1
|
Vignolo J, Jacus JP, Darnaud T, Cuervo-Lombard CV. [Conscience des déficits dans le cadre de la maladie d'Alzheimer : représentations et vécu des professionnels soignants]. Can J Aging 2024:1-8. [PMID: 38449386 DOI: 10.1017/s0714980824000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
La qualité des soins apportés aux personnes vivant avec la maladie d'Alzheimer (MA) dépend en partie de la capacité des professionnels à déterminer le degré de conscience de la maladie chez les patients. La présente recherche s'est intéressée aux représentations des soignants concernant la conscience des troubles chez les résidents d'établissements de soins de longue durée présentant un diagnostic de MA. Le pouvoir prédicteur de l'anosognosie sur le fardeau soignant a également été examiné. L'anosognosie des troubles de la construction (r = 0,40, p = 0,0164) et de l'initiation (r = 0,32, p = 0,052) était corrélée au fardeau soignant. Les professionnels se représentaient les résidents comme ayant une conscience altérée de leurs capacités, même en l'absence d'anosognosie. Les scores réels d'anosognosie ne prédisaient pas les estimations soignantes, hormis le score global sous forme de tendance (χ2 = 3,38, p = 0,066). Les soignants surestimaient pourtant les performances cognitives des résidents, telles que mesurées au moyen du protocole Misawareness (prédictions aidants/performances réelles : DC = 12,32, p < 0,0001).
Collapse
Affiliation(s)
- Julie Vignolo
- Master 2 en Psychologie Clinique et Gérontologie. LCPI : Laboratoire Cliniques Psychopathologique et Interculturelle EA4591, Université Toulouse 2 Jean-Jaurès, 5 Allée Antonio Machado, 31058, Toulouse, France
| | - Jean-Pierre Jacus
- Doctorat. LCPI : Laboratoire Cliniques Psychopathologique et Interculturelle EA4591, Université Toulouse 2 Jean-Jaurès, 5 Allée Antonio Machado, 31058, Toulouse, France
| | - Thierry Darnaud
- HDR. LCPI : Laboratoire Cliniques Psychopathologique et Interculturelle EA4591, Université Toulouse 2 Jean-Jaurès, 5 Allée Antonio Machado, 31058, Toulouse, France
| | - Christine Vanessa Cuervo-Lombard
- HDR. CERPPS : Centre d'Études et de Recherche en Psychopathologie et Psychologie de la Santé EA7411, Université Toulouse 2 Jean-Jaurès, Allée Antonio Machado, 31058, Toulouse, France
| |
Collapse
|
2
|
Pachón-Basallo M, de la Fuente J, González-Torres MC, Martínez-Vicente JM, Peralta-Sánchez FJ, Vera-Martínez MM. Effects of factors of self-regulation vs. factors of external regulation of learning in self-regulated study. Front Psychol 2022; 13:968733. [PMID: 35992476 PMCID: PMC9386275 DOI: 10.3389/fpsyg.2022.968733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Since the mid-20th century, the study of Self-Regulated Learning (SRL) has aimed to identify the distinctive characteristics that enable individuals to acquire new knowledge and skills under their control. The theory of Internal Self-Regulation vs. External-Regulation in Learning (SRL vs. ERL; 2017) has postulated that a large number of self-regulatory variables are mediated by regulated/non-regulated or dysregulated features of the context. After signing their informed consent, a total of 616 university students completed validated instruments of SRL vs. ERL, behavioral regulation (SRB), regulatory teaching (RT), and metacognitive study control strategies (SRS). Using an ex-post facto design and correlation, regression, structural equation model and mediation analyses, the present research aimed to establish multicausal predictive relationships among the analyzed variables. Results indicated positive predictive effects between the external regulation variables on the self-regulation variables in learning [regulation (SRL)/non-regulation (NRL)/dysregulation (DRL)]; as well as positive predictive effects between SRL on SRB, RT and metacognitive SRS. Additionally, external regulation (ERL) not only predicted but mediated numerous relations among the variables studied. Other findings and important considerations for future research in the field of self-regulation are discussed.
Collapse
Affiliation(s)
- Mónica Pachón-Basallo
- School of Education and Psychology, University of Navarra, Pamplona, Spain
- *Correspondence: Mónica Pachón-Basallo, ,
| | - Jesús de la Fuente
- School of Education and Psychology, University of Navarra, Pamplona, Spain
- School of Psychology, University of Almería, Almería, Spain
| | | | | | | | | |
Collapse
|
3
|
Arroyo-Anlló EM, Sánchez JC, Gil R. Could Self-Consciousness Be Enhanced in Alzheimer’s Disease? An Approach from Emotional Sensorial Stimulation. J Alzheimers Dis 2020; 77:505-521. [DOI: 10.3233/jad-200408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alzheimer’s disease (AD) provides a valuable field of research into impairment of self-consciousness (SC), because AD patients have a reduced capacity to understand their mental world, to experience and relive previous personal events, as well as to interpret thoughts, feelings, and beliefs about themselves. Several studies observed that AD patients had an altered SC, but not a complete abolition of it. Emotions are an integral part of the construction of personal identity, therefore of Self. In general, most studies on emotion in AD patients have observed that emotion is not completely abolished and it lets them better remember autobiographical events with greater emotional charge. The positive effect of autobiographical memories rich in emotional content, evoked directly/automatically by sensorial stimuli such as familiar odors or music, could be used to reestablish/reinforce the permanence and coherence of the Self in AD. We studied the research of empirical evidence supporting the power of the sensorial cues associated with emotion, which could be capable of enhancing the SC in AD. We presented the studies about “Emotional stimulations” using odor, music, or taste cues in AD. All studies have shown to have a positive impact on SC in AD patients such as odor-evoked autobiographical memories, taste/odor-evoked autobiographical memories, emotional sensorial stimulation using musical cues, and multi-sensorial stimulations using healing gardens. We found research supporting the notion that emotional sensorial stimulations can even temporarily exalt memory, affective state, and personal identity, that is, the SC in AD. The emotional sensory stimulations could be used as a tool to activate the SC in AD and hence improve the quality of life of patients and caregivers.
Collapse
Affiliation(s)
- Eva M. Arroyo-Anlló
- Department of Psychobiology, University of Salamanca, Neuroscience Institute of Castilla-León, Spain
| | | | - Roger Gil
- Emeriti Professor of Neurology, University Hospital, Poitiers, France
| |
Collapse
|
4
|
Gueib C, Pop A, Bannay A, Nassau E, Fescharek R, Gil R, Luc A, Rivasseau Jonveaux T. Impact of a Healing Garden on Self-Consciousness in Patients with Advanced Alzheimer’s Disease: An Exploratory Study1. J Alzheimers Dis 2020; 75:1283-1300. [DOI: 10.3233/jad-190748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Claire Gueib
- Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, Nancy, France
| | - Alina Pop
- Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, Nancy, France
- Centre Mémoire Ressources Recherche de Lorraine, Hôpital de Brabois, Allée du Morvan, CHRU Nancy, Vandoeuvre les Nancy, France
| | - Aurélie Bannay
- Service d’Evaluation et Information Médicales, CHRU Nancy, Nancy, France
| | - Emeline Nassau
- Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, Nancy, France
| | | | - Roger Gil
- Espace Ethique Régional CHU Poitiers Université de Poitiers, Poitiers Cédex France
| | - Amandine Luc
- DRCI, Département MPI, unité de Méthodologie, Data management et Statistique, CHRU de Nancy Hôpital de Brabois, Allée du Morvan, Vandoeuvre les Nancy, France
| | - Thérèse Rivasseau Jonveaux
- Centre Paul Spillmann, Unité Cognitivo Comportementale, CHRU de Nancy, Nancy, France
- Centre Mémoire Ressources Recherche de Lorraine, Hôpital de Brabois, Allée du Morvan, CHRU Nancy, Vandoeuvre les Nancy, France
- Laboratoire Lorrain de Psychologie et de Neurosciences de la Dynamique des Comportements 2LPN EA 7489, Nancy, France
| |
Collapse
|
5
|
Gagliardi G, Houot M, Cacciamani F, Habert MO, Dubois B, Epelbaum S. The meta-memory ratio: a new cohort-independent way to measure cognitive awareness in asymptomatic individuals at risk for Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2020; 12:57. [PMID: 32408882 PMCID: PMC7222501 DOI: 10.1186/s13195-020-00626-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/01/2020] [Indexed: 01/28/2023]
Abstract
Background Lack of awareness of cognitive decline (ACD) has been described at the preclinical and prodromal stages of Alzheimer’s disease (AD). In this study, we introduced a meta-memory ratio (MMR) and explored how it is associated with neuroimaging AD biomarkers in asymptomatic individuals at risk for AD. Method Four hundred forty-eight cognitively healthy participants from two cohorts of subjective memory complainers (INSIGHT-PreAD and ADNI) were included. Regression models were used to assess the impact of AD biomarkers on the MMR. Result In both cohorts, there was a significant quadratic effect of cerebral amyloidosis on the MMR value. In particular, participants had a high ACD up to the amyloid positivity threshold, above which a decrease of ACD was eventually observed as the amyloid load increased. Conclusion This nonlinear evolution of ACD in very early AD must be taken into account in clinical care and for trial enrollment as well.
