Rosen Howard J
UCSF Department of Neurology, Memory and Aging Center, San Francisco, CA 94143, USA.
Neurocase. 2011 Jun;17(3):231-41. doi: 10.1080/13554794.2010.522588.
Patients with neurological disorders are often partially or completely unaware of the deficits caused by their disease. This impairment is referred to as anosognosia, and it is very common in neurodegenerative disease, particularly in frontotemporal dementia. Anosognosia has significant impacts on function and quality of life for patients with neurodegenerative disease and their caregivers, but the phenomenon has received little formal study, especially in non-Alzheimer's (non-AD) dementias. Furthermore, few studies have attempted to systematically verify the potential role of specific cognitive impairments in producing anosognosia. As a result, the mechanisms underlying this phenomenon are poorly understood. Episodic memory likely plays an important role. In addition, the frontal lobe systems are important for intact self-awareness, but the most relevant frontal functions have not been identified. Motivation required to engage in self-monitoring and emotional activation marking errors as significant are often-overlooked aspects of performance monitoring that may underlie anosognosia in some patients. The present review offers a working model that incorporates these functions and stipulates specific processes that may be important for awareness of changes in one's abilities. Specification of the specific processes whose potential failure results in anosognosia can establish a roadmap for future studies.
患有神经系统疾病的患者往往部分或完全没有意识到其疾病所导致的缺陷。这种损害被称为疾病感缺失，在神经退行性疾病中非常常见，尤其是在额颞叶痴呆中。疾病感缺失对神经退行性疾病患者及其照料者的功能和生活质量有重大影响，但这一现象很少受到正式研究，特别是在非阿尔茨海默病（非AD）痴呆方面。此外，很少有研究试图系统地验证特定认知障碍在导致疾病感缺失中所起的潜在作用。因此，这种现象背后的机制尚不清楚。情景记忆可能起着重要作用。此外，额叶系统对于完整的自我意识很重要，但尚未确定最相关的额叶功能。参与自我监测所需的动机以及将错误标记为重要的情绪激活，是绩效监测中经常被忽视的方面，可能是一些患者疾病感缺失的潜在原因。本综述提供了一个工作模型，该模型整合了这些功能，并规定了可能对意识到自身能力变化很重要的特定过程。明确指出那些潜在失败会导致疾病感缺失的特定过程，可以为未来的研究建立一个路线图。
