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Anosognosia and confabulation during the Wada test

From the Departments of Clinical and Health Psychology (L.H. Lu) and Neurology (Drs. Barrett, Cibula, Gilmore, Uthman, and Heilman), University of Florida College of Medicine, Gainesville; the Department of Neurology(Dr. Schwartz), University of Florida Health Science Center, Jacksonville; and the Neurology Service (Drs. Uthman and Heilman), VA Medical Center, Gainesville, FL.

Address correspondence and reprint requests to Dr. Kenneth M. Heilman, Box 100236, University of Florida, Gainesville, FL 32610-0236.

Feinberg et al. proposed that right-hemisphere-damaged stroke patients with anosognosia for hemiplegia (AHP) confabulate seeing stimuli on the left side but those without AHP admit to having inadequate visual information. This study examines the relationship between AHP and confabulation using selective anesthesia of the cerebral hemispheres. Seventeen patients with intractable epilepsy were tested during intracarotid methohexital infusion. For half of the trials, subjects were stimulated on their paretic hand with a material (sandpaper, metal, or cloth), and for the remaining trials they were not stimulated. The subjects were trained to use a pointing response to indicate if they been stimulated and the type of material they had felt. Admission of uncertainty was defined as pointing to a question mark. Confabulation was defined as any material response to a no-touch trial. During anesthesia of either hemisphere, subjects with and without AHP confabulated responses. The AHP and non-AHP groups did not differ in admission of uncertainty. Our results support the postulate that confabulation and AHP are independent disorders, and therefore confabulation cannot fully account for AHP.

Supported by the National Institutes of Health grant RO1NS30639, the State of Florida Department of Elder Affairs, and the Medical Research Service of the Department of Veterans Affairs.

Received December 5, 1996. Accepted in final form May 29, 1997.

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