Collapse
Affiliation(s)
- Geoffroy Gagliardi
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, Institut du cerveau et de la moelle (ICM) - Hôpital Pitié-Salpêtrière, Paris, France. .,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Paris, France.
| | - Marion Houot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Paris, France.,Centre of excellence of neurodegenerative disease (CoEN), ICM, CIC Neurosciences, APHP Department of Neurology, Hopital Pitié-Salpêtrière, University Paris 6, Paris, France
| | - Federica Cacciamani
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, Institut du cerveau et de la moelle (ICM) - Hôpital Pitié-Salpêtrière, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Paris, France.,Aramis project-team, Inria-APHP collaboration, F-75013, Paris, France
| | - Marie-Odile Habert
- Sorbonne Universités, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Centre pour l'Acquisition et le Traitement des Images, Paris, France.,Département de Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bruno Dubois
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, Institut du cerveau et de la moelle (ICM) - Hôpital Pitié-Salpêtrière, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Paris, France.,Centre of excellence of neurodegenerative disease (CoEN), ICM, CIC Neurosciences, APHP Department of Neurology, Hopital Pitié-Salpêtrière, University Paris 6, Paris, France
| | - Stéphane Epelbaum
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, CNRS, Institut du cerveau et de la moelle (ICM) - Hôpital Pitié-Salpêtrière, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Neurologie, Institut de la mémoire et de la maladie d'Alzheimer, Paris, France.,Aramis project-team, Inria-APHP collaboration, F-75013, Paris, France
| | | |
Collapse
|
6
|
Thirioux B, Harika-Germaneau G, Langbour N, Jaafari N. The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Front Psychiatry 2020; 10:966. [PMID: 32116810 PMCID: PMC7020772 DOI: 10.3389/fpsyt.2019.00966] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/06/2019] [Indexed: 01/12/2023] Open
Abstract
Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.
Collapse
Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Ghina Harika-Germaneau
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Langbour
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, CHU de Poitiers, INSERM U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche CNRS 3557, Poitiers, France
| |
Collapse
|
7
|
Mayelle A, El Haj M, Antoine P. "What" and "How": A New Perspective for Understanding Unawareness in Alzheimer's Disease Through a Combination of Two Perspectives. Am J Alzheimers Dis Other Demen 2020; 35:1533317520925333. [PMID: 32508159 PMCID: PMC10624057 DOI: 10.1177/1533317520925333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Assessments of unawareness in Alzheimer's disease mainly focus on the objects (the "what") of unawareness. A recent person-centered approach proposes to also assess the processes (the "how"). The present study combines 2 approaches to understand this heterogeneity in assessments of unawareness. METHOD We recruited 46 participants from 8 nursing homes. They underwent a semi-structured interview and were assessed using a prediction-performance paradigm. Spearman correlations were calculated, and generalized additive models were established. RESULTS The 2 approaches are associated through cognitive deficits, confrontation with difficulties and identity changes. Objects (the what), mechanisms, and modes of expression (the how) explain at least 29.6% of the variance of unawareness. CONCLUSIONS Unawareness is more than simply being unaware of something; it is a synergy between the objects and processes of arousal and expression. Moreover, unawareness extends beyond the disease to include the self. Considering the entire person seems to be necessary.
Collapse
Affiliation(s)
- Amandine Mayelle
- University Lille, CNRS, UMR 9193 – SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), Nantes Université, Univ Angers, F-44000 Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing 59200, France
- Institut Universitaire de France, Paris 75000, France
| | - Pascal Antoine
- University Lille, CNRS, UMR 9193 – SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| |
Collapse
|
8
|
Dutzi I, Schwenk M, Kirchner M, Bauer JM, Hauer K. "What would you like to achieve?" Goal-Setting in Patients with Dementia in Geriatric Rehabilitation. BMC Geriatr 2019; 19:280. [PMID: 31640595 PMCID: PMC6805571 DOI: 10.1186/s12877-019-1296-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Setting meaningful, individualized rehabilitation goals is an essential part of the rehabilitation process. Even though patients with dementia are a drastically increasing patient group in geriatric rehabilitation, empirical data about meaningful rehabilitation goals and collaborative goal-setting in this target group is missing. Cognitive impairment and lack of insight in current deficits have been discussed as barriers for participation in goal-setting, but require empirical examination. This study investigated the feasibility of a semi-structured versus a structured goal-setting approach and the types of goals, rehabilitation patients with mild to moderate dementia perceive as personally relevant. Insights in acute functional and motor deficits, differentiated by cognitive status were explored. METHODS Cohort study in a geriatric rehabilitation center. Semi-structured and ICF-based, structured interviews were applied to explore patients` rehabilitation goals. Patients` insight in deficits was operationalized as the relationship of self-ratings and objective measures of linked clinical assessments for the same functional construct. RESULTS Patients (n = 101, MMSE 22 ± 2.6, age 83.9 ± 5.9 years) stated the improvement of mobility-related functions and self-care activities (> 70%) but also psychological well-being such as handling stress or mood (> 38%) as most important rehabilitation goals. The structured interview facilitated goal-setting and provided a broader view of rehabilitation needs. Correlations between self-ratings and clinical assessments were medium to high (rho = 0.29 to 0.83) with highest associations for key motor features. Trend tests identified a significant trend between values of the clinical assessment and categories of self-ratings (p ≤ 0.01) with lower cognitive status derogating this relationship. CONCLUSIONS Collaborative goal-setting was feasible, especially when supported by a structured approach and yielded a large spectrum of functional but also psychological rehabilitation needs from the patients` perspective. Patients showed sustained insight in their actual functional impairments, limited in a subgroup of patients with more advanced cognitive impairment.
Collapse
Affiliation(s)
- Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Geriatric Center at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research, University of Heidelberg, Bergheimer St. 20, 69115 Heidelberg, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jürgen M. Bauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Geriatric Center at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer St. 20, 69115 Heidelberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Geriatric Center at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| |
Collapse
|
9
|
Mayelle A, El Haj M, Antoine P. Awareness of Self and Disease Assessment: Development and Validation of a Subjective Measure in People with Alzheimer’s Disease. J Alzheimers Dis 2019; 71:841-850. [DOI: 10.3233/jad-190371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Amandine Mayelle
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Mohamad El Haj
- Univ. Nantes, EA 4638 – LPPL – Laboratoire de Psychologie des Pays de la Loire, Nantes, France
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Institut Universitaire de France, Paris, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| |
Collapse
|
10
|
Chen X, Xie XJ, Yu L. The pathway from cognitive impairment to caries in older adults: A conceptual model. J Am Dent Assoc 2018; 149:967-975. [PMID: 30205901 DOI: 10.1016/j.adaj.2018.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/08/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Caries significantly increases in people with cognitive impairment (PWCI). However, the interrelationships among cognitive impairment, dentally related function (DRF), oral hygiene, and caries remain unclear, increasing difficulties to care appropriately for PWCI. In this study, the researchers tested a conceptual model in which impaired DRF acts as a mediator between cognitive impairment and poor oral hygiene, which then leads to caries. METHODS The researchers recruited 68 older adult dentate participants with normal to severely impaired cognition from 3 assisted-living communities in North Carolina. Within 1 week of a calibrated oral examination performed by a geriatric dentist, a trained examiner blinded to the oral examination results conducted cognitive and functional assessments. The researchers conducted statistical analyses to examine the mediating effect of DRF on the relationship between cognitive impairment and oral hygiene or caries. RESULTS Cognitive impairment (β = 0.05; standard error [SE], 0.02; P = .017) and DRF (β = -0.07; SE, 0.02; P = .005) were significantly associated with oral hygiene. However, the association between cognitive impairment and oral hygiene was greatly reduced and became nonsignificant after controlling for DRF (β = 0.01; SE, 0.03; P = .430), suggesting that the effect of cognitive impairment on oral hygiene was mediated by DRF. DRF accounted for 80% of the total effect of cognitive impairment on oral hygiene. The ratio of the indirect effect to the total effect was .8. Associations between either cognitive impairment or DRF and caries were not significant, but oral hygiene was significantly associated with caries (β = 0.87; SE, 0.28; P < .001). CONCLUSIONS DRF mediated the association between cognitive impairment and oral hygiene. It accounted for 80% of the total impact of cognitive impairment on oral hygiene, which was associated with increased caries in PWCI. PRACTICAL IMPLICATIONS As a result of cognitive impairment, impaired DRF plays a critical role in the pathway from cognitive impairment to oral health decline. Therefore, DRF assessment should be a standard component of geriatric dental assessment. A functionally-tailored oral hygiene intervention is essential to improve oral health for persons with cognitive impairment.
