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Revue de neuropsychologie

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Anosognosia: theoretical models and rehabilitation programs Volume 12, issue 1, Janvier-Février-Mars 2020

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Authors
1 Université de Liège,
GIGA-CRC in vivo Imaging,
quartier Agora,
allée du 6 Août, 8,
B30, 4000 Liège,
Belgique
2 CHU de Liège,
Clinique de la mémoire,
Liège,
Belgique
* Correspondance

Anosognosia refers to individuals’ lack of knowledge, awareness, or recognition of a disease or a deficit that they have. In this paper, we review the methods of measuring anosognosia, the theoretical models that offer explanations about its origin, and programs to improve brain-damaged patients’ awareness of their deficits. The presence of anosognosia can be detected using clinical assessments based on observation, questionnaires comparing patients’ and their relatives’ evaluation of the patients’ everyday functioning and cognition, or by measuring the accuracy of patients’ predictions about their performance. There are three classes of theoretical models about anosognosia. First, neurocognitive models suggest that cognitive deficits (particularly executive and mnemonic deficits) associated with damage to certain brain regions (especially the prefrontal cortex) lead to a poor understanding of current functioning. Psychological models meanwhile evoke denial as a defense mechanism against the threat that deficits represent for the person. Last, biopsychosocial models propose that anosognosia emerges from the interaction between neuropsychological deficits, psychological defense mechanisms, and social influences. Because anosognosia can prevent the patient from seeking help and sticking to rehabilitation programs, improving awareness of deficits is required for maximizing the benefit of therapeutic programs. A few rehabilitation programs have attempted to improve awareness of deficits by combining various approaches. The most common approaches are the use of feedback during the performance of an everyday task, and metacognitive training focusing on prediction of performance, self-assessment, and self-discovery of strategies to improve performance. While most programs aimed at improving anosognosia have been the subject of single case studies, a few controlled and randomized trials have shown the effectiveness of programs that allowed patients to better detect mistakes they were making during tasks, and to gain independence in everyday life.