Anosognosia in Alzheimer's disease- The petrified Self

King's College London, Institute of Psychiatry, Department of Psychology, London, UK.
Consciousness and Cognition (Impact Factor: 2.31). 09/2009; 18(4):989-1003. DOI: 10.1016/j.concog.2009.07.005
Source: PubMed


This paper reviews the literature concerning the neural correlates of the self, the relationship between self and memory and the profile of memory impairments in Alzheimer's disease (AD) and explores the relationship between the preservation of the self and anosognosia in this condition. It concludes that a potential explanation for anosognosia in AD is a lack of updating of personal information due to the memory impairments characteristic of this disease. We put forward the hypothesis that anosognosia is due in part to the "petrified self."

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    • "Awareness can be expressed at different levels, including ability to monitor immediate performance, to make evaluative judgments about functioning in a given domain, and to reflect on the The Cognitive Awareness Model (CAM) [8] [9] [10] has been formulated to explain the heterogeneity of unawareness in dementia and postulates the existence of different causes for awareness. For example, unawareness can result from: (a) executive dysfunction , with impaired ability to detect a discrepancy between current deficits/performance and previously formed self-knowledge (executive unawareness); or, from (b) memory dysfunction, which prevents updating of self knowledge matching the development of deficits and thus results in outdated self-knowledge (mnemonic unawareness) [11]. In addition, direct impairments in metacognition may also be present due to disconnection between brain areas. "
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    ABSTRACT: Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (α = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.
    Journal of Alzheimer's disease: JAD 04/2014; 41(3). DOI:10.3233/JAD-140183 · 4.15 Impact Factor
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    • "Unawareness, lack of insight, or anosognosia refers to impaired awareness in persons with dementia [1] [2] [3] [4] [5] [6] [7]. Awareness is multifactorial and likely modular [4, 8–10], with each domain separable and potentially unique. "
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    ABSTRACT: Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific.
    Journal of aging research 01/2014; 2014(1):674716. DOI:10.1155/2014/674716
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    • "Our study revealed, however, that certain qualitative characteristics of their sense of identity differed significantly from those of ECs. AD patients may thus be unable to update their self-knowledge, mainly owing to their episodic memory deficit, eventually leading to a petrified self (Mograbi et al., 2009). There are some limitations in the current study. "
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    ABSTRACT: We looked at whether sense of identity persists in patients with Alzheimer's disease (AD) and if its profile remains the same between two examinations. A specifically designed protocol was administered to 16 AD patients in the mild to severe stages of dementia and to 16 matched healthy controls, both living in the same institution. We showed that sense of identity was broadly preserved in AD patients. The patterns of their responses were similar to those of controls, and remained consistent over a two-week period. However, some qualitative characteristics of sense of identity in AD patients differed significantly from those of controls, suggesting that AD patients may not be able to update their self-knowledge, probably because of their episodic memory deficit. These results are discussed in the light of both current models of the self and philosophical concepts such as sameness and selfhood.
    Consciousness and Cognition 10/2013; 22(4):1456-1467. DOI:10.1016/j.concog.2013.09.009 · 2.31 Impact Factor
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