Collapse
|
11
|
Rozzini L, Conti MZ, Riva M, Ceraso A, Caratozzolo S, Zanetti M, Padovani A. Non-amnestic mild cognitive impairment and sleep complaints: a bidirectional relationship? Aging Clin Exp Res 2018; 30:661-668. [PMID: 28849412 DOI: 10.1007/s40520-017-0814-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior studies documented that several sleep disorders may coexist in patients affected by Mild Cognitive Impairment (MCI) and Alzheimer disease (AD), and have a strong bidirectional relationship with cognitive decline. AIM To assess the self-reported sleep quality and daytime sleepiness among subjects affected by MCI and AD at early-stage and healthy controls, and to verify if sleep disturbances might be an indicator of specific cognitive deficits. METHODS 139 patients (102 MCI, 37 AD) underwent comprehensive neuropsychological, functional, and behavioral assessment, which also included Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). 80 healthy elderly subjects were used as controls. MCI patients have been divided into Good Sleepers and Bad Sleepers, depending on their reported sleep quality (PSQI global score ≤5/>5). RESULTS MCI patients experienced more subjective daytime sleepiness than AD matches. As for the subjective sleep quality among MCI patients, 54% of Bad Sleepers met diagnostic criteria for non-amnestic MCI; vice-versa, 73% of Good Sleepers were diagnosed with amnestic-MCI (p = 0.005), independently of depression and anxiety. CONCLUSIONS MCI patients complain of daytime sleepiness and dysfunction more than AD patients; among MCI patients, Bad Sleepers appear mainly characterized by a non-amnestic cognitive profile.
Collapse
Affiliation(s)
- Luca Rozzini
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy.
- Geriatric Research Group, Brescia, Italy.
| | - Marta Zaffira Conti
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| | - Maddalena Riva
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| | - Salvatore Caratozzolo
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| | - Marina Zanetti
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25100, Brescia, Italy
| |
Collapse
|
12
|
Guerrier L, Le Men J, Gane A, Planton M, Salabert AS, Payoux P, Dumas H, Bonneville F, Péran P, Pariente J. Involvement of the Cingulate Cortex in Anosognosia: A Multimodal Neuroimaging Study in Alzheimer's Disease Patients. J Alzheimers Dis 2018; 65:443-453. [PMID: 30056422 PMCID: PMC6130407 DOI: 10.3233/jad-180324] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anosognosia is a frequent symptom of Alzheimer's disease (AD), but its neural substrates remain in question. OBJECTIVE In this study, we combined neuroimaging with a neuropsychological evaluation to assess neural substrates of anosognosia. METHODS We prospectively recruited 30 patients with probable early-stage AD and matched healthy controls. Participants underwent MRI, FDG-PET, and a neuropsychological evaluation that includes an assessment of anosognosia. In the AD group, correlations between the anosognosia score, neuroimaging modalities, and neuropsychological performance were performed. RESULTS Atrophy and hypometabolism were correlated with the anosognosia score in the left dorsal anterior cingulate cortex. The anosognosia score was also correlated with atrophy of the cerebellar vermis, the left postcentral gyrus, and the right fusiform gyrus. No relation was found between anosognosia and the neuropsychological assessment. DISCUSSION Structural and metabolic alteration in the dorsal anterior cingulate cortex seems to be associated with a diminution of awareness in patients with early-stage AD.
Collapse
Affiliation(s)
- Laura Guerrier
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Johanne Le Men
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Anaıs Gane
- UMR1027 INSERM, University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France
| | - Mélanie Planton
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Anne-Sophie Salabert
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
- Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France
| | - Pierre Payoux
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
- Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France
| | - Hervé Dumas
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Fabrice Bonneville
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Jérémie Pariente
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| |
Collapse
|
13
|
Chavoix C, Insausti R. Self-awareness and the medial temporal lobe in neurodegenerative diseases. Neurosci Biobehav Rev 2017; 78:1-12. [DOI: 10.1016/j.neubiorev.2017.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/03/2017] [Accepted: 04/15/2017] [Indexed: 12/13/2022]
|
14
|
Jacus JP. Awareness, apathy, and depression in Alzheimer's disease and mild cognitive impairment. Brain Behav 2017; 7:e00661. [PMID: 28413709 PMCID: PMC5390841 DOI: 10.1002/brb3.661] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Results 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. METHODS We 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). RESULTS Groups 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). CONCLUSION These results evidence comparable awareness between AD and MCI patients. The correlates were more affective and behavioral than cognitive, independently from assessment method.
Collapse
Affiliation(s)
- Jean-Pierre Jacus
- Consultations Mémoire Centre Hospitalier du val d'Ariège Foix Cedex France.,Laboratoire Epsylon, EA 4556 Université Paul-Valery Montpellier France
| |
Collapse
|
15
|
Reliability and construct validity of the Early Dementia Questionnaire (EDQ). BMC Geriatr 2016; 16:202. [PMID: 27903242 PMCID: PMC5131430 DOI: 10.1186/s12877-016-0384-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022] Open
Abstract
Background Early Dementia Questionnaire (EDQ) was developed as a screening tool to detect patients with early dementia in primary care. It was developed based on 20 symptoms of dementia. From a preliminary study, EDQ had been shown to be a promising alternative for screening of early dementia. This study was done to further test on EDQ’s reliability and validity. Methods Using a systematic random sampling, 200 elderly patients attending primary health care centers in Kuching, Sarawak had consented to participate in the study and were administered the EDQ. Geriatric Depression Scale (GDS) was used to exclude patients with depression. Those who scored >21 MMSE, were retested using the EDQ. Reliability was determined by Cronbach’s alpha for internal consistency and construct validity was assessed using confirmatory factor analysis (principle component with varimax rotation). Test retest Intraclass Correlation Coeeficient (ICC) was used to determine the reliability of the scale. Results The result showed that the sensitivity and specificity for EDQ was 71.2% and 59.5%. The overall Cronbach’s alpha coefficient was good which was 0.874. Confirmatory factor analysis on 4 factors indicated that the Cronbach’s alpha for each domain were acceptable with memory (0.741), concentration (0.764), emotional and physical symptoms (0.754) and lastly sleep and environment (0.720). The Intraclass Correlation Coefficient between the first EDQ score and the retest EDQ score among those with MMSE of >21 showed a very strong overall agreement, ICC = 0.764, N = 160, P <0.001. Conclusions The results of the validation study showed that Early Dementia Questionnaire (EDQ) is a valid and reliable tool to be used as a screening tool to detect early dementia in primary care.
Collapse
|
16
|
Bertrand E, Landeira-Fernandez J, Mograbi DC. Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review. Front Psychol 2016; 7:1812. [PMID: 27909421 PMCID: PMC5112262 DOI: 10.3389/fpsyg.2016.01812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022] Open
Abstract
Metacognition refers to the monitoring and regulation of cognitive processes and its impairment can lead to a lack of self-awareness of deficits, or anosognosia. In the context of different neurological and psychiatric disorders (e.g., traumatic brain injury, dementia, and schizophrenia), studies have shown that patients who present impairments in metacognitive abilities may be able to recognize such difficulties in others and in themselves when exposed to material in a third-person perspective. Considering that metacognitive impairments are an important characteristic of dementia, especially in Alzheimer's Disease (AD), studies of the relationship between metacognition and perspective-taking may be relevant to improve the quality of life of people with dementia. The current paper first briefly addresses the theme of metacognition and the impact of metacognitive deficits in people with AD. The focus then turns to the relationship between metacognition and perspective-taking in different neurological and psychiatric disorders, particularly AD. This relationship is also discussed based on theoretical models, particularly the Cognitive Awareness Model (CAM). Specifically, the CAM suggests the existence of distinct memory systems for self- and other-information, an idea which is supported by neuroimaging findings. We suggest that the Default Mode Network, as it has been shown to be implicated in self vs. other processing and is affected early in AD, could explain the impact of perspective-taking on awareness of deficits in AD. Finally, we present possible clinical implications of the relationship between metacognition and perspective-taking in AD. Indeed, we considered the possibility of improving patient's awareness through the use of a third-person perspective, which, consequently, may decrease the negative impacts of anosognosia in AD.
