Clinical Correlates of Unawareness of Deficits Among Patients With Dementia Due to Alzheimer’s Disease

Chen, Yi‐Lung; Huang, Mei-Feng; Yeh, Yi-Chun; Yen, Cheng‐Fang; Chen, Cheng-Sheng

doi:10.1177/1533317514523484

Cited by 8 publications

(37 citation statements)

References 46 publications

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“…Reduced awareness about cognitive deficits or illness, was also termed anosognosia, and ranges from the diagnosis and the condition itself to reduced awareness of deficits in specific abilities 49 . Moreover, unawareness of deficits was defined as inability to recognize the presence or appreciate the severity of deficits in sensory, perceptual, motor, affective, or cognitive functioning 42 .…”

Section: Resultsmentioning

confidence: 99%

“…Different concepts were used to define the construct of awareness [12][13][14][15][16][17][18][19][20] , anosognosia [21][22][23][24][25][26][27][28][29][30][31][32] , self-awareness 33,34 , self -appraisal 35 , insight 36,37 , cognitive insight 38 , metacognition [39][40][41] , unawareness of deficits 42 , awareness of deficit 43,44 , awareness of disease 1,45 , awareness of functioning 46 , awareness of cognitive deficits 47 , awareness of disabilities 48 , awareness of performance 49 , unawareness of memory 42,[50][51][52] , anosognosia of memory 53 , awareness of memory deficits 54,55 , awareness of memory function and functional abilities 56 , unawareness of psychosis or behavioral problems …”

Section: Resultsmentioning

confidence: 99%

“…Among them, 13 evaluated only this domain 20,23,27,38,39,41,44,47,[50][51][52][53]55 . Ten studies evaluated awareness of cognitive and functional deficits domains 1,18,20,[33][34][35]40,45,46,54 , nine assessed cognitive and social-emotional functioning domains 12,13,17,24,28,30,36,37,49 , and three focused on cognitive and behavioral impairment domains 14,16,42 . Three researches compared awareness of cognitive, functional and behavioral impairment domains 22,25,32 and four studied the recognition of cognitive, functional, and social-emotional 15,19,29,43 .…”

Section: Resultsmentioning

confidence: 99%

“…The association of cognitive deficits with both unawareness of memory and behavior problems domains indicated that cognition may be a basis for self-insight and self-awareness. Thus, cognitive deficits may lead to global unawareness 42 . A negative association between awareness and MiniMental State Examination (MMSE) suggested that awareness increased as global cognitive functions declined.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, unawareness of memory deficit among people with AD was associated with lower scores on the MMSE and higher scores on the Cornell Scale for Depression in Dementia. So, depression may occur among people with higher levels of awareness as an emotional response to cognitive declines 42 . Awareness of cognitive deficits had association with general neuropsychological variables 15 .…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

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

Lacerda¹,

Sousa²,

Santos³

et al. 2016

J. bras. psiquiatr.

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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...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Lacerda¹,

Sousa²,

Santos³

et al. 2016

J. bras. psiquiatr.

View full text Add to dashboard Cite

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Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease

Verhülsdonk

Lange-Asschenfeldt

Höft

et al. 2017

Alzheimer Disease &Amp; Associated Disorders

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Anosognosia is common in patients with Alzheimer disease (AD) even in early stages. Although neural correlates and the impact of cognitive dysfunctions have been described, possible psychodynamic processes such as a repressive coping style as described in other illnesses, have not been examined. Our study aimed to examine possible psychological influence factors on illness perception embracing a repressive coping style and cognitive functions in AD patients in the diagnostic process. Fifty-four subjects with mild AD diagnosed in our memory clinic were enrolled. Anosognosia was evaluated using a patient-caregiver discrepancy rating. All patients underwent comprehensive neuropsychological testing. In addition, characteristics of a repressive coping style were assessed. In total, 79.6% of our patients showed a lack of awareness at least to some degree. 33.3% of the patients were classified as repressors. Repressors and nonrepressors did not differ in cognition, or the unawareness score. Multivariate regression analysis showed that repressive coping style did not significantly contribute to anosognosia, but that verbal memory and naming ability had a strong influence. Although our data indicate that a high proportion of patients with mild AD show characteristics of repressive coping, this possible defense mechanism had no influence on the awareness of illness-related deficits measured by caregiver patient discrepancy.

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Factors Related to Different Objects of Awareness in Alzheimer Disease

Lacerda

Santos

Neto

et al. 2017

Alzheimer Disease &Amp; Associated Disorders

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Awareness of deficits is a multidimensional phenomenon described as the ability to acknowledge difficulties and impairments. We investigated whether unawareness affects distinct domains to different degrees and identified the factors related to the awareness impairment in Alzheimer Disease (AD). Using a cross-sectional design, we assessed 89 people with AD (PwAD) and their caregivers. Awareness was evaluated by scoring discrepant responses between PwAD and their caregivers across domains including cognitive functioning and health condition, functional activity impairments, emotional state, social functioning, and interpersonal relationships. The awareness of functional activity impairments domain showed a greater discrepancy compared with the other domains. Multiple regression analysis revealed that lack of awareness of cognitive functioning and health condition was related to PwAD unawareness of functional activity impairments, age, and caregiver burden. The emotional state domain was related to PwAD unawareness of functional activity impairments and depressive symptoms. There was also a relationship between the social functioning and relationships domain and caregiver burden. The functional activity impairments domain was related to deficits in the following domains: cognitive functioning and health condition, emotional state, social and emotional functioning, and PwAD self-reported quality of life. Although we observed that 1 domain can influence another, our results suggest that the factors related to each of the different objects of awareness are varied.

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Clinical Correlates of Unawareness of Deficits Among Patients With Dementia Due to Alzheimer’s Disease

Abstract: Unawareness of deficits among patients with AD was common. The 2 domains of unawareness showed different characteristics and may possibly present different etiologies.

Cited by 8 publications

References 46 publications

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

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

Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease

Factors Related to Different Objects of Awareness in Alzheimer Disease

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