Denial or unawareness of cognitive deficit associated with multiple sclerosis? A case report.

A nondemented, 55-year-old woman with a 20-year history of relapsing-remitting multiple sclerosis (MS) recently began having significant difficulties performing her job after several years of successful employment. While the patient acknowledged that others considered her job performance as being below standards, she did not subjectively experience any change in her cognitive functioning that would negatively impact job performance. She had no explanation as to why her job performance was now considered unsatisfactory. She also appeared to be in no distress over her situation. Was the patient's unawareness a form of anosognosia or psychological denial of her clinical condition? We provide neuropsychological, neuroimaging, and behavioral descriptions of the patient that suggest that the underlying disturbance appeared to be a neuropsychologically based, impaired self-awareness (ISA). Clinical suggestions are provided for distinguishing between ISA and denial of disability (DD) in MS patients.