Assessing Awareness of Disability (AoD) in neurological patients with neglect

Introduction: Patients with spatial neglect often show deficient Awareness of Disability (AoD) for their stroke-induced impairments. Since awareness deficits have been shown to complicate the rehabilitation process, the present study aimed at investigating AoD in patients with and without neglect using a newly developed test battery.

Methods: 70 patients with right-hemispheric stroke (n=22 patients with neglect; n=48 patients without neglect) were assessed using neuropsychological neglect tests (like e.g. cancellation tasks, line bisection, figure copying) as well as tests based upon standardized activities of daily living (ADL; like e.g. dialling a telephone number, combing one's hair). In these tests, the performance was rated by an external observer and by the patients themselves. The discrepancy between the external and the self evaluation was used as an indicator for AoD.

Results: Patients with neglect showed higher discrepancy scores for external- versus self-ratings than patients without neglect reflecting deficient AoD in neglect. These differences were modulated by the type of test, so that discrepancy scores for the ADL-based tests were lower than for the neuropsychological paper-and-pencil tests in patients with neglect.

Conclusion: The data showed that spatial neglect is associated with reduced AoD which can be assessed by discrepancy measures of external- and self-ratings of test performance. Moreover, the degree of AoD in patients with neglect depends on the type of test employed, indicating that more abstract and complex tests further compromise the realistic self-reflexion of test performance. These results have important implications for the clinical diagnosis of AoD as well as for the development and evaluation of rehabilitative interventions in patients with neglect.