Anosognosia in moderate-to-severe traumatic brain injury: A review of prevalence, clinical correlates, and diversity considerations

Abstract

Objective: Anosognosia, or poor self-awareness into current deficits, is a common sequela in both acute and chronic stages of recovery following moderate-to-severe traumatic brain injury (msevTBI). Poor insight into one’s limitations following brain injury can have wide-ranging negative implications on treatment engagement, utilization of compensatory strategies, functional independence, and caregiver burden. Despite its clinical importance, this is the first literature review to document the prevalence and course of anosognosia following msevTBI as well as the demographic, injury-related, neuroanatomical, and neuropsychological correlates of this condition. In addition, this review highlights a range of diversity and cultural considerations for anosognosia assessment and intervention.

Method

A comprehensive search of peer-reviewed articles was conducted from September to November 2020 using Google Scholar and PubMed databases. Key terms included “anosognosia,” “self-awareness,” “traumatic brain injury,” and variants thereof. Our search was restricted to articles published in English within the last 25 years, although a few historical articles were included due to scientific merit. Articles were chosen based on methodological quality, inclusion of solely or predominantly msevTBI sample, and relevance to the current topic.

Conclusions

Anosognosia is a multifaceted and domain-specific construct that affects the majority of those with msevTBI. It is related to TBI severity, injuries in right-hemispheric and cortical midline regions, specific aspects of executive function, psychological function, and cultural factors. We offer pragmatic advice for clinicians working with this population and discuss implications for the field regarding “best practices” of anosognosia assessment and intervention.

Keywords:

• Anosognosia
• self-awareness
• traumatic brain injury
• cognition
• neuroimaging

Disclosure statement

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official position of the Department of Defense; Department of Veterans Affairs; or any other federal agency, policy, or decision unless so designated by other official documentation. The authors declare no conflicts of interest.