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Gamm S, Ummel D, Vasil N, Grenier S. Getting Insight to the Lived Emotional Experience of People with Alzheimer's Disease Shortly After Diagnosis: A Phenomenological Approach. J Alzheimers Dis 2024; 99:1129-1145. [PMID: 38788071 DOI: 10.3233/jad-231403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background A diagnosis of Alzheimer's disease (AD) is a crucial moment in an individual's existence and represents a major life change that often results in psychological distress, diminish of perceived quality of life, and loss of independence. It is important to better understand the emotional experience of people with dementia to intervene according to their specific needs. Objective The aim of the research was to get insight to the emotional experience of people with AD shortly after its discovery and the consequences thereof. Methods A qualitative exploratory design was engaged, and in-depth interviews were conducted with ten French-speaking participants over 70 years recently diagnosed. Interviews were guided by Heideggerian phenomenology about movements in the worldview of individuals. The transcribed data was subjected to interpretative phenomenological analysis. Results Following the diagnosis, participants experienced either shock or denial. Emotions felt were unpleasant and disturbing for most of them. Especially when participants were confronted with news concerning the illness, they experienced incomprehension. They engaged in an oscillatory motion of connection and disconnection to establish new meanings of their worldview. Thinking about the past seemed to diminish their worries, to reinforce the possibility to fulfil a significant place in their existence and to maintain their autonomy. Conclusions When participants could express their emotional experience and their concerns, they regained a sense of control in their life that seemed du reduce their distress. With this insight, intervention could be adapted to the specific needs of people with AD to enhance their self-determination and quality of life.
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Affiliation(s)
- Simone Gamm
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | | | - Nancy Vasil
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
| | - Sébastien Grenier
- University of Montréal, Montréal, QC, Canada
- Research Centre of the University Institute of Geriatrics of Montréal (CRIUGM), Montréal, QC, Canada
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2
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Fu Y, Luo X, Zeng Q, Li K, Zhang T, Li Z, Xu X, Hong L, Chen Y, Zhang M, Liu Z. Effects of Anosognosia on Static and Dynamic Amplitudes of Low-Frequency Fluctuation in Mild Cognitive Impairment. Front Aging Neurosci 2021; 13:705097. [PMID: 35221980 PMCID: PMC8867082 DOI: 10.3389/fnagi.2021.705097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Anosognosia is a significant symptom in patients with mild cognitive impairment (MCI) while the underlying neurological mechanism behind it is still unclear. Methods: A total of 121 subjects were included and classified into three groups, including 39 normal controls (NCs), 42 individuals with MCI without anosognosia (MCI-NA), and 40 individuals with MCI with anosognosia (MCI-A), based on their everyday cognition (ECog) questionnaire (discrepancy score). Resting-state functional MRIs were acquired from all the subjects, and the static amplitudes of low-frequency fluctuation (sALFF) and dynamic ALFF (dALFF) variance were investigated to evaluate the intrinsic functional network strength and stability, respectively, and both were corrected by age, sex, education, and gray matter volume. Eventually, correlation analyses were conducted to explore the relationship between brain activity changes and cognitive status in all the subjects. Results: No significant difference was found between MCI-A and MCI-NA (P > 0.05) in cognitive ability. Regarding intrinsic brain activity, MCI-A had increased sALFF and dALFF variance in the anterior cingulate cortex (ACC) relative to MCI-NA, as well as decreased sALFF and dALFF variance in the precuneus relative to MCI-NA and controls. Moreover, MCI-A had decreased sALFF in the inferior temporal gyrus (ITG) and paracentral lobule (PCL) compared to MCI-NA. Among all the subjects, correlation analyses showed that the sALFF and dALFF variance in the precuneus was related to the Ecog discrepancy score (r = 0.232 and 0.235, respectively), immediate story recall (r = 0.200 and 0.277, respectively), and delayed story recall (r = 0.255 and 0.298, respectively). Conclusion: Alterations of intrinsic brain activation in the ACC and precuneus seem to be associated with the anosognosia symptom in patients with MCI.
