Orfei M D, Caltagirone C, Spalletta G
IRCCS Santa Lucia Foundation, Rome, Italy.
Cerebrovasc Dis. 2009;27(3):280-9. doi: 10.1159/000199466. Epub 2009 Feb 6.
Anosognosia in stroke patients showed a relevant detrimental effect on the rehabilitation course and patients' quality of life, especially in those with brain injury. Although a number of reliable scales for the assessment of anosognosia in stroke and traumatic brain injury have been developed, at present no single measure fully explores the multifaceted nature of the phenomenon.
A PubMed search with appropriate terms was carried out in order to critically review the issue.
The main dimensions to consider in the investigation of anosognosia in brain-injured patients are (a) awareness of deficit and related functional implications, (b) modality specificity, (c) causal attribution, (d) expectations of recovery, (e) implicit knowledge and (f) differential diagnosis with psychological denial. Time elapsed from stroke, aetiology, laterality, aphasia and clinical complications may influence all these characteristics and must be taken into consideration. Finally, an adequate association of the anosognosia evaluation with other neuropsychological and behavioural aspects is relevant for a modern holistic approach to the patient.
This review is meant to stimulate the development of a new comprehensive assessment procedure for anosognosia in brain injury and particularly in stroke, in order to catch the multidimensionality of the phenomenon and to shape rehabilitation programmes suitable to the specific clinical features of every single patient.
中风患者的疾病感缺失对康复进程和患者生活质量有显著的不利影响，尤其是对脑损伤患者。尽管已经开发了一些用于评估中风和创伤性脑损伤患者疾病感缺失的可靠量表，但目前尚无单一测量方法能全面探究该现象的多面性。
为批判性地审视该问题，利用适当检索词在PubMed上进行了检索。
在调查脑损伤患者的疾病感缺失时，主要应考虑的维度有：（a）对缺陷及其相关功能影响的认识；（b）模态特异性；（c）因果归因；（d）恢复期望；（e）隐性知识；（f）与心理否认的鉴别诊断。中风后的时间、病因、病变侧别、失语症和临床并发症可能会影响所有这些特征且必须予以考虑。最后，将疾病感缺失评估与其他神经心理学和行为方面进行充分关联，对于采用现代整体方法治疗患者至关重要。
本综述旨在推动开发一种针对脑损伤尤其是中风患者疾病感缺失的全新综合评估程序，以便把握该现象的多维性，并制定适合每位患者具体临床特征的康复方案。
