Anosognosia

Anosognosia is a neurological condition characterized by a lack of awareness or denial of a real deficit or illness. It most often arises after brain injury or disease and is particularly associated with right-hemisphere damage. People with anosognosia may be unaware of weaknesses, sensory losses, or cognitive impairments that are evident to others.

The condition can affect multiple domains. The best-known form is anosognosia for hemiplegia, in which individuals do not recognize paralysis on one side of the body. It can also accompany sensory loss, apraxia, neglect, or memory and other cognitive deficits, leading to underestimation of disability and unsafe behavior.

Pathophysiology involves disruption of neural networks that support self-awareness, monitoring of performance, and body representation. Lesions are commonly in the parietal and frontal regions of the right hemisphere, including the temporoparietal junction, with impairments in fronto-parietal connectivity. The precise mechanisms may include impaired error monitoring, reduced reflective insight, and disrupted feedback about one’s own abilities.

Diagnosis relies on observed discrepancies between patient report and external observation or caregiver reports, often aided by formal assessment tools such as questionnaires designed to measure anosognosia for specific deficits. It is more frequent after right-hemisphere stroke and among individuals with more severe overall impairment, dementia, or traumatic brain injury.

Management emphasizes safety and rehabilitation planning. Interventions focus on educating patients and families, using structured feedback and environmental supports, and employing rehabilitation strategies tailored to improve awareness and functional recovery. There are no established pharmacologic treatments for anosognosia itself; outcomes vary with underlying condition and rehabilitation intensity.