Collapse
Affiliation(s)
- Elodie Bertrand
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
| | - Jesus Landeira-Fernandez
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
| | - Daniel C. Mograbi
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondon, UK
| |
Collapse
|
17
|
Mood-congruent recollection and anosognosia in Alzheimer's disease. Cortex 2016; 84:55-62. [DOI: 10.1016/j.cortex.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/05/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022]
|
18
|
Castrillo Sanz A, Andrés Calvo M, Repiso Gento I, Izquierdo Delgado E, Gutierrez Ríos R, Rodríguez Herrero R, Rodríguez Sanz F, Tola-Arribas M. Anosognosia en la enfermedad de Alzheimer: prevalencia, factores asociados e influencia en la evolución de la enfermedad. Neurologia 2016; 31:296-304. [DOI: 10.1016/j.nrl.2015.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/15/2015] [Accepted: 03/05/2015] [Indexed: 11/17/2022] Open
|
19
|
Castrillo Sanz A, Andrés Calvo M, Repiso Gento I, Izquierdo Delgado E, Gutierrez Ríos R, Rodríguez Herrero R, Rodríguez Sanz F, Tola-Arribas M. Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
20
|
Abstract
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.
Collapse
|
21
|
Agyapong VIO. Factors predicting the presence of impaired clinical insight in liaison psychiatric patients assessed in the Emergency Room. Int J Psychiatry Clin Pract 2016; 20:32-9. [PMID: 26472047 DOI: 10.3109/13651501.2015.1107910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There are limited studies on the factors that can predict the presence of impaired clinical insight specifically in an Emergency Room (ER) psychiatric patient population. The objective of this study is to examine the factors that can predict the likelihood that a patient presenting to the ER will have impaired clinical insight. METHODS Nineteen independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression. RESULTS Patients who were unemployed or had a history of self-harm or had psychotic symptoms on mental state examination were about two, three and six times, respectively, more likely to have impaired clinical insight compared with those who were employed, had no history of self-harm or had no psychotic symptoms on mental state examination, controlling for other factors in the logistic regression model. CONCLUSION Patients who are unemployed, have a history of self-harm or have psychotic symptoms following as psychiatric assessment in the ER may benefit from an insight-oriented psychotherapy.
Collapse
Affiliation(s)
- Vincent I O Agyapong
- a Department of Psychiatry , University of Alberta , Edmonton , AB , Canada ;,b Department of Psychiatry , Northern Lights Regional Health Centre , Fort McMurray , AB , Canada
| |
Collapse
|
22
|
Perrotin A, Desgranges B, Landeau B, Mézenge F, La Joie R, Egret S, Pélerin A, de la Sayette V, Eustache F, Chételat G. Anosognosia in Alzheimer disease: Disconnection between memory and self-related brain networks. Ann Neurol 2015; 78:477-86. [PMID: 26085009 DOI: 10.1002/ana.24462] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/20/2015] [Accepted: 06/14/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Impaired awareness is a common symptom in many mental disorders including Alzheimer disease (AD). This study aims at improving our understanding of the neural mechanisms underlying anosognosia of memory deficits in AD by combining measures of regional brain metabolism (resting state fluorodeoxyglucose positron emission tomography [FDG-PET]) and intrinsic connectivity (resting state functional magnetic resonance imaging [fMRI]). METHODS Twenty-three patients diagnosed with probable AD based on clinical and biomarker data and 30 matched healthy control subjects were recruited in this study. An anosognosia index (difference between subjective and objective memory scores) was obtained in each participant. Resting state FDG-PET for glucose metabolism measurement and resting state fMRI for intrinsic connectivity measurement were also performed. AD and control groups were compared on behavioral data, and voxelwise correlations between anosognosia and neuroimaging data were conducted within the AD group. RESULTS AD patients underestimated their memory deficits. Anosognosia in AD patients correlated with hypometabolism in orbitofrontal (OFC) and posterior cingulate (PCC) cortices. Using OFC and PCC as seed regions, intrinsic connectivity analyses in AD revealed a significant association between anosognosia and reduced intrinsic connectivity between these regions as well as with the medial temporal lobe. INTERPRETATION Anosognosia in AD is due not only to functional changes within cortical midline structures involved in self-referential processes (OFC, PCC), but also to disconnection between these regions as well as with the medial temporal lobe. These findings suggest that the lack of awareness of memory deficits in AD results from a disruption of the communication within, but also between, the self-related and the memory-related brain networks.
Collapse
Affiliation(s)
- Audrey Perrotin
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Béatrice Desgranges
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Brigitte Landeau
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Florence Mézenge
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Renaud La Joie
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Stéphanie Egret
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Alice Pélerin
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,Department of Neurology, CHU (University Hospital Center) of Caen, Caen, France
| | - Vincent de la Sayette
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,Department of Neurology, CHU (University Hospital Center) of Caen, Caen, France
| | - Francis Eustache
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| | - Gaël Chételat
- INSERM (French National Institute of Health and Medical Research), Unit 1077, Caen, France.,University of Caen Lower Normandy, UMR-S1077, Caen, France.,EPHE (French Practical School of Higher Studies), UMR-S1077, Caen, France.,CHU (University Hospital Center) of Caen, Caen, France
| |
Collapse
|
23
|
Lindau M, Bjork R. Anosognosia and anosodiaphoria in mild cognitive impairment and Alzheimer's disease. Dement Geriatr Cogn Dis Extra 2014; 4:465-80. [PMID: 25759713 PMCID: PMC4282043 DOI: 10.1159/000369132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims To evaluate the occurrence of anosognosia (lack of awareness) and anosodiaphoria (insouciance) in mild cognitive impairment (MCI) and Alzheimer's disease (AD) and to evaluate the influence of a worsening of dementia on these phenomena. Methods A self-evaluation scale was used assessing degrees of anosognosia and anosodiaphoria; furthermore, a neuropsychological assessment and statistical analyses with nonparametric tests which could cope with data on an ordinal scale level and small samples were employed. Results Cognitive ability was lower in AD (n = 9) than in MCI patients (n = 12), but AD patients self-rated lower cognitive disabilities, which is interpreted as one relative sign of anosognosia in AD. Awareness of the reasons for cognitive problems was also lower in AD, which is considered as another sign of anosognosia. The main pattern in MCI found that the higher the awareness, the lower the cognitive ability. In AD low awareness paralleled low cognitive functioning. Anosodiaphoria was present in AD but not in MCI. Conclusion According to the literature anosognosia and anosodiaphoria seem to increase with progression of dementia from MCI as a result of right hemispheric alterations.
Collapse
Affiliation(s)
- Maria Lindau
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Randall Bjork
- Colorado Springs Neurological Associates, Colorado Springs, Colo., USA
| |
Collapse
|
24
|
McCusker E, Loy CT. The many facets of unawareness in huntington disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:257. [PMID: 25411649 PMCID: PMC4231168 DOI: 10.7916/d8fj2fd3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Abstract
Background Unawareness or diminished awareness is present when a patient's perception of obvious disease manifestations and impact differ from that of observers such as clinicians or family members. Methods We examined studies that specifically investigate unawareness in Huntington disease (HD). Results Unawareness of motor, cognitive, behavioral, and functional aspects of HD has been documented throughout the disease course. This can occur at motor and cognitive onset but is more pronounced as the disease progresses. Discussion We discuss the implications for diagnosis, symptom report at presentation, timing of diagnosis, acceptance of symptomatic care strategies, and reporting in clinical trials. Assessments of work place competency, discrimination, driving, and the particular challenges of isolated patients without caregivers are described. Engaging with a person who is unaware of their disease or its impact presents a number of conflicts, including maintaining the right to autonomy, privacy, confidentiality, and independence while recognizing concerns for the wellbeing of the vulnerable person with HD and their caregiver when the unaware person refuses assistance. Unawareness is seen increasingly as neurologically based due to the impairment of functional networks, predominantly in nondominant frontostriatal pathways.
