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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 9/2016

01-09-2016 | Behavior (H Kirshner, Section Editor)

Anosognosia in Dementia

Authors: Robert S. Wilson, Joel Sytsma, Lisa L. Barnes, Patricia A. Boyle

Published in: Current Neurology and Neuroscience Reports | Issue 9/2016

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Abstract

Progressive decline in memory (and other functions) is the defining feature of late-life dementia but affected individuals are often unaware of this impairment. This article reviews recent research on anosognosia in dementia, including methods of assessing anosognosia, its prevalence and developmental course in dementia, its occurrence in different forms of dementia, neuroimaging findings, and hypothesized component mechanisms. The results suggest that anosognosia is eventually exhibited by nearly all persons with dementia. Its occurrence is robustly associated with common dementia-related pathologies and damage to memory and self-referential brain networks and their interconnections.
Literature
1.
Babinski J. Contribution a l’etude des troubles mentaux dans l’hemiplegie organique cerebrale (anosognosie). Rev Neurol. 1914;27:845–8.
2.
Morris RG, Mograbi DC. Anosognosia, autobiographical memory and self-knowledge in Alzheimer’s disease. Cortex. 2013;49:1553–65.CrossRefPubMed
3.
Clare L, Nelis SM, Martyr A, et al. The influence of psychological, social and contextual factors on the expression and measurement of awareness in early stage dementia: testing a biopsychosocial model. Int J Geriatr Psychiatry. 2012;27:167–77.CrossRefPubMed
4.
Farias ST, Mungas D, Reed B, et al. Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults. J Int Neuropsychol Soc. 2004;10:342–54.CrossRefPubMedPubMedCentral
5.
Farias ST, Park LQ, Harvey DJ, et al. Everyday cognition in older adults: association with neuropsychological performance and structural brain imaging. J Int Neuropsychol Soc. 2013;19:430–41.CrossRefPubMed
6.
Jorm AF. The informant questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr. 2004;16:275–93.CrossRefPubMed
7.
Wilson RS, Leurgans SE, Boyle PA, Bennett DA. Cognitive decline in prodromal Alzheimer disease and mild cognitive impairment. Arch Neurol. 2011;68:351–6.CrossRefPubMedPubMedCentral
8.
Ritchie K, Carriere I, Berr C, et al. The clinical picture of Alzheimer’s disease in the decade before diagnosis: clinical and biomarker trajectories. J Clin Psychiatry. 2016;77:e305–11.CrossRefPubMed
9.
Clare L. Awareness in early-stage Alzheimer’s disease: a review of methods and evidence. Br J Clin Psychol. 2004;43:177–96.CrossRefPubMed
10.
Razani J, Kakos B, Orieta-Barbalace C, et al. Predicting caregiver burden from daily functional abilities of patients with mild dementia. J Am Geriatr Soc. 2007;55:1415–20.CrossRefPubMedPubMedCentral
11.
Martyr A, Nelis SM, Clare L. Predictors of perceived functional ability in early-stage dementia: self-ratings, informant ratings and discrepancy scores. Intl J Geriatr Psychiatry. 2014;29:852–62.CrossRef
12.
O’Keeffe FM, Murray B, Coen RF, et al. Loss of insight in frontotemporal dementia, corticobasal degeneration and progressive supranuclear palsy. Brain. 2007;130:753–64.CrossRefPubMed
13.••
Wilson RS, Boyle PA, Yu L, et al. Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology. 2015;85:984–91. A longitudinal clinical-pathologic study showing that anosognosia begins to develop before dementia onset, is eventually seen in nearly all persons with dementia, and is robustly related to common dementia related pathologies on postmortem examination of the brain.CrossRefPubMed
14.
Williamson C, Alcantar O, Rothlind J, et al. Standardised measurement of self-awareness deficits in FTD and AD. J Neurol Neurosurg Psychiatry. 2010;81:140–5.CrossRefPubMed
15.
Rosen HJ, Alcantar O, Zakrzewski J, et al. Metacognition in the behavioral variant of frontotemporal dementia and Alzheimer’s disease. Neuropsychologia. 2014;3:436–47.CrossRef
16.
Gallo DA, Cramer SJ, Wong JT, Bennett DA. Alzheimer’s disease can spare local metacognition despite global agnosognosia: revisiting the confidence-accuracy relationship in episodic memory. Neuropsychologia. 2012;50:2356–64.CrossRefPubMedPubMedCentral
17.
Reed BR, Jagust WJ, Coulter L. Anosognosia in Alzheimer’s disease: relationships to depression, cognitive function, and cerebral perfusion. J Clin Exp Neuropsychol. 1993;15:231–44.CrossRefPubMed
