Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up

Abstract

Abstract. Anosognosia in Alzheimer's disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1-47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6-48.0), persistence was 80.0% (95% CI = 69.9-90.1) and remission was 20.0% (95% CI = 9.9-30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severity.

Self- and Informant-Reported Memory Complaints: Frequency and Severity in Cognitively Intact Individuals and those with Mild Cognitive Impairment and Neurodegenerative Dementias

“…Anosognosia is a recognized part of many dementias [3], but current MCI and AD criteria rely on the premise that insight is sufficiently preserved in the early stages of AD to allow for accurate and meaningful self-ratings. The above assumption should have resulted in a gradient of worsening self-reported memory from normal to MCI to AD participants [33]; however, our findings revealed that older adults, regardless of memory disorder diagnosis, perceive their memory to be “about the same” as it was in their teens and early twenties. These findings parallel a study by Edmonds et al [34], who examined self-reported memory complaints of pre-defined MCI subtypes drawn from a larger cohort of patients diagnosed with MCI based on Alzheimer’s Disease Neuroimaging Initiative (ADNI) criteria.…”

Functional Neural Correlates of Anosognosia in Mild Cognitive Impairment and Alzheimer’s Disease: a Systematic Review

“…Anosognosia for activities of daily living (ADL) deficits can be present from an early stage of AD and has a reported frequency between 20 and 80% (Starkstein, 2014 ). Patients with mild or moderate AD have a reported incidence between 21.0 and 38.3% and a prevalence between 24.2 and 71.0% for anosognosia (Starkstein, Brockman, Bruce, & Petracca, 2010 ; Castrillo-Sanz et al, 2016 ; Turró-Garriga et al, 2016 ). Cross-cultural assessment of the differences in unawareness of memory deficits in a large community-based study reports regional differences in the frequency of anosognosia, from 81.2% in India to 72.0% in Latin America and 63.5% in China (Mograbi et al, 2012 ).…”

Clinical Considerations in Physician-Assisted Death for Probable Alzheimer’s Disease: Decision-Making Capacity, Anosognosia, and Suffering

“…Clinical data associate anosognosia with different dementias; in fact, clinical-pathological studies have suggested that dementia-related pathologies account for most cases of late-life anosognosia [38]. In a nondemented-at-baseline large longitudinal study, the temporal course of unawareness of memory impairment occurred 2.6 years before dementia onset [39], with an incidence of mild and moderate dementia of 37.0 and 42.3%, respectively [12]. Anosognosia in AD most often refers to deficits in ADL and behavioral changes rather than awareness of illness or deficits in neuropsychological evaluations [10].…”

“…Anosognosia for activities of daily living (ADL) deficits can be present from an early stage of AD dementia and it has a reported frequency between 20 and 80%, and it varies greatly due to the use of diverse diagnostic methods, sampling bias (i.e., community vs. memory clinic samples), and the use of heterogeneous sample sizes [10]. Patients with mild or moderate AD have a reported anosognosia incidence between 21 and 38% and a prevalence between 24.2 and 71.0% [11, 12, 13]. Cross-cultural assessment of the differences in unawareness of memory deficits in a large community-based study has shown regional differences in the frequency of anosognosia (i.e., 81.2% in India, 72.0% in Latin America, and 63.5% in China) [14].…”