Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK.
Psychology Department, Goldsmiths University of London, London, UK.
Arch Clin Neuropsychol. 2022 Aug 23;37(6):1185-1198. doi: 10.1093/arclin/acac009.
To study awareness of problems with one's own Activities of Daily Living (ADL) following stroke by means of a novel instrument-the Visual-Analogue Test for Anosognosia for Activities of Daily Living (VATA-ADL).
The new test overcomes some of the methodological problems of traditional structured interviews and self-rating questionnaires. In particular, to account for possible verbal communication difficulties, each question is illustrated by a drawing and a 4-point visual-analogue Likert scale. The patient's self-rating is compared with that given by informants (personal or professional caregiver) to acquire a measure of metacognition of one's own problems in performing everyday tasks.
The VATA-ADL was validated in 61 dyads of older people and their informants. A group of 80 post-acute stroke patients and their informants then completed the test. Informant ratings correlated highly with traditional ADL scales, the questionnaire items showed high internal consistency (α = .95) and loaded onto one factor. By comparison to informants' assessments, the patients showed a generally poor appreciation of their functional disabilities. Thirty-nine patients overestimated their abilities (anosognosia) whereas nine showed underestimation of their abilities.
Anosognosia (overestimation of abilities) for ADL is frequent, even in post-acute stages post-stroke. Some other patients underestimated their abilities, indicating that poor metacognition of one's own abilities in brain damaged patients is bi-directional. Both types of misestimation may have clinical consequences worth considering for the wellbeing of patients and their carers.
使用一种新的工具——日常生活活动认知觉测试（VATA-ADL），研究脑卒中后患者对自身日常生活活动（ADL）问题的认知情况。
该新测试克服了传统结构访谈和自评问卷的一些方法学问题。特别是，为了考虑到可能存在的言语交流困难，每个问题都通过绘画和 4 点视觉类比李克特量表进行说明。将患者的自评与知情者（个人或专业护理人员）的自评进行比较，以获得对自身执行日常任务的问题的元认知的度量。
VATA-ADL 在 61 对老年人及其知情者中进行了验证。然后，80 名急性脑卒中后患者及其知情者完成了该测试。知情者的评定与传统 ADL 量表高度相关，问卷条目表现出较高的内部一致性（α=0.95），并可归结为一个因素。与知情者的评估相比，患者对自身功能障碍的评估普遍较差。39 名患者高估了自己的能力（认知失认症），而 9 名患者低估了自己的能力。
即使在脑卒中后的急性后期阶段，ADL 的认知失认症（高估能力）也很常见。其他一些患者低估了自己的能力，这表明脑损伤患者对自身能力的元认知是双向的。这两种类型的错误估计都可能对患者及其护理人员的福祉产生临床影响，值得关注。
