{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:31:58Z","timestamp":1786422718546,"version":"build-2736575974"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Impaired self-awareness affects 30\u201350% of patients with moderate to severe acquired brain injury (ABI) and represents one of the most clinically consequential obstacles to effective rehabilitation. Despite substantial evidence that self-awareness and executive functions share neural substrates in prefrontal cortex, the mechanisms linking these two functions remain incompletely specified. This paper reviews the empirical evidence for the relationship between executive functions and insight in ABI, and evaluates four theoretical frameworks: the Cognitive Awareness Model, the Dynamic Comprehensive Model of Awareness, Mograbi et al.\u2019s predictive coding framework, and Duncan\u2019s adaptive coding model. It then proposes a novel integration of the latter two as a mechanistically grounded account of why executive dysfunction and impaired self-awareness co-occur following prefrontal damage. We argue that adaptive coding describes the representational flexibility of prefrontal neurons in coding self-relevant information, whilst predictive coding provides the computational logic, driven by precision-weighted prediction errors, through which this adaptive selection is updated. We conclude by discussing assessment and rehabilitation implications in ABI.<\/jats:p>","DOI":"10.3389\/fneur.2026.1884495","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:21:53Z","timestamp":1786422113000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Insight and executive functions in acquired brain injury: empirical evidence and theoretical frameworks"],"prefix":"10.3389","volume":"17","author":[{"given":"Natasha","family":"Sigala","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Brighton, University of Sussex","place":["Brighton, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melis","family":"Cobandag","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Brighton, University of Sussex","place":["Brighton, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Leppard","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, South London and Maudsley NHS Foundation Trust","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Medford","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, South London and Maudsley NHS Foundation Trust","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1080\/09647040802537064","article-title":"Babinski's anosognosia for hemiplegia in early twentieth-century French neurology","volume":"18","author":"Langer","year":"2009","journal-title":"J Hist Neurosci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.cortex.2014.09.011","article-title":"The construction of anosognosia: history and implications","volume":"61","author":"Markova","year":"2014","journal-title":"Cortex"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3075","DOI":"10.1093\/brain\/awm106","article-title":"Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: a systematic review of the literature","volume":"130","author":"Orfei","year":"2007","journal-title":"Brain"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/j.cortex.2012.04.011","article-title":"Neuroanatomy of impaired self-awareness in Alzheimer's disease and mild cognitive impairment","volume":"49","author":"Zamboni","year":"2013","journal-title":"Cortex"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.schres.2006.09.016","article-title":"Prefrontal cortex and insight in schizophrenia: a volumetric MRI study","volume":"89","author":"Sapara","year":"2007","journal-title":"Schizophr Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1093\/schbul\/sbs122","article-title":"Insight in schizophrenia: involvement of self-reflection networks?","volume":"39","author":"van der Meer","year":"2013","journal-title":"Schizophr Bull"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"101468","DOI":"10.1016\/j.rehab.2020.101468","article-title":"Impaired self-awareness after traumatic brain injury: a systematic review. 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