ANOSOGNOSIA AND VISUOVERBAL CONFABULATION

Objective: To examine the relationship between verbal confabulation and anosognosia for hemiplegia (AHP). Design: We compared patients with right hemisphere lesions and AHP with a control group with right hemisphere lesions without anosognosia. Patients attempted visual identifications of objects exposed to the left hemifield with brief (condition 1) or prolonged (condition 2) presentations. Responses were recorded as correct, incorrect, or admission of failure to perceive. Setting: Inpatients at Beth Israel Medical Center, New York, NY. Patients: A consecutive sample of nine patients with right hemisphere infarcts who demonstrated left hemiparesis, extrapersonal neglect, and left-sided visual field defects. Main Outcome Measures: Rates of correct, incorrect, and admission of failure to perceive responses. Results: Patients with AHP had higher error rates (confabulations) and lower admission of failure to perceive rates than nonanosognosic patients in condition 1. Patients with AHP continued to have higher error rates in condition 2. Nonanosognosic patients had higher correct rates in condition 2 than condition 1. Groups did not differ in degree of neglect, lesion size or location, atrophy, sensory loss, or disorientation. Conclusion: Verbal confabulation is an important determinant in anosognosia.