The current review integrates recent findings regarding the construct of self-awareness in dementia from both clinical and cognitive perspectives. We present the predominant theoretical models of awareness, and summarize both traditional and emerging approaches to assessing awareness from clinical and metacognitive perspectives. In this review, we focus primarily on findings from recent studies in anosognosia and metacognition in the context of neurodegenerative disease with special emphasis on Alzheimer's disease and Frontotemporal dementia. Emerging trends in the study of awareness, including examination of the longitudinal course of anosognosia, and investigation of the neural substrates underlying metacognitive abilities are addressed. Finally, the practical importance of studying and assessing awareness from both theoretical and clinical angles is emphasized.

Background: The utility of subjective cognitive decline (SCD) as an indicator of preclinical AD is overshadowed by its inconsistent association with objective cognition. Objective: This study examines if manipulations of SCD measurement affect its association with early cognitive dysfunction characteristic of preclinical AD. Methods: Cognitively healthy older adults (n = 110) completed SCD questionnaires that elicited complaints in general, compared to 5 years ago (retrospective SCD) and compared to their peers (age-anchored SCD) in binary and Likert scales. Outcome cognitive tasks included an associative memory task (Face-Name Test), a visual short-term memory binding task (STMB test), and a clinical neuropsychological list learning test (Selective Reminder Test). Results: SCD complaints, when compared to age-matched peers (age-anchored SCD) was endorsed less frequently than complaints compared to 5 years ago (retrospective SCD) (p <  0.01). In demographically adjusted regressions, age-anchored ordinal-rated SCD was associated with short term memory binding (β= –0.22, p = 0.040, CI = –0.45, –0.01), associative memory (β= –0.26, p = 0.018, CI = –0.45, –0.06), and list learning (β= –0.31, p = 0.002, CI = –0.51, –0.12). Retrospective and general ordinal-rated SCD was associated with associative memory (β= –0.25, p = 0.012, CI = –0.44, –0.06; β= –0.29, p = 0.003, CI = –0.47, –0.10) and list learning only (β= –0.25, p = 0.014, CI = –0.45, –0.05; β= –0.28, p = 0.004, CI = –0.48, –0.09). Conclusion: Ordinal age-anchored SCD appears better suited than other SCD measurements to detect early cognitive dysfunction characteristic of preclinical AD.

Objective We compared the relationships among sex, clustering strategy, and recall across different task demands using the 16-word California Verbal Learning Test–Second Edition (CVLT-II) and the 9-word Philadelphia (repeatable) Verbal Learning Test (PrVLT). Background Women generally score higher than men on verbal memory tasks, possibly because women tend to use semantic clustering. This sex difference has been established via word-list learning tests such as the CVLT-II. Methods In a retrospective between-group study, we compared how 2 separate groups of cognitively healthy older adults performed on a longer and a shorter verbal learning test. The group completing the CVLT-II had 36 women and 26 men; the group completing the PrVLT had 27 women and 21 men. Results Overall, multiple regression analyses revealed that semantic clustering was significantly associated with total recall on both tests’ lists (P < 0.001). Sex differences in recall and semantic clustering diminished with the shorter PrVLT word list. Conclusions Semantic clustering uniquely influenced recall on both the longer and shorter word lists. However, serial clustering and sex influenced recall depending on the length of the word list (ie, the task demand). These findings suggest a complex nonlinear relationship among verbal memory, clustering strategies, and task demand.

Objective Cognition and mobility are interrelated. However, this association can be impacted by the specific facets of cognition and mobility that are measured, and further by the different task conditions, e.g., single- versus dual-task walking, under which these associations are evaluated. Systematically studying the multiple facets of cognitive-mobility associations under both the task conditions is critical because both cognition and mobility change with age and pose significant risks associated with falls, morbidity, and disability. Methods Using a cross-sectional, prospective study design, data from 124 healthy adults [mean age (SD) = 61.51 (11.90); mean education (SD) = 15.94 (2.18)] were collected. A comprehensive battery of cognitive tests was administered, and gait was assessed using a small, lightweight, three-axis accelerometer with a gyroscope. Analytical Plan Data were transformed, and only relatively strong relationships survived after strict statistical criteria adjusting for multiple comparisons were applied. Spearman rho correlation coefficients were used to examine the matrix of correlations between the cognitive-motor variables while adjusting for age and gender. Results Executive functions, processing speed, and language were associated with distinct facets of variability, pace, and asymmetry, especially under the dual-task walking condition. Both turns and transitions were also associated with cognition during the Timed Up and Go Task. Conclusion Our results extend converging evidence of the involvement of executive functions and processing speed in specific aspects of mobility, along with the role of language. The study has important implications for aging in terms of both assessment and rehabilitation of cognition and gait as well as for the emerging dual-tasking theories and the role of the neural pathways involved in mobility.

Objective In the wake of the coronavirus pandemic, teleneuropsychology utilization has increased. There is a need to characterize the first-hand experiences of individuals using teleneuropsychology, identify the common teleneuropsychology challenges, and devise practical strategies for mitigating/resolving these challenges. Method Survey data were collected from U.S. based neuropsychologists and other individuals (e.g., graduate students and research assistants) who were engaged in remote cognitive assessment with adults (n = 87). Frequency analyses were conducted to examine: how respondents used teleneuropsychology (e.g., duration of use, types of measures and devices/technology platforms used); challenges that were encountered with different technology platforms and teleneuropsychology use; and advice for navigating these challenges. Results Most respondents began using teleneuropsychology relatively recently in the context of the coronavirus pandemic, with home-to-home or clinic-to-home settings being the most frequently reported teleneuropsychology settings. Zoom®, Doxy.Me®, and MyChart® were the most frequently used platforms, largely due to workplace mandates and/or Health Insurance Portability and Accountability Act-compliant features. Common challenges with teleneuropsychology included internet connection issues and environmental distractions in examinees’ homes, and examinees having limited-to-no access to technologies requisite for teleneuropsychology. Providing clear instructions to the examinee prior to the teleneuropsychology visit was the most common advice for ensuring a successful teleneuropsychology evaluation. Similar response patterns were generally noted for those who used TeleNP for clinical or research purposes. Conclusions These survey results reflect common experiences and challenges with teleneuropsychology and identify priority targets for increasing its feasibility, reliability, and validity. Findings provide context for the development of formal teleneuropsychology competencies.