Prognosis for patients with neglect and anosognosia with special reference to cognitive impairment

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.