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Affiliation(s)
- Yanv Fu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tianyi Zhang
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zheyu Li
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaopei Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Luwei Hong
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhirong Liu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Alexander CM, Martyr A, Savage SA, Morris RG, Clare L. Measuring Awareness in People With Dementia: Results of a Systematic Scoping Review. J Geriatr Psychiatry Neurol 2021; 34:335-348. [PMID: 32400259 PMCID: PMC8326902 DOI: 10.1177/0891988720924717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Awareness of the diagnosis or related changes in functioning varies in people with dementia (PwD), with implications for the well-being of PwD and their carers. Measuring awareness in a clinical setting could facilitate tailored support and optimize involvement in personal health and care decisions. This scoping review aimed to identify validated methods of assessing awareness in dementia and appraise their clinical utility. METHOD A systematic search was conducted of English-language publications that measured awareness in PwD, in 6 electronic databases. Search terms included dement*, Alzheimer*, Pick disease, and awareness, unawareness, anosognosia, insight, denial, metacognit*, or discrepanc*. RESULTS We screened 30,634 articles, finding 345 articles that met our inclusion criteria. We identified 76 measures, most commonly using a discrepancy questionnaire comparing evaluations of function by PwD and an informant. There were 30 awareness measures developed and validated for use in dementia populations but few designed for general clinical use. CONCLUSIONS Although we found a range of clinical indications for measuring awareness, there were few studies investigating clinical applications and few tools designed for clinical purposes. Further investigation and development of a person-centered tool could facilitate health and care choices in mild-to-moderate dementia.
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Affiliation(s)
- Catherine M. Alexander
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom,Catherine M. Alexander, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, United Kingdom.
| | - Anthony Martyr
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
| | - Sharon A. Savage
- Psychology Department, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, United Kingdom
| | - Robin G. Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, United Kingdom
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Lloyd O, Ownsworth T, Zimmer-Gembeck MJ, Fleming J, Shum DHK. Measuring domain-specific deficits in self-awareness in children and adolescents with acquired brain injury: Component analysis of the Paediatric Awareness Questionnaire. Neuropsychol Rehabil 2021; 32:1814-1834. [PMID: 33980136 DOI: 10.1080/09602011.2021.1926290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-awareness has been found to vary across different functional domains for adults with acquired brain injury (ABI); however, domain-specific self-awareness is yet to be investigated following paediatric ABI. This study aimed to validate the Paediatric Awareness Questionnaire (PAQ) as a multi-domain measure of self-awareness and to investigate domain-specific self-awareness in children with ABI. One hundred and ninety-seven children and adolescents (8-16 years, M = 12.44, SD = 2.62) with mixed causes of ABI (70% with traumatic brain injury) and their parents (n = 197) were recruited through consecutive rehabilitation appointments and completed the PAQ. The 37 items of the parent version of the PAQ were subjected to a principal component analysis with varimax rotation. A five-component solution (29 items) explained 64% of the variance in the PAQ items. Components revealed five domains of self-awareness: socio-emotional functioning, activities of daily living (ADLs), cognition, physical functioning, and communication. Internal consistency of the components ranged from acceptable to excellent (α = .70-.95). The analysis identified that children had poorer self-awareness of cognitive functioning than socio-emotional functioning, ADLs, and communication skills. Overall, the findings identify five components (i.e., functional domains) of self-awareness and provide some support that self-awareness varies across domains following paediatric ABI.
