Buchmann Ilka, Jung Rebecca, Liepert Joachim, Randerath Jennifer
Department of Psychology, University of Konstanz, Konstanz, Germany.
Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.
Front Hum Neurosci. 2018 Mar 27;12:119. doi: 10.3389/fnhum.2018.00119. eCollection 2018.
In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To our knowledge no study has investigated anosognosia for apraxia of common tool-use (CTU) so far. CTU-apraxia is a disorder frequently occurring after stroke that affects the use of familiar objects. Here, we introduce a new questionnaire to diagnose anosognosia for CTU-apraxia, the Visual Analogue Test assessing Anosognosia for Naturalistic Action Tasks (VATA-NAT). This assessment is adapted from a series of VATA-questionnaires that evaluate insight into motor (VATA-M) or language (VATA-L) impairment and take known challenges such as aphasia into account. Fifty one subacute stroke patients with left (LBD) or right (RBD) brain damage were investigated including patients with and without CTU-apraxia. Patients were assessed with the VATA-L, -M and -NAT before and after applying a diagnostics session for each function. Interrater reliability, composite reliability as well as convergent and divergent validity were evaluated for the VATA-NAT. Seven percent of the LBD patients with CTU-apraxia demonstrated anosognosia. After tool-use diagnostics this number increased to 20 percent. For the VATA-NAT, psychometric data revealed high interrater-reliability ( ≥ 0.828), composite reliability (CR ≥ 0.809) and convergent validity ( = -0.626). When assessing patients with severe aphasia, the possible influence of language comprehension difficulties needs to be taken into account for interpretation. Overall, close monitoring of anosognosia over the course of rehabilitation is recommended. With the VATA-NAT we hereby provide a novel assessment for anosognosia in patients with CTU-apraxia. For diagnosing anosognosia we recommend to combine this new tool with the existing VATA-M and -L subtests, particularly in patients who demonstrate severe functional deficits.
在神经系统疾病患者中，对自身损伤缺乏认知可能导致危险情况，并导致康复治疗中的不依从，从而产生更差的康复结果。这种所谓的失认症是一种多方面的综合征，可在影响不同神经或认知功能的脑损伤后出现。据我们所知，目前尚无研究调查过对常见工具使用失用症（CTU）的失认症。CTU失用症是中风后经常出现的一种疾病，会影响对熟悉物体的使用。在此，我们介绍一种用于诊断CTU失用症失认症的新问卷，即评估自然动作任务失认症的视觉模拟测试（VATA-NAT）。该评估改编自一系列VATA问卷，这些问卷评估对运动（VATA-M）或语言（VATA-L）损伤的认知，并考虑到诸如失语症等已知挑战。对51例患有左侧（LBD）或右侧（RBD）脑损伤的亚急性中风患者进行了调查，包括有和没有CTU失用症的患者。在对每个功能进行诊断评估之前和之后，使用VATA-L、-M和-NAT对患者进行评估。对VATA-NAT评估了评分者间信度、综合信度以及收敛效度和区分效度。7%患有CTU失用症的LBD患者表现出失认症。在工具使用诊断后，这一数字增加到20%。对于VATA-NAT，心理测量数据显示出高评分者间信度（≥0.828）、综合信度（CR≥0.809）和收敛效度（=-0.626）。在评估严重失语症患者时，解释结果时需要考虑语言理解困难的可能影响。总体而言，建议在康复过程中密切监测失认症。通过VATA-NAT，我们在此为患有CTU失用症的患者提供了一种新的失认症评估方法。对于诊断失认症，我们建议将这种新工具与现有的VATA-M和-L子测试相结合，特别是在表现出严重功能缺陷的患者中。
