Marcel Anthony J, Tegnér Richard, Nimmo-Smith Ian
Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, England, UK.
Cortex. 2004 Feb;40(1):19-40. doi: 10.1016/s0010-9452(08)70919-5.
This study of anosognosia for hemiplegia investigated: whether it is homogeneous; specificity to plegia of unawareness; extension to different kinds of and objects of awareness regarding plegia; partiality of unawareness. Sixty-four hemiplegic stroke patients were assessed with control subjects on (a) motor and somatosensory function, immediately followed by participants' evaluations of performance; (b) conventional structured interview questions addressing awareness of various capacities: (c) Neglect, Mental Flexibility, General Mental State, Verbal Fluency, Short-Term Memory; (d) pre- and post-performance estimates of ability on the last two; (e) estimates of current ability on bilateral and unilateral tasks, addressed by questions in 1st- and 3rd-person forms, explanations of how overestimated tasks would be accomplished, attempts at 3 bimanual tasks and post-attempt estimates of ability on these. Anosognosia for plegia was mostly associated with right-brain damage. No single factor or combination accounted for all patients. Double dissociations indicated that anosognosia can be specific to plegia: and patients do not generally overestimate other abilities. Although unawareness of paralysis and of its consequences appear linked, the latter is more widespread and persistent. Double dissociation showed that concurrent unawareness of movement failures is a separate deficit from these. There was differential awareness of different aspects of plegia. Further, some patients who overestimated current bilateral task ability when asked in 1st-person form did not overestimate when asked how well the examiner, if he was in their current condition, could do each task. This suggests split awareness of a single aspect of plegia. Patients anosognosic on conventional questioning showed two distinctions. (1) Some were unaware of movement failures when they occurred; others were aware but quickly forgot such failures and seem unable to update long-term body knowledge. (2) Some patients' explanations of bimanual task performance reflect unawareness of hemiplegia; others' explanations were bizarre and imply some awareness. The latter group's deficit appears to be nonspecific and linked to right-hemisphere predominance of anosognosia, an account of which is offered. Anosognosia for hemiplegia is not a unitary phenomenon: several factors underlie deficits in bodily awareness.
它是否具有同质性；对瘫痪无知觉的特异性；对瘫痪的不同类型和认知对象的扩展；无知觉的片面性。64名偏瘫中风患者与对照组受试者进行了以下评估：(a) 运动和躯体感觉功能，随后立即让参与者对表现进行评估；(b) 针对各种能力认知的传统结构化访谈问题；(c) 忽视、心理灵活性、一般心理状态、言语流畅性、短期记忆；(d) 对后两项能力的表现前和表现后的估计；(e) 通过第一人称和第三人称形式的问题对双侧和单侧任务当前能力的估计，对高估任务将如何完成的解释，尝试三项双手任务以及对这些任务尝试后的能力估计。偏瘫失认症大多与右脑损伤有关。没有单一因素或因素组合能解释所有患者的情况。双重分离表明失认症可能对瘫痪具有特异性：患者通常不会高估其他能力。尽管对瘫痪及其后果的无知觉似乎有关联，但后者更为普遍和持久。双重分离表明，同时对运动失败的无知觉是与这些情况不同的缺陷。对瘫痪的不同方面存在不同的认知。此外，一些以第一人称形式被询问时高估当前双侧任务能力的患者，当被问及如果检查者处于他们当前的状况能完成每项任务的程度时，并没有高估。这表明对瘫痪单一方面的认知存在分裂。在传统询问中表现出失认症的患者有两个区别。(1) 一些患者在运动失败发生时没有意识到；另一些患者意识到了，但很快忘记了这些失败，似乎无法更新长期的身体知识。(2) 一些患者对双手任务表现的解释反映了对偏瘫缺乏认知；另一些患者的解释很奇怪，暗示有一定认知。后一组的缺陷似乎不具有特异性，与失认症的右脑优势有关，并对此进行了阐述。偏瘫失认症不是一种单一现象：身体认知缺陷有几个因素作为基础。
