The training and research described in this K23 application would enable the PI to accomplish two goals: (1) develop the skills necessary to become an independent investigator of high-order cognitive impairments and interventions, and (2) through mentored research, identify neuropathological and psychological factors related to the course of recovery from anosognosia for hemiplegia (AHP) in stroke. Existing data indicate that following right hemisphere stroke, approximately 30% of patients have AHP, a cognitive impairment in the ability to self-assess and monitor changes in motor abilities. Without insight into their impairments, these patients do not accurately perceive the need for rehabilitation services, which in turn negatively affects their participation and functional outcomes. Current theories of AHP are based on research that has relied on data collected during the subacute to chronic stages of recovery after a variable amount of brain reorganization has already occurred. Additionally, these current theories do not take into consideration the possible role of co-morbid psychological processes that may contribute to the clinical presentation of AHP. This project will test the hypothesis that persistent AHP is related to infarcted tissue in specific brain regions and the presence of co-morbid psychological processes. Specifically, the proposed mentored research will use methodology developed at Johns Hopkins in order to (1) identify AHP in the primary stages of recovery (first 48 hours) from stroke that serves as a clinical marker of dysfunction of hypothesized brain regions as shown on magnetic resonance perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI); (2) demonstrate that primary AHP is related to the volume of hypoperfused and/or infarcted tissue in a circuit that Includes the right precuneus, circulate, thalamus and insula, and that AHP, which persists into the later stages of recovery, is related to the volume of the infarcted tissue in this circuit; and (3) demonstrate that persistent AHP is also related to higher levels of apathy and denial of illness. This project is a first step to mapping out the neural circuitry that underlies AHP, understanding how the neuropathology relates to recovery course, and determining how psychological adjustment factors play a role in prolonging the unawareness presentation. This study will be key in linking the diagnosis with targets for intervention that can lead to adaptive change early in the recovery course and rehabilitation process. [unreadable] [unreadable] [unreadable] [unreadable]