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Affiliation(s)
- Owen Lloyd
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - David H K Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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5
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Azocar I, Livingston G, Huntley J. The Association Between Impaired Awareness and Depression, Anxiety, and Apathy in Mild to Moderate Alzheimer's Disease: A Systematic Review. Front Psychiatry 2021; 12:633081. [PMID: 33613344 PMCID: PMC7889585 DOI: 10.3389/fpsyt.2021.633081] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Impaired awareness of cognitive and functional deficits is a common feature of Alzheimer's disease (AD). Although a lack of awareness has been suggested to be a protective factor against experiencing affective symptoms, such as depression, anxiety, and apathy which are common in AD, there is conflicting evidence about the links between them. This systematic review examines the evidence for an association between impaired awareness and depressive, anxiety, and apathy symptoms in mild to moderate AD. Method: We searched four databases (OvidMedline, Embase, PsycInfo, and PsycArticles) using terms encompassing awareness, apathy, depression, anxiety, and mild-moderate AD. We included studies that assessed the relationship between awareness and depressive symptoms, anxiety symptoms, or apathy. We assessed included papers for quality and report results using a narrative approach, prioritizing high quality studies. Results: We identified 1,544 articles, and twenty-seven studies fulfilled inclusion criteria (high-quality = 15; moderate-quality = 12). Most high-quality studies reported that impaired awareness in early-stage AD is cross-sectionally linked with fewer depressive symptoms and anxiety symptoms (correlation ranged from -0.3 to -0.7), but with more apathy. Conclusions: High-quality studies suggested that in people with early AD, impaired awareness is related to fewer depressive and anxiety symptoms and to more apathy. Future research should focus on elucidating causality among impaired awareness and these symptoms in AD.
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Affiliation(s)
- Ignacia Azocar
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, United Kingdom
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6
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Di Cara M, Palmeri R, Formica C, Lo Buono V, Andaloro A, Bonanno L, Romeo L, Rifici C, Bramanti P, Marino S, Corallo F. Assessment of insight in hospitalized neurological patient: Cognitive profile and mood disorder. J Clin Neurosci 2020; 79:104-107. [DOI: 10.1016/j.jocn.2020.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/19/2020] [Indexed: 11/27/2022]
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7
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Alexander CM, Martyr A, Savage SA, Clare L. Measuring awareness in people with dementia: protocol for a scoping review. Syst Rev 2019; 8:160. [PMID: 31272501 PMCID: PMC6610918 DOI: 10.1186/s13643-019-1078-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with dementia (PwD) vary in the degree of awareness they show about their situation, both generally concerning the diagnosis and more specifically around certain aspects or objects of awareness such as awareness of memory impairment, altered daily activities or social functioning. The extent of awareness or lack of awareness has consequences for well-being of PwD and carers, impacting on rates of hospital admission, institutionalization, mood, adjustment to diagnosis, outcomes from intervention and carer burden. An accurate estimation of a person's awareness could therefore be useful in a clinical setting to support PwD and their carers in making appropriate choices for health and care decisions, and could facilitate safe management by health care professionals, e.g. in an acute care setting. There is a range of different approaches to measuring awareness reported in the dementia research literature, with varying estimates of the frequency of lack of awareness, reflecting different methodologies and populations. The majority of the methods have been developed for research purposes and may not be suitable for clinical use. There are no recent scoping or systematic reviews of the available methods. METHOD We will conduct a scoping review of published studies that have assessed awareness in people with dementia of all types, and all degrees of severity. The systematic search will include the electronic databases PubMed, Embase, PsycInfo, CINAHL, Web of Science and Cochrane Library, using search terms for dementia ("dement*" or "Alzheimer*" or "Pick's disease") and "awareness", "unawareness", "anosognosia", "insight", "denial", "metacognit*" or "discrepanc*" identified from pilot searches. Findings will be mapped and described according to the method used, the setting and diagnosis and the object of awareness studied if specified. Validated measures will be identified. DISCUSSION This scoping review will provide an overview of the methods used to measure awareness in people with dementia, allowing comparison of the methods along with identification of validated measures. The methods or components will be appraised for potential clinical use, and gaps in research will be highlighted.
