Unawareness of motor impairment and emotions in right hemispheric stroke: A preliminary investigation

Gianfranco Spalletta, Laura Serra, Lucia Fadda, Alessandra Ripa, Pietro Bria, Carlo Caltagirone

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Background: Awareness may lack in some stroke patients who are not capable of evaluating the nature and severity of illness. Thus, unawareness may have different forms such as anosognosia, neglect, and alexithymia or unawareness of emotions. In this study we investigated the relationship among anosognosia, neglect, alexithymia, and cognition. Methods: Fifty consecutive right stroke inpatients were approached within the first 3 months from the acute event. Anosognosia was measured with the Bisiach scale, alexithymia with the TAS-20 scale and neglect with line crossing, letter cancellation, figure and shape copying, and line bisection tests. A neuropsychological test battery was used to measure different areas of cognition. Results: despite the strong comorbidity rate among the different forms of unawareness, there are patients who suffer from pure forms of these types of lack of awareness. A multivariate logistic regression model evidenced that presence of neglect (OR = 10.3; 95% CI = 1.4-76.3; p = 0.023) and more difficulty in describing feelings (TAS-20 F2 subscore; OR = 1.3; 95% CI=1.1-1.7; p=0.014) were the only predictors of anosognosia. In addition, anosognosics with alexithymia performed worst in a frontal task such as the verbal fluency task (p = 0.042) and in the verbal span forward task (p = 0.026) than pure anosognosics. Conclusions: Anosognosia for motor impairment is strictly associated with a specific form of unawareness of emotions. Future studies have to clarify if frontal cognitive impairment previously described in anosognosics is a manifestation of unawareness of emotions or anosognosia for motor impairment.

Original languageEnglish
Pages (from-to)1241-1246
Number of pages6
JournalInternational Journal of Geriatric Psychiatry
Issue number12
Publication statusPublished - Dec 2007


  • Alexithymia
  • Anosognosia
  • Cognition
  • Neglect
  • Stroke
  • Unawareness

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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