Anosodiaphoria is a condition in which a person who has a

brain injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...

seems indifferent to the existence of their impairment. Anosodiaphoria is specifically used in association with indifference to paralysis. It is a somatosensory agnosia, or a sign of neglect syndrome. It might be specifically associated with defective functioning of the

frontal lobe The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe). It is parted from the parietal lobe by a groove be ...

of the right hemisphere.

Joseph Babinski Joseph Jules François Félix Babinski ( pl, Józef Julian Franciszek Feliks Babiński; 17 November 1857 – 29 October 1932) was a French- Polish professor of neurology. He is best known for his 1896 description of the Babinski sign, a pathologi ...

first used the term anosodiaphoria in 1914 to describe a disorder of the body schema in which patients verbally acknowledge a clinical problem (such as

hemiparesis Hemiparesis, or unilateral paresis, is weakness of one entire side of the body ('' hemi-'' means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medi ...

) but fail to be concerned about it. Anosodiaphoria follows a stage of anosognosia, in which there may be verbal, explicit denial of the illness, and after several days to weeks, develop the lack of emotional response. Indifference is different from denial because it implies a lack of caring on the part of the patient, who otherwise acknowledges his or her deficit.

Causes

A few possible explanations for anosodiaphoria exist: # The patient is aware of the deficit but does not fully comprehend it or its significance for functioning # May be related to an affective communication disorder and defective arousal. These emotional disorders cannot account for the verbal explicit denial of illness of anosognosia. Other explanations include reduced emotional experience, impaired emotional communication, alexithymia, behavioral abnormalities,

dysexecutive syndrome Dysexecutive syndrome (DES) consists of a group of symptoms, usually resulting from brain damage, that fall into cognitive, behavioural and emotional categories and tend to occur together. The term was introduced by Alan BaddeleyWilson, B.A., Evans, ...

, and the

Neurology

Anosodiaphoria occurs after stroke of the brain. 27% of patients with an acute hemispheric stroke had the stroke in the right hemisphere, while 2% have it in their left. Anosodiaphoria is thought to be related to

unilateral neglect Hemispatial neglect is a neuropsychological condition in which, after damage to one hemisphere of the brain (e.g. after a stroke), a deficit in attention and awareness towards the side of space opposite brain damage (contralesional space) is obse ...

, a condition often found after damage to the non-dominant (usually the right) hemisphere of the

cerebral cortex The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. The cerebral cortex mostly consists of the six-layered neocortex, with just 10% consistin ...

in which patients seem unable to attend to, or sometimes comprehend, anything on a certain side of their body (usually the left). The

is thought to be the primary area for the lack of emotional insight seen in anosodiaphoria, such as in frontotemporal dementia. A recent 2011 study done by Mendez and Shapira found that people with frontotemporal dementia also had a loss of insight more properly described at "frontal anosodiaphoria", a lack of concern for proper self-appraisal. Patients were found to have a lack of emotional updating, or concern for having an illness; an absence of an emotional self-referent tagging of information on their disorder, which they think is possibly from disease in the

ventromedial prefrontal cortex The ventromedial prefrontal cortex (vmPFC) is a part of the prefrontal cortex in the mammalian brain. The ventral medial prefrontal is located in the frontal lobe at the bottom of the cerebral hemispheres and is implicated in the processing of r ...

, anterior cingulate-anterior insula area, especially on the right.

Treatment

Indifference to illness may have an adverse impact on a patient's engagement in

neurological rehabilitation Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main o ...

, cognitive rehabilitation and

physical rehabilitation Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patien ...

. Patients are not likely to implement rehabilitation for a condition about which they are indifferent. Although anosognosia often resolves in days to weeks after stroke, anosodiaphoria often persists.Barrett, A.M., Buxbaum, L.J., Coslett, H.B., Edwards, E., Heilman, K.M., Hillis, A.E., Milberg, W.P., and Robertson, I.H. (2006). Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. ''Journal of Cognitive Neuroscience'', ''18(7), 1223-1236''. Therefore, the therapist has to be creative in their rehabilitation approach in order to maintain the interest of the patient.{{citation needed, date=December 2021

References

Neurological disorders Symptoms and signs of mental disorders

Causes

Neurology

Treatment

See also

References