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Razafimahatratra S, Guieysse T, Lejeune FX, Houot M, Medani T, Dreyfus G, Klarsfeld A, Villain N, Pereira FR, La Corte V, George N, Pantazis D, Andrade K. Can a failure in the error-monitoring system explain unawareness of memory deficits in Alzheimer's disease? Cortex 2023; 166:428-440. [PMID: 37423786 DOI: 10.1016/j.cortex.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Unawareness of memory deficits is an early manifestation in patients with Alzheimer's disease (AD), which often delays diagnosis. This intriguing behavior constitutes a form of anosognosia, whose neural mechanisms remain largely unknown. We hypothesized that anosognosia may depend on a critical synaptic failure in the error-monitoring system, which would prevent AD patients from being aware of their own memory impairment. To investigate, we measured event-related potentials (ERPs) evoked by erroneous responses during a word memory recognition task in two groups of amyloid positive individuals with only subjective memory complaints at study entry: those who progressed to AD within the five-year study period (PROG group), and those who remained cognitively normal (CTRL group). A significant reduction in the amplitude of the positivity error (Pe), an ERP related to error awareness, was observed in the PROG group at the time of AD diagnosis (vs study entry) in intra-group analysis, as well as when compared with the CTRL group in inter-group analysis, based on the last EEG acquisition for all subjects. Importantly, at the time of AD diagnosis, the PROG group exhibited clinical signs of anosognosia, overestimating their cognitive abilities, as evidenced by the discrepancy scores obtained from caregiver/informant vs participant reports on the cognitive subscale of the Healthy Aging Brain Care Monitor. To our knowledge, this is the first study to reveal the emergence of a failure in the error-monitoring system during a word memory recognition task at the early stages of AD. This finding, along with the decline of awareness for cognitive impairment observed in the PROG group, strongly suggests that a synaptic dysfunction in the error-monitoring system may be the critical neural mechanism at the origin of unawareness of deficits in AD.
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Affiliation(s)
- Solofo Razafimahatratra
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Guieysse
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - François-Xavier Lejeune
- Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), AP-HP, INSERM, CNRS, University Hospital Pitié-Salpêtrière, Paris, France; Paris Brain Institute's Data and Analysis Core, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marion Houot
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA 90089, USA
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Nicolas Villain
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filipa Raposo Pereira
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Valentina La Corte
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie George
- Brain & Spine Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Centre MEG-EEG, F-75013, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Katia Andrade
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France; FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, 47 Bd de l'Hôpital, 75013, Paris, France.
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Guieysse T, Lamothe R, Houot M, Razafimahatratra S, Medani T, Lejeune FX, Dreyfus G, Klarsfeld A, Pantazis D, Koechlin E, Andrade K. Detecting Anosognosia from the Prodromal Stage of Alzheimer's Disease. J Alzheