Possible mechanisms of anosognosia: a defect in self-awareness
Possible mechanisms of anosognosia: a defect in self-awareness
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DOI：
10.1098/rstb.1998.0342
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发表时间：
1998-11-29
影响因子：
6.3
通讯作者：
Adair, JC
中科院分区：
文献类型：
--
作者：
Heilman, KM;Barrett, AM;Adair, JC
偏瘫的病感失认症既有实用的原因，也有理论的原因。我们讨论了几种神经心理学理论，这些理论已经被提出来解释这种缺陷。尽管出于心理原因，人们可能会否认缺陷，但否认假说不能解释与这种疾病相关的大脑半球不对称性，也不能解释为什么有些患者可能否认一个缺陷，而承认另一个同样致残的缺陷。有一些证据表明，来自感觉缺陷、空间忽视和失认症的错误反馈可能是一些患者感觉失认症的原因。然而，这些反馈假说并不能解释所有患者的病感缺失。尽管大脑半球连接中断的假说很有吸引力，但连接中断可能只是导致这种疾病的一个罕见原因。病感失认症的前馈意向性理论表明，虚弱的发现依赖于尝试的行动，一些患者可能患有病感失认症，因为他们不试图移动。我们提出了支持这一理论的证据。然而，一种病感缺失机制的存在并不排除其他机制也可能导致这种疾病的可能性。虽然需要进行大量的人群研究，但我们怀疑病感失认症可能是由我们讨论的几种机制引起的。根据我们回顾的身体自我意识受损的研究，我们可以推断正常的自我意识依赖于几个平行的过程。一个人必须有感官反馈，并有能力同时关注自己的身体和身体部位可能定位或行动的空间。一个人必须制定一个身体的表述，这种表述必须通过预期(前馈)和对结果的了解(反馈)来不断修改。
Anosognosia of hemiplegia is of interest for both pragmatic and theoretical reasons. We discuss several neuropsychological theories that have been proposed to explain this deficit. Although for psychological reasons people might deny deficits, the denial hypothesis cannot account for the hemispheric asymmetries associated with this disorder and cannot explain why some patients might deny one deficit and recognize another equally disabling deficit. There is some evidence that faulty feedback from sensory deficits, spatial neglect and asomatognosia might be responsible for anosognosia in some patients. However, these feedback hypotheses cannot account for anosognosia in all patients. Although the hemispheric disconnection hypothesis is appealing, disconnection is probably only a rare cause of this disorder. The feedforward intentional theory of anosognosia suggests that the discovery of weakness is dependent on attempted action and some patients might have anosognosia because they do not attempt to move. We present evidence that supports this theory. The presence of one mechanism of anosognosia, however, does not preclude the possibility that other mechanisms might also be working to produce this disorder. Although a large population study needs to be performed, we suspect that anosognosia might be caused by several of the mechanisms that we have discussed.On the basis of the studies of impaired corporeal self-awareness that we have reviewed, we can infer that normal self-awareness is dependent on several parallel processes. One must have sensory feedback and the ability to attend to both one's body and the space where parts of the body may be positioned or acting. One must develop a representation of the body and this representation must be continuously modified by expectations (feedforward) and knowledge of results (feedback).