Prigatano George P
Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joesph's Hospital and Medical Center, Phoenix, AZ, USA.
J Int Neuropsychol Soc. 2024 Dec;30(10):913-922. doi: 10.1017/S1355617724000705. Epub 2024 Dec 16.
The purpose of this invited paper was to summarize my clinical research on disturbances of higher order consciousness (i.e., primarily on self-awareness but including anosognosia and impaired awareness of another person's cognitive/emotional state) that contributed to my receiving the Distinguished Career Award from the International Neuropsychology Society.
I reviewed my early clinical encounters with disturbances in higher order consciousness and then a series of studies performed with various colleagues over the last 45 years to better understand the nature of these disturbances. The findings obtained are also discussed within the context of other researchers' observations during this time frame.
Disturbances in higher order consciousness include classic anosognosia, impaired self-awareness, denial of disability, and denial of ability. Proposed diagnostic features of each of these disturbances are outlined and a model for understanding their complex relationships suggested. Different treatment/rehabilitation approaches for these disturbances are also summarized.
Disturbances in higher order consciousness are often revealed when exploring with the person their subjective experiences of their neurological and neuropsychological functioning following different brain disorders. These subjective experiences have diagnostic value and lead to different rehabilitation approaches. The neuropsychological investigation of disturbances in higher order consciousness should include integrating knowledge from the neurosciences with nonbiological understandings of how cultural and personality features of the person may also influences their subjective experiences associated with a known or suspected brain disorder.
这篇特邀论文的目的是总结我对高阶意识障碍（即主要关于自我意识，但包括疾病失认症以及对他人认知/情感状态的意识受损）的临床研究，这些研究促使我获得了国际神经心理学协会颁发的杰出职业奖。
我回顾了我早期遇到的高阶意识障碍临床病例，然后是在过去45年里与不同同事开展的一系列研究，以便更好地理解这些障碍的本质。在这一时间段内其他研究者的观察背景下，对所获得的研究结果也进行了讨论。
高阶意识障碍包括典型的疾病失认症、自我意识受损、对残疾的否认以及对能力的否认。概述了每种障碍的拟诊特征，并提出了一个理解它们复杂关系的模型。还总结了针对这些障碍的不同治疗/康复方法。
在与患者探讨他们在不同脑部疾病后对自身神经和神经心理功能的主观体验时，常常会发现高阶意识障碍。这些主观体验具有诊断价值，并会导向不同的康复方法。对高阶意识障碍的神经心理学研究应包括将神经科学知识与对患者文化和个性特征如何也可能影响其与已知或疑似脑部疾病相关的主观体验的非生物学理解相结合。
