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AnosognosiaNCT05654350

Lesion Site and Neglect Anosognosia in Patients With Left Hemispatial Neglect

An observational study of Anosognosia and Neglect, Hemispatial, run by Gazi University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this retrospective is to investigate the relationship between lesion site and neglect anosognosia in subacute or chronic right hemispheric stroke patients with left hemispatial neglect. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Anosognosia, Neglect, Hemispatial, Stroke
How many people
78 participants
Where
1 siteTurkey (Türkiye)
Study dates
16 Dec 2022to 21 Jan 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with subacute or chronic right hemispheric stroke with left hemispatial neglect

Who may be able to join

  • Being older than 18 years of age
  • Having a subacute or chronic right hemispheric supratentorial stroke
  • Having left hemispatial neglect

Who cannot join

  • Being in the first 2 weeks of the stroke
  • Lesions involving the left hemisphere and/or brainstem and/or cerebellum
  • Having other neurological conditions such as traumatic brain injury, central nervous system neoplasm, neurodegenerative or neuropsychiatric diseases
  • Presence of severe cognitive impairment in the mini-mental state examination scale (<10 points)
  • Lack of brain imaging data
  • Having visual problems and psychiatric disorders hindering neglect and anosognosia evaluation

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Gazi University Hospital, Department of Physical Medicine and Rehabilitation

    Ankara, 06560

Other trials in Turkey (Türkiye)

About this study

Official title: The Relationship Between Lesion Site And Neglect Anosognosia in Right Hemispheric Stroke Patients With Left Hemispatial Neglect

The goal of this retrospective is to investigate the relationship between lesion site and neglect anosognosia in subacute or chronic right hemispheric stroke patients with left hemispatial neglect. The main questions it aims to answer are:

  • Was any lesion site related to a higher neglect anosognosia rate?
  • Did any lesion site related to a more severe neglect anosognosia? Participants will be divided into two groups regarding the presence of anosognosia for spatial neglect.

Researchers will compare patients with and without anosognosia to see if any lesion site resulted in a higher anosognosia rate and more severe unawareness of neglect symptoms in daily life.

Read the detailed description

Babinski first defined anosognosia in 1914 as being unaware of paralysis in patients with right hemisphere stroke. Today, this term is used for the unawareness of various neurological and cognitive diseases or disabilities. One of these, anosognosia for hemispatial neglect, is an interesting phenomenon and has not been explored as thoroughly as hemiplegia anosognosia. Lesions of the right superior and inferior temporal gyrus, temporoparietal junction, and insula have been blamed for hemiplegia anosognosia. However, the neural correlates of neglect anosognosia are yet to be elucidated. Therefore, in this study, the investigators aim to investigate the relationship between lesion site and neglect anosognosia in subacute or chronic right hemispheric stroke patients with left hemispatial neglect.

In this retrospective study, the investigators will screen the medical records of our inpatient cognitive rehabilitation unit from 2011 to 2021. Patients diagnosed with left hemispatial neglect using Catherine Bergego Scale (CBS), line bisection, star cancellation, figure and shape copying, or representational drawing tests will be included in the study. Demographic and clinical data such as age, gender, weeks after stroke, stroke type (ischemic or hemorrhagic), lesion site, Brunnstrom stages, mini-mental status examination score and severities of neglect and neglect anosognosia will be noted.

Both neglect and neglect anosognosia severities will be determined using CBS. The underestimation of spatial deficits in daily living detected by parallel CBS testing will be considered as neglect anosognosia. The neglect anosognosia score will be calculated by subtracting the patient's self-assessment score from the evaluator-assigned CBS score. A difference of at least one point will be considered the presence of anosognosia. Patients will be divided into two groups with and without anosognosia according to the CBS-anosognosia score. Demographic and clinical features of patients with and without anosognosia will be compared. The correlation between neglect and neglect anosognosia scores will be examined.

The lesion site will be described by regions of interest (ROI) involvement using a semi-quantitative analyse. The association between anosognosia presence and involvement of the ROI will be analysed using the odds ratio with %95 confidence intervals. Neglect and anosognosia severities will also be compared between involvement and sparing of each ROI. Mini-mental state examination scores will be compared between the groups with and without anosognosia to address mental status, which may be a confounding factor in the evaluation of anosognosia.

Keywords
Neglect anosognosia, Stroke, Hemispatial neglect, Self-awareness, Anosognosia
Medical subject headings
Agnosia, Perceptual Disorders, Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT05654350
Study groupRoleWhat they receive
Patients with neglect anosognosiaSubacute or chronic right hemispheric stroke patients with left hemispatial neglect and neglect anosognosia.
Patients without neglect anosognosiaSubacute or chronic right hemispheric stroke patients with left hemispatial neglect but no neglect anosognosia.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Neglect Score on Catherine Bergego Scale (CBS)

    CBS-neglect score, which was assigned by an experienced rehabilitation nurse, will be obtained. CBS is a 10-item questionnaire based on direct observation of the patient's activities of daily living such as grooming, dressing, eating, cleaning mouth after a meal, gaze orientation, left limb knowledge, auditory attention, colliding when moving, spatial orientation and, finding belongings. Each item is scored on a 4-point scale ranging from 0 (no ignore) to 3 (severe ignore). The total score ranges from 0 to 30. Higher scores represent more severe spatial neglect behaviour.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