Collapse
Affiliation(s)
- Elizabeth McCusker
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| | - Clement T Loy
- Huntington Disease Service, Westmead Hospital, Westmead, Australia ; The University of Sydney, Sydney, Australia
| |
Collapse
|
25
|
Gambina G, Bonazzi A, Valbusa V, Condoleo MT, Bortolami O, Broggio E, Sala F, Moretto G, Moro V. Awareness of cognitive deficits and clinical competence in mild to moderate Alzheimer's disease: their relevance in clinical practice. Neurol Sci 2014; 35:385-90. [PMID: 23959532 DOI: 10.1007/s10072-013-1523-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/07/2013] [Indexed: 11/26/2022]
Abstract
Awareness of cognitive deficits and clinical competence were investigated in 79 mild to moderate Alzheimer's disease patients. Awareness was assessed by the anosognosia questionnaire for dementia, and clinical competence by specific neuropsychological tests such as trail making test-A, Babcock story recall test, semantic and phonemic verbal fluency. The findings show that 66 % of the patients were aware of memory deficits, while the 34 % were unaware. Deficit in awareness correlated with lower scores on the Mini Mental State Examination test that, in the score range from 24.51 to 30 and from 19.50 to 24.50, appeared to be a significant predictor of level of awareness. None of the AD patients had fully preserved clinical competence, only 7 patients (9 %) had partially preserved clinical competence and 72 patients (91 %) had completely lost clinical competence. All the patients with partially preserved clinical competence (9 %) were aware of their memory deficit. The study indicates that neuropsychological tests used for the assessment of executive functions are not suitable for investigating clinical competence. Therefore, additional and specific tools for the evaluation of clinical competence are necessary. Indeed, these might allow clinicians to identify AD patients who, despite their deficits in selected functions, retain their autonomy of choice as well as recognize those patients who should proceed to the nomination of a legal representative.
Collapse
|
26
|
Jacus JP, Belorgey N, Trivalle C, Gély-Nargeot MC. [Factors associated with awareness in early stages of Alzheimer's disease and in mild cognitive impairment]. Encephale 2014; 41 Suppl 1:S44-8. [PMID: 25238907 DOI: 10.1016/j.encep.2014.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022]
Affiliation(s)
- J-P Jacus
- Laboratoire Epsylon, EA 4556, université de Montpellier, rue du Professeur-Henri-Serre, 34000 Montpellier, France; Consultations mémoire, centre hospitalier du val d'Ariège, BP 01, 09017 Foix, France.
| | - N Belorgey
- Laboratoire Sage, UMR 7363, CNRS, université de Strasbourg, MISHA, 5, allée du Général-Rouvillois, 67083 Strasbourg cedex, France
| | - C Trivalle
- Pôle gériatrie, hôpital Paul-Brousse (AP-HP), hôpitaux universitaires Paris-Sud, 12, avenue Paul-Vaillant-Couturier, BP 200, 94804 Villejuif cedex, France
| | - M-C Gély-Nargeot
- Laboratoire Epsylon, EA 4556, université Paul-Valéry, Montpellier III, rue du Professeur-Henri-Serre, 34000 Montpellier, France
| |
Collapse
|
27
|
Chen YL, Chen HM, Huang MF, Yeh YC, Yen CF, Chen CS. Clinical correlates of unawareness of deficits among patients with dementia due to Alzheimer's disease. Am J Alzheimers Dis Other Demen 2014; 29:533-9. [PMID: 24550546 PMCID: PMC10852770 DOI: 10.1177/1533317514523484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND To investigate the associations between unawareness of deficits and clinical correlates, including apathy and depression, among patients with dementia due to Alzheimer's disease (AD). METHODS Fifty-five patients with AD were enrolled. Unawareness of memory deficits and psychosis or behavior problems was assessed. The Apathy Evaluation Scale informant version and the Cornell Scale for Depression in Dementia (CSDD) were used to measure apathy and depression, respectively. RESULTS In all, 32 (57.2%) and 27 (49.1%) participants were identified as being unaware of memory deficits and psychosis or behavior problems, respectively. Unawareness of memory deficits was associated with lower scores on the Mini-Mental State Examination (MMSE) and higher scores on the CSDD. Unawareness of psychosis or behavior problems was associated with lower scores on the MMSE. CONCLUSION Unawareness of deficits among patients with AD was common. The 2 domains of unawareness showed different characteristics and may possibly present different etiologies.
Collapse
Affiliation(s)
- Yi-Lung Chen
- Graduate Institute of Psychology, National Taiwan University, Taiwan Department of Psychology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Mei Chen
- Department of Occupational Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
28
|
Turró-Garriga O, Conde-Sala JL, Reñé-Ramírez R, López-Pousa S, Gascón-Bayarri J, Garre-Olmo J. Prevalencia de anosognosia en la enfermedad de Alzheimer. Med Clin (Barc) 2014; 143:13-9. [DOI: 10.1016/j.medcli.2013.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/12/2013] [Accepted: 04/18/2013] [Indexed: 11/28/2022]
|
29
|
Transcranial direct current stimulation over right dorsolateral prefrontal cortex enhances error awareness in older age. J Neurosci 2014; 34:3646-52. [PMID: 24599463 DOI: 10.1523/jneurosci.5308-13.2014] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The ability to detect errors during cognitive performance is compromised in older age and in a range of clinical populations. This study was designed to assess the effects of transcranial direct current stimulation (tDCS) on error awareness in healthy older human adults. tDCS was applied over DLPFC while subjects performed a computerized test of error awareness. The influence of current polarity (anodal vs cathodal) and electrode location (left vs right hemisphere) was tested in a series of separate single-blind, Sham-controlled crossover trials, each including 24 healthy older adults (age 65-86 years). Anodal tDCS over right DLPFC was associated with a significant increase in the proportion of performance errors that were consciously detected, and this result was recapitulated in a separate replication experiment. No such improvements were observed when the homologous contralateral area was stimulated. The present study provides novel evidence for a causal role of right DLPFC regions in subserving error awareness and marks an important step toward developing tDCS as a tool for remediating the performance-monitoring deficits that afflict a broad range of populations.
Collapse
|
30
|
Jacus JP, Dupont MP, Herades Y, Pelix C, Large H, Baud M. [Awareness disorders in Alzheimer's disease and in mild cognitive impairment]. Encephale 2014; 40:180-7. [PMID: 24630532 DOI: 10.1016/j.encep.2013.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/07/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Awareness disorders in Alzheimer's disease still remains unclear despite much research regarding this phenomenon. Papers report various and contrasted results with varying frequency from one study to another. Hence, the interest in awareness in Alzheimer's disease remains limited. Nevertheless, this symptom is closely associated with caregivers' burden and increases the patient's dependency, since the patient is unable to avoid dangers, requiring some care services or institutionalization The purpose of this current review is to recall the main neuro-anatomical and theoretical basis of awareness disorders, and to highlight the recent findings in Alzheimer's disease and in its pre-clinical stages. METHOD With this in mind, we have conducted a non-exhaustive search using the pubmed online database to collect the most important reviews and the most recent findings regarding awareness disorders in Mild Cognitive Impairment (MCI) and/or in Alzheimer's disease. LITERATURE FINDINGS In Alzheimer's disease, the links between awareness disorders and other variables, such as severity of dementia or depression, change from one study to the other and do not permit one to understand whether unawareness is an intrinsic or extrinsic reaction to the pathological process itself. Recent results suggest executive, cognitive and behavioral correlates more than psychopathological correlates, although the latter cannot be excluded. In Mild Cognitive Impairment, studies show varied results. Some studies report that patients suffering from Mild Cognitive Impairment can be compared to healthy control subjects and both groups have better awareness than patients with Alzheimer's disease. However, other studies show contrary results and awareness disorders might be a predictor of conversion from Mild Cognitive Impairment to dementia, as with apathy, in which the ability to cope with difficulties represents one of the main features. DISCUSSION These controversial results are due to the heterogeneity of Alzheimer patients and in particular of MCI patients, but also to various conceptions of awareness disorders in Alzheimer's disease; none of them, however, taking into account all its diversity and complexity. Thus, neurological approaches underline neuropsychological dysfunctions linked to right frontal and/or hemispheric damage but are based on brain injury or strokes, which are events that differ greatly from a neurodegenerative disease involving progressive cognitive, emotional and social disturbances. Psychiatric approaches have taken into account the various aspects of insight, which before were often forbidden and reduced to a categorical point of view, and so could contribute to a better understanding of awareness disorders in Alzheimer's disease. However, these aspects have been conceptualized for psychiatric patients, suffering from positive symptoms, where compliance in treatment is the central key. Insight in neurological diseases is more focused on negative symptoms and generally concerns a basic perception of impairments in mainly cognitive domains. Moreover, modeling has often opposed neurological and psychological mechanisms, so awareness disorders are out of scope of a primary and secondary symptomatology. Although some authors have proposed to take into account these two mechanisms (unawareness and denial), clinical practice has shown that it was impossible to distinguish them both. Finally, some social cognitive approaches are able to demonstrate that there is no correlation between severity of dementia and awareness disorders. Nevertheless, the Self-concept, underlying this point of view, does not permit distinguishing neuropsychological from psycho-social factors. Moreover, only one evaluation tool based on Self-modeling in Alzheimer's disease exists, and to conceptualize Self in a specific pathology does not permit the comparison of this pathology to others or to healthy control subjects. So, the authors present the multidimensional model proposed by Clare et al., and some perspectives to stimulate future research, and perform potential meta-analyses.
