaired neurophysiological activity related to monitoring one's own versus others' actions in patients with brain lesions. EEG recordings of this dissociation in the same patients might be a useful index of motor recovery, and therefore, potentially also beneficial in rehabilitation protocols.
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Affiliation(s)
- Maria Pyasik
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy
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The relations between cognitive and motivational components of anosognosia for left-sided hemiplegia and the right hemisphere dominance for emotions: A historical survey. Conscious Cogn 2021; 94:103180. [PMID: 34392025 DOI: 10.1016/j.concog.2021.103180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/22/2022]
Abstract
Since the description of anosognosia for hemiplegia by Babinski (who also stressed the links between anosognosia and right hemisphere damage) both motivational and cognitive mechanisms have been advanced to explain this awareness disorder. In this review I will discuss first the neurophysiological mechanisms that can impede the discovery of the motor deficits contralateral to the brain lesion and then suggest that some instances of anosognosia for left-sided hemiplegia may also be due to motivational mechanisms of denial. Among the cognitive mechanisms, sensory feedback and intentional feed-forward disorders can lead to a poor awareness of the motor defects, whereas denial mechanisms could result from an interaction between the right hemisphere dominance for emotions and the anxiety raised by the catastrophic consequences of the brain damage. In particular, a maladaptive reaction to the personal implications of the brain lesion could be revealed by the presence of an implicit acknowledgement of the motor defect.
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Kirsch LP, Mathys C, Papadaki C, Talelli P, Friston K, Moro V, Fotopoulou A. Updating beliefs beyond the here-and-now: the counter-factual self in anosognosia for hemiplegia. Brain Commun 2021; 3:fcab098. [PMID: 34151264 PMCID: PMC8209286 DOI: 10.1093/braincomms/fcab098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
The syndrome of anosognosia for hemiplegia, or the lack of awareness for one’s paralysis following right hemisphere stroke, can provide unique insights into the neurocognitive mechanisms of self-awareness. Yet it remains unclear whether anosognosia for hemiplegia is a modality-specific deficit of sensorimotor monitoring, or whether domain-general processes of attention and belief-updating converge to cause anosognosia for hemiplegia. Using a Bayesian learning framework, we formalized and empirically investigated the hypothesis that failures to update anosognosic beliefs can be explained by abnormalities in the relative uncertainty (i.e. precision) ascribed to prior beliefs versus sensory information in different contexts. We designed a new motor belief-updating task that manipulated both the temporal (prospective and retrospective) and spatial (hemispace most affected by inattention and hemispace less affected by inattention) conditions in which beliefs had to be updated, and we validated its sensitivity to anosognosia for hemiplegia in 26 patients with right hemisphere stroke. We then computed and empirically tested two different Bayesian predictors of prospective beliefs using two proxies for precision in anosognosia for hemiplegia patients: (i) standardized, neuropsychological measures of objective attention abilities, i.e. visuospatial neglect scores and (ii) subjective uncertainty reports, i.e. confidence ratings. Our results suggest that while neglect does not affect local, sensorimotor error monitoring, it does seem to affect the degree to which observed errors are used to update more general, prospective beliefs about counterfactual motor abilities in anosognosia for hemiplegia. Difficulties in such ‘counterfactual’ belief-updating were associated with disruptions in tracts of the ventral attentional network (i.e. superior longitudinal fasciculus connecting the temporo-parietal junction and ventral frontal cortex) and associated lesions to the insula, inferior parietal cortex and superior temporal regions. These results suggest that self-awareness extends beyond local, retrospective monitoring, requiring also salience-based, convergence of beliefs about the self that go beyond the ‘here-and-now’ of sensorimotor experience.
