DOCSLIB.ORG

Treatment of Unawareness of Deficits in Patients with Acquired Brain Injury

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment of Unawareness of Deficits in Patients with Acquired Brain Injury J Head Trauma Rehabil Vol. 29, No. 5, pp. E9–E30 Copyright c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury: A Systematic Review Anne-Claire Schrijnemaekers, MSc; Sanne M. J. Smeets, MSc; Rudolf W. H. M. Ponds, PhD; Caroline M. van Heugten, PhD; Sascha Rasquin, PhD Objective: To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI). Methods: Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated. Results: A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large. Conclusion: Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness. High-quality intervention studies are urgently needed using controlled designs (eg, single-case experimental designs, randomized controlled trials) based on a theoretic perspective with a detailed description of the content of the intervention and suitable outcome measures. Key words: awareness, brain injuries, intervention studies, literature review, rehabilitation CQUIRED BRAIN INJURY (ABI) can lead to ranges from 30% to 97%, depending on multiple factors A impairments in physical, emotional, cognitive, including the measurement instrument used, severity and social abilities. Diminished awareness of these of injury, and amount of time since injury.1,3–9 Areas impairments—a well-known clinical problem following of diminished functioning about which patients may ABI—is seen as compromise of the ability to appraise lack awareness include cognition, behavior, and inter- one’s strengths and weaknesses and the implications for personal skills as well as the effects their behavior have life, presently and in the future.1,2 Reported prevalence on others.10 Frontal lobe dysfunction has often been linked to impaired awareness of deficits, but currently there is no clinical consensus regarding the pathogenesis Author Affiliations: Rehabilitation Centre Adelante, Department of 10–12 Brain Injury, Hoensbroek (Ms Schrijnemaekers and Drs Rasquin, and underlying this phenomenon. Ponds); Adelante knowledge centre, Hoensbroek (Dr Rasquin); School for The concept of impaired awareness can be divided Mental Health and Neuroscience (MHeNS), Department of Psychiatry into different types of impairment. A practical model and Neuropsychology, Maastricht University (Ms Smeets and Drs Ponds 13 and van Heugten); Department of Medical Psychology, Maastricht defined by Crosson et al outlines a 3-stage hierarchi- University Medical Center (MUMC), Maastricht (Dr Ponds); and cal model in which intellectual awareness represents the Department of Neuropsychology and Psychopharmacology, Faculty of ability to understand that a function is impaired or to un- Psychology and Neuroscience, Maastricht University (Dr van Heugten), The Netherlands. derstand the complications caused by the impairment. Emergent awareness is the ability to recognize a problem Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions when it is occurring, which requires the person to reach of this article on the journal’s Web site (www.headtraumarehab.com). a level of intellectual awareness similar to that before in- The authors declare no conflicts of interest. jury. Anticipatory awareness is the ability to foresee that a problem will occur as a result of having some type Corresponding Author: Anne-Claire Schrijnemaekers, MSc, Rehabilitation Centre Adelante, Department of Brain Injury, Zandbergsweg 111, 6432 CC of deficit. Other models concerning impaired aware- Hoensbroek, The Netherlands ([email protected]). ness of deficits after ABI also describe 3 components 1,14–18 DOI: 10.1097/01.HTR.0000438117.63852.b4 of awareness and show considerable overlap. In E9 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. E10 JOURNAL OF HEAD TRAUMA REHABILITATION/SEPTEMBER–OCTOBER 2014 2 models,16,17 the psychological factor of denial is more, studies were excluded if the primary aim of the prominent. Taken together, these models include cog- intervention was related to visuospatial or somatosen- nitive components (basic cognitive abilities to perceive, sory neglect. Neglect is based on impaired mechanisms understand, and recognize situations), higher-order cog- of visual attention and, hence, represents a specific de- nitive components (self-regulation and anticipation), marcated area that lies outside the scope of this review. and a psychological component (with denial on 1 side Studies were independently selected on the basis of of the spectrum and acceptance on the other). title, abstract, and full text by the first 2 authors (A.C.S. The implications associated with impaired awareness and S.S.). In cases of disagreement, a third author (S.R.) of deficits include diminished motivation for treatment made the final decision. The reference lists of the se- (as the patient may not recognize or acknowledge the lected articles were examined for other potentially rele- need for intervention),19 worse treatment adherence and vant studies. If appropriate, the