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Unawareness of memory impairment in PwD varies across international regions. Our data support the notion that unawareness should be seen not only as a common neurobiological feature of dementia, increasing with severity of dementia, but also as a phenomenon influenced by social and cultural factors.

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

Unawareness  of deficits caused by brain damage or neurodegeneration, termed anosognosia, has been demonstrated in a number of different neurological conditions. Clinical observation suggests that unawareness paradoxically can be accompanied by signs of understanding or representation of deficit, but not explicitly expressed. Such "implicit awareness," an apparent oxymoron, is implied by or inferred from actions or statements of the person with neurological disorder. In the current paper, we review clinical observations and experimental evidence which suggest the occurrence of implicit awareness in dementia and hemiplegia, and explore the clinical and theoretical implications of this phenomenon. We present a theoretical framework to understand implicit awareness in these two conditions.

Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (α = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.

The incidence of obesity has reached epidemic proportions, affecting 30% of the adult population globally. During the last decade, the rising rates of obesity in developing countries has been particularly striking. One potential consequence of obesity is a decline in quality of life (QoL). Thus, the objective of the present study was to investigate the possible relationship between obesity, defined by body mass index (BMI), and QoL, evaluated using the short version of the World Health Organization Quality of Life (WHOQOL) scale in a Brazilian population. The sample consisted of 30 men and 30 women, divided into three groups according to BMI: normal weight, obese, and morbidly obese. All of the subjects responded to the WHOQOL inventories. The results indicated that the groups with lower BMIs had better QoL than the groups with higher BMIs. Being overweight interfered with QoL equally in both sexes, with no difference found between men and women. The results indicate the necessity of multidisciplinary care of obese individuals.

This review explores the relationships between depression, apathy, and anosognosia in Alzheimer's disease. Depressed mood is found to be associated with less anosognosia, while greater apathy is associated with more anosognosia, and the contrasting reasons for these associations are discussed. The review also describes recent research findings indicating a dissociation between impaired awareness of condition/deficit and preserved emotional reactivity in response to illness-related material or the experience of failure in tests. We conclude by pointing to future directions for this area of research and clinical implications.