Collapse
Affiliation(s)
- J-P Jacus
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France.
| | - M-P Dupont
- Unité cognitivo-comportementale, consultation mémoire, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
| | - Y Herades
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France; Centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France
| | - C Pelix
- Consultation mémoire, centre hospitalier du Val-d'Ariège, 09017 Foix cedex, France
| | - H Large
- Unité mobile de gériatrie, consultation mémoire, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
| | - M Baud
- Unité cognitivo-comportementale, centre hospitalier Ariège-Couserans, 09200 Saint-Girons, France
| |
Collapse
|
31
|
Abstract
BACKGROUND Unawareness of deficits is common and is associated with poor outcomes in Alzheimer's disease (AD); however, little is known about correlated neurobiochemical changes. METHODS Proton magnetic resonance spectroscopy was used to examine neurobiochemical correlates of unawareness of deficits as assessed by the Dementia Deficit Scale in 36 patients with AD. Magnetic resonance spectroscopy spectra were acquired from the anterior cingulate area and right orbitofrontal area. Concentrations of N-acetyl-aspartate (NAA), total creatine, and other neurometabolites were calculated. RESULTS Nineteen (52.8%) participants had relative unawareness of deficits. This condition was negatively correlated with NAA/creatine in the anterior cingulate area (β = -0.36, p = 0.025) and positively correlated with NAA/creatine in the right orbitofrontal area (β = 0.41, p = 0.009) after controlling for dementia severity. CONCLUSIONS These findings suggest unawareness of deficits in AD was associated with the altered neurochemical metabolites in the anterior cingulate area and right orbitofrontal area. However, the two areas might have opposite neuronal functions in unawareness of deficits.
Collapse
|
32
|
McCusker EA, Gunn DG, Epping EA, Loy CT, Radford K, Griffith J, Mills JA, Long JD, Paulsen JS. Unawareness of motor phenoconversion in Huntington disease. Neurology 2013; 81:1141-7. [PMID: 23966256 DOI: 10.1212/wnl.0b013e3182a55f05] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether Huntington disease (HD) mutation carriers have motor symptoms (complaints) when definite motor onset (motor phenoconversion) is diagnosed and document differences between the groups with and without unawareness of motor signs. METHODS We analyzed data from 550 HD mutation carriers participating in the multicenter PREDICT-HD Study followed through the HD prodrome. Data analysis included demographics, the Unified Huntington's Disease Rating Scale (UHDRS) and the Participant HD History of symptoms, self-report of progression, and cognitive, behavioral, and imaging measures. Unawareness was identified when no motor symptoms were self-reported but when definite motor HD was diagnosed. RESULTS Of 38 (6.91%) with onset of motor HD, almost half (18/38 = 47.36%) had no motor symptoms despite signs of disease on the UHDRS motor rating and consistent with unawareness. A group with motor symptoms and signs was similar on a range of measures to the unaware group. Those with unawareness of HD signs reported less depression. Patients with symptoms had more striatal atrophy on imaging measures. CONCLUSIONS Only half of the patients with newly diagnosed motor HD had motor symptoms. Unaware patients were less likely to be depressed. Self-report of symptoms may be inaccurate in HD at the earliest stage.
Collapse
Affiliation(s)
- Elizabeth A McCusker
- From the Neurology Department (E.A.M., D.G.G., C.T.L., K.R., J.G.), Westmead Hospital, Sydney; Sydney Medical School (E.A.M., C.T.L.), University of Sydney, Australia; and Department of Psychiatry (E.A.E., J.A.M., J.D.L, J.S.P.), University of Iowa, Iowa City
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Conde-Sala JL, Reñé-Ramírez R, Turró-Garriga O, Gascón-Bayarri J, Juncadella-Puig M, Moreno-Cordón L, Viñas-Diez V, Vilalta-Franch J, Garre-Olmo J. Factors associated with the variability in caregiver assessments of the capacities of patients with Alzheimer disease. J Geriatr Psychiatry Neurol 2013; 26:86-94. [PMID: 23514974 DOI: 10.1177/0891988713481266] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies have identified certain caregiver factors that can produce variability in their assessments of the capacities of patients with Alzheimer disease (AD). OBJECTIVES To identify the caregiver variables associated with variability in their ratings of patients' capacities. METHODS Consecutive sample of 221 outpatients with AD and their family caregivers. The capacities evaluated by caregivers were the degree of functional disability, using the Disability Assessment for Dementia (DAD); psychological and behavioral symptoms, via the Neuropsychiatric Inventory (NPI); anosognosia, with the Anosognosia Questionnaire-Dementia (AQ-D); and quality of life, using the Quality of Life in AD (QOL-AD). The relationship between these measures and caregiver's gender, burden, depression, and health was analyzed by means of a bivariate analysis, calculating the effect size (Cohen d) and subsequently by a regression analysis, calculating the contribution coefficient (CC). RESULTS The greatest variability in caregiver assessments was observed in relation to patients with early-stage dementia, where caregiver's burden was the main factor associated with a more negative evaluation (d = 1.02-1.25). Depression in the caregiver was associated with less variability and only in the assessments of patients with moderate dementia (d = 0.38-0.69). In the regression analysis, caregiver factors were associated with greater variance in scores on the NPI (CC = 37.4%) and QOL-AD (CC = 27.2%), and lower variance in AQ-D (CC = 21.6%) and DAD (CC = 10.3%) scores. CONCLUSIONS Caregiver's burden and depression were associated with more negative assessments of patients' psychological and behavioral symptoms and quality of life.
Collapse
|
34
|
Abstract
This article reviews the current recommendations in early diagnosis and the desires of the patients and their relatives, put in perspective with the reality of the clinical practices. More specific situations covered are: (1) the issue of young diseased patients, taking into account the psychological implications of the early occurrence of the disease in life and of the longer delay for these patients between the first observable signs and the diagnosis and (2) the issue of genetic testing, taking into account the implications of this extremely early form of bad news on the individual's existence and on the family structure.
Collapse
|
35
|
Antoine P, Nandrino JL, Billiet C. Awareness of deficits in Alzheimer's disease patients: analysis of performance prediction discrepancies. Psychiatry Clin Neurosci 2013; 67:237-44. [PMID: 23683154 DOI: 10.1111/pcn.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 08/31/2012] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
Abstract
AIM Unawareness has been operationalized in terms of a discrepancy between the patient's self-reports and three main categories of standards: judgment of a relative, clinical assessment, and objective test performance. The purpose of this study was to develop a new measure of deficit unawareness based on multidimensional, isomorphic, simple tasks and to examine the relationship between this measure and neuropsychological tests. METHODS : Analysis was conducted on cognitive performance prediction discrepancies in a sample of Alzheimer's disease (AD) patients and a matched comparison group. RESULTS Patients rated their cognitive functioning more highly than their performance, but their overall self-reports were lower than the overall self-reports of the comparison group. AD patients performed significantly lower than their predicted scores in all Dementia Rating Scale (DRS) domains, in contrast to comparison participants, who did not consistently perform significantly lower across domains. All unawareness scores were moderately inter-correlated, except for memory, and all unawareness scores with the exception of memory were correlated with overall neuropsychological functioning. CONCLUSION A methodological and conceptual difficulty has been identified, and this raises the issue of the generalizability of studies with a focus on memory unawareness. The method proposed seems a good tool to assess the relationships between unawareness and several different aspects of cognitive functioning, in particular executive functioning.
