Anosognosia for Hemiplegia: Neural Basis, Physchological Correlates, and Recovery

描述（由申请人提供）：本K23申请中描述的培训和研究将使PI能够实现两个目标：(1)发展成为高阶认知障碍和干预的独立研究者所需的技能，(2)通过指导研究，确定与中风偏瘫病感失认（AHP）康复过程相关的神经病理和心理因素。现有数据表明，右半球中风后，大约30%的患者患有AHP，这是一种自我评估和监测运动能力变化的认知障碍。如果不了解自己的缺陷，这些患者就不能准确地认识到康复服务的需要，这反过来又会对他们的参与和功能结果产生负面影响。目前的AHP理论是建立在亚急性到慢性恢复期的研究基础上的，而在此期间，大脑已经发生了不同程度的重组。此外，这些目前的理论并没有考虑到可能导致AHP临床表现的共病心理过程的可能作用。本项目将检验持续性AHP与特定脑区梗死组织和共病心理过程相关的假设。具体来说，建议的指导研究将使用约翰霍普金斯大学开发的方法，以(1)确定AHP在中风恢复的初级阶段（前48小时），作为磁共振灌注加权成像（PWI）和扩散加权成像（DWI）显示的假设脑区域功能障碍的临床标志；(2)证明原发性AHP与包括右楔前叶、循环、丘脑和脑岛在内的脑回路中灌注不足和/或梗死组织的体积有关，并且持续到恢复后期的AHP与该回路中梗死组织的体积有关；(3)证明持续的AHP也与更高水平的冷漠和否认疾病有关。该项目是绘制AHP基础神经回路的第一步，了解神经病理学与康复过程的关系，并确定心理调节因素如何在延长无意识表现中发挥作用。这项研究将是将诊断与干预目标联系起来的关键，这些目标可以在恢复过程和康复过程的早期导致适应性改变。

DESCRIPTION (provided by applicant): The training and research described in this K23 application would enable the PI to accomplish two goals: (1) develop the skills necessary to become an independent investigator of high-order cognitive impairments and interventions, and (2) through mentored research, identify neuropathological and psychological factors related to the course of recovery from anosognosia for hemiplegia (AHP) in stroke. Existing data indicate that following right hemisphere stroke, approximately 30% of patients have AHP, a cognitive impairment in the ability to self-assess and monitor changes in motor abilities. Without insight into their impairments, these patients do not accurately perceive the need for rehabilitation services, which in turn negatively affects their participation and functional outcomes. Current theories of AHP are based on research that has relied on data collected during the subacute to chronic stages of recovery after a variable amount of brain reorganization has already occurred. Additionally, these current theories do not take into consideration the possible role of co-morbid psychological processes that may contribute to the clinical presentation of AHP. This project will test the hypothesis that persistent AHP is related to infarcted tissue in specific brain regions and the presence of co-morbid psychological processes. Specifically, the proposed mentored research will use methodology developed at Johns Hopkins in order to (1) identify AHP in the primary stages of recovery (first 48 hours) from stroke that serves as a clinical marker of dysfunction of hypothesized brain regions as shown on magnetic resonance perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI); (2) demonstrate that primary AHP is related to the volume of hypoperfused and/or infarcted tissue in a circuit that Includes the right precuneus, circulate, thalamus and insula, and that AHP, which persists into the later stages of recovery, is related to the volume of the infarcted tissue in this circuit; and (3) demonstrate that persistent AHP is also related to higher levels of apathy and denial of illness. This project is a first step to mapping out the neural circuitry that underlies AHP, understanding how the neuropathology relates to recovery course, and determining how psychological adjustment factors play a role in prolonging the unawareness presentation. This study will be key in linking the diagnosis with targets for intervention that can lead to adaptive change early in the recovery course and rehabilitation process.