Awareness in dementia: A review of clinical correlates

Aalten, Pauline; Valen, Evelien van; Clare, Linda; Kenny, Geraldine; Verhey, Frans R.J.

doi:10.1080/13607860500143075

Cited by 122 publications

(124 citation statements)

References 33 publications

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“…However, these studies did not take into account the possible influence of psychotropic drugs, which are often used in the treatment of NPS. Higher rates of psychotropic drug use (PDU) are found in nursing home residents with YOD (87%) than in those with LOD (rang-ing from 63%-75%) (Aalten, Van Valen, Clare, Kenny, & Verhey, 2005;Mulders et al, 2016;Nijk, Zuidema, & Koopmans, 2009;Wetzels, Zuidema, de Jonghe, Verhey, & Koopmans, 2011). Therefore, a greater decline in NPS due to treatment with PDU might be expected in YOD.…”

Section: Introductionmentioning

confidence: 99%

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Appelhof

Bakker

IJssel

et al. 2018

Aging & Mental Health

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Objective: The aims of the current study are (1) to explore the differences in neuropsychiatric symptoms (NPS) between young-onset dementia (YOD) and late-onset dementia (LOD), and (2) to investigate whether the possible differences can be attributed to differences in dementia subtype, gender, psychotropic drug use (PDU), or dementia severity. Method: Three hundred and eighty-six nursing home (NH) residents with YOD and 350 with LOD were included. Multilevel modeling was used to compare NPS between the groups . Furthermore, dementia subtype, gender, PDU, and dementia severity were added to the crude multilevel models to investigate whether the possible differences in NPS could be attributed to these characteristics. Results: Higher levels of apathy were found in NH residents with YOD. After the characteristics were added to the models, also lower levels of verbally agitated behaviors were found in YOD . Conclusion: We recommend that special attention be paid to interventions targeting apathy in YOD. Although no differences in other NPS were found, the PDU rates were higher in YOD, suggesting that the threshold for the use of PDU in the management of NPS is lower. This underscores the need for appropriate attention to non-pharmacological interventions for the management of NPS in YOD.

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Section: Introductionmentioning

confidence: 99%

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Appelhof

Bakker

IJssel

et al. 2018

Aging & Mental Health

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“…However, patients with impaired selfawareness may not adapt their behaviour to current limitations, possibly resulting in hazardous behaviour in circumstances where, for instance, they can no longer drive or manage finances. Impaired self-awareness can also negatively impact patient care and rehabilitation, as it may cause resistance to treatment and rehabilitation efforts (Sherer et al, 1998;Aalten et al, 2005;Rosen, 2011;Zamboni and Wilcock, 2011).…”

Section: Introductionmentioning

confidence: 99%

Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention

Shany‐Ur

Lin

Rosen

et al. 2014

Brain

113

108

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Accurate self-awareness is essential for adapting one's tasks and goals to one's actual abilities. Patients with neurodegenerative diseases, particularly those with right frontal involvement, often present with poor self-awareness of their functional limitations that may exacerbate their already jeopardized decision-making and behaviour. We studied the structural neuroanatomical basis for impaired self-awareness among patients with neurodegenerative disease and healthy older adults. One hundred and twentyfour participants (78 patients with neurodegenerative diseases including Alzheimer's disease, behavioural variant frontotemporal dementia, right-temporal frontotemporal dementia, semantic variant and non-fluent variant primary progressive aphasia, and 46 healthy controls) described themselves on the Patient Competency Rating Scale, rating observable functioning across four domains (daily living activities, cognitive, emotional control, interpersonal). All participants underwent structural magnetic resonance imaging. Informants also described subjects' functioning on the same scale. Self-awareness was measured by comparing self and informant ratings. Group differences in discrepancy scores were analysed using general linear models, controlling for age, sex and disease severity. Compared with controls, patients with behavioural variant frontotemporal dementia overestimated their functioning in all domains, patients with Alzheimer's disease overestimated cognitive and emotional functioning, patients with right-temporal frontotemporal dementia overestimated interpersonal functioning, and patients with non-fluent aphasia overestimated emotional and interpersonal functioning. Patients with semantic variant aphasia did not overestimate functioning on any domain. To examine the neuroanatomic correlates of impaired self-awareness, discrepancy scores were correlated with brain volume using voxel-based morphometry. To identify the unique neural correlates of overlooking versus exaggerating deficits, overestimation and underestimation scores were analysed separately, controlling for age, sex, total intracranial volume and extent of actual functional decline. Atrophy related to overestimating one's functioning included bilateral, right greater than left frontal and subcortical regions, including dorsal superior and middle frontal gyri, lateral and medial orbitofrontal gyri, right anterior insula, putamen, thalamus, and caudate, and midbrain and pons. Thus, our patients' tendency to under-represent their functional decline was related to degeneration of domain-general dorsal frontal regions involved in attention, as well as orbitofrontal and subcortical regions likely involved in assigning a reward value to self-related processing and maintaining accurate self-knowledge. The anatomic correlates of underestimation (right rostral anterior cingulate cortex, uncorrected significance level) were distinct from overestimation and had a substantially smaller effect size. This suggests that underestimation or 'tarnishing' may be influ...

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“…Lack of insight refers to a range of phenomena whereby people with dementia lack awareness (Aalten et al, 2005) in relation to specific cognitive deficits (anosognosia), social functioning, behaviour, or general life circumstances. It has been argued that if a dementia patient is not fully aware of the disease "how can we believe a patient's assessment of the impact of the disease on QoL?"…”

Section: Introductionmentioning

confidence: 99%

Predictors of quality of life ratings from persons with dementia: the role of insight

Trigg

Watts

Jones

et al. 2010

Int J Geriat Psychiatry

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Objective Evidence suggests that people with dementia are able to respond accurately and consistently to questions about quality of life (QoL), although large discrepancies exist between patient and proxy ratings. This may be due, in part, to the reduced insight of the person with dementia. The aim of this study was to explore the predictors of QoL ratings in a sample of people with mild dementia, with a particular focus on the role of insight.

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Awareness in dementia: A review of clinical correlates

Cited by 122 publications

References 33 publications

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention

Predictors of quality of life ratings from persons with dementia: the role of insight

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