specific study cited was performance,20,21 and an unfavorable short- and long- tracked down and included in the review. term employment outcome.22,23 By contrast, patients with more intact intellectual awareness achieve better Data extraction independent living skills.24 Herein lies the challenge of treating patients with awareness problems. Data extraction was based on the checklist of items Currently, there are no well-established clinical guide- to consider from the Cochrane manual,29 together with lines for treating unawareness of deficits after ABI,25 de- data extraction methods from similar reviews.30,31 The spite an array of studies that have evaluated different following study characteristics were extracted from the treatments to improve awareness of deficits. The objec- articles: design of the study, number of patients, type of tive of this article is to review the available treatment intervention, effects on the awareness, and functional methods for impaired awareness and to provide a com- outcome measures. The overall effect of each interven- prehensive summary of their effectiveness. The current tion was summarized as positive (+), no effect (0), or review differs from previous reviews26–28 in that it has negative (−).32 Results were considered to be positive no restriction on the type of brain injury, intervention, when statistically significant at the P < .05 level. If no study design, and number of participants; it comprises a statistical test results were available, the interpretation broad spectrum of research of interventions that aim to of the effect was based on the interpretations made by improve awareness of deficits. The following questions the authors of the study in question. are addressed: (i) which interventions have been investi- In addition, we calculated effect sizes. gated and what are their specific characteristics and (ii) For independent group studies (eg, RCTs), how effective were these interventions? the standardized difference between means, Hedge’s g, was calculated where possible (ef- METHODS fect size = [(Meanexperimental group, postmeasurement − Meanexperimental, pre)/SDexperimental, pre] − [(Meancontrol, post Selection of articles 33 −Meancontrol, pre)/SDcontrol, pre]). An effect size of 0.2 A systematic literature search was performed using the is considered small, 0.5 medium, and 0.8 large.34 electronic databases PsycINFO (1887 to October 2012), For single-case studies (eg SCED), the percentage of PubMed (1953 to October 2012), Embase (1989 to nonoverlapping data (PND)35 was used as a measure of October 2012), The Cochrane Library (1890 to October effect size. For calculating the PND, the highest data 2012), and PsychBITE (1940 to October 2012). Free text point in the baseline phase needs to be identified. The words as well as index terms were combined. The search PND is then determined by calculating the percentage strategy used 3 categories: diagnosis (ABI), the specific of data points during the intervention phase exceeding condition (unawareness of deficits), and intervention. this level. A PND smaller than 50% reflects minimally The search was limited to human
Load more

Recommended publications
  • NEGLECT and ANOSOGNOSIA a CHALLENGE for PSYCHOANALYSIS Psychoanalytic Treatment of Neurological Patients with Hemi-Neglect
    Psychoanalytische Perspectieven, 2002, 20, 4: 611-631 NEGLECT AND ANOSOGNOSIA A CHALLENGE FOR PSYCHOANALYSIS Psychoanalytic treatment of neurological patients with hemi-neglect Klaus Röckerath1 Introduction This paper deals with two phenomena often observed in patients with a lesion to the right hemisphere of the brain: neglect and anosognosia. Fol- lowing an overview of the neglect syndrome from a neuroscientific per- spective I will present preliminary results and hypotheses formulated by our group based on the psychoanalytic treatment of seven such patients. It may be somewhat unusual for neurologically impaired patients to undergo psychoanalytic treatment. But in recent years, a combined effort to under- stand the underlying mechanisms of psychic phenomena has evolved in psychoanalysis and the neurosciences. Hence, the field of neuro-psycho- analysis established itself, studying the psychic implications of neurologi- cal damage in order to understand and gain insight into the "psychic appa- ratus", as constructed by Freud, from a different point of view. It is well known that Freud, a trained neurologist, hoped that one day the mecha- nism of psychic functions would be understood from a neurologist's point of view. He was convinced that the answer to the psychic problems he encountered with his patients must be rooted in the matter of the mind: the brain. That is why groups of psychoanalysts and neuroscientists all over the world have begun to exchange news and views about their common interest: the human mind. Both sciences basically deal with the same object. One way psychoanalysts can contribute is by looking at neurologically impaired patients in a psychoanalytic framework to establish what is dif- 1.The Neurops ychoanalytic Study Group Frankfurt/Cologne, Germany.
