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

Abstract

Impaired insight for deficits (anosognosia) is common in Alzheimer's disease (AD). However, it has not yet been determined clearly (a) whether different methods for assessing insight are comparable, and (b) whether anosognosia affects different domains to different degrees (domain-specificity). Impaired insight was investigated in 32 patients with AD, who were each accompanied by a caregiver. Anosognosia was assessed by a global clinical rating, questionnaire discrepancies (patient vs. caregiver) covering different domains, and performance discrepancies (self-assessment vs. performance) based on four neuropsychological tests which were compared with those of a healthy control sample. The results of clinical rating and questionnaire discrepancies were closely correlated, but performance discrepancies showed no association with the other methods. Anosognosia was present in the majority of the sample, and occurred across domains. The domains corresponding to core deficits in AD (recent memory, activities of daily living) appeared especially prone to anosognosia. However, results do not suggest that anosognosia itself is domain-specific. Rather, it appears that insight may be invariant, while differences in patient-caregiver discrepancies arise largely from different degrees of deficit across domains.

Subjective Cognitive Impairment and Affective Symptoms: A systematic review

“…It is important to note that individuals with MCI also have SCI (self-or informant-reported) as part of MCI's diagnostic criteria (Albert et al, 2011). However, self-awareness of cognitive impairment is highly variable in AD, including in its early stages (Leicht, Berwig, & Gertz, 2010;Orfei et al, 2010); therefore, individuals with AD in the included studies did not necessarily have SCI or had varying levels of SCI depending on study instrumentation. For the purposes of this review, inclusion of MCI or AD groups was used as an additional point of comparison with SCI groups (individuals with no objectively measured cognitive impairment).…”

“…Therefore, it is important for future research to consider the meaning of self-versus informant-reported SCI as it relates to a potential preclinical AD indicator versus a component of affective symptomatology. It has been shown that there is variability in awareness of cognitive impairment among individuals at similar AD stages (i.e., mild to moderate impairment; Leicht et al, 2010;Orfei et al, 2010;Ownsworth, Clare, & Morris, 2006). Among individuals with MCI, self-reports of cognitive problems may relate more to affective symptoms, whereas informant reports may more reliably indicate objective cognitive decline (Edmonds et al, 2014).…”

Prevalencia de anosognosia en la enfermedad de Alzheimer

“…La prevalencia en la EA, oscila entre el 15 y el 68% y está estrechamente relacionada con la gravedad de la demencia [9][10][11] . No obstante, algunos autores han evidenciado discordancias entre el grado de anosognosia y la puntuación del Mini-Mental State Examination (MMSE) [9][10][11] .…”

“…No obstante, algunos autores han evidenciado discordancias entre el grado de anosognosia y la puntuación del Mini-Mental State Examination (MMSE) [9][10][11] . Debe mencionarse también, que la metodología utilizada para evaluar la presencia de anosognosia es muy diversa [12][13] .…”

“…La anosognosia está asociada a una mayor presencia de trastornos de conducta, a un mayor número de conductas de riesgo del paciente, así como a una mayor carga de los cuidadores 11,17 .…”