Denial in the first days of acute stroke

Denial is a disorder of self-awareness that is frequent after acute stroke, with potential negative influence in the care of patients. The aim of this study was to describe the presence and correlates of denial in acute stroke. We assessed denial in a sample of 180 consecutive acute stroke patients (<= 4 days) and in a control group of 50 acute coronary patients using the Denial of Illness Scale (DIS). 41% (74) acute stroke patients (mean DIS score=4.1, SD=2.2, range 0 to 10) and 24% (12) acute coronary patients (mean DIS score=3.2, SD=1.5, range 0 to 10) presented denial (chi(2)=4.19, p=.04; U=3405.50, p=.01). Denial was more frequent and severe in patients with lower educational level (chi(2)=5.04, p=.04; U=2110.50; p=.01), neglect (chi(2)=21.38, p=.00; U=1130.50; p=.00), cognitive impairment (chi(2)=6.27, p=.02; U=1181.50; p=.01) and after hemispherical lesions (chi(2)=4.68, p=.05; U=1982.50; p=.04). In logistic regression low educational level, neglect and cognitive impairment were independent factors predicting denial in stroke patients (R-2=21%). Patients with denial can express depressive symptoms. Patients with denial had a worse outcome at discharge (chi(2)=4.91, p=.04; U=2918.00; p=.03). Denial is a frequent phenomenon after acute stroke. We propose that there is a multifactorial model for the emergence of denial, lower educational as a predisposing condition, and acute stroke due to hemisphere lesion and causing neglect and cognitive impairment as precipitating events. All these factors limit patients' assessment of their condition and body functions.