Domains of awareness in Alzheimer's disease: The influence of executive function

Abstract

Objective Awareness is a developing area in dementia research and the evaluation of its domains has been increasingly included as part of care for people with Alzheimer's disease (PwAD). Our aim is to examine whether executive dysfunction is associated with awareness domains. Methods A consecutive series of 75 people with mild‐to‐moderate Alzheimer's disease completed assessments about global cognitive function, executive functioning, and their awareness of disease. Their primary caregivers' dyad provided information about demographics, awareness of disease, dementia severity, neuropsychiatric symptoms, and functional status. Results Different types of executive dysfunction were presented as a predictor for awareness of disease (cognitive flexibility, inhibitory control, and working memory), of emotional state (short‐term memory and attention) and of social functioning and relationships (visuospatial organization, integrative functions, and abstract thinking). Awareness of cognitive functioning and health condition and of functional activity impairments exhibit only global cognitive function as a predictor. Conclusions Findings confirm some degree of independence between awareness domains. The importance of identifying differences in domains of awareness relies in the understanding of awareness as a clinical phenomenon in order to guide the management and support of PwAD and their caregivers.

Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms – Findings from the IDEAL Program

“…Formal methods for calculating discrepancies between self- and informant ratings on ADL scales are frequently used to quantify reduced awareness in PwD [31] with the assumption that carers are an accurate benchmark with which to compare PwD self-appraisal. The majority of studies that have investigated ADL discrepancy have focused on cognition, reporting moderate associations between greater discrepancies (indicating less awareness), and scores on the Mini-Mental State Examination (MMSE) [32] and for language, memory, attention, and executive functioning [9, 19, 21, 23, 26, 29, 33]. ADL discrepancy has also been associated with a higher number of neuropsychiatric symptoms, including depression [21, 26, 29, 34].…”

Altered Interplay Among Large-Scale Brain Functional Networks Modulates Multi-Domain Anosognosia in Early Alzheimer’s Disease

“…The onset of this symptom, however, tends to occur quite early on throughout the clinical timeline, either at the stage of mild cognitive impairment (MCI), or even before that, during the preclinical period when individuals who are still psychometrically normal but report subjective cognitive complaints might show poorer awareness of the extent of their decline than their informant would report (Cacciamani et al, 2017;Hanseeuw et al, 2020). Anosognosia might not manifest only as lack of awareness of a memory impairment but can also apply to other cognitive domains, such as unawareness of executive dysfunction, of socio-emotional deficits or of difficulties with daily life activities (Lacerda et al, 2021). This heterogeneity highlights the multidimensionality of this phenomenon and warrants the necessity for a multidomain clinical assessment (Leicht et al, 2010;de Ruijter et al, 2020).…”

Awareness of Disease and Its Domains in Young-onset and Late-onset Dementia

“…9 Awareness is the ability to recognize changes caused by the deficits associated with the disease process. 10,11 An essential awareness aspect is its heterogeneous presentation, with various potential causes. 12 Awareness of disease is a relational concept as it can only be expressed in relation to something, namely the domains and objects of awareness.…”

“…Lacerda et al 10 showed that EF fundamentally determined variation in different domains of awareness, such as emotional state, social functioning and relationships, and disease as a whole. So neurocognitive models of awareness must consider its multidimensionality to develop a comprehensive explanation of potential causes for impaired awareness 10 …”