Agnosia
Agnosia
Agnosia is a deficit of higher sensory (most often visual) processing causing impaired recognition. The term, coined by Freud in 1891, means literally "absence of knowledge", but its precise clinical definition continues to be a subject of debate. Lissauer (1890) originally conceived of two kinds of agnosia:
- Apperceptive:
- In which there is a defect of complex (higher order) perceptual processes.
- Associative:
- In which perception is thought to be intact but there is a defect in giving meaning to the percept by linking its content with previously encoded percepts (the semantic system); this has been described as "a normal percept that has somehow been stripped of its meaning", or "perception without knowledge."
These deficits should not be explicable by a concurrent intellectual impairment, disorder of attention, or by an inability to name or describe verbally the stimulus (anomia). As a corollary of this last point, there should be no language disorder (aphasia) for the diagnosis of agnosia.
Intact perception is sometimes used as a sine qua non for the diagnosis of agnosia, in which case it may be questioned whether apperceptive agnosia is truly agnosia. However, others retain this category, not least because the supposition that perception is normal in associative visual agnosia is probably not true. Moreover, the possibility that some agnosias are in fact higher order perceptual deficits remains: examples include some types of visual and tactile recognition of form or shape (e.g., agraphognosia; astereognosis; dysmorphopsia); some authorities label these phenomena "pseudoagnosias." The difficulty with definition perhaps reflects the continuing problem of defining perception at the physiological level.
Theoretically, agnosias can occur in any sensory modality, but some authorities believe that the only unequivocal examples are in the visual and auditory domains (e.g., prosopagnosia and pure word deafness, respectively). Nonetheless, many other "agnosias" have been described, although their clinical definition may lie outwith some operational criteria for agnosia. With the passage of time, agnosic defects merge into anterograde amnesia (failure to learn new information).
Anatomically, agnosias generally reflect dysfunction at the level of the association cortex, although they can on occasion result from thalamic pathology. Some may be of localizing value. The neuropsychological mechanisms underpinning these phenomena are often poorly understood.
References
Bauer RM, Demery JA. Agnosia. In: Heilman KM, Valenstein E (eds.). Clinical neuropsychology (4th edition). Oxford: OUP, 2003: 236-295
Farah MJ. Visual agnosia: disorders of object recognition and what theytell us about normal vision. Cambridge: MIT Press, 1995
Ghadiali E. Agnosia. Advances in Clinical Neuroscience & Rehabilitation
2004; 4(5): 18-20
Cross References
Agraphognosia; Alexia; Amnesia; Anosognosia; Aprosodia, Aprosody; Asomatognosia; Astereognosis; Auditory Agnosia; Autotopagnosia; Dysmorphopsia; Finger agnosia; Phonagnosia; Prosopagnosia; Pure word deafness; Simultanagnosia; Tactile agnosia; Visual agnosia; Visual form agnosia