    [Show full text]
  • The Riddle of Anosognosia: Does Unawareness of Hemiplegia Involve a Failure to Update Beliefs?
    cortex 49 (2013) 1771e1781 Available online at www.sciencedirect.com Journal homepage: www.elsevier.com/locate/cortex Research report The riddle of anosognosia: Does unawareness of hemiplegia involve a failure to update beliefs? Roland Vocat a, Arnaud Saj b and Patrik Vuilleumier a,b,* a Laboratory for Behavioral Neurology & Imaging of Cognition, Department of Neuroscience, Medical School, University of Geneva, Switzerland b Clinic of Neurology, University Hospital of Geneva, Geneva, Switzerland article info abstract Article history: Anosognosia for hemiplegia (AHP) is defined as a lack of awareness for motor incapacity Received 1 February 2012 after a brain lesion. The causes of AHP still remain poorly understood. Many associations Reviewed 10 May 2012 and dissociations with other deficits have been highlighted but no specific cognitive or Revised 30 August 2012 neurological impairment has been identified as a unique causative factor. We hypothe- Accepted 20 October 2012 sized that a failure to update beliefs about current state might be a crucial component of Action editor Giuseppe Vallar AHP. Here, we report results from a new test that are compatible with this view. We Published online 27 November 2012 examined anosognosic and nosognosic brain-damaged patients, as well as healthy con- trols, on a task where they had to guess a target word based on successive clues, with Keywords: increasing informative content. After each clue, participants had to propose a word solu- Anosognosia for hemiplegia tion and rated their confidence. Compared to other participants, anosognosic patients were AHP abnormally overconfident in their responses, even when information from the clues was Awareness insufficient. Furthermore, when presented with new clues incongruent with their previous Denial response, they often stuck to their former “false” beliefs instead of modifying them.
    [Show full text]
  • Incidence and Diagnosis of Anosognosia for Hemiparesis Revisited B Baier, H-O Karnath
    358 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2004.036731 on 16 February 2005. Downloaded from PAPER Incidence and diagnosis of anosognosia for hemiparesis revisited B Baier, H-O Karnath ............................................................................................................................... J Neurol Neurosurg Psychiatry 2005;76:358–361. doi: 10.1136/jnnp.2004.036731 Background: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis. See end of article for Objective: To determine whether this wide variation might be explained by the different criteria used for authors’ affiliations ....................... diagnosing anosognosia. Methods: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for Correspondence to: hemiparesis using the anosognosia scale of Bisiach et al. Prof Hans-Otto Karnath, Results: 94% of the patients who were rated as having ‘‘mild anosognosia’’—that is, they did not Centre of Neurology, Hertie-Institute for Clinical acknowledge their hemiparesis spontaneously following a general question about their complaints— Brain Research, University suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. of Tu¨bingen, Hoppe- However, they immediately acknowledged their paresis when they were asked about the strength of their Seyler-Str 3, D-72076 Tu¨bingen, Germany; limbs. Their other deficits clearly had a greater
    [Show full text]
  • Apraxia, Neglect, and Agnosia
    REVIEW ARTICLE 07/09/2018 on SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO by https://journals.lww.com/continuum from Downloaded Apraxia, Neglect, Downloaded CONTINUUM AUDIO INTERVIEW AVAILABLE and Agnosia ONLINE from By H. Branch Coslett, MD, FAAN https://journals.lww.com/continuum ABSTRACT PURPOSEOFREVIEW:In part because of their striking clinical presentations, by SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO disorders of higher nervous system function figured prominently in the early history of neurology. These disorders are not merely historical curiosities, however. As apraxia, neglect, and agnosia have important clinical implications, it is important to possess a working knowledge of the conditions and how to identify them. RECENT FINDINGS: Apraxia is a disorder of skilled action that is frequently observed in the setting of dominant hemisphere pathology, whether from stroke or neurodegenerative disorders. In contrast to some previous teaching, apraxia has clear clinical relevance as it is associated with poor recovery from stroke. Neglect is a complex disorder with CITE AS: many different manifestations that may have different underlying CONTINUUM (MINNEAP MINN) mechanisms. Neglect is, in the author’s view, a multicomponent disorder 2018;24(3,
    [Show full text]
  • Anosognosia As a Comorbidity in Mental Health Conditions
