Awareness Deficits in Alzheimer's Disease: Issues in Assessment and Intervention

Abstract

Unawareness of deficits is a challenging problem frequently encountered in individuals with Alzheimer's disease (AD). Understanding mediating and causative factors of unawareness is important for accurate assessment and effective intervention. However, clinicians should also consider the variability that is often present between and within AD patients and should avoid the use of dichotomous classifications of unawareness. In this article, current knowledge generated by both neurosciences and behavioral sciences provides the basis for identifying issues and offering recommendations pertinent to assessment and intervention of awareness deficits m AD. Remedial and compensatory efforts used with head-injured patients may have potential application to dementia patients with awareness deficits, especially for those in earlier stages. Knowledge in this area is still in an early stage of investigation. As more is known about the nature of awareness deficits, it will be possible to design more effective approaches based on the characteristics of individual patients.

Experiences in early stage Alzheimer's disease: Understanding the paradox of acceptance and denial

“…This research contributes to literature which suggests empirically derived measures of personality changes in early stage AD likely include elements reflective of both neurogenic as well as psychosocial processes (Aggarwal et al, 2003;Cotrell, 1997;Vittoria, 1998). Thus some of the constructs that are studied as personality change in AD are likely an interaction of the person with the disease and her/his psychosocial environment.…”

“…Other theorists had suggested denial of memory problems and attempts to cover up mistakes were examples of coping behaviors in AD participants (Cotrell, 1997). The current research locates denial and other acts of resistance as part of a system of understanding which balances tensions between agency and objectification.…”

“…There remains much individual variation in the outward symptoms of AD which a strictly biomedical model cannot explain. Explanatory value can be added if disease symptoms are understood to reflect not only a neurogenic but also a psychological and sociohistorical process (Cotrell, 1997;Cotrell & Schulz, 1993;Lebert, Pasquier, Souliez, & Petit, 1998;Lyman, 1989;Vittoria, 1998).…”

Persistence of Self in Advanced Alzheimer's Disease

“…Caregivers' attitudes are based on beliefs and assumptions about the diminishing humanness of people in their care (Cotrell, 1997). In view of pervasive negative attitudes, there is need for further study of the subjective experiences of people with Alzheimer's disease.…”

Reframing Person-Centered Nursing Care for Persons With Dementia

“…She carefully relearned basic directions (i.e., left-right or up-down) and composed maps annotated with landmarks for directional assistance to aid her navigation through the neighborhood in which she had resided for decades. For others, unawareness deficits mark a lack of insight regarding the impact of their new way of being in social contexts (Bahro, Silber, & Sunderland, 1995;Cotrell, 1997;Sevush & Leve, 1993;Vasterling, Seltzer, Carpenter, & Thompson, 1997).…”