Collapse
Affiliation(s)
- Pascal Antoine
- URECA, University of Lille Nord de France, Villeneuve d'Ascq, France.
| | | | | |
Collapse
|
36
|
Kalenzaga S, Clarys D. Self-referential processing in Alzheimer's disease: two different ways of processing self-knowledge? J Clin Exp Neuropsychol 2013; 35:455-71. [PMID: 23631426 DOI: 10.1080/13803395.2013.789485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Two previous studies showed that self-reference encoding had no effect on Alzheimer's disease (AD) patients' recollective experience when it was compared to other-reference encoding, whereas it did have an effect when it was compared to semantic processing, but only for emotional trait adjectives. In the present study, the performance of 22 AD patients was compared with that of 21 normal controls on a task involving recognition of emotional versus neutral adjective traits following self-reference versus other-reference encoding, using the remember/know/guess paradigm. Results showed that although AD patients had a positive explicit view of themselves, their self became salient for negative adjective traits only. We concluded that there might exist two ways of processing self-referential knowledge in human cognition: one explicit and the other more implicit.
Collapse
Affiliation(s)
- Sandrine Kalenzaga
- UMR-CNRS 6234 Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, Poitiers, France.
| | | |
Collapse
|
37
|
Ecological Evaluation of Executive Functions in Mild Cognitive Impairment and Alzheimer Disease. Alzheimer Dis Assoc Disord 2013; 27:95-101. [DOI: 10.1097/wad.0b013e31826540b4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Massimo L, Libon DJ, Chandrasekaran K, Dreyfuss M, McMillan CT, Rascovsky K, Boller A, Grossman M. Self-appraisal in behavioural variant frontotemporal degeneration. J Neurol Neurosurg Psychiatry 2013; 84:148-53. [PMID: 22952324 PMCID: PMC3556171 DOI: 10.1136/jnnp-2012-303153] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Previous work investigating deficits in self-appraisal in behavioural-variant frontotemporal degeneration (bvFTD) has focused on a single domain: social/behavioural processes. We examined whether a domain-specific versus multi-domain model best explains degraded self-appraisal in bvFTD. METHODS 49 patients with bvFTD and 73 patients with Alzheimer's disease (AD) were administered quantitative assessments of episodic memory, naming and grammatical comprehension. Self-appraisal of cognitive test performance was assessed by asking patients to rate their performance immediately after completing each neuropsychological test. A discrepancy score was created to reflect the difference between patient performance on neuropsychological tests and self-appraisal of their test performance. Self-appraisal for each neuropsychological measure was related to grey matter (GM) density in each group using voxel-based morphometry. RESULTS bvFTD patients were poor at evaluating their own performance on all cognitive tests, with no significant correlations between self-appraisal and actual performance. By contrast, poor self-appraisal in AD was restricted to episodic memory performance. Poor self-appraisal on each task in bvFTD and AD was related to reduced GM density in several ventral and rostral medial prefrontal regions. Crucially, poor self-appraisal for all domains in bvFTD was related to a specific area of reduced GM density in the subgenual cingulate (BA 25). CONCLUSION Poor self-appraisal in bvFTD affects multiple domains, and this multi-domain impairment pattern is associated with frontal disease in the subgenual cingulate.
Collapse
Affiliation(s)
- Lauren Massimo
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Gates Building, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Yokoi T, Okamura H. Why do dementia patients become unable to lead a daily life with decreasing cognitive function? DEMENTIA 2012; 12:551-68. [PMID: 24337329 DOI: 10.1177/1471301211435193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to understand the words and deeds of dementia patients that we find very hard to explain or understand, we have paid attention to the self-awareness ability of dementia patients, the intellectual subject that integrates their own intellectual functions, and created 'a model for interpreting puzzling words and deeds of dementia patients from the viewpoint of self-awareness'. The purpose of this study is to explain the reasons why dementia patients become unable to successfully perform activities of daily living (ADL) with advancement of dementia, using our model to present viewpoints understandable to caregivers. We classified dementia inpatients of a geriatric health services facility into four stages, using the model of self-awareness ability (consisting of 'theory of mind', 'self-evaluation' and 'self-consciousness') that was constructed by combining 'theory of mind' and Lewis's developmental model of cognition and emotion. Furthermore, we observed and documented scenes from daily life, and we interpreted the reasons why patients become unable to seek assistance from others for ADL, based on the model. We came to understand why the patients could not seek assistance from others, because the patients who failed in the task of 'theory of mind' were unable to self-assess their own mind and the minds of others, and those having failed in the task of 'self-evaluation' could not evaluate their own situation.
Collapse
|
40
|
Driving simulation can improve insight into impaired driving skills in cirrhosis. Dig Dis Sci 2012; 57:554-60. [PMID: 21901255 PMCID: PMC3971431 DOI: 10.1007/s10620-011-1888-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/16/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimal hepatic encephalopathy (MHE) is associated with poor driving skills and insight. Increasing insight may improve receptiveness for therapy or driving restrictions. AIM To evaluate the change in the self-assessment of driving skills (SADS) using a driving simulator. METHODS Cirrhotic patients and age/education-matched controls underwent MHE testing with inhibitory control (ICT) and the psychometric hepatic encephalopathy score (PHES). SADS, a Likert scale from 0 to 10, was administered just before and after a standardized driving simulation comprising testing and navigation tasks. The percentage SADS change from baseline was compared within/between groups. RESULTS A total of 84 patients (60% men, age 55 years) and 12 controls were included. Controls were significantly better than cirrhotics on cognitive/simulator testing. The baseline SADS was similar between the groups. The baseline patient SADS was only correlated with ICT lures (r = -0.4, P = 0.001). Post-simulation, 60% of patients improved their insight, i.e., reduced SADS (from 8 to 6.5, P = 0.0001) compared to 25% of controls (P = 0.02). The mean percentage SADS reduction was also higher in cirrhotics (18% vs. 8%, P = 0.03). MHE on ICT patients had a significantly higher SADS improvement (P = 0.004) compared to the other patients; no difference was seen in those with/without MHE due to the PHES. The percentage SADS reduction in patients was correlated with getting lost (r = 0.468, P < 0.0001), crashes (P = 0.002), and centerline/road-edge excursions (P = 0.01). There was a significantly higher percentage SADS reduction in cirrhotics who got lost (25%) compared to those who did not get lost (12%) and controls (8%, P = 0.014). CONCLUSIONS Insight into driving skills in cirrhosis improves after driving simulation and is highest in those with navigation errors and MHE on ICT. Driving simulator-associated insight improvement may be the first step towards the cognitive rehabilitation of driving skills in cirrhosis.
Collapse
|
41
|
Hosseini-Sharifabad A, Ghahremani MH, Sabzevari O, Naghdi N, Abdollahi M, Beyer C, Bollen E, Prickaerts J, Roghani A, Sharifzadeh M. Effects of protein kinase A and G inhibitors on hippocampal cholinergic markers expressions in rolipram- and sildenafil-induced spatial memory improvement. Pharmacol Biochem Behav 2012; 101:311-9. [PMID: 22306745 DOI: 10.1016/j.pbb.2012.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/26/2011] [Accepted: 01/20/2012] [Indexed: 02/06/2023]
Abstract
Although there are number of studies showing that phosphodiesterase (PDE) 4 and 5 inhibitors affect different kinds of memory, their effects on spatial memory consolidation in conjunction with the cholinergic activity in the hippocampus have not been studied before. In the present study firstly, rats were evaluated for the effects of different doses of the PDE4 inhibitor rolipram and the PDE5 inhibitor sildenafil on spatial memory consolidation in the water maze task. Rolipram or sildenafil was daily administered intraperitoneally 3 or 0 h after the last trial of training, respectively. Then in a separate related experiment the effect of the most efficient doses of rolipram or sildenafil accompanied by an intrahippocampally injected protein kinase A (PKA) or protein kinase G (PKG) inhibitor, respectively, was examined. Finally for determination of the hippocampal cholinergic activity the protein expression of hippocampal vesicular acetylcholine transporter (VAChT) and cholineacetyltransferase (ChAT) was measured. Rolipram at 0.03 mg/kg as well as sildenafil at 3 mg/kg increased spatial memory and their enhancing effect was completely blocked following inhibition of PKA and PKG, respectively. Furthermore, none of the treatments had a significant effect on the hippocampal ChAT and VAChT levels. Our data showed that rolipram and sildenafil enhanced spatial memory consolidation in an inverted U-shaped dose-response curve. This effect is dependent on the activity of cAMP/PKA- and cGMP/PKG-mediated pathways, respectively in the hippocampus. However, we did not find evidence for a chronic increase of cholinergic activity in the observed PDE inhibitor-induced memory improvement.