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Affiliation(s)
- Louise P Kirsch
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris 75005, France.,Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Christoph Mathys
- Scuola Internazionale Superiore di Studi Avanzati (SISSA), Trieste 34136, Italy.,Interacting Minds Centre, Aarhus University, Aarhus 8000, Denmark.,Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich 8032, Switzerland
| | - Christina Papadaki
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | | | - Karl Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona 37129, Italy
| | - Aikaterini Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
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Chapman S, Cosentino S, Igwe KC, Abdurahman A, Elkind MSV, Brickman AM, Charlton R, Cocchini G. Mnemonic monitoring in anosognosia for memory loss. Neuropsychology 2020; 34:675-685. [PMID: 32852998 DOI: 10.1037/neu0000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Anosognosia, or unawareness, for memory loss has been proposed to underlie cognitive functions such as memory and executive function. However, there is an inconsistent association between these constructs. Recent studies have shown that compromise ongoing self-monitoring of one's memory associates with anosognosia for memory loss. Yet to date it is unclear which memory monitoring mechanisms are impaired in these patients. In this study, we examined the extent to which temporal monitoring or orbitofrontal reality filtering (e.g., ability to monitor the temporal relevance of a memory) and source monitoring (e.g., the ability to distinguish which memories stem from internal as opposed to external sources) are associated with awareness of memory deficits. METHOD A total of 35 patients (M = 69 years; M = 14 years of education) with memory difficulties following a stroke were recruited from outpatient clinics. Patients were assessed with measures of self-awareness of memory difficulties, cognitive abilities and 2 experimental paradigms assessing source and temporal monitoring. RESULTS AND CONCLUSION Results showed that patients unaware of their memory difficulties were more likely to externalize the source of their memories. Specifically, those unaware of their deficits were more likely to assign an external source to memories that were internally produced (e.g., imagined). No differences were observed in relation to temporal monitoring between patients aware and unaware of their deficits. This study informs current theoretical models of self-awareness of memory loss. Future studies should attempt to replicate these findings and explore different memory monitoring mechanisms in relation to anosognosia for memory loss. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Silvia Chapman
- Department of Psychology, Goldsmiths University of London
| | - Stephanie Cosentino
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University
| | - Kay C Igwe
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University
| | | | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University
| | - Adam M Brickman
- Cognitive Neuroscience Section of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University
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Cipresso P, Pedroli E, Serino S, Semonella M, Tuena C, Colombo D, Pallavicini F, Riva G. Assessment of Unilateral Spatial Neglect Using a Free Mobile Application for Italian Clinicians. Front Psychol 2018; 9:2241. [PMID: 30524341 PMCID: PMC6262901 DOI: 10.3389/fpsyg.2018.02241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/29/2018] [Indexed: 01/12/2023] Open
Abstract
Background: Unilateral Spatial Neglect (USN) is traditionally assessed with paper-and-pencil tests or computer-based tests. Thanks to the wide-spreading of mobile devices, and the extensive capabilities that they have in dealing complex elements, it is possible to provide clinicians with tools for cognitive assessment. Contemporary 3D engine is, in general generally, able to deploy complex 3D environments for iOS, Android and Windows mobile, i.e., most of the mobile phone and tablet operative systems. Results: This brand-new scenario and pressing requests from professionals, pushed us to build an application for the assessment of USN. Our first attempt was to replicate the classic cognitive tests, traditionally used at this purpose. Ecological assessment is difficult in real scenarios so we implemented virtual environments to assess patients' abilities in realistic situations. At the moment, the application is available only for iPad and iPhone for free, from the Apple Store, under the name of "Neglect App." The App contains traditional tests (e.g., barrage with and without distractors) and ecological tests (e.g., to distribute the tea in a table to close people). Scoring of each test is available to the clinicians through a database with the executed ecological tasks, that are stored locally. Conclusion: In conclusion, Neglect App is an advanced mobile platform for the assessment of Neglect.
