Awareness of Deficit in Alzheimer's Disease: Relation to Caregiver Burden

Seltzer, Benjamin; Vasterling, Jennifer J.; Yoder, Joanne; Thompson, Kenneth

doi:10.1093/geront/37.1.20

Cited by 149 publications

(129 citation statements)

References 12 publications

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“…Several cross-sectional studies have found anosognosia in people with dementia to be associated with caregiver burden and, to a lesser extent, depression [4][5][6][7][8]. At least two different conclusions may be drawn from these results.…”

Section: Introductionmentioning

confidence: 98%

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Perales

Turró‐Garriga

Gascón‐Bayarri

et al. 2016

JAD

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Abstract.Background: According to cross-sectional studies, there is an association between anosognosia in people with dementia and caregiver's burden and depression. Anosognosia in patients may be a cause of caregiver burden and depression. However, variability in caregiver anosognosia ratings may exist as caregivers with burden and depression may have a more pessimistic view of the patients' health. Objective: To assess the variability of caregiver anosognosia ratings of patients with dementia using a widely used anosognosia scale and its longitudinal relationship with caregiver burden and depression. Methods: A convenience cohort of 221 consecutive dementia outpatient and caregiver dyads was followed up at 12 and 24 months. The main instruments used were the Anosognosia Questionnaire-Dementia (AQ-D), Caregiver Burden Interview, and Geriatric Depression Scale. Linear mixed models were used including time as a factor in every model. Multivariate analyses controlled for caregiver's socio-demographic and possible confounding factors. Results: Attrition at 12 and 24 months was 24.9% and 42.5% respectively. Patients at baseline were on average 77.8 years of age, 63.3% were women, and 63.3% had < 5 years of education. In the bivariate analyses, caregiver burden, depression, and gender were associated with caregiver ratings of total, cognitive, and personality AQ-D of the patient at different time points. Multivariate analyses revealed burden as the caregiver variable most consistently associated with total, cognitive, and personality caregiver AQ-D ratings of the patient. Conclusion: Some caregiver characteristics, especially burden, are associated with caregiver ratings of AQ-D with regard to the patient.

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Section: Introductionmentioning

confidence: 98%

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Perales

Turró‐Garriga

Gascón‐Bayarri

et al. 2016

JAD

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“…The lack of a gold standard for defining and detecting anosognosia has led to several different instruments being developed to assess it [17,32,33], and this makes it difficult to compare our results with previous studies. Starkstein et al also used the AQ-D in a longitudinal study and reported an accumulated incidence rate much lower than ours (21% versus 38%) [34].…”

Section: Discussionmentioning

confidence: 93%

“…Although anosognosia is associated with cognitive impairment, it may also be present in the early stages of the disease (between 25.7% and 38.5% of patients with mild dementia present with anosognosia), where it has worse repercussions for both patients and caregivers [7,[15][16][17]. Currently, however, there is no biological marker or gold standard for detecting anosognosia, and several instruments have been developed [11,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…However, in all patients, whether they suffer from stroke, schizophrenia, or dementia, the consequences of anosognosia are similar, namely poor treatment adherence or denial of the need for treatment, and increased risk of dangerous behaviours. Importantly, anosognosia also impacts on quality of life and implies greater burden on caregivers [17,19]. Furthermore, the tendency to underestimate symptoms or to ascribe them to mere aging often delays the request for a medical consultation or the provision of well-timed interventions [10].…”

Section: Introductionmentioning

confidence: 99%

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Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up

Turró‐Garriga

Garré-Olmo

Calvó-Perxas

et al. 2016

JAD

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Abstract. Anosognosia in Alzheimer's disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1-47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6-48.0), persistence was 80.0% (95% CI = 69.9-90.1) and remission was 20.0% (95% CI = 9.9-30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severity.

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“…La presencia de altos niveles de sobrecarga en el cuidador asociada a la presencia de anosognosia puede influir en la valoración objetiva de las capacidades de los pacientes e incrementar la discrepancia entre paciente y cuidador 34,35 . La valoración de la calidad de vida, un factor importante en la evaluación de tratamientos, también presenta alteraciones asociadas a la presencia de anosognosia 27,28 .…”

Section: Discussionunclassified

Prevalencia de anosognosia en la enfermedad de Alzheimer

et al. 2014

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RESUMENFundamento y objetivo: La presencia de anosognosia es un trastorno que afecta a la presentación clínica de la enfermedad de Alzheimer (EA), incrementándose su frecuencia con la evolución de la EA. El objetivo fue determinar la prevalencia de anosognosia y analizar los factores asociados y predictores.Pacientes y método: Estudio multicéntrico transversal, observacional y analítico de 345 pacientes con EA. La anosognosia se evaluó mediante la Anosognosia Questionnaire in Dementia (AQ-D) y el estadio evolutivo con la Global Deterioration Scale (GDS). Se utilizaron los tests MMSE, DAD y NPI para valorar la cognición, el estado funcional y los síntomas neuropsiquiátricos, respectivamente. Se ajustaron modelos de regresión lineal para determinar las variables asociadas y de regresión logística binaria (RLog) para analizar los factores predictores de la anosognosia. Resultados: La prevalencia global de la anosognosia fue del 46,7% (intervalo de confianza del 95% [IC 95%] 41,3-52,1). La prevalencia en los estadios fue de 28,4% (GDS 4), 64,6%(GDS 5) y 91,4% (GDS 6). La RLog identificó como variables predictoras la mayor edad (odds ratio [OR] 1,04; IC 95% 1,01-1,09), la menor capacidad funcional (OR 0,96; IC 95% 0,93-0,98), el menor nivel cognitivo (OR 0,9; IC 95% 0,88-0,99), y la mayor apatía (OR 1,1; IC 95% 1,03-1,18), desinhibición (OR 1,2; IC 95% 1,09-1,50), irritabilidad (OR 1,1; IC 95% 1,09-1,50) y trastornos motores (OR 1,2; IC 95% 1,09-1,50).Conclusiones: La anosognosia se incrementa con el mayor deterioro. En los pacientes en fase leve las variables predictoras fueron la apatía, la desinhibición y los trastornos motores.

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Awareness of Deficit in Alzheimer's Disease: Relation to Caregiver Burden

Cited by 149 publications

References 12 publications

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

The Longitudinal Association Between a Discrepancy Measure of Anosognosia in Patients with Dementia, Caregiver Burden and Depression

Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up

Prevalencia de anosognosia en la enfermedad de Alzheimer

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