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

Abstract

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...

Awareness of cognitive impairment in individuals with essential tremor

“…Disordered awareness has significant clinical and practical implications, such as reduced decision making capacity 43 poor quality of life 6 and increased caregiver burden 7 even in MCI 44 . Additionally, disordered awareness has been previously associated with poorer functional outcomes in Parkinson’s and AD 45, 46 and was also the primary clinical correlate associated with dangerous behaviors in AD 40 .…”

Awareness of dementia and coping to preserve quality of life: a five-year longitudinal narrative study

“…Awareness is always attention focused on “something” (Clare, 2002 ); this has been called a particular “object” and is, presumably, “situationally specific” (Markova & Berrios, 2014 ). Depending on the “object”, awareness may include a broad range of reactions, which may include internal states, the self, mental representations, cognitive symptoms, functional impairments or changes in behaviour or relationships (Lacerda et al, 2016 ). Emotional reactions were added by Starkstein ( 2014 ).…”

The Relationship Between Social Cognition and Awareness in Alzheimer Disease

“…The score was based on the degree of discrepancy between the person with AD and caregiver dyad responses, with 1 point being scored for each discrepant response. The ratings of awareness range from preserved (0-4), mildly impaired, (5)(6)(7)(8)(9)(10)(11), moderately impaired (12)(13)(14)(15)(16)(17), to absent (over 18). 10 Cognition.…”

“…11 Awareness should be considered a relational concept, because it can only be expressed in relation to an "object," such as to the pathological state or nonmorbid experience. 12 A recent review on awareness 13 indicates that PwAD may show decreased awareness of deficits in activities requiring executive function, such as handling money, practicing favorite hobbies, and doing home activities. In addition, longitudinal research 14 has found that impaired awareness of disease is associated with cognitive and functional deficits at baseline.…”