Clinical associations of anosognosia in mild cognitive impairment and Alzheimer's disease

Mak, Elijah; Chin, Rowena; Ng, Lynette; Yeo, Dannel; Hameed, Shahul

doi:10.1002/gps.4275

Cited by 58 publications

(55 citation statements)

References 31 publications

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“…A negative association between awareness and MiniMental State Examination (MMSE) suggested that awareness increased as global cognitive functions declined. This finding supported the view that low awareness was related to advanced disease stages 30 . Conversely, a longitudinal assessment of a group of PwD (Alzheimer's disease, vascular dementia and mixed dementia) presented that initial discrepancies were moderate in relation to memory.…”

Section: Discussionsupporting

confidence: 88%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Lacerda¹,

Sousa²,

Santos³

et al. 2016

J. bras. psiquiatr.

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Objectives: To compare and discuss the objects of awareness in Alzheimer's disease (AD): awareness of cognitive deficits, of functional activities, of social-emotional functioning and behavioral impairment. Methods: A search in the PsycINFo, Pilots, PubMed/Medline and ISI electronic databases according to Prisma methodology was performed. We included studies about awareness in people with AD published between 2010 and 2015, with the combination of keywords: "Alzheimer AND awareness of deficits", "Alzheimer AND anosognosia", "Alzheimer AND insight", "dementia AND awareness of deficits", "dementia AND anosognosia", "dementia AND insight". The articles were categorized according to the specific object of awareness. Results: Seven hundred and ten records were identified and, after application of the exclusion criteria, 191 studies were retrieved for potential use. After excluding the duplicates, 46 studies were included. Most studies assessed the cognitive domain of awareness, followed by the functional, social-emotional, and behavioral impairment domains. Memory deficits were not sufficient to explain impaired awareness in AD. Longitudinal studies did not find discrepancies between patients and caregivers' reports, indicating that awareness is not related to cognition. Conflicting findings were observed, including the relation between awareness, mood, severity of disease, and personal characteristics. Conclusions: The studies show lack of conceptual consensus and significant methodological differences. The inclusion of samples without differentiation of dementia etiology is associated to symptomatic differences, which affect awareness domains. Awareness in AD is a complex and multidimensional construct. Different objects elicit different levels of awareness. RESUMOObjetivos: Comparar e discutir os objetos de consciência na doença de Alzheimer (DA): consciência dos déficits cognitivos, das atividades funcionais, do funcionamento socioemocional e prejuízos comportamentais. Métodos: Realizou-se uma busca nas bases de dados PsycINFo, Pilots, PubMed/Medline e ISI de acordo com a metodologia do Prisma. Os artigos incluídos, publicados entre 2010 e 2015, avaliavam a consciência na DA com as combinações de palavras-chave: "Alzheimer AND consciência do déficit", "Alzheimer AND anosognosia", "Al- zheimer AND insight", "demência AND consciência do déficit", "demência AND anosognosia", "demência AND insight". Os artigos foram categorizados conforme os objetos específicos da consciência. Resultados: Setecentos e dez estudos foram identificados e, após a aplicação dos critérios de exclusão, 191 foram selecionados. Após a exclusão dos duplicados, 46 estudos foram incluídos. A maioria dos estudos avaliou o domínio cognitivo da consciência, seguido do funcional, do funcionamento socioemocional e prejuízos comportamentais. Dé-ficits na memória não se mostraram suficientes para explicar o prejuízo da consciência na DA. Os estudos longitudinais não encontraram discrepâncias entre os relatos de pacientes e cuidadores, indicando...

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

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

Lacerda¹,

Sousa²,

Santos³

et al. 2016

J. bras. psiquiatr.

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“…In this context, these results may also indicate the patients' reduced awareness of memory difficulties or denial of decreasing cognitive abilities, which constitutes the common phenomenon of anosognosia in patients with beginning cognitive impairment [39]. However, there are conflicting findings regarding the presence of impaired insight and anosognosia among MCI patients, and other causes may explain our findings [40]. Facing the fact that MCI represents a transitional period preceding the development of dementia, it seems highly important to assess and to address the unmet needs of these patients at an early stage.…”

Section: Discussionmentioning

confidence: 79%

Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders: Results of the AgeCoDe and AgeQualiDe Study