    University of Central Florida STARS Honors Undergraduate Theses UCF Theses and Dissertations 2020 Awareness of the Unaware: Anosognosia as a Comorbidity in Mental Health Conditions Tiffany L. Baula University of Central Florida Part of the Nursing Commons, and the Psychiatric and Mental Health Commons Find similar works at: https://stars.library.ucf.edu/honorstheses University of Central Florida Libraries http://library.ucf.edu This Open Access is brought to you for free and open access by the UCF Theses and Dissertations at STARS. It has been accepted for inclusion in Honors Undergraduate Theses by an authorized administrator of STARS. For more information, please contact [email protected]. Recommended Citation Baula, Tiffany L., "Awareness of the Unaware: Anosognosia as a Comorbidity in Mental Health Conditions" (2020). Honors Undergraduate Theses. 671. https://stars.library.ucf.edu/honorstheses/671 AWARENESS OF THE UNAWARE: ANSOGNOSIA AS A COMORBIDITY IN MENTAL HEALTH CONDITIONS by TIFFANY LAUREN BAULA A thesis submitted in partial fulfillment of the requirements for the Honors in the Major Program in Nursing in the College of Nursing and in the Burnett Honors College at the University of Central Florida Orlando, Florida Spring Term 2020 ABSTRACT AWARENESS OF THE UNAWARE: ANOSOGNOSIA AS A COMORBIDITY IN MENTAL HEALTH CONDITIONS Integrative Literature Review The primary purpose of this integrative review of the literature is to describe healthcare provider’s recognition of anosognosia in individuals with comorbid mental health disorders, as a differentiating diagnosis needing preeminent early intervention. The secondary purpose is to examine how anosognosia influences outcomes in the population of individuals with severe mental illness.
    [Show full text]
  • GLOSSARY Terms in the Field of Psychiatry and Neurology A
    GLOSSARY Terms in the field of Psychiatry and Neurology A abreaction :An emotional release or discharge after recalling a painful experience that has been repressed because it was not consciously tolerable. abstract attitude: (categorical attitude) This is a type of thinking that includes voluntarily shifting one's mind set from a specific aspect of a situation to the general aspect; It involves keeping in mind different simultaneous aspects of a situation while grasping the essentials of the situation. abulia A lack of will or motivation which is often expressed as inability to make decisions or set goals. acalculia The loss of a previously possessed ability to engage in arithmetic calculation. acetylcholine A neurotransmitter in the brain, which helps to regulate memory, and in the peripheral nervous system, where it affects the actions of skeletal and smooth muscle. acting out This is the process of expressing unconscious emotional conflicts or feelings via actions rather than words. The person is not consciously aware of the meaning or etiology of such acts. Acting out may be harmful or, in controlled situations, therapeutic (e.g., children's play therapy). 1 actualization The realization of one's full potential - intellectual, psychological, physical, etc. adiadochokinesia The inability to perform rapid alternating movements of one or more of the extremities. This task is sometimes requested by physicians of patients during physical examinations to determine if there exists neurological problems. adrenergic This refers to neuronal or neurologic activity caused by neurotransmitters such as epinephrine, norepinephrine, and dopamine. affect This word is used to described observable behavior that represents the expression of a subjectively experienced feeling state (emotion).
    [Show full text]
  • What Is Anosognosia?
    _________________Treatment Advocacy Center Backgrounder______________ What is Anosognosia? (updated March 2014) Anosognosia is an awkward term introduced by neurologists a century ago “to denote a complete or partial lack of awareness of different neurological…and/or cognitive dysfunctions.” This definition comes from G.P. Prigatano, ed. The Study of Anosognosia, Oxford University Press, 2010, p.17. Anosognosia thus means lack of awareness or lack of insight. It is not the same as denial of illness; anosognosia is caused by physical damage to the brain and is thus anatomical in origin whereas denial is psychological in origin. Anosognosia is very difficult to imagine or understand. Oliver Sacks, in The Man Who Mistook His Wife for a Hat (p.5), explained anosognosia as follows: It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems – a peculiar and specific ‘anosognosia,’ as Babinski called it. And it is singularly difficult, for even the most sensitive observer, to picture the inner state, the ‘situation’ of such patients, for this is almost unimaginably remote from anything he himself has ever known. Among neurological patients, anosognosia is seen most commonly in Alzheimer’s disease, Huntington’s disease, and traumatic brain injury and occasionally in patients with stroke (especially those involving the right parietal lobe) and Parkinson’s disease. Most patients with Alzheimer’s disease, for example, are aware that something is wrong early in the course of their illness but then lose all awareness of their illness as it progresses. Anosognosia is also very important in psychiatry since approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder have anosognosia.
