Anosognosia in aphasics.

The notion that aphasia may be accompanied by some degree of unawareness of the disorder was introduced by Wernicke in 1874. Ever since the idea has prevailed that sensory aphasics, especially jargonaphasics, are not, or but little, conscious of their deviant verbal output. This view was disputed in recent years. It was claimed that anosognosia was not a typical feature of Wernicke's aphasia or of jargonaphasia. However, analysis of the behavior of sensory aphasics shows that some of these patients are not well aware of the deviances in their verbal output. This unawareness may be due to verbal deafness or to disturbed feedback. On the other hand, some aphasics appear to realize that their verbal expression is anomalous but choose to ignore the fact in order to preserve their self-image or to keep up the social intercourse with the environment. Anosognosia can be found in association not only with sensory aphasia but also with monophasia and with modality-specific aphasia, as well as with unilateral neglect and with apraxia. If a patient has anosognosia, the speech therapist must know about it and take it into account, lest it renders therapeutical efforts fruitless.