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Affiliation(s)
- Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Serino
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Michelle Semonella
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Federica Pallavicini
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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11
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Pierce J, Saj A. A critical review of the role of impaired spatial remapping processes in spatial neglect. Clin Neuropsychol 2018; 33:948-970. [DOI: 10.1080/13854046.2018.1503722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jordan Pierce
- Department of Neurosciences, University of Geneva, Geneva, Switzerland
| | - Arnaud Saj
- Department of Neurosciences, University of Geneva, Geneva, Switzerland
- Department of Neurology, University Hospital of Geneva, Geneva, Switzerland
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Chapman S, Colvin LE, Vuorre M, Cocchini G, Metcalfe J, Huey ED, Cosentino S. Cross domain self-monitoring in anosognosia for memory loss in Alzheimer's disease. Cortex 2018. [PMID: 29518705 DOI: 10.1016/j.cortex.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anosognosia for memory loss is a common feature of Alzheimer's disease (AD). Recent theories have proposed that anosognosia, a disruption in awareness at a global level, may reflect specific deficits in self-monitoring, or local awareness. Though anosognosia for memory loss has been shown to relate to memory self-monitoring, it is not clear if it relates to self-monitoring deficits in other domains (i.e., motor). The current study examined this question by analyzing the relationship between anosognosia for memory loss, memory monitoring, and motor monitoring in 35 individuals with mild to moderate AD. Anosognosia was assessed via clinical interview before participants completed a metamemory task to measure memory monitoring, and a computerized agency task to measure motor monitoring. Cognitive and psychological measures included memory, executive functions, and mood. Memory monitoring was associated with motor monitoring; however, anosognosia was associated only with memory monitoring, and not motor monitoring. Cognition and mood related differently to each measure of self-awareness. Results are interpreted within a hierarchical model of awareness in which local self-monitoring processes are associated across domain, but appear to only contribute to a global level awareness in a domain-specific fashion.
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Affiliation(s)
- Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Goldsmiths College, University of London, London, United Kingdom.
| | - Leigh E Colvin
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Teachers College, Columbia University, New York, NY, United States
| | - Matti Vuorre
- Department of Psychology, Columbia University, New York, NY, United States
| | - Gianna Cocchini
- Goldsmiths College, University of London, London, United Kingdom
| | - Janet Metcalfe
- Department of Psychology, Columbia University, New York, NY, United States
| | - Edward D Huey
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States
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Bourlon C, Urbanski M, Quentin R, Duret C, Bardinet E, Bartolomeo P, Bourgeois A. Cortico-thalamic disconnection in a patient with supernumerary phantom limb. Exp Brain Res 2017; 235:3163-3174. [PMID: 28752330 DOI: 10.1007/s00221-017-5044-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022]
Abstract
Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse. Here, we tested this hypothesis by studying an extremely rare patient with chronic SPL, still present 3 years after a vascular stroke affecting cortical and subcortical right-hemisphere structures. Anatomical analysis included an advanced in vivo reconstruction of white matter tracts using diffusion-based spherical deconvolution. This reconstruction demonstrated a massive and relatively selective disconnection between anatomically preserved SMA/PMC and the thalamus. Our results provide strong anatomical support for the hypothesis that cortico-thalamic loops involving motor-related circuits are crucial to integrate sensorimotor processing with bodily self-awareness.
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Affiliation(s)
- Clémence Bourlon
- Unité de Neurorééducation, Centre de Rééducation Fonctionnelle Les Trois Soleils, 77310, Boissise Le Roi, France. .,Service de Médecine et de Réadaptation gériatrique et neurologique, Hôpitaux de Saint-Maurice, 94410, Saint-Maurice, France. .,Inserm U1127, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Brain and Spine Institute, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
| | - Marika Urbanski
- Service de Médecine et de Réadaptation gériatrique et neurologique, Hôpitaux de Saint-Maurice, 94410, Saint-Maurice, France.,Inserm U1127, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Brain and Spine Institute, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Romain Quentin
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Christophe Duret
- Unité de Neurorééducation, Centre de Rééducation Fonctionnelle Les Trois Soleils, 77310, Boissise Le Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, 91100, Corbeil-Essonnes, France
| | - Eric Bardinet
- Centre de NeuroImagerie de Recherche-CENIR, Institut du Cerveau et de la Moelle épinière-ICM, 75013, Paris, France
| | - Paolo Bartolomeo
- Inserm U1127, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Brain and Spine Institute, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Alexia Bourgeois
- Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, Geneva, Switzerland