    [Show full text]
  • Prognosis for Patients with Neglect and Anosognosia with Special Reference to Cognitive Impairment
    J Rehabil Med 2003; 35: 254–258 PROGNOSIS FOR PATIENTS WITH NEGLECT AND ANOSOGNOSIA WITH SPECIAL REFERENCE TO COGNITIVE IMPAIRMENT Peter Appelros,1,2 Gunnel M. Karlsson,1 A˚ ke Seiger2,3 and Ingegerd Nydevik2,3 From the 1Departments of Neurology and Geriatrics, O¨ rebro University Hospital, O¨ rebro, 2Neurotec Department, Karolinska Institutet, 3Stockholms Sjukhem, Stockholm, Sweden Objective: To describe prognosis in patients with unilateral variate statistics, so it is difficult to be certain about the neglect, anosognosia, or both, within a community based independence of predictors. stroke cohort. It is also known that anosognosia presents a risk for negative Methods: Patients (n = 377) were evaluated at baseline for stroke rehabilitation outcome (8, 9) as well as for activities of the presence of neglect and anosognosia. After 1 year, the daily living (ADL) function at hospital discharge (10). Results level of disability was established in survivors. Predictors for from a recent study have shown that patients with anosognosia in death and dependency were examined in multivariate the acute phase of stroke had a poorer functional outcome after 1 analysis. The following independent variables were used: year than patients who were aware of illness (11). Anosognosia age, consciousness, hemianopia, arm paresis, leg paresis, has been associated with cognitive impairment and subcortical sensory disturbance, aphasia, neglect, anosognosia, diabetes brain atrophy (12). Although the association between anosog- mellitus, cardiovascular disease, pre- and post-stroke nosia and general cognition has been emphasized, it is not cognitive impairment. known how close their relationship is in an unselected group of Results: Age, consciousness and sensory disturbance pre- patients.
    [Show full text]
  • Improving Insight and Awareness in Brain Injury Kristy Easley, M.A., CCC-SLP, CBIS Neurorestorative Learning Objectives
    Improving Insight and Awareness in Brain Injury Kristy Easley, M.A., CCC-SLP, CBIS NeuroRestorative Learning Objectives • Relate the anatomy and physiology of the pre-frontal cortex and frontal lobes to the clinical phenomenon of anosognosia. • Identify and contrast two different models of awareness to support treatment planning. • Describe at least 2 effective strategies to improve insight and awareness in brain injury. Executive Function & Insight Lobes of the Brain • Frontal lobes comprise 20% of cortex • Function as “CEO” of the brain Metacognition-”Thinking about thinking” Anosognosia • A deficit of self-awareness • Also known as a “lack of insight” • Refers to a condition in which a patient is unaware of deficits resulting from a brain injury Anosognosia • “I’m ok to drive. Ninety percent of driving occurs straight in front of you…” – RS, a 60 y/o with severe left neglect and left homonymous hemianopsia. “Your mailboxes are not set up like USPS. Had the names been to the right side, I would have scored 100%...” – DH, 58 y/o rural mail carrier with severe left neglect after finding out his score on a mail delivery task was 56% accuracy. Self-awareness deficits in brain injury have been reported as occurring in up to 97% of patients with Traumatic Brain Injury. Sherer. M, et al, 1998 What’s in YOUR tool belt? Treatment for Awareness Deficits Intellectual Knowledge Emergent Online awareness Anticipatory Crosson, et al, 1989 Toglia and Kirk, 2000 Model of Awareness • Anticipatory Awareness: Patient is able to anticipate when an impairment will affect performance and implement strategies. • Emergent Awareness: Patient recognizes when an impairment affects their ability as it occurs.