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Affiliation(s)
- Catherine M. Alexander
- REACH: The Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Anthony Martyr
- REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Sharon A. Savage
- REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, EX1 2LU UK
- Psychology, College of Life and Environmental Sciences, University of Exeter, Washington Singer Laboratories, Streatham Campus, Exeter, EX4 4QG UK
| | - Linda Clare
- REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter Medical School and College of Life and Environmental Sciences, St Luke’s Campus, Exeter, EX1 2LU UK
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8
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Cameron KV, Ponsford JL, Stolwyk RJ. Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction? Neuropsychol Rehabil 2019; 30:1430-1448. [PMID: 30874467 DOI: 10.1080/09602011.2019.1586734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = -4.21, p < .001) and instrumental activity limitation (Z = -4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = -4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
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Affiliation(s)
- Kate V Cameron
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Renerus J Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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9
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FitzGerald MCC, O'Keeffe F, Carton S, Coen RF, Kelly S, Dockree P. Rehabilitation of emergent awareness of errors post traumatic brain injury: A pilot intervention. Neuropsychol Rehabil 2017; 29:821-843. [PMID: 28728461 DOI: 10.1080/09602011.2017.1336102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impaired awareness of errors is common following traumatic brain injury (TBI) and can be a barrier to successful rehabilitation. The objective of this study was to develop and evaluate a computer-based intervention programme aimed at improving error awareness in individuals with TBI. A further aim was to explore its effects on metacognitive awareness and variability of performance. Participants were 11 individuals with TBI and impaired error awareness who performed a sustained attention task twice-weekly for four weeks. The intervention consisted of audio-visual feedback-on-errors during the sustained attention task. Six participants received audio-visual feedback-on-error, five did not receive feedback. Emergent and metacognitive awareness were measured pre- and post-intervention. Between-groups comparisons of emergent awareness from pre- to post-intervention showed that audio-visual feedback-on-error improved emergent awareness compared to no feedback-on-error. Some changes in metacognitive awareness of executive behaviours as a result of feedback were observed. Audio-visual feedback-on-error improved emergent awareness in individuals with TBI following a four-week/eight-session intervention. This improvement was not observed in the no-feedback group. This pilot intervention is not a stand-alone treatment but it has potential to be usefully incorporated into cognitive or clinical rehabilitation programmes to improve emergent awareness.
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Affiliation(s)
- Mary C C FitzGerald
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland.,b Psychology Department , Trinity College Dublin , Dublin , Ireland
| | - Fiadhnait O'Keeffe
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | - Simone Carton
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | | | - Simon Kelly
- d School of Electrical and Electronic Engineering , University College Dublin , Dublin , Ireland
| | - Paul Dockree
- b Psychology Department , Trinity College Dublin , Dublin , Ireland
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Kelly G, Simpson GK, Brown S, Kremer P, Gillett L. The Overt Behaviour Scale-Self-Report (OBS-SR) for acquired brain injury: exploratory analysis of reliability and validity. Neuropsychol Rehabil 2017; 29:704-722. [PMID: 28532322 DOI: 10.1080/09602011.2017.1322523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objectives were to test the properties, via a psychometric study, of the Overt Behaviour Scale-Self-Report (OBS-SR), a version of the OBS-Adult Scale developed to provide a client perspective on challenging behaviours after acquired brain injury. Study sample 1 consisted of 37 patients with primary brain tumour (PBT) and a family-member informant. Sample 2 consisted of 34 clients with other acquired brain injury (mixed brain injury, MBI) and a service-provider informant. Participants completed the OBS-SR (at two time points), and the Awareness Questionnaire (AQ) and Mayo Portland Adaptability Inventory-III (MPAI-III) once; informants completed the OBS-Adult and AQ once only. PBT-informant dyads displayed "good" levels of agreement (ICC2,k = .74; OBS-SR global index). Although MBI-informant dyads displayed no agreement (ICC2,k = .22; OBS-SR global index), the sub-group (17/29) rated by clinicians as having moderate to good levels of awareness displayed "fair" agreement (ICC2,k = .58; OBS-SR global index). Convergent/divergent validity was demonstrated by significant correlations between OBS-SR subscales and MPAI-III subscales with behavioural content (coefficients in the range .36 -.61). Scores had good reliability across one week (ICC2,k = .69). The OBS-SR took approximately 15 minutes to complete. It was concluded that the OBS-SR demonstrated acceptable reliability and validity, providing a useful resource in understanding clients' perspectives about their behaviour.