Stein

Pabst

Luck

et al. 2017

Dement Geriatr Cogn Disord

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Background: In the future, an increase in health care needs in the elderly is expected. Reports on unmet care needs of the oldest old with cognitive disorders are pending. This study aims at exploring unmet needs in the oldest old primary care patients with mild cognitive impairment (MCI) and dementia. Furthermore, the association between sociodemographic and clinical factors and unmet needs ought to be analyzed. Methods: Based on the study “Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)” (AgeQualiDe), 749 patients (unimpaired, MCI, and dementia) aged 85 years and older, their relatives (n = 421), and general practitioners (GPs) (n = 607) were assessed. Descriptive, inferential, and regression analyses were run. Results: Most unmet needs were observed in dementia patients, although needs were less frequently rated as unmet by dementia patients themselves as compared to relatives and GPs. Unmet needs were associated with MCI and dementia; other risk factors were age, education, and marital status. Conclusion: This study provides first data on unmet needs according to different perceptions in the elderly with MCI and dementia in Germany. Need assessments should be part of medical examinations to ensure a high-quality health care in the elderly.

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“…In an 18-month longitudinal study, patients with anosognosia at baseline had a significant increase in apathy scores during follow-up, compared with patients without anosognosia 53. Previous studies of the relationship between apathy and anosognosia in AD and MCI suggest that apathy manifests at later stages of neurodegeneration 55,56. Therefore, the current cross-sectional study in the early stages of AD might not have been able to identify this relationship between apathy and anosognosia, and longitudinal studies are required for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Brain regions associated with anosognosia for memory disturbance in Alzheimer’s disease: a magnetic resonance imaging study

Fujimoto

Matsuoka

Kato

et al. 2017

NDT

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Background and objectivePatients with Alzheimer’s disease (AD) are frequently unaware of their cognitive symptoms and medical diagnosis. The term “anosognosia” is used to indicate a general lack of awareness of one’s disease or disorder. The neural substrate underlying anosognosia in AD is unclear. Since anosognosia for memory disturbance might be an initial sign of AD, it is important to determine the neural correlates. This study was designed to investigate the characteristics and neural correlates of anosognosia for memory disturbance in patients with mild AD.MethodsThe subjects were 49 patients with mild AD who participated in a retrospective cross-sectional study. None of the patients had been treated with cholinesterase inhibitors, memantine, or psychotropic drugs. All patients underwent magnetic resonance imaging (MRI). Anosognosia for memory disturbance was assessed based on the discrepancy between questionnaire scores of patients and their caregivers. Structural MRI data were analyzed to explore the association between anosognosia and brain atrophy, using a voxel-based approach. Statistical parametric mapping software was used to explore neural correlations. In image analysis, multiple regression analysis was performed to examine the relationship between anosognosia score and regional gray matter volume. Age, years of education, and total intracranial volume were entered as covariates.ResultsThe anosognosia score for memory disturbance was significantly negatively correlated with gray matter volume in the left superior frontal gyrus.ConclusionThe left superior frontal gyrus was involved in anosognosia for memory disturbance, while the medial temporal lobe, which is usually damaged in mild AD, was not associated with anosognosia. The left superior frontal gyrus might be an important region for anosognosia in mild AD.

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Clinical associations of anosognosia in mild cognitive impairment and Alzheimer's disease

Abstract: The results indicated that anosognosia is common in both AD and MCI patients and associated with cognitive dysfunction and apathy in AD. The findings of this study warrant further research to delineate the mechanisms of anosognosia as it poses a challenge to treatment outcomes.

Cited by 58 publications

References 31 publications

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

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

Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders: Results of the AgeCoDe and AgeQualiDe Study

Brain regions associated with anosognosia for memory disturbance in Alzheimer’s disease: a magnetic resonance imaging study

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Clinical associations of anosognosia in mild cognitive impairment and Alzheimer's disease

Abstract: The results indicated that anosognosia is common in both AD and MCI patients and associated with cognitive dysfunction and apathy in AD. The findings of this study warrant further research to delineate the mechanisms of anosognosia as it poses a challenge to treatment outcomes.

Cited by 58 publications

References 31 publications

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

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

Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders: Results of the AgeCoDe and AgeQualiDe Study

Brain regions associated with anosognosia for memory disturbance in Alzheimer&rsquo;s disease: a magnetic resonance imaging study

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Brain regions associated with anosognosia for memory disturbance in Alzheimer’s disease: a magnetic resonance imaging study