Awareness, apathy, and depression in Alzheimer's disease and mild cognitive impairment

Abstract

IntroductionResults from studies on awareness disorders in Alzheimer's disease (AD) are controversial because the methodologies, the “objects” of awareness, and the patients' pathologic stage all vary. Our study aimed to compare scores and correlates of awareness according to the stage of the disease and the assessment method.MethodsWe compared 20 mild AD patients to 20 mild cognitive impairment (MCI) patients, using the Patient Competency Rating Scale (PCRS; patient vs. caregiver report) and the Self‐Consciousness Scale (rating scale). All patients underwent cognitive, psycho‐affective and behavioral assessments (global cognition, executive functions, episodic memory, anxiety‐depression, and apathy measures).ResultsGroups were matched for age, education, and gender. They were comparable on the depression, anxiety, apathy and awareness scales (ps > .05), and differed for all cognitive variables (p < .05). Using the median split approach, greater apathy and lower depression were associated with poorer awareness on the Self‐Consciousness Scale (respectively: odds ratio [OR] = 4.8, p = .03; OR = 4.84, p = .04), and the PCRS (only apathy: OR = 9.3, p = .003). Greater apathy plus lower depression were associated with poorer awareness in both scales (PCRS: OR = 40.5, p = .005; Self‐consciousness scale: OR = 28, p = .012).ConclusionThese results evidence comparable awareness between AD and MCI patients. The correlates were more affective and behavioral than cognitive, independently from assessment method.

Awareness and its relationships with neuropsychiatric symptoms in people with Korsakoff syndrome or other alcohol‐related cognitive disorders living in specialized nursing homes

“…In contrast to research in people with dementia, we did not find a relationship between the level of awareness and the presence of depressive symptoms, although these symptoms were highly common in residents with KS (43.4%) . In people with dementia, it is hypothesized that, in particular, dysthymia can be seen as an emotional reaction of people who are aware of their progressive cognitive decline, especially in the beginning of their disease process .…”

“…These researchers were, however, cautious in interpreting their results due to the small sample size and the procedure that was followed to assess impaired awareness (clinical observation and evaluation). On the other hand and in line with our findings, several studies on people with dementia have also shown that lower levels of awareness seemed to be related to more severe apathy …”

“…With regard to the studies on people with Alzheimer's disease by Shany‐Ur et al (very mild/mild dementia) and Jacus et al (mild dementia), it appeared that awareness in our study sample was much more impaired (PCRS discrepancy score = 11.9 and 1.5, respectively). Furthermore, dementia research showed that impaired awareness becomes more frequent and the level of impaired awareness increases as the severity of dementia progresses.…”

“…Awareness of functional deficits was assessed with the Patient Competency Rating Scale (PCRS). This instrument was originally developed to assess awareness of deficits after traumatic brain injury, but it has also been used in stroke, Alzheimer's disease, and other neurodegenerative diseases . The PCRS has good validity, reliability, and feasibility in people with traumatic brain injury …”

Response: Commentary: Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review

“…Error monitoring is a prerequisite to develop awareness of performance. There is an association between error awareness and apathy in AD, with higher levels of the latter being related to poorer awareness in people with mild AD and MCI (Jacus, 2017). It is possible that this relationship reflects the importance of emotional processing in error monitoring (Mograbi and Morris, 2014).…”