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Affiliation(s)
- Glenn Kelly
- a Diverge Consulting , Melbourne , Australia.,b Private practice , Melbourne , Australia
| | - Grahame K Simpson
- c Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Sydney , Australia.,d John Walsh Centre for Rehabilitation Research , University of Sydney , Sydney , Australia
| | | | - Peter Kremer
- e School of Exercise and Nutrition Sciences, Deakin University , Geelong , Australia
| | - Lauren Gillett
- c Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Sydney , Australia
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11
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Lloyd O, Ownsworth T, Fleming J, Zimmer-Gembeck MJ. Development and preliminary validation of the Paediatric Awareness Questionnaire for children and adolescents with traumatic brain injury. Child Neuropsychol 2017; 24:702-722. [DOI: 10.1080/09297049.2017.1332173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Melanie J. Zimmer-Gembeck
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Australia
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12
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Belchev Z, Levy N, Berman I, Levinzon H, Hoofien D, Gilboa A. Psychological traits predict impaired awareness of deficits independently of neuropsychological factors in chronic traumatic brain injury. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:213-234. [PMID: 28467630 DOI: 10.1111/bjc.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 03/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To dissociate injury-related factors from psychological contributions to impaired awareness of deficits following traumatic brain injury (TBI); impaired awareness is theorized to partly reflect psychological factors (e.g., denial), but empirical evidence for this theory is scarce. DESIGN We examined how different factors predict awareness in patients undergoing rehabilitation (N = 43). Factors included (1) neurological (injury severity), (2) neuropsychological loss, (3) psychological (denial, projection, identification), and (4) personality (narcissism). METHODS/MAIN MEASURES The Patient Competency Rating Scale, comparing patient with clinician reports on different functional domains; the Thematic Apperception Test, an injury-independent measure of the propensity to mobilize specific defence mechanisms; and the Narcissism Personality Inventory. RESULTS Impaired awareness was not predicted by injury-related and neuropsychological scores but was significantly predicted by use of primitive defence mechanisms (denial and projection). Patients who underestimate their abilities also demonstrated high denial levels, but contrary to underestimators, this was positively related to depression and negatively to awareness. CONCLUSIONS Primitive defence mechanism use significantly contributes to impaired awareness independent of injury-related factors, particularly in domains associated with self-identity. Well-validated tests of defence mechanism mobilization are needed to support clinical interpretation of and intervention with impaired awareness. More research is needed to understand the psychology of hypersensitivity to deficits. PRACTITIONER POINTS This study provides an empirical demonstration of dissociable contributions of neurological and psychological factors to awareness of deficits in TBI. Trait proclivity to mobilize defence mechanisms in response to anxiety-provoking situations can be measured, and strongly predicts impaired awareness. Importantly, measures of psychological reactions were independent of responses to the neurological deficits themselves, discriminating between psychological and neurological contributions to impaired awareness. The importance of identifying psychological reactions to impaired awareness and hindering rehabilitation success is highlighted, and vital for clinicians to consider during the rehabilitation process. Psychological reactions to TBI can be identified using well-validated, quantitative measures of the use of psychological defences (e.g., Cramer's Thematic Apperception Test scoring system), and the authors suggest this is a critical step to properly characterize and manage awareness in patients during treatment. Although only TBI patients were examined, the results may inform impaired awareness that occur as a result of other disorders and illnesses. The patients in this study were in the chronic stages of the injury, and therefore, the results may not generalize to patients in more acute stages.
