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Disturbances in higher order consciousness encountered in neuropsychological rehabilitation and assessment

Published online by Cambridge University Press:  16 December 2024

George P. Prigatano Open the ORCID record for George P. Prigatano [Opens in a new window]
George P. Prigatano*
Affiliation:
Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joesph’s Hospital and Medical Center, Phoenix, AZ, USA
*
Corresponding author: George P. Prigatano; Email: [email protected]
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Abstract

Objective:

The purpose of this invited paper was to summarize my clinical research on disturbances of higher order consciousness (i.e., primarily on self-awareness but including anosognosia and impaired awareness of another person’s cognitive/emotional state) that contributed to my receiving the Distinguished Career Award from the International Neuropsychology Society.

Methods:

I reviewed my early clinical encounters with disturbances in higher order consciousness and then a series of studies performed with various colleagues over the last 45 years to better understand the nature of these disturbances. The findings obtained are also discussed within the context of other researchers’ observations during this time frame.

Results:

Disturbances in higher order consciousness include classic anosognosia, impaired self-awareness, denial of disability, and denial of ability. Proposed diagnostic features of each of these disturbances are outlined and a model for understanding their complex relationships suggested. Different treatment/rehabilitation approaches for these disturbances are also summarized.

Conclusion:

Disturbances in higher order consciousness are often revealed when exploring with the person their subjective experiences of their neurological and neuropsychological functioning following different brain disorders. These subjective experiences have diagnostic value and lead to different rehabilitation approaches. The neuropsychological investigation of disturbances in higher order consciousness should include integrating knowledge from the neurosciences with nonbiological understandings of how cultural and personality features of the person may also influences their subjective experiences associated with a known or suspected brain disorder.

Keywords

Anosognosiaimpaired self-awarenessdenial of disabilitydenial of abilityneuropsychological rehabilitationpsychological care
Type
Critical Review
Information
Journal of the International Neuropsychological Society , Volume 30 , Issue 10 , December 2024 , pp. 913 - 922
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Neuropsychological Society

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