Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type

Abstract

The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits.

Anosognosia in Alzheimer’s disease: The role of impairment levels in assessment of insight across domains

“…These fi ndings concur with previous studies, which have consistently found correlations between clinical ratings and questionnaire discrepancies (Derouesné et al, 1999 ;Howorth and Saper, 2003 ;Ott et al, 1996 ;Vogel et al, 2004), but not between performance discrepancies and questionnaire discrepancies or clinical ratings (Correa et al, 1996 ;Duke et al, 2002 ;Green et al, 1993 ;Hannesdottir and Morris, 2007 ;Howorth and Saper, 2003 ). This lack of overlap may exist because different measures tap into different aspects of self-awareness which are not uniformly impaired.…”

An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury

“…Marcel et al (2004) found that responses to questions framed in the third person reflected greater awareness of hemiplegia than questions framed in the first person. In relation to AD, Derouesné et al (1999) and Kaszniak and Christenson (1996) have noted that results from different methods of assessing unawareness are not closely correlated, and that the presence and degree of awareness deficits elicited varies according to the assessment methods used. This might go some way, therefore, to explaining some of the anomalies in the literature.…”

Approaches to the assessment of awareness: Conceptual issues

“…Other approaches have employed combinations of both clinician-rated assessments and discrepancy measures in an attempt to provide a more global and comprehensive picture of awareness or insight (Correa et al, 1996;Derouesné et al, 1999;Howorth & Saper, 2003;Ott et al, 1996). In addition, some studies have included novel ways of assessing awareness.…”

“…Examining the different approaches taken to assess awareness clinically, it is evident from the above that the phenomena of awareness determined by the various measures are likely to be different. There is also some empirical confirmation of this in that studies using different measures of awareness concomitantly have obtained different clinical outcomes in relation to the particular measure of awareness used (Derouesné et al, 1999;Duke et al, 2002;Green et al, 1993;Howorth & Saper, 2003;Sanz et al, 1998;Sevush, 1999). If the clinical phenomena of awareness are different in relation to the different approaches taken to evaluate awareness, questions then follow concerning the nature of such differences and the implications they carry for understanding insight, in terms of its structure, its role in disease states and in terms of its practical application in relation to communication with and management of patients with various disabilities.…”

“…For example, some questionnaires focusing on awareness of memory problems, ask patients (with parallel questions for carers) to rate the degree of severity of problems they perceive as having with their memory (Green et al, 1993;Duke et al, 2002) while other questionnaires ask patients to rate their memory compared with some years previously (McGlynn & Kaszniak, 1991a, 1991bMichon et al, 1994) or even with others of a similar age (Deckel & Morrison, 1996) or to rate the frequency with which they make mistakes in various memory-related tasks (Derouesné et al, 1999;Migliorelli et al, 1995;Seltzer et al, 1995b) and some studies include various mixtures of such types of judgements (Clare et al, 2002;Feher et al, 1991). On the other hand, the memory questionnaire devised by Kopelman et al (1998), to explore memory complaints in patients with various focal organic lesions, focuses on judgements concerning premorbid, recent and prospective memories.…”