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Affiliation(s)
- Zorry Belchev
- Department of Psychology, University of Toronto, Ontario, Canada.,The Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
| | - Neta Levy
- Department of Psychology, University of Haifa, Israel
| | - Itamar Berman
- Department of Psychology, University of Haifa, Israel
| | - Hila Levinzon
- Department of Psychology, University of Haifa, Israel
| | - Dan Hoofien
- Department of Psychology, Hebrew University of Jerusalem, Israel.,The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
| | - Asaf Gilboa
- Department of Psychology, University of Toronto, Ontario, Canada.,The Rotman Research Institute at Baycrest, Toronto, Ontario, Canada
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Yoon B, Shim YS, Hong YJ, Choi SH, Park HK, Park SA, Jeong JH, Yoon SJ, Yang DW. Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2017; 30:170-177. [PMID: 28421896 DOI: 10.1177/0891988717700508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). METHODS We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. RESULTS The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. CONCLUSION These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.
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Affiliation(s)
- Bora Yoon
- 1 Department of Neurology, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Yong S Shim
- 2 Department of Neurology, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Yun Jeong Hong
- 3 Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seong Hye Choi
- 4 Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hee Kyung Park
- 5 Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sun Ah Park
- 6 Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jee Hyang Jeong
- 7 Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Yoon
- 8 Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Dong-Won Yang
- 9 Department of Neurology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Egbert AR. A Framework for Ethical Decision Making in the Rehabilitation of Patients with Anosognosia. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017281057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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15
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Rigon J, Burro R, Guariglia C, Maini M, Marin D, Ciurli P, Bivona U, Formisano R. Self-awareness rehabilitation after Traumatic Brain Injury: A pilot study to compare two group therapies. Restor Neurol Neurosci 2017; 35:115-127. [PMID: 28059799 PMCID: PMC5302046 DOI: 10.3233/rnn-150538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND PURPOSE Deficits of self-awareness (SA) are very common after severe acquired brain injury (sABI), especially in traumatic brain injury (TBI), playing an important role in the efficacy of the rehabilitation process. This pilot study provides information regarding two structured group therapies for disorders of SA. METHODS Nine patients with severe TBI were consecutively recruited and randomly assigned to one SA group therapy programme, according either to the model proposed by Ben-Yishay & Lakin (1989) (B&L Group), or by Sohlberg & Mateer (1989) (S&M Group). Neuropsychological tests and self-awareness questionnaires were administered before and after a 10 weeks group therapy. RESULTS Results showed that both SA and neuropsychological functioning significantly improved in both groups. CONCLUSION It is important to investigate and treat self-awareness, also to improve the outcome of neuropsychological disorders. The two group therapies proposed seem to be specific for impulsivity and emotional dyscontrol and for cognitive disorders.
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Affiliation(s)
- Jessica Rigon
- IRCCS Fondazione Ospedale San Camillo, Venezia Lido, Italy
| | - Roberto Burro
- Università degli Studi di Verona, Dipartimento di Scienze Umane, Verona, Italy
| | | | - Manuela Maini
- CRA Nucleo Speciale Gravissime Disabilità Virginia Grandi, Bologna, Italy
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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.
