Awareness of Cognitive Deficits and Anosognosia in Probable Alzheimer’s Disease
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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ABSTRACT: Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. Objective: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer’s disease (pAD) and elderly controls (EC). Methods: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. Results: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (ArithmeticDRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. Conclusion: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.Dementia e Neuropsychologia 06/2013; 7(2):198-206.
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ABSTRACT: The study investigated different types of awareness of memory dysfunction in dementia, specifically judgements concerning memory task performance or appraisal of everyday memory functioning and also exploring the neuropsychological correlates of such awareness. This was investigated in 76 people with dementia, comprising 46 patients with Alzheimer's disease (AD) and 30 patients with vascular dementia (VaD). The Memory Awareness Rating Scale (Clare et al., 2002, Neuropsychol Rehabil, 12, 341–362) was used, which includes an Objective-Judgement Discrepancy (OJD) technique involving comparison of subjective evaluation of performance on specific memory tasks with actual performance, and a Subjective Rating Discrepancy (SRD) technique, which compares self versus informant judgement of everyday memory function. The AD and VaD groups showed lower awareness than a normal control group for both types of measures, the AD group showing less awareness than the VaD group on the OJD measure. Regression analyses supported associations for both groups between memory impairment and the OJD measure and between naming impairment and the SRD measure. The findings are discussed in terms of neurocognitive theories accounting for loss of awareness in dementia.Journal of Neuropsychology 12/2014; · 3.82 Impact Factor
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ABSTRACT: Anosognosia is present in a large proportion of patients with mild Alzheimer's disease (AD), and its frequency increases with the progression of the illness. Several instruments have been validated to assess anosognosia in AD, but there is no consensus regarding the best diagnostic strategy. Anosognosia in AD is a significant predictor of apathy and is significantly related to lower depression and anxiety scores, more severe caregiver burden and dangerous behaviours. Studies using different imaging modalities have demonstrated an association between anosognosia and dysfunction in frontal, temporomedial and temporoparietal regions. The mechanism of anosognosia remains unknown, but it has been explained as a consequence of deficits of encoding and updating biographical memory, and dysfunction of comparator, executive and metacognitive systems. Copyright © 2014 Elsevier Ltd. All rights reserved.Cortex 12/2014; 61C:64-73. · 6.04 Impact Factor