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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    • "According to these authors, patients can conserve the Self through narration by using it as an organizer.Ramanathan (1997) andMills (1997), both believe that the repetition of small " frozen " segments (verbal perseverations), even if apparently out of place, can say something important about the way a person gives meaning to his/her life, as well as show a link to basic meanings. Other studies and reviews (Mograbi et al., 2009, Gil et al., 2011) showed that personality modifications usually described by caregivers are actually not recognised by patients. Moreover, it was found out that the patient's self-evaluation corresponds to his/her personality before the illness, not in the present. "
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    ABSTRACT: The World Alzheimer Report (2014) stated that 44 million people worldwide suffer from AD. Perhaps the worst effect of the disease is the loss of Self, which is based on the loss of identity and memory (Caddell & Clare, 2010). Research into the initial stages of the disease with the scope of developing some sort of ‘salvage therapy’ is rather scarce. This work reports research done from a psycho-linguistic point of view with the goal of identifying how Alzheimer's patients maintain the Self through narrative. Self-narrative may be effective in maintaining the Self in AD patients if begun in the preliminary stages of AD .The purpose of this study was to extend knowledge about how subjects with a probable AD diagnosis or in a medium-low phase maintain the continuity of Self. The use of narration with linguistic analysis was used. Various authors have considered the use of narrative therapy (England, 2010; Ramanthan, 1997; Hyman, 2011). The study was conducted on a group of 10 patients /7 females and 3 males) with ages ranging between 67-82 (average=73.70; DS=4.76), a medium-low education level (between 1 and 11 years of education) and a probable diagnosis of AD. Three interviews were conducted including neuropsychological tests. Interviews were recorded, transcribed according to Mergenthaler (1992) and analysed following the GT approach and using the textual analysis software of Atlas.ti. This research showed that the emotional aspects which give continuity to the patients’ Self seem to be well conserved in their implicit memory. The analysis of the beginning phase of the disease and the way in which it progresses seems to be useful in the effort to understand the patient's psychic reaction to the diagnosis as well as how he or she reorganizes self-representation. It is also useful in observing how the subject's identity weave or self concept begins to deteriorate. Intervention protocols could be developed as well as a subsequent model to promote psychological health and efficacy of available traditional treatments. More research needs to be done in this area internationally, in order to test the universality of these results.
    Full-text · Article · Oct 2015 · Procedia - Social and Behavioral Sciences
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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.
    Full-text · Article · Apr 2014 · Journal of Alzheimer's disease: JAD
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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.
    Full-text · Article · Jan 2014 · Journal of aging research
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