Psychology Department, Goldsmiths University of London, New Cross, London, SW14 6NW, UK.
Neuropsychologia. 2010 Apr;48(5):1489-94. doi: 10.1016/j.neuropsychologia.2010.01.019. Epub 2010 Feb 1.
If asked directly, anosognosic patients deny or seriously underestimate their motor difficulties. However explicit denial of hemiplegia does not necessarily imply a lack of insight of the deficit. In this study we explored explicit and implicit awareness for upper limb motor impairment in a group of 30 right-brain damaged patients. Explicit awareness was assessed using a questionnaire (the VATAm) in which patients are asked to rate their motor abilities, whereas implicit awareness was assessed by means of a newly developed test (BMT - bimanual task). This test requires the performance of a series of bimanual tasks that can be better performed using two hands, but could also be performed using one hand only. With the BMT, patients' performance rather than their verbal reports is evaluated and scored as an index of awareness. Paretic patients with anosognosia tend to approach these tasks as if they could use both hands. Our findings showed that explicit and implicit awareness for motor deficits can be dissociated, and they may be differently affected by feedback suggesting that different underlying mechanisms may account for the multi-factorial phenomenon of anosognosia.
如果直接询问，失认症患者会否认或严重低估自己的运动障碍。然而，对偏瘫的明确否认并不一定意味着对缺陷缺乏洞察力。在这项研究中，我们在一组 30 名右脑损伤患者中探索了对上肢运动损伤的明确和隐含意识。明确的意识是通过问卷调查（VATAm）来评估的，患者被要求评估自己的运动能力，而隐含的意识是通过新开发的测试（BMT-双手任务）来评估的。该测试要求执行一系列双手任务，这些任务可以用两只手更好地完成，但也可以只用一只手完成。在 BMT 中，评估和评分的是患者的表现，而不是他们的口头报告，作为意识的指标。患有失认症的偏瘫患者在进行这些任务时往往会认为自己可以同时使用双手。我们的研究结果表明，对运动缺陷的明确和隐含意识可以分离，并且它们可能会受到不同的反馈影响，这表明不同的潜在机制可能解释了失认症的多因素现象。