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Modulating anosognosia for hemiplegia: The role of dangerous actions in emergent awareness. Cortex 2017; 92:187-203. [DOI: 10.1016/j.cortex.2017.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
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Moro V, Pernigo S, Tsakiris M, Avesani R, Edelstyn NM, Jenkinson PM, Fotopoulou A. Motor versus body awareness: Voxel-based lesion analysis in anosognosia for hemiplegia and somatoparaphrenia following right hemisphere stroke. Cortex 2016; 83:62-77. [DOI: 10.1016/j.cortex.2016.07.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/06/2016] [Accepted: 07/06/2016] [Indexed: 01/01/2023]
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Garrison JR, Bond R, Gibbard E, Johnson MK, Simons JS. Monitoring what is real: The effects of modality and action on accuracy and type of reality monitoring error. Cortex 2016; 87:108-117. [PMID: 27444616 PMCID: PMC5312673 DOI: 10.1016/j.cortex.2016.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/06/2022]
Abstract
Reality monitoring refers to processes involved in distinguishing internally generated information from information presented in the external world, an activity thought to be based, in part, on assessment of activated features such as the amount and type of cognitive operations and perceptual content. Impairment in reality monitoring has been implicated in symptoms of mental illness and associated more widely with the occurrence of anomalous perceptions as well as false memories and beliefs. In the present experiment, the cognitive mechanisms of reality monitoring were probed in healthy individuals using a task that investigated the effects of stimulus modality (auditory vs visual) and the type of action undertaken during encoding (thought vs speech) on subsequent source memory. There was reduced source accuracy for auditory stimuli compared with visual, and when encoding was accompanied by thought as opposed to speech, and a greater rate of externalization than internalization errors that was stable across factors. Interpreted within the source monitoring framework (Johnson, Hashtroudi, & Lindsay, 1993), the results are consistent with the greater prevalence of clinically observed auditory than visual reality discrimination failures. The significance of these findings is discussed in light of theories of hallucinations, delusions and confabulation.
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Affiliation(s)
- Jane R Garrison
- Department of Psychology, University of Cambridge, UK; Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Rebecca Bond
- Department of Psychology, University of Cambridge, UK
| | - Emma Gibbard
- Department of Psychology, University of Cambridge, UK
| | | | - Jon S Simons
- Department of Psychology, University of Cambridge, UK; Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK.
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Abstract
Brain imaging techniques provide unprecedented opportunities to study the neural mechanisms underlying functional neurologic disorder (FND, or conversion disorder), which have long remained a mystery and clinical challenge for physicians, as they arise with no apparent underlying organic disease. One of the first questions addressed by imaging studies concerned whether motor conversion deficits (e.g., hysteric paralysis) represent a form of (perhaps unconscious) simulation, a mere absence of voluntary movement, or more specific disturbances in motor control (such as abnormal inhibition). Converging evidence from several studies using different techniques and paradigms has now demonstrated distinctive brain activation patterns associated with functional deficits, unlike those seen in actors simulating similar deficits. Thus, patients with motor FND show consistent hypoactivation of both cortical and subcortical motor pathways, with frequent increases in other brain areas within the limbic system, but no recruitment of prefrontal regions usually associated with voluntary motor inhibition. Other studies point to a dysfunction in sensorimotor integration and agency - related to parietal dysfunction - and abnormal motor planning related to supplementary motor area and prefrontal areas. These findings not only suggest that functional symptoms reflect a genuine brain dysfunction, but also give new insights into how they are produced. However, fewer studies attempted to understand why these symptoms are produced and linked to potential psychologic or emotional risk/triggering factors. Results from such studies point towards abnormal limbic regulation with heightened emotional arousal and amygdalar activity, potentially related to engagement of defense systems and stereotyped motor behaviors, mediated by medial prefrontal cortex and subcortical structures, including the periaqueductal gray area and basal ganglia. In addition, across different symptom domains, several studies reported abnormal recruitment of ventromedial prefrontal cortex (vmPFC), a region known to regulate emotion appraisal, memory retrieval, and self-reflective representations. The vmPFC might provide important modulatory signals to both cortical and subcortical sensorimotor, visual, and even memory circuits, promoting maladaptive self-protective behaviors based on personal affective appraisals of particular events. A better understanding of such a role of vmPFC in FND may help link how and why these symptoms are produced. Further research is also needed to determine brain activation patterns associated with FND across different types of deficits and different evolution stages (e.g., acute vs. chronic vs. recovered).
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