Clinical Correlates of Awareness for Balance, Function, and Memory: Evidence for the Modality Specificity of Awareness

Abstract

Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific.

Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer's disease and Parkinson's disease

“…Importantly, however, the reported correlations were only observed in some, yet not in all investigated groups. Thus, as posited in prior research (O'Connell et al, 2014), our findings further demonstrate that clinical correlates of memory awareness depend on diagnostic group, which implies restrictions in cross-domain generalizations.…”

Awareness of Cognitive Decline in Patients With Alzheimer's Disease: A Systematic Review and Meta-Analysis

“…Thirteen studies assessed the ACD as the discrepancy between subject's and informant's ratings of decline (Vogel et al, 2005 ; Onor et al, 2006 ; Ries et al, 2007 ; Orfei et al, 2010 ; Galeone et al, 2011 ; Spalletta et al, 2012 ; Maki et al, 2013 ; Zamboni et al, 2013 ; Ford et al, 2014 ; Jacus et al, 2015 ; Senturk et al, 2017 ; Tondelli et al, 2018 ; Oba et al, 2019 ). Four studies as the discrepancy between subjective and objective scores of cognitive functioning (O'Connell et al, 2014 ; Coutinho et al, 2016 ; Vannini et al, 2017a ; Hanseeuw et al, 2020 ). In Stites et al ( 2017 ), participants who responded affirmatively to any of the diagnosis-related questions were classified as “aware” of their diagnosis, whereas all others were coded “unaware.”…”

Depression, Anxiety, and Apathy in Mild Cognitive Impairment: Current Perspectives

“…A meta-analysis showed the prevalence of depression in patients with MCI is 32% (Ismail et al, 2017), but the use of anti-depressive drugs was not shown to be a protective factor of dementia (Chan et al, 2019). Other studies have shown that subjects with depression have a higher incidence of MCI (Muller et al, 2007;Ng et al, 2009). Depressive patients have more amyloid abnormalities than non-depressive patients (Donovan et al, 2018) MCI with Aβ burden of the brain is associated with an increased risk of having neuropsychiatric symptoms (Krell-Roesch et al, 2019).…”

“…Depressive symptomatology might precede the development of cognitive decline by a decade or more (Geda et al, 2004) and is a clinical correlate of memory awareness in patients with AD dementia (O'Connell et al, 2014). Depression exacerbates pre-existing cognitive impairment by depleting cognitive reserve or otherwise lowering the threshold for the clinical manifestation of dementia (Jorm, 2001).…”