Awareness and behavioral problems in dementia patients: A prospective study

Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands.
International Psychogeriatrics (Impact Factor: 1.93). 04/2006; 18(1):3-17. DOI: 10.1017/S1041610205002772
Source: PubMed


The results of studies of the association between awareness and clinical correlates in patients with dementia are inconclusive. The aims of this study were to investigate whether awareness changed during the course of dementia and to determine whether awareness was associated with certain behavioral symptoms. Specifically, it was hypothesized that relatively intact awareness was related to affective disorders.
One hundred and ninety-nine patients with dementia were included in a prospective 18-month follow-up study. Behavioral problems were assessed with the Neuropsychiatric Inventory and the Cornell Scale for Depression in Dementia. Awareness was assessed by means of the Guidelines for the Rating of Awareness Deficits.
Cross-sectional analyses showed awareness to be positively associated with age, gender, education and socioeconomic status, and negatively associated with psychosis, apathy, and overall behavioral disorders at baseline. After 1 year, a higher level of awareness was related to depression and anxiety. The level of awareness at baseline also predicted depression and anxiety after 1 year. Awareness decreased during the study.
A higher level of awareness is associated with subsyndromal depression and anxiety, whereas lack of awareness is associated with psychosis and apathy. The level of awareness decreases as dementia progresses. Clinicians should be more alert to changes in awareness in patients with dementia because psychosocial support might help to prevent the development of affective symptoms.

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    • "This also manifests as poor awareness of deficits in ADL. In general, awareness of deficits seems to decrease with an increased severity of dementia [39,59]. This could account for the lack of association between severity and HRQL. "
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    • "Others have found few group-based differences, but high individual variability in awareness declines when studied over one year [23], potentially because severity and awareness are mediated by cognitive reserve [24]. Other important clinical correlates of awareness include depression [18] [21] [22] [25], neuropsychiatric status [19–21, 26] caregiver burden [10] [11] [14] [26], activities of daily living [19], and neuropsychological status [12, 19, 20, 22, 27–29] which demonstrate variability in associations with awareness across domains and measurement methods [1]. Models of awareness suggest awareness is mediated by the frontal lobes [2] [3] or the right frontal lobe [30] [31], and lack of awareness is associated with other behavioural indicators of frontal dysfunction, such as increased apathy [32]. "
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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.
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