Assessing anosognosias after stroke: a review of the methods used and developed over the past 35 years.

This review provides an overview of research into anosognosia after stroke over the past 35 years. We are specifically interested in the assessment of anosognosia in group studies and in how any changes in assessment procedures have impacted the study of anognosia. Our work is based on a systematic review of reports drawn from electronic databases covering the period from 1978 to 2013 (CINAHL, PubMedMEDLINE, PsycINFO, Web of Knowledge). Sixty-four articles met the selection criteria. The results of our review show that a deeper understanding has evolved of the multifaceted syndrome of anosognosia during the past decade. The most recent studies made more extensive use of research, observational and performance-based procedures as well as traditional interview methods. Modality specificities and patients with language impairment also receive closer consideration than earlier. Furthermore, the results are more often obtained from homogeneous patient groups. The limitations of recent anosognosia research include the diversity of assessment methods used and the variation in the assessment times between and within patient groups, and the tendency to rely on only 1 method to assess and diagnose anosognosia. In order to improve the comparability of anosognosia studies it would be useful to have guidelines for the number and type of assessment methods used in studying different subtypes of anosognosia, and to focus on homogeneous patient samples. Furthermore, it is recommended that more research be done to explore chronic anosognosia and its impact on daily living.

Driving ability in stroke patients with residual visual inattention: a case study.

Driving ability of three patients having a right hemisphere infarct and residual visual inattention was examined. The neuropsychological examination included the Peripheral Perception Test and the Signal Detection Test from the Vienna Test System, and the Behavioural Inattention Test (BIT). Driving ability was assessed with an on-road evaluation. The patients had no neglect based on the BIT and had normal visual fields, but they showed slightly poorer visual search on the left side. All patients passed the official on-road driving test and were considered capable of driving. This study raises the question if acute neglect can recover to a degree in which driving may be possible.

Right hemisphere infarct patients and healthy controls: evaluation of starting points in cancellation tasks.

Patients with visual neglect (VN) tend to start cancellation tasks from the right. This exceptional initial rightward bias is also seen in some right hemisphere (RH) stroke patients who do not meet the criteria of VN in conventional tests. The present study compared RH infarct patients' (examined on average 4 days post-stroke) and healthy controls' starting points (SPs) in three cancellation tasks of the Behavioural Inattention Test (BIT). Furthermore, task-specific guideline values were defined for a normal SP to differentiate the performance of healthy subjects from that of patients with subclinical inattention. Conventional tests indicated that 15 of the 70 RH infarct patients had VN. The control group comprised 44 healthy volunteers. In each task, the VN group started the cancellations mainly from the right. The non-neglect and healthy groups initiated most cancellations from the left, more so in the healthy group. Starting more than one BIT task outside the guideline value indicated pathological inattention, as this was typical among the VN patients, but exceptional among the healthy subjects. One-third of the non-neglect patients showed pathological inattention by starting more than one task outside the guideline value. Clinical assessment of VN should, therefore, include an evaluation of the SPs to detect this subtle form of neglect.