Anosognosia increases caregiver burden in mild cognitive impairment

Kelleher, Mary; Tolea, Magdalena I.; Galvin, James E.

doi:10.1002/gps.4394

Cited by 41 publications

(44 citation statements)

References 64 publications

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“…This result is consistent with a recent study of these instruments in an MCI population (39), though a prior report did show informant effects on similar behavioral and functional assessments in a mixed population of participants with MCI and dementia (14). Our findings suggest that behavioral and functional assessments may be relatively more objective than QOL ratings, and therefore less likely to be modulated by participant-informant relationships.…”

Section: Discussionsupporting

confidence: 92%

Participant–Informant Relationships Affect Quality of Life Ratings in Incipient and Clinical Alzheimer Disease

Lin

Brook

Grill

et al. 2017

The American Journal of Geriatric Psychiatry

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Objective Clinical trials in incipient and clinical Alzheimer's disease (AD) often include informant-reported outcomes. While informant reports in AD dementia may be modulated by the nature of participant-informant relationships, whether informant type affects reporting at earlier disease stages is less certain. We sought to determine the effects of participant-informant relationships on informant assessments of quality of life (QOL), functional abilities, and behavioral symptoms in individuals with normal cognition (NC), mild cognitive impairment (MCI), and mild-to-moderate AD dementia. Design Cross-sectional. Setting Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles. Participants A total of 399 individuals who met criteria for NC (n=100), MCI [amnestic (n=125) and nonamnestic (n=61)], and AD (n=113). Participants were subdivided into groups based on informant/participant relationships (spouse versus other). Measurements We examined informant effects on the Quality of Life-Alzheimer's Disease (QOL-AD) scale, Functional Activities Questionnaire (FAQ), and Neuropsychiatric Inventory (NPI). Results After adjustments for demographic and cognitive factors, spouse informants reported higher participant QOL in the amnestic MCI and AD groups than did other informants. No informant effects were seen on QOL-AD ratings in the nonamnestic MCI or NC groups or on the FAQ or NPI in the MCI and AD groups. Conclusions Participant-informant relationships may modulate informant responses on subjective measures such as the QOL-AD in both incipient and clinical AD. Clinical trials that use informant measures may need to address these effects.

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Section: Discussionsupporting

confidence: 92%

Participant–Informant Relationships Affect Quality of Life Ratings in Incipient and Clinical Alzheimer Disease

Lin

Brook

Grill

et al. 2017

The American Journal of Geriatric Psychiatry

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“…Disordered awareness has significant clinical and practical implications, such as reduced decision making capacity 43 poor quality of life 6 and increased caregiver burden 7 even in MCI 44 . Additionally, disordered awareness has been previously associated with poorer functional outcomes in Parkinson’s and AD 45, 46 and was also the primary clinical correlate associated with dangerous behaviors in AD 40 .…”

Section: Discussionmentioning

confidence: 99%

Awareness of cognitive impairment in individuals with essential tremor

Azar

Bertrand

Louis

et al. 2017

Journal of the Neurological Sciences

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Objective The extent to which individuals with ET who have clinically significant cognitive impairment are aware of their cognitive changes is unclear. Reduced awareness has important implications for everyday function and decision-making. Methods 150 individuals with ET (109 Normal Cognition (ET-NC group), and 30 with MCI and 11 dementia (ET-CI group)) completed self-ratings and objective assessments of memory, language, and executive functioning. Discrepancy scores were calculated to assess awareness of cognitive functioning. One sample t-tests evaluated whether mean discrepancy scores in each group were comparable to zero (i.e., accurate). Analyses of Covariance(ANCOVA) compared discrepancy scores across two groups controlling for age and education. Results In the ET-NC group, discrepancy scores for language (M=−0.08, SD=1.10) and executive functioning (M=−0.01, SD=0.99) were comparable to zero. Memory discrepancy scores (M=0.32, SD=1.22) were greater than zero. In the ET-CI group, memory, (M=0.78, SD=1.01), language, (M=0.46, SD=0.95), and executive (M=0.39, SD=1.14) discrepancy scores were all greater than zero. Discrepancy scores were larger in ET-CI group than in ET-NC group for memory: F(1,148)=4.02, p=0.047, language: F(1,148)=6.16, p=0.014, and executive: F(1,148)=4.51, p=0.035. Conclusions Individuals with ET and normal cognition accurately assessed their language and executive abilities, demonstrating mild overconfidence in memory function. Individuals with ET and cognitive impairment overestimated their performance in all domains of functioning. Since ET is linked to increased risk for cognitive impairment, and such impairment may not be accurately perceived, cognitive functioning should be proactively and regularly screened in ET.

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“…On average, patients with MCI and mild AD have higher clinically rated awareness than those with moderate to severe AD [26, 28]. A longitudinal study examining individuals with incident dementia showed that, on average, awareness of memory functioning declined in the 2-3 years before dementia onset [26].…”

Section: Course and Predictors Of Self-awareness In Dementiamentioning

confidence: 99%

“…These measures of awareness are largely subjective (i.e., awareness is determined on the basis of another's subjective impression) and capture awareness in an offline fashion (i.e., awareness of functioning in general; not when engaged in a specific cognitive task). Clinical ratings of awareness, or anosognosia, have been shown to map onto clinically relevant behaviors including decision making, depression, dangerous behaviors, and caregiver burden [18, 28, 44, 45]. Insofar as there is an absence of well standardized, normed, metacognitive tests to evaluate self-awareness, it may be advantageous to collect information from several collateral sources such as the clinicians and caregivers along with the patients' self-report [34].…”

Section: Theoretical Models Of Self-awarenessmentioning

confidence: 99%

Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia

Sunderaraman

Cosentino

2017

Curr Neurol Neurosci Rep

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The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness, and summarize both traditional and emerging approaches to assessing awareness from clinical and metacognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and metacognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and Frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying metacognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.

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Anosognosia increases caregiver burden in mild cognitive impairment

Cited by 41 publications

References 64 publications

Participant–Informant Relationships Affect Quality of Life Ratings in Incipient and Clinical Alzheimer Disease

Participant–Informant Relationships Affect Quality of Life Ratings in Incipient and Clinical Alzheimer Disease

Awareness of cognitive impairment in individuals with essential tremor

Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia

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