18.
Verhey FRJ, Rozendaal N, Ponds RWHM, et al. Dementia, awareness and depression. Int J Geriatr Psychiatry. 1993;8:851–6.CrossRef
19.
Okonkwo OC, Spitznagel MB, Alosco ML, et al. Associations among measures of awareness of cognitive deficits in dementia. Alzheimers Dement. 2010;6:312–8.CrossRefPubMedPubMedCentral
20.
Clare L, Whitaker CJ, Nels SM, et al. Multidimensional assessment of awareness in early-stage dementia: a cluster analytic approach. Dement Geriatr Cogn Disord. 2011;31:317–27.CrossRefPubMed
21.
Cosentino S, Metcalfe J, Butterfield B, et al. Objective metamemory testing captures awareness of deficit in Alzheimer’s disease. Cortex. 2007;43:1004–19.CrossRefPubMedPubMedCentral
22.
Beaudoin M, Desrichard O. Are memory self-efficacy and memory performance related? A meta-analysis. Psychol Bull. 2011;137:211–41.CrossRefPubMed
23.
Crumley JJ, Steler CA, Horhota M. Examining the relationship between subjective and objective memory performance in older adults: a meta-analysis. Psychol Aging. 2014;29:250–63.CrossRefPubMed
24.
McDonald-Miszczak L, Hertzog C, Hultsch DF. Stability and accuracy of metamemory in adulthood and aging: a longitudinal analysis. Psychol Aging. 1995;10:553–64.CrossRefPubMed
25.
Lane CJ, Zelinski EM. Longitudinal hierarchical linear models of the memory functioning questionnaire. Psychol Aging. 2003;18:38–53.CrossRefPubMed
26.
Pearman A, Hertzog C, Gerstorf D. Little evidence for links between memory complaints and memory performance in very old age: longitudinal analyses from the Berlin Aging Study. Psychol Aging. 2014;29:828–42.CrossRefPubMed
27.
Mascherek A, Zimprich D. Correlated change in memory complaints and memory performance across 12 years. Psychol Aging. 2011;26:884–9.CrossRefPubMed
28.
Parisi JM, Gross AL, Rebok GW, et al. Modeling change in memory performance and memory perceptions: findings from the ACTIVE study. Psychol Aging. 2011;26:518–24.CrossRefPubMedPubMedCentral
29.
Hülür G, Hertzog C, Pearman AM, et al. Correlates and moderators of change in subjective memory and memory performance: findings from the Health and Retirement Study. Gerontology. 2015;61:232–40.CrossRefPubMed
30.
Hülür G, Hertzog C, Pearman AM, et al. Longitudinal association of subjective memory with memory performance and depressive symptoms: between-person and within-person perspectives. Psychol Aging. 2014;29:814–27.CrossRefPubMedPubMedCentral
31.
Waldorff FB, Siersma V, Vogel A. Subjective memory complaints in general practice predicts future dementia: a 4-year follow-up study. Int J Geriatr Psychiatry. 2012;27:1180–8.CrossRefPubMed
32.
Kryscio RJ, Abner EL, Cooper GE, et al. Self-reported memory complaints implications from a longitudinal cohort with autopsies. Neurology. 2014;83:1359–65.CrossRefPubMedPubMedCentral
33.
34.
Starkstein SE, Chemerinski E, Sabe L, et al. Prospective longitudinal study of depression and anosognosia in Alzheimer’s disease. Br J Psychiatry. 1997;171:47–52.CrossRefPubMed
35.
Orfei MD, Varsi AE, Blundo C, et al. Anosognosia in mild cognitive impairment and mild Alzheimer’s disease: frequency and neuropsychological correlates. Am J Geriatr Psychiatry. 2010;12:1133–40.CrossRef
36.
Roberts JL, Clare L, Woods RT. Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord. 2009;28:95–109.CrossRefPubMed
37.
Lin F, Wharton W, Dowling NM, et al. Awareness of memory abilities in community-dwelling older adults with suspected dementia and mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;30:83–92.CrossRefPubMedPubMedCentral
38.
Galeone F, Pappalardo S, Shieffi S, et al. Anosognosia for memory deficit in amnestic mild cognitive impairment and Alzheimer’s disease. Int Geriatr Psychiatry. 2011;26:695–701.CrossRef
39.
Vasterling JJ, Seltzer B, Watrous WE. Longitudinal assessment of deficit unawareness in Alzheimer’s disease. Neuropsychiatry Neuropsychol Behav Neurol. 1997;10:197–202.PubMed
40.
Derouesne C, Thibault S, Lagha-Pierucci S, et al. Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type. Int J Geriatr Psychiatry. 1999;14:1019–30.CrossRefPubMed
41.
Akai T, Hanyu H, Sakurai H, et al. Longitudinal patterns of unawareness of memory deficits in mild Alzheimer’s disease. Geriatr Gerontol Int. 2009;9:16–20.CrossRefPubMed
42.
Kiyak HA, Teri L, Borson S. Physical and functional health assessment in normal aging and in Alzheimer’s disease: self-reports vs family reports. Gerontologist. 1994;34:324–30.CrossRefPubMed
43.
