Cognitive and Motivational Factors in Anosognosia

Patients with anosognosia fail to acknowledge, or even outright deny, their impairment or illness (see Orfei et al., 2007, for a recent review). Anosognosia is usually assessed by means of a structured interview beginning with questions about general health and moving to specic questions about the patient’s impairment.2 In this chapter, we shall be concerned with anosognosia for hemiplegia (paralysis of one side of the body) or, more generally, for motor impairments. A patient whose arm or leg is paralyzed or weak following a stroke may deny the weakness in response to questions like, “Is there anything wrong with your arm or leg? Is it weak, paralyzed or numb?” (questions from Cutting, 1978; see also Nathanson, Bergman, & Gordon, 1952), and they may continue to deny the impairment even when it has been demonstrated. For example, the examiner may ask the patient to raise both arms and then demonstrate to the patient that one arm is not raised as high as the other. Our aim is to explore the role of cognitive impairments in anosognosia and also the role of motivation.