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Lloyd O, Ownsworth T, Fleming J, Zimmer-Gembeck MJ. Awareness Deficits in Children and Adolescents After Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:311-23. [DOI: 10.1097/htr.0000000000000113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Gasquoine PG. Blissfully unaware: Anosognosia and anosodiaphoria after acquired brain injury. Neuropsychol Rehabil 2015; 26:261-85. [DOI: 10.1080/09602011.2015.1011665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Starkstein SE. Anosognosia in Alzheimer's disease: Diagnosis, frequency, mechanism and clinical correlates. Cortex 2014; 61:64-73. [DOI: 10.1016/j.cortex.2014.07.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/13/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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20
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Malouf T, Langdon R, Taylor A. The Insight Interview: A new tool for measuring deficits in awareness after traumatic brain injury. Brain Inj 2014; 28:1523-41. [DOI: 10.3109/02699052.2014.922700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tania Malouf
- Queensland Paediatric Rehabilitation Service, Royal Children’s Hospital
BrisbaneAustralia
- Department of Psychology, Mater Children’s Hospital
BrisbaneAustralia
| | | | - Alan Taylor
- Department of Psychology, Macquarie University
SydneyAustralia
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21
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Psychometric properties and feasibility of instruments used to assess awareness of deficits after acquired brain injury: a systematic review. J Head Trauma Rehabil 2013; 27:433-42. [PMID: 21897287 DOI: 10.1097/htr.0b013e3182242f98] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unawareness of deficits after acquired brain injury (ABI) is often reported in the clinic. Several methods have been developed to measure a patient's awareness of deficits after ABI; however, no criterion standard currently exists to measure this phenomenon. OBJECTIVE To review all instruments for measuring awareness of deficits and evaluate their psychometric and conceptual properties as well as their feasibility. METHODS Systematic literature search for available awareness measurement instruments used in experimental ABI studies. Instruments were divided into the following 4 assessment methods: clinician ratings, structured interviews, performance-based discrepancy, and self-other rating discrepancy methods. The quality of the instruments was evaluated. RESULTS The literature search identified 39 instruments and 8 of these were selected. The following 3 instruments stood out in terms of quality: Self-Awareness of Deficits Interview, Patient Competency Rating Scale, and Awareness Questionnaire. CONCLUSION Although these quantitative instruments are useful tools in research, they have limited utility in the clinic because they only measure intellectual awareness. Therefore, in addition to these instruments, qualitative tools should also be used to gain a complete view of a patient's awareness problem.
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Cleret de Langavant L, Fénelon G, Benisty S, Boissé MF, Jacquemot C, Bachoud-Lévi AC. Awareness of memory deficits in early stage Huntington's disease. PLoS One 2013; 8:e61676. [PMID: 23620779 PMCID: PMC3631142 DOI: 10.1371/journal.pone.0061676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/05/2013] [Indexed: 11/25/2022] Open
Abstract
Patients with Huntington's disease (HD) are often described as unaware of their motor symptoms, their behavioral disorders or their cognitive deficits, including memory. Nevertheless, because patients with Parkinson's disease (PD) remain aware of their memory deficits despite striatal dysfunction, we hypothesize that early stage HD patients in whom degeneration predominates in the striatum can accurately judge their own memory disorders whereas more advanced patients cannot. In order to test our hypothesis, we compared subjective questionnaires of memory deficits (in HD patients and in their proxies) and objective measures of memory dysfunction in patients. Forty-six patients with manifest HD attending the out-patient department of the French National Reference Center for HD and thirty-three proxies were enrolled. We found that HD patients at an early stage of the disease (Stage 1) were more accurate than their proxies at evaluating their own memory deficits, independently from their depression level. The proxies were more influenced by patients' functional decline rather than by patients' memory deficits. Patients with moderate disease (Stage 2) misestimated their memory deficits compared to their proxies, whose judgment was nonetheless influenced by the severity of both functional decline and depression. Contrasting subjective memory ratings from the patients and their objective memory performance, we demonstrate that although HD patients are often reported to be unaware of their neurological, cognitive and behavioral symptoms, it is not the case for memory deficits at an early stage. Loss of awareness of memory deficits in HD is associated with the severity of the disease in terms of CAG repeats, functional decline, motor dysfunction and cognitive impairment, including memory deficits and executive dysfunction.
