Impaired Awareness of Deficits in Alzheimer's Disease: The Role of Everyday Executive Dysfunction

Abstract

The present study analyzed the awareness of deficits in 117 mild Alzheimer's disease participants. Since few studies have examined the cognitive and behavioral domains of reduced awareness in detail, we performed a domain-specific assessment using the Awareness of deficit Questionnaire - Dementia scale with the novel aim of describing the relationship with everyday executive dysfunction. Through the use of the subtests of the Behavioral Assessment of the Dysexecutive Syndrome, we hypothesized that executive cognitive functions may play an important role in the reduced awareness of deficits. We also considered other variables of interest to provide a novel comprehensive explanation of this phenomenon. Our first approach to the study was a factor analysis considering the role of these variables in the awareness of deficits; subsequently, regression analysis models were used to define which variables were associated with a reduction of awareness in cognitive and behavioral domains. In particular, the factors retained from the factor analysis, in terms of inhibition, self-monitoring, set-shifting, and mood orientation changes, appear to be important skills for awareness of instrumental activities of daily living (R(2) = .32). We also found hypo manic mood orientation and a tendency through apathy to be prominent indications of reduced behavioral awareness (R(2) = .13).

Consciência do déficit na doença de Alzheimer: diferenças entre os domínios cognitivo e funcional

“…Foram utilizados conceitos como falta de consciência do déficit (n = 7) 16,[19][20][21][22][23][24] , anosognosia (n = 4) 19,20,23,25 , insight (n = 2) 19,25 , falta de consciência das dificuldades cognitivas (n = 1) 10 e limitada consciência das deficiências (n = 1) 26 . A etiologia do comprometimento da consciência do dé-ficit foi relacionada a fatores biológicos como associações neuroanatômicas (n = 2) 16,23 , alterações neuropsiquiátricas (n = 3) 10,16,20 e a gravidade clínica da doença, também investigada pelo modelo psicossocial (n = 9) 10,16,19,[20][21][22][23][24][25] .…”

“…A etiologia do comprometimento da consciência do dé-ficit foi relacionada a fatores biológicos como associações neuroanatômicas (n = 2) 16,23 , alterações neuropsiquiátricas (n = 3) 10,16,20 e a gravidade clínica da doença, também investigada pelo modelo psicossocial (n = 9) 10,16,19,[20][21][22][23][24][25] . Os artigos que relacionaram o comprometimento da consciência do déficit aos fatores psicossociais (n = 4) 21,22,24,26 abordaram aspectos como a influência de fatores psicológicos e sociais (n = 1) 21 , o impacto nas AVD (n = 2) 22,26 e o valor prognóstico da avaliação global do cuidado na avaliação médica (n = 1) 24 .…”

“…Dessa forma, o nível de comprometimento da consciência do déficit está relacionado com o prejuízo em cada domínio 15 . Os domínios cognitivo e funcional são os mais comumente estudados, em especial nas pessoas com DA 16 . Contudo, estudos recentes demonstram que existem controvérsias relacionadas aos fatores responsáveis pelo comprometimento da consciência do déficit nesses domínios 5,15,17,18 .…”

Awareness of executive functioning as a diagnostic tool for mild cognitive impairment and Alzheimer's disease.

“…Studies have also shown that both executive functioning performance and global awareness decline over time (Amanzio et al, 2013;Mathalon et al, 2003;Ott et al, 1996;Suchy et al, 2011;Van Wielingen et al, 2004). However, there…”

“…Although research into executive functioning awareness is limited, studies have operationalized this awareness into several forms, from success at daily activities (Ott et al, 1996;Suchy, Kraybill, & Franchow, 2011) to finance management (Van Wielingen, Tuokko, Cramer, Mateer, & Hultsch, 2004) to error monitoring (Amanzio et al, 2013;Mathalon et al, 2003). A common theme among such studies is that both executive functioning performance and awareness deteriorate between healthy aging and early stages of dementia.…”