We read with interest the report by Starkstein et al1 in the April 1995 issue of the Archives. Our group has also studied anosognosia in Alzheimer's disease (AD) and has reported significantly greater visuoconstructive dysfunction in patients with AD and anosognosia compared with patients with AD without anosognosia.2 In our study, we suggested that extensive right-sided cerebral dysfunction underlies this finding. Consequently, we were pleased to see the results of the report by Starkstein et al showing reduced cerebral blood flow in the right cerebral hemisphere of patients with AD and anosognosia.
We do not, however, agree with the conclusion by Starkstein et al that anosognosia in AD does not relate to deficits in specific neurocognitive domains. The statistical approach that they used to study this issue (two-way analysis of variance with repeated measures) is inappropriate. The authors treated "neuropsychological tasks" as a repeated-measures variable. However, data points
Auchus AP, Woodard JL, Goldstein FC, Green J, Green RC. Anosognosia in Alzheimer's Disease. Arch Neurol. 1996;53(1):10. doi:10.1001/archneur.1996.00550010016002
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