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Affiliation(s)
- Laurent Cleret de Langavant
- INSERM U955 E01, Neuropsychologie Interventionnelle, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure (ENS), Paris, France
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
- Université Paris Est, Faculté de Médecine, Créteil, France
| | - Gilles Fénelon
- INSERM U955 E01, Neuropsychologie Interventionnelle, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure (ENS), Paris, France
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
| | - Sarah Benisty
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
| | - Marie-Françoise Boissé
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
| | - Charlotte Jacquemot
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
| | - Anne-Catherine Bachoud-Lévi
- INSERM U955 E01, Neuropsychologie Interventionnelle, Créteil, France
- Département d'Etudes Cognitives, Ecole Normale Supérieure (ENS), Paris, France
- AP-HP, Centre de Référence – Maladie de Huntington, Hôpital H. Mondor - A. Chenevier, Créteil, France
- Université Paris Est, Faculté de Médecine, Créteil, France
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Awareness of olfactory deficits in healthy aging, amnestic mild cognitive impairment and Alzheimer's disease. Int Psychogeriatr 2011; 23:1097-106. [PMID: 21251352 DOI: 10.1017/s1041610210002371] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Olfactory dysfunction is present in early Alzheimer's disease (AD), and has now been reported in people with amnestic mild cognitive impairment (aMCI). Recent evidence suggests that unawareness of an olfactory deficit may predict which MCI patients will subsequently meet AD criteria. However, important methodological limitations challenge this suggestion. While addressing some of the limitations of previous research, this preliminary study explores unawareness of olfactory deficits as a predictive factor of future AD among people with aMCI. METHODS Twenty-five participants with aMCI, 25 AD patients, and 22 healthy elderly participants underwent testing of olfactory identification. Subjective reports regarding perceived decline in olfactory detection and olfactory identification were also obtained. A subset of participants was reassessed 12 months later. RESULTS Control participants performed better than both aMCI and AD patients on olfactory identification. Almost uniformly, participants did not report decline in either olfactory detection or identification. Prediction of olfactory identification scores from subjective reports of olfactory function was poor, and awareness of olfactory decline bore no relationship to the likelihood of aMCI patients progressing to AD by the 12-month review. CONCLUSIONS Treating awareness of olfactory function as a unitary construct can be misleading, and there is a poor relationship between subjective and objective measures of olfactory ability. Our preliminary data suggest that unawareness of olfactory decline does not improve the identification of patients with MCI who are more likely to be in the prodromal phase of AD. Replication in a larger cohort is needed to support these findings.
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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.
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O'Keeffe FM, Dockree PM, Moloney P, Carton S, Robertson IH. Characterising error-awareness of attentional lapses and inhibitory control failures in patients with traumatic brain injury. Exp Brain Res 2007; 180:59-67. [PMID: 17216412 DOI: 10.1007/s00221-006-0832-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 12/14/2006] [Indexed: 11/25/2022]
Abstract
Awareness deficits are a significant problem following traumatic brain injury (TBI). This study examined error processing as candidate marker of awareness and compared the performance of 18 TBI participants and 18 controls using an online error-monitoring task while participants performed simple go/no-go tasks. Error-monitoring performance was compared where the no-go target was part of (a) a predictive sequence, (b) predictive sequence plus a dual-task element and (c) a random sequence. Results showed that the TBI participants, in contrast to control participants, were significantly impaired at monitoring their errors during both predictive sequence tasks but were not impaired on the random sequence task. These findings suggest that following TBI, when an error is more impulsive it may be more easily monitored, whereas when an error is characterised by attentional drift, subsequent error-processing mechanisms may fail to engage. Higher levels of online error-awareness were also associated with lower levels of anxiety, fewer symptoms of frontal dysfunction and greater competence in everyday functioning.
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Affiliation(s)
- F M O'Keeffe
- Trinity College Institute of Neuroscience and Department of Psychology, Trinity College Dublin, Dublin 2, Ireland
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