Sevush S. Relationship between denial of memory deficit and dementia severity in Alzheimer disease. Neuropsychiatry Neuropsychol Behav Neurol. 1999;12:88–94.PubMed
44.
Clare L, Wilson BA. Longitudinal assessment of awareness in early-stage Alzheimer’s disease using comparable questionnaire-based and performance-based measures: a prospective one-year follow-up study. Aging Ment Health. 2006;10:156–65.CrossRefPubMed
45.
Clare L, Nelis SM, Martyr A, et al. Longitudinal trajectories of awareness in early-stage dementia. Alzheimer Dis Assoc Disord. 2012;26:140–7.CrossRefPubMed
46.
Sousa MF, Santos RL, Nogueira ML, et al. Awareness of disease is different for cognitive and functional aspects in mild Alzheimer’s disease: a one-year observation study. J Alzheimers Dis. 2015;43:905–13.PubMed
47.
Vogel A, Waldorff FB, Waldemar G. Longitudinal changes in awareness over 36 months in patients with mild Alzheimer’s disease. Int Psychogeriatr. 2015;27:95–102.CrossRefPubMed
48.
Rajan KB, Wilson RS, Weuve J, et al. Cognitive impairment 18 years prior to clinical diagnosis of Alzheimer’s disease dementia. Neurology. 2015;85:898–904.CrossRef
49.
50.
de Cleret LL, Fénelon G, Benisty S, et al. Awareness of memory deficits in early stage Huntington’s disease. PLoS One. 2013;8:e61676.CrossRef
51.
Lehrner J, Kogler S, Lamm C. Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease. Int Psychogeriatr. 2015;27:357–66.CrossRefPubMed
52.
Morris RG, Nelis SM, Martyr A, et al. Awareness of memory task impairment versus everyday memory difficulties in dementia. J Neuropsychol. 2016;10:130–42.CrossRefPubMed
53.
DeLozier SJ, Davalos D. A systematic review of metacognitive differences between Alzheimer’s disease and frontotemporal dementia. Am J Alzheimers Dis Other Demen. 2016;31:381–8.
54.
Zamboni G, Wilcock G. Lack awareness of symptoms in people with dementia: the structural and functional basis. Int Geriatr Psychiatry. 2011;26:783–92.CrossRef
55.
Starkstein SE. Anosognosia in Alzheimer’s disease: diagnosis, frequency, mechanism and clinical correlates. Cortex. 2014;61:64–73.
56.
Ries ML, Jabbar BM, Schmitz TW, et al. Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. Int Neuropsychol Soc. 2007;13:450–61.
57.
Shany-Ur T, Lin N, Rosen HJ, et al. Self-awareness in neurodegenerative disease relies on neural structures mediating reward-driven attention. Brain. 2014;137:2368–81.CrossRefPubMedPubMedCentral
58.
Cosentino S, Brickman AM, Griffith E, et al. The right insula contributes to memory awareness in cognitively diverse older adults. Neuropsychologia. 2015;75:75163–9.CrossRef
59.
Amanzio M, Torta DE, Sacco K, et al. Unawareness of deficits in Alzheimer’s disease: role of the cingulate cortex. Brain. 2011;134:1061–76.CrossRefPubMed
60.•
Perrotin A, Desgranges B, Landeau B, et al. Anosognosia in Alzheimer’s disease: disconnection between memory and self-related networks. Ann Neurol. 2015;78:477–86. Anosognosia in Alzheimer’s disease was not only associated with hypometabolism in self-referential brain networks but also with diminished intrinsic connectivity of these regions with medial temporal lobe structures that support autobiographical memory.CrossRefPubMed
61.
McGlynn SM, Schacter DL. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol. 1989;2:143–205.CrossRef
62.
Schacter DL. Toward a cognitive neuropsychology of awareness: implicit knowledge and anosognosia. J Clin Exp Neuropsychol. 1990;12:155–78.CrossRefPubMed
63.
Agnew SK, Morris RG. The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: a review of the literature and a proposed model. Aging Ment Health. 1998;2:7–19.CrossRef
64.
Hannesdottir K, Morris RG. Primary and secondary anosognosia for memory impairment in patients with Alzheimer’s disease. Cortex. 2007;43:1020–30.CrossRefPubMed
65.
Dodson CS, Spaniol M, O’Connor MK, et al. Alzheimer’s disease and memory monitoring impairment: Alzheimer’s patients show a monitoring deficit that is greater than their accuracy deficit. Neuropsychologia. 2011;49:2609–18.CrossRefPubMedPubMedCentral
66.
Mograbi DC, Brown RG, Morris RG. Anosognosia in Alzheimer’s disease - the petrified self. Conscious Cogn. 2009;18:989–1003.
Metadata
Title
Anosognosia in Dementia
Authors
Robert S. Wilson
Joel Sytsma
Lisa L. Barnes
Patricia A. Boyle
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 9/2016
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-016-0684-z

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