Awareness of memory deficit in alzheimer's disease patients and memory-impaired older adults

Abstract

Disturbances in awareness of memory deficit have been observed in Alzheimer's disease (AD), yet few studies have systematically investigated the phenomena in this population. The present study has applied the concepts and instruments used in the metamemory literature to the study of awareness of memory deficit in twenty mild AD patients, eighteen individuals with, memory impairment, and eighteen normal elderly controls. Specifically, a multidimensional approach to metamemory was selected including an evaluation of perception of memory change, knowledge about memory functioning, and self-monitoring of memory performance. Consistent with previous research, AD patients reported less change in memory functioning than did their informants, suggesting that these patients have diminished awareness of the extent of the decline in their memory abilities. No differences among the three groups were observed in self-report measures addressing the use of strategies, perception of control over memory functioning, and presence of anxiety in memory-related activities. Diminished self-monitoring abilities were observed in the AD patients' tendency to make a high number of intrusion errors with few self-corrections, and iii to overestimate their performance on memory tests, The results also suggest that relatives' evaluation of memory functioning may be particularly useful in differentiating AD patients from older adults displaying memory impairment

Memory Impairment and Awareness of Memory Deficits in Early-Stage Alzheimer's Disease

“…Using this questionnaire discrepancy method, patients with AD or MCI often underestimate their memory dysfunction as compared with caregiver reports (Reisberg et al 1985;McGlynn and Kaszniak 1991;Albert et al 1999;Vogel et al 2004). Correa et al (1996) proposed that AD individuals' underestimation of their own memory deficits observed in the questionnaire discrepancy ing the likelihood of remembering studied items. Similarly, Souchay et al (2002) assessed another metacognitive index, feeling-of-knowing (FOK), in which predictions are made about the likelihood of subsequent recognition of non-recalled information.…”

“…Between-method correlations have b e e n r e p o r t e d t o b e s m a l l b u t p o s i t i v e . Accordingly, the questionnaire discrepancy and performance prediction/postdiction are hypothesized to emphasize different aspects of selfawareness (Correa et al 1996;Duke et al 2002). These two methods seem most likely to rely on various overlapping cognitive processes involved in awareness, but to differing extents.…”

“…Since self-monitoring is supposed to be deeply dependent on the prefrontal lobes, previous neuropsychological and neuroimaging studies have naturally found that underawareness is associated with frontal dysfunction (Mangone et al 1991;Reed et al 1993;Lopez et al 1994;Michon et al 1994;Starkstein et al 1995Starkstein et al , 1997Ott et al 1996). Specifically, the prediction/postdictions method is thought to require on-line processes dependent on frontal lobe integrity (Correa et al 1996). Based on associations found between underawareness of deficit and deficient frontal lobe functioning, individuals with frontal impairment would be unable to monitor their ongoing memory performances and therefore would fail to significantly adjust estimations of self-performance from prediction to postdiction trials.…”

Multidimensional Assessment of Awareness in Early-Stage Dementia: A Cluster Analytic Approach

“…All have significant limitations [12,19,20]. In view of this, some studies have compared findings from two different types of measure, typically participant-informant discrepancies and participant-test discrepancies [21,22,23,24]. Others have combined one or both of these with clinician ratings of awareness and in some cases qualitative interview data [25,26,27,28,29].…”

Consciência da doença na demência do tipo Alzheimer: uma revisão sistemática de estudos longitudinais

“…Geralmente, pacientes subestimam suas alterações de memória quando comparados ao relato do cuidador 32 . A sobrecarga do cuidador, assim como o tipo de relação pré-mórbida entre paciente e cuidador, características de personalidade, condições físicas, sintomas ansiosos e depressivos do próprio cuidador interferem na avaliação dele sobre o desempenho do paciente 33 . No entanto, nenhum dos estudos longitudinais controlou esses aspectos, o que coloca em questão a acurácia dos relatos dos cuidadores, uma grande limitação metodológica.…”