Updating beliefs beyond the here-and-now: the counter-factual self in anosognosia for hemiplegia

Abstract The syndrome of anosognosia for hemiplegia, or the lack awareness one’s paralysis following right hemisphere stroke, can provide unique insights into neurocognitive mechanisms self-awareness. Yet it remains unclear whether hemiplegia is a modality-specific deficit sensorimotor monitoring, domain-general processes attention and belief-updating converge to cause hemiplegia. Using Bayesian learning framework, we formalized empirically investigated hypothesis that failures update anosognosic beliefs be explained by abnormalities in relative uncertainty (i.e. precision) ascribed prior versus sensory information different contexts. We designed new motor task manipulated both temporal (prospective retrospective) spatial (hemispace most affected inattention hemispace less inattention) conditions which had updated, validated its sensitivity 26 patients with stroke. then computed tested two predictors prospective using proxies precision patients: (i) standardized, neuropsychological measures objective abilities, i.e. visuospatial neglect scores (ii) subjective reports, confidence ratings. Our results suggest while does not affect local, error seem degree observed errors are used more general, about counterfactual abilities Difficulties such ‘counterfactual’ were associated disruptions tracts ventral attentional network superior longitudinal fasciculus connecting temporo-parietal junction frontal cortex) lesions insula, inferior parietal cortex regions. These self-awareness extends beyond retrospective requiring also salience-based, convergence self go ‘here-and-now’ experience.