The self and self-knowledge after frontal lobe neurosurgical lesions

Abstract

Background: Evidence suggests that damage to the frontal lobes can be associated with changes in cognitive and behavioral functioning and reduced awareness that such changes have occurred. In the current study, the Cognitive Awareness Model was used as a theoretical framework to explore knowledge of the self in people with acquired frontal lesions.

Methods: Fifteen individuals with focal frontal lobe lesions (FFL) and their nominated informants were compared with fifteen healthy matched control-informant dyads on questionnaire measures designed to assess awareness of difficulties. Questionnaires were adapted to ensure all enabled pre- and post-injury perspectives to be gained from both patient and informant, and to allow novel exploration of awareness of deficits from a third person perspective.

Results: Individuals with frontal lobe lesions showed adequate awareness of their post-surgery changes, which was substantiated by their informant report. Compared to the control group, the patient group was found to acknowledge more difficulties in current functioning. Perspective-taking ability was limited with both patients and controls being comparatively unreliable in assessing how they were perceived by others.

Conclusion: These results demonstrate that FLL patients are engaging in more atypical behaviors compared to healthy controls, but suggest that they are aware of and acknowledge these difficulties. The importance of obtaining multiple viewpoints when examining an individual's level of awareness and the clinical implications of this are discussed.

Keywords: Awareness; Cognitive awareness model; Frontal lesions; Perspective-taking; Self-knowledge.