Prognosis for patients with neglect and anosognosia with special reference to cognitive impairment
Peter Appelros, Gunnel M. Karlsson, Åke Seiger, Ingegerd Nydevik
A1 Departments of Neurology and Geriatrics Örebro University Hospital Örebro Sweden
A2 Neurotec Department Karolinska Institutet Stockholm Sweden
A3 Stockholms Sjukhem Stockholm Sweden
Objective: To describe prognosis in patients with unilateral neglect, anosognosia, or both, within a community based stroke cohort. Methods: Patients (n = 377) were evaluated at baseline for the presence of neglect and anosognosia. After 1 year, the level of disability was established in survivors. Predictors for death and dependency were examined in multivariate analysis. The following independent variables were used: age, consciousness, hemianopia, arm paresis, leg paresis, sensory disturbance, aphasia, neglect, anosognosia, diabetes mellitus, cardiovascular disease, pre- and post-stroke cognitive impairment. Results: Age, consciousness and sensory disturbance predicted death. Post-stroke cognitive impairment, neglect, hemianopia, arm paresis and age predicted dependency. Conclusion: Neglect in the acute phase, which occurs in patients irrespective of pre-stroke cognitive level, negatively affects disability after 1 year. Anosognosia more often occurs in patients who are cognitively impaired before the stroke. These patients often are ADL-dependent already, or become dependent because of cognitive impairment, not because of anosognosia.
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