  2. Neglect Anosognosia Score on Catherine Bergego Scale (CBS)

    CBS is a parallel test in which patients can evaluate themselves while an external observer evaluates the patient. The CBS-neglect anosognosia score is calculated by subtracting the patient's self-assessment score from the score given by the external observer for each CBS item. The anosognosia score ranges from 0 to 3 for each item and 0 to 30 in total. Higher scores represent more severe neglect anosognosia.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

  3. Lesion site-cortical involvement

    A semi-quantitative lesion analysis will be conducted on brain magnetic resonance or computed tomography imaging records. Lesions will be scored as 1 or 0, respectively, as those with and without cortical involvement. The frequency of lesions with cortical involvement will be determined.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

  4. Lesion site-regions of interest

    A semi-quantitative lesion analysis will be conducted on brain magnetic resonance or computed tomography imaging records. Lesions will be scored as 1 and 0, respectively, with and without the involvement of each region of interest (ROI). Seven ROIs have been identified: frontal, parietal, temporal, occipital, insula, basal ganglia, and thalamus. The frequencies will be determined for each ROI involvement. The frequency of lesions involving multiple ROIs will also be noted.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

  5. Lesion pervasiveness

    A semi-quantitative lesion analysis will be conducted on brain magnetic resonance or computed tomography imaging records. The total scores of ROIs involved will define the lesion pervasiveness score. It will range from 0 to 7, with a higher score representing a more pervasive lesion.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

Secondary outcomes (1)
  1. Turkish version of the Mini-Mental State Examination (MMSE)

    Turkish version of the Mini-Mental State Examination (MMSE) is a scale used to evaluate the cognitive status of individuals. It evaluates verbal responses including attention, orientation and memory; the abilities to follow verbal and written orders, write spontaneous sentences, and copy a complex drawing. The score is the number of items answered correctly, giving a total of 0 to 30 points. A score of 23 or less is the accepted cut-off point for cognitive impairment. The lower score represents a more severe cognitive impairment. The reliability and validity studies of the Turkish version of the MMSE were performed by Güngen et al. in 2002.

    Measured: Within the first week of admission to the inpatient rehabilitation clinic

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Dec 2022
  2. Study start16 Dec 2022
  3. Primary completion20 Jan 2023
  4. Study completion21 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Retrospective
Enrolment
78 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05654350
Sponsor's protocol ID
Anosognosia and lesion site
Status last verified
Dec 2022
First submitted
29 Nov 2022
Last updated
22 Feb 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Langer KG, Bogousslavsky J. The Merging Tracks of Anosognosia and Neglect. Eur Neurol. 2020;83(4):438-446. doi: 10.1159/000510397. Epub 2020 Sep 14.

    PubMed 32927461
  • Jehkonen M, Laihosalo M, Kettunen J. Anosognosia after stroke: assessment, occurrence, subtypes and impact on functional outcome reviewed. Acta Neurol Scand. 2006 Nov;114(5):293-306. doi: 10.1111/j.1600-0404.2006.00723.x.

    PubMed 17022776
  • Heilman KM. Possible mechanisms of anosognosia of hemiplegia. Cortex. 2014 Dec;61:30-42. doi: 10.1016/j.cortex.2014.06.007. Epub 2014 Jun 19.

    PubMed 25023619
  • Vossel S, Weiss PH, Eschenbeck P, Saliger J, Karbe H, Fink GR. The neural basis of anosognosia for spatial neglect after stroke. Stroke. 2012 Jul;43(7):1954-6. doi: 10.1161/STROKEAHA.112.657288. Epub 2012 May 24.

    PubMed 22627992
  • Rousseaux M, Allart E, Bernati T, Saj A. Anatomical and psychometric relationships of behavioral neglect in daily living. Neuropsychologia. 2015 Apr;70:64-70. doi: 10.1016/j.neuropsychologia.2015.02.011. Epub 2015 Feb 10.

    PubMed 25676676
  • Karnath HO, Baier B. Right insula for our sense of limb ownership and self-awareness of actions. Brain Struct Funct. 2010 Jun;214(5-6):411-7. doi: 10.1007/s00429-010-0250-4. Epub 2010 May 29.

    PubMed 20512380
  • Laporta-Hoyos O, Fiori S, Pannek K, Ballester-Plane J, Leiva D, Reid LB, Pagnozzi AM, Vazquez E, Delgado I, Macaya A, Pueyo R, Boyd RN. Brain lesion scores obtained using a simple semi-quantitative scale from MR imaging are associated with motor function, communication and cognition in dyskinetic cerebral palsy. Neuroimage Clin. 2018 Jun 14;19:892-900. doi: 10.1016/j.nicl.2018.06.015. eCollection 2018.

    PubMed 30013928
  • Pia L, Neppi-Modona M, Ricci R, Berti A. The anatomy of anosognosia for hemiplegia: a meta-analysis. Cortex. 2004 Apr;40(2):367-77. doi: 10.1016/s0010-9452(08)70131-x.

    PubMed 15156794

Questions about this trial

What is this clinical trial studying?

An observational study of Anosognosia and Neglect, Hemispatial, run by Gazi University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 22 Feb 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Neglect Score on Catherine Bergego Scale (CBS) (time frame: Within the first week of admission to the inpatient rehabilitation clinic). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05654350, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Feb 2023.

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