Awareness of Disease is Different for Cognitive and Functional Aspects in Mild Alzheimer's Disease: A One-Year Observation Study

Abstract

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review

“…Different concepts were used to define the construct of awareness [12][13][14][15][16][17][18][19][20] , anosognosia [21][22][23][24][25][26][27][28][29][30][31][32] , self-awareness 33,34 , self -appraisal 35 , insight 36,37 , cognitive insight 38 , metacognition [39][40][41] , unawareness of deficits 42 , awareness of deficit 43,44 , awareness of disease 1,45 , awareness of functioning 46 , awareness of cognitive deficits 47 , awareness of disabilities 48 , awareness of performance 49 , unawareness of memory 42,[50][51][52] , anosognosia of memory 53 , awareness of memory deficits 54,55 , awareness of memory function and functional abilities 56 , unawareness of psychosis or behavioral problems …”

“…Among them, 13 evaluated only this domain 20,23,27,38,39,41,44,47,[50][51][52][53]55 . Ten studies evaluated awareness of cognitive and functional deficits domains 1,18,20,[33][34][35]40,45,46,54 , nine assessed cognitive and social-emotional functioning domains 12,13,17,24,28,30,36,37,49 , and three focused on cognitive and behavioral impairment domains 14,16,42 . Three researches compared awareness of cognitive, functional and behavioral impairment domains 22,25,32 and four studied the recognition of cognitive, functional, and social-emotional 15,19,29,43 .…”

“…However, in the second evaluation, awareness remained stable in a proportion of PwD and was followed by a relative decline, which is not only due to the cognitive impairment. Thus, deficits in awareness and cognition seem to be relatively independent, because mild PwD unawareness is mainly manifested by poor recognition on changes in functional activities 1 . Van Vliet et al 12 concluded that memory deficits are unlikely to explain impaired awareness, as mild PwD can display impaired awareness and PwD with severely disturbed memory retention and consolidation may still have intact awareness.…”

“…Empirical research has recently focused on exploring awareness in people with dementia (PwD) 1,2 . Awareness is the recognition of changes caused by the deficits related to the disease process.…”

“…Probably, the several conceptual models of awareness and methodological differences, such as heterogeneity of sample and level of disease severity may explain these uncertain findings 9 . It is essential to understand the differences between each object of awareness and of their specific traits, as it may be helpful for the improvement of strategies focused on the management of PwD 1,6,10 . In this context, this systematic review is aimed at exploring the different objects of awareness in Alzheimer's disease (AD).…”