VATA-ADL: The Visual Analogue Test for Anosognosia for Activities of Daily Living

Della Sala, Sergio; Cocchini, Gianna; Beschin, Nicoletta; Fowler, Elizabeth A.; Kaschel, Patrick and McIntosh, Robert D.. 2022. VATA-ADL: The Visual Analogue Test for Anosognosia for Activities of Daily Living. Archives of Clinical Neuropsychology, 37(6), pp. 1185-1198. ISSN 0887-6177 [Article]

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Abstract or Description

Objective. To study awareness of problems with one’s own Activities of Daily Living following stroke by means of a novel instrument, the Visual-Analogue Test for Anosognosia for Activities of Daily Living (VATA-ADL).

Methods. The new test overcomes some of the methodological problems of traditional structured interviews and self-rating questionnaires. In particular, to account for possible verbal communication difficulties, each question is illustrated by a drawing and a 4-point visual-analogue Likert scale. The patient’s self-rating is compared with that given by informants (personal or professional caregiver) to acquire a measure of metacognition of one’s own problems in performing everyday tasks.

Results. The VATA-ADL was validated in 61 dyads of older people and their informants. A group of 80 post-acute stroke patients and their informants then completed the test. Informant ratings correlated highly with traditional ADL scales, the questionnaire items showed high internal consistency (α = .95) and loaded onto one factor. By comparison to informants’ assessments, the patients showed a generally poor appreciation of their functional disabilities. Thirty-nine patients overestimated their abilities (anosognosia) whereas nine showed underestimation of their abilities.

Conclusions. Anosognosia (overestimation of abilities) for ADL is frequent, even in post-acute stages post-stroke. Some other patients underestimated their abilities, indicating that poor metacognition of one’s own abilities in brain damaged patients is bi-directional. Both types of misestimation may have clinical consequences worth considering for the wellbeing of patients and their carers.

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Additional Information:

This is a pre-copyedited, author-produced version of an article accepted for publication in Archives of Clinical Neuropsychology following peer review. The version of record is available online at:


Anosognosia, Unawareness, ADL/iADL, Stroke, Assessment

Departments, Centres and Research Units:

Psychology > Centre for Cognition, Computation and Culture (CCCC)


26 January 2022Accepted
21 March 2022Published Online
September 2022Published

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Date Deposited:

18 Feb 2022 15:10

Last Modified:

21 Mar 2023 02:26

Peer Reviewed:

Yes, this version has been peer-reviewed.


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