Article

Awareness of Cognitive Deficits and Anosognosia in Probable Alzheimer’s Disease

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
European Neurology (Impact Factor: 1.36). 09/1994; 34(5):277-282. DOI: 10.1159/000117056

ABSTRACT We examined the relationship between unawareness of cognitive deficits and psychiatric and neuropsychological manifestations in 181 patients with probable Alzheimer’s disease (AD). Patients unaware of their cognitive deficits were more cognitively impaired, as measured by the Mini-Mental State Examination, and had a specific defect in ‘frontal/executive’ functions. The presence of major depression, delusions and hallucinations was no more likely among patients who were aware of their cognitive impairment than among those who were not. These findings have important implications for the understanding of anosognosia and deficit awareness in dementia.

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    • "The most studied cognitive disorders relating to this phenomenon are memory (Galeone, Pappalardo, Chieffi, Iavarone, & Carlomagno, 2011) and executive dysfunctions. Despite some contrary evidence (Derouesne et al., 1999; Hannesdottir & Morris, 2007; Migliorelli et al., 1995; Reed, Jagust, & Coulter, 1993; Starkstein et al., 1996), several authors have described AD patients with reduced awareness of deficits as significantly more severely impaired on neuropsychological tests that are fairly sensitive to prefrontal lobe damage (Auchus, Goldstein, Green, & Green, 1994; Loebel, Dager, Berg, & Hyde, 1990; Lopez, Becker, Somsak, Dew, & DeKosky, 1994; Mangone et al., 1991; Michon, Deweer, Pillon, Agid, & Dubois, 1994; Ott et al., 1996), particularly the Trail Making Test (Drewe, 1985; Lopez et al., 1994), the Continuous Performance Test (Mangone et al., 1991), the Wisconsin Card Sorting Test (Michon et al., 1994), and the World Color subtest of the Stroop Test (Kashiwa et al., 2005). Consistent with this, patients with impaired awareness showed reduced activation in the medial prefrontal circuit, in particular in the Anterior Cingulate Cortex (ACC), during a response inhibition (go/no-go) task, compared to subjects aware of their deficits (Amanzio et al., 2011). "
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    • "The most studied cognitive disorders relating to this phenomenon are memory (Galeone, Pappalardo, Chieffi, Iavarone, & Carlomagno, 2011) and executive dysfunctions. Despite some contrary evidence (Derouesne et al., 1999; Hannesdottir & Morris, 2007; Migliorelli et al., 1995; Reed, Jagust, & Coulter, 1993; Starkstein et al., 1996), several authors have described AD patients with reduced awareness of deficits as significantly more severely impaired on neuropsychological tests that are fairly sensitive to prefrontal lobe damage (Auchus, Goldstein, Green, & Green, 1994; Loebel, Dager, Berg, & Hyde, 1990; Lopez, Becker, Somsak, Dew, & DeKosky, 1994; Mangone et al., 1991; Michon, Deweer, Pillon, Agid, & Dubois, 1994; Ott et al., 1996), particularly the Trail Making Test (Drewe, 1985; Lopez et al., 1994), the Continuous Performance Test (Mangone et al., 1991), the Wisconsin Card Sorting Test (Michon et al., 1994), and the World Color subtest of the Stroop Test (Kashiwa et al., 2005). Consistent with this, patients with impaired awareness showed reduced activation in the medial prefrontal circuit, in particular in the Anterior Cingulate Cortex (ACC), during a response inhibition (go/no-go) task, compared to subjects aware of their deficits (Amanzio et al., 2011). "
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    • "This discrepancy may be due to a methodological problem. Whereas the former set of authors applied instruments directly to the patient, the latter assessed depression according to DSM-IV criteria for major depression [21] [34], using either the items from the AQ-D [22] or the NPI-Depression subscale [28]. Assessing depression in the patient directly during the early stages of dementia enables reliable information to be obtained, whereas it is possible than in more advanced stages, the patient's mood will also be affected by anosognosia. "
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    ABSTRACT: This study aimed to determine the factors that predict anosognosia in patients with Alzheimer's disease (AD) and to examine the effect of anosognosia on patient and caregiver perceptions of the patient's quality of life (QoL-p), using a cross-sectional design with 164 patients and their caregivers. Instruments of measurement included Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Quality of Life in AD (QoL-AD), Disability Assessment for Dementia, Neuropsychiatric Inventory, and the Global Deterioration Scale (GDS). A binary logistic regression analysis was performed to identify the factors that predict anosognosia, while a linear regression analysis was conducted to determine the factors associated with QoL-AD. The degree of anosognosia increased in line with GDS stage (F (2,161) = 41.3, p < 0.001). In the binary regression analysis, the variables that predicted anosognosia were more neuropsychiatric symptoms (OR = 1.11, 95% CI: 1.06-1.17, p < 0.001), deficits in ADL (OR = 0.88, 95% CI: 0.83-0.94, p < 0.001), less depression (OR = 0.66, 95% CI: 0.54-0.82, p < 0.001), and older age (OR = 1.08, 95% CI: 1.00-1.15, p = 0.027). With regards to QoL-p, the multiple linear regression analysis for patients (r2 = 0.486) showed that less depression (β = -0.52, p < 0.001) and greater anosognosia (β = 0.40, p < 0.001) explained 33% and 10% of the variance in QoL-AD, respectively. Greater anosognosia was associated with better perceived QoL-p, especially in advanced GDS stages. Anosognosia was associated with greater caregiver burden and a greater discrepancy between patient and caregiver ratings of QoL-p.
    Journal of Alzheimer's disease: JAD 01/2013; 33(4):1105-1116. DOI:10.3233/JAD-2012-121360 · 4.15 Impact Factor
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