Collapse
Affiliation(s)
- Ali Hosseini-Sharifabad
- Department of Pharmacology, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Gerretsen P, Diaz P, Mamo D, Kavanagh D, Menon M, Pollock BG, Graff-Guerrero A. Transient insight induction with electroconvulsive therapy in a patient with refractory schizophrenia: a case report and systematic literature review. J ECT 2011; 27:247-50. [PMID: 20966768 DOI: 10.1097/yct.0b013e3181f816f6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anosognosia or lack of illness awareness is a clinical manifestation of both schizophrenia and right hemispheric lesions associated with stroke, neurodegeneration, or traumatic brain injury. It is thought to result from right hemispheric dysfunction or interhemispheric disequilibrium, which provides a neuroanatomical model for illness unawareness in schizophrenia. Lack of insight contributes to medication nonadherence and poor treatment outcomes and is often refractory to pharmacological and psychological interventions. We present the first report of transient illness awareness (<8 hours) after individual bilateral electroconvulsive therapy treatments in the case of a 39-year-old man with antipsychotic refractory schizophrenia. Electroencephalography demonstrated frontal slow wave activity with shifting frontotemporal predominance, which was concurrent with the patient's transient level of insight. A systematic review of the literature on electroconvulsive therapy-induced illness awareness in schizophrenia and psychotic disorders produced zero relevant results. Future research should focus on the prospective role of focal interventions, such as transcranial magnetic stimulation, in the development of a neurophysiological model for anosognosia reversal in schizophrenia that may, in turn, contribute to novel therapeutic developments targeting lack of illness awareness.
Collapse
Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
43
|
Thames AD, Becker BW, Marcotte TD, Hines LJ, Foley JM, Ramezani A, Singer EJ, Castellon SA, Heaton RK, Hinkin CH. Depression, cognition, and self-appraisal of functional abilities in HIV: an examination of subjective appraisal versus objective performance. Clin Neuropsychol 2011; 25:224-43. [PMID: 21331979 DOI: 10.1080/13854046.2010.539577] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression frequently co-occurs with HIV infection and can result in self-reported overestimates of cognitive deficits. Conversely, genuine cognitive dysfunction can lead to an under-appreciation of cognitive deficits. The degree to which depression and cognition influence self-report of capacity for instrumental activities of daily living (IADLs) requires further investigation. This study examined the effects of depression and cognitive deficits on self-appraisal of functional competence among 107 HIV-infected adults. As hypothesized, higher levels of depression were found among those who over-reported problems in medication management, driving, and cognition when compared to those who under-reported or provided accurate self-assessments. In contrast, genuine cognitive dysfunction was predictive of under-reporting of functional deficits. Together, these results suggest that over-reliance on self-reported functional status poses risk for error when diagnoses require documentation of both cognitive impairment and associated functional disability in everyday life.
Collapse
Affiliation(s)
- April D Thames
- Semel Institute for Neuroscience and Human Behavior, School of Medicine, University of California-Los Angeles, CA 90095, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
The objective of the study was to explore, in a sample of spouses of mild-to-moderate Alzheimer disease patients, predictors of quality of life (QoL) by rating QoL and burden. The authors assessed 97 spouses in a cross-sectional study with the Schedule for the Evaluation of Individual Quality of Life (SEIQoL), Self-Rated Burden scale (SRB), self-perceived stress scale (EDIZ; Ervaren Druk door Informele Zorg/Self-Perceived Pressure from Informal Care), and Zarit Burden Interview (ZBI). Patient cognition was rated with the Mini-Mental State Examination (MMSE). Factors best predicting QoL were analyzed with multiple regression analysis. Eighty-seven (53% male, mean 72 y) fulfilled the SEIQoL internal reliability criteria, and had a mean SEIQoL score of 68.6+/-14.8. Most important QoL domains were condition of patient (31%) and marriage (26%). Caregiver burden scores on SRB, Ervaren Druk door Informele, Zorg, and ZBI were 44.1+/-23.5 (n=67), 4.9+/-2.2 (n=53), and 13.1+/-6.2 (n=53), respectively. Mean patient MMSE score (0 to 30) was 20.3+/-4.2. Spouses experienced lower QoL than Alzheimer disease patients and healthy elderly (historical controls), and perceived moderate levels of burden. Patient cognition is a significant predictor of caregiver QoL. Burden, measured by ZBI, is significantly negatively correlated with SEIQoL. The results underline the importance of implementing health services known to improve QoL and alleviate burden, and to explore new effective interventions.
Collapse
|
45
|
Raffard S, Bayard S, Capdevielle D, Garcia F, Boulenger JP, Gely-Nargeot MC. La conscience des troubles (insight) dans la schizophrénie : une revue critique. Encephale 2008; 34:597-605. [DOI: 10.1016/j.encep.2007.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 10/10/2007] [Indexed: 11/26/2022]
|
46
|
Orfei MD, Robinson RG, Bria P, Caltagirone C, Spalletta G. Unawareness of illness in neuropsychiatric disorders: phenomenological certainty versus etiopathogenic vagueness. Neuroscientist 2007; 14:203-22. [PMID: 18057389 DOI: 10.1177/1073858407309995] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Awareness of illness is a form of self-knowledge concerning information about the pathological state, its functional consequence, and the way it affects the patient and his interaction with the environment. Unawareness of illness has raised much interest for its consequences on compliance with treatment, prognosis, and the patient's quality of life. This review highlights the great complexity of this phenomenon both at phenomenological and etiopathogenic levels in stroke, traumatic brain injury, psychosis, dementias, and mood disorders. In particular, the clinical expression is characterized by failure to acknowledge being ill, misattribution of symptoms, and noncompliance with treatment. Unawareness of illness may also be linked with characteristics that are peculiar to each individual disturbance, such as symptom duration and cognitive impairment. Despite a long-lasting interest in the clinical characteristics of unawareness, only recently has the focus of research investigated pathogenic mechanisms, with sometimes controversial results. The vast majority of studies have pointed out a remarkable involvement of the right hemisphere. Specifically, functional and structural changes of the dorso-lateral prefrontal cortex and some other frontal areas have often been found to be associated with awareness deficit, as well as parieto-temporal areas and the thalamus, although to a lesser extent. These data indicate the present difficulty of localizing a specific cerebral area involved in unawareness and suggest the existence of possible brain circuits responsible for awareness. In conclusion, phenomenological manifestations of poor awareness are well outlined in their complexity, whereas neuroanatomic and neuropsychological findings are still too vague and sparse and need further, greater efforts to be clarified.
Collapse
|
47
|
Evers K, Kilander L, Lindau M. Insight in frontotemporal dementia: Conceptual analysis and empirical evaluation of the consensus criterion “loss of insight” in frontotemporal dementia. Brain Cogn 2007; 63:13-23. [PMID: 16914245 DOI: 10.1016/j.bandc.2006.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Revised: 07/03/2006] [Accepted: 07/06/2006] [Indexed: 12/25/2022]
Abstract
The objective of this study was to suggest a new formulation of the core research diagnostic consensus criterion "loss of insight" in frontotemporal dementia (FTD). Eight patients with FTD (diagnoses made by interviews, medical and neuropsychological examination, CT scan, and regional cerebral glucose metabolism measured by positron emission tomography (PET) participated in the study). The results indicated that insight was present in three out of eight patients, and that insight appears to be a heterogeneous concept. Two types of insight emerged: Emotional insight associated with frontotemporal functions, and cognitive insight, related to posterior cognitive functions. These results suggest that loss of insight should not serve as a core criterion on FTD, but serves well as a supportive criterion of the disease.
Collapse
Affiliation(s)
- Kathinka Evers
- Department of Public Health and Caring Sciences, Centre for Bioethics at Karolinska Institutet and Uppsala University, Uppsala, Sweden.
| | | | | |
Collapse
|
48
|
|
49
|
Morbo di Alzheimer. Neurologia 2007. [DOI: 10.1016/s1634-7072(07)70544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|