    [Show full text]
  • Traumatic Brain Injury Basics and Beyond
    Traumatic Brain Injury Basics and Beyond Thursday June 19, 2014 Tad Gorske, Ph.D. Assistant Professor Division of Neuropsychology and Rehabilitation Psychology Department of Physical Medicine and Rehabilitation University of Pittsburgh School of Medicine Acknowledgements • I want to thank Dr. Camiolo-Reddy from the UPMC Department of Physical Medicine and Rehabilitation and Dr. Michael Collins from the UPMC Sports Medicine Concussion Program for giving me permission to use information from their slide presentations. Traumatic Brain Injury Definition of Traumatic Brain Injury • Closed head injury (CHI) – Skull intact, brain not exposed. • Penetrating head injury (PHI) – Open head injury where skull and dura are penetrated by an object. • Vascular insults (due to stroke, anoxia, etc. will also be included for today’s purposes.) Head Injury Morphology: Blunt versus Penetrating Blunt Injury Penetrating • Coup: adjacent to the area • Bladed weapons, low and struck by an object high velocity projectiles • Countercoup injuries: • Injury from GSW results usually due to acceleration from energy transfer from of the brain. striking the the projectile to impacted calvarium or skull base of tissue the opposite side Coup and Contrecoup Injury • Centers for Disease Control TBI Definition – Craniocerebral trauma, specifically, an occurrence of injury to the head (arising from blunt or penetrating trauma or from acceleration/deceleration forces) that is associated with any of these symptoms attributable to injury: decreased level of consciousness, amnesia, other neurologic or neuropsychological abnormalities, skull fracture, diagnosed intracranial lesions, or death. – Thurman DJ, Sniezek JE, Johnson D, et al., Guidelines for Surveillance of Central Nervous System Injury. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, US Department of Health and Human Services, 1995.
    [Show full text]
  • Hughes' Outline of Modern Psychiatry
    Hughes’ Outline of Modern Psychiatry Fifth Edition Hughes’ Outline of Modern Psychiatry Fifth Edition David Gill Consultant Psychiatrist Lister Hospital Stevenage: Hertfordshire Partnership NHS Trust John Wiley & Sons, Ltd Copyright © 2007 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO 19 8SQ, England Telephone (+44) 1243 779777 Email (for orders and customer service enquiries): [email protected] Visit our Home Page on www.wileyeurope.com or www.wiley.com All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London W1T 4LP, UK, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to the Permissions Department, John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO 19 8SQ, England, or emailed to [email protected], or faxed to (+44) 1243 770620. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services.
    [Show full text]
  • Brain Regions Associated with Anosognosia for Memory Disturbance in Alzheimer’S Disease: a Magnetic Resonance Imaging Study
    Journal name: Neuropsychiatric Disease and Treatment Article Designation: Original Research Year: 2017 Volume: 13 Neuropsychiatric Disease and Treatment Dovepress Running head verso: Fujimoto et al Running head recto: Brain regions associated with anosognosia in AD open access to scientific and medical research DOI: http://dx.doi.org/10.2147/NDT.S139177 Open Access Full Text Article ORIGINAL RESEARCH Brain regions associated with anosognosia for memory disturbance in Alzheimer’s disease: a magnetic resonance imaging study Hiroshi Fujimoto1 Background and objective: Patients with Alzheimer’s disease (AD) are frequently unaware Teruyuki Matsuoka1 of their cognitive symptoms and medical diagnosis. The term “anosognosia” is used to indi- Yuka Kato1 cate a general lack of awareness of one’s disease or disorder. The neural substrate underlying Keisuke Shibata1 anosognosia in AD is unclear. Since anosognosia for memory disturbance might be an initial Kaeko Nakamura1 sign of AD, it is important to determine the neural correlates. This study was designed to Kei Yamada2 investigate the characteristics and neural correlates of anosognosia for memory disturbance in patients with mild AD. Jin Narumoto1 Methods: The subjects were 49 patients with mild AD who participated in a retrospective 1 Department of Psychiatry, Graduate cross-sectional study. None of the patients had been treated with cholinesterase inhibitors, School of Medical Science, Kyoto For personal use only. Prefectural University of Medicine, memantine, or psychotropic drugs. All patients underwent magnetic resonance imaging (MRI). Kyoto, Japan; 2Department of Anosognosia for memory disturbance was assessed based on the discrepancy between question- Radiology, Graduate School of Medical naire scores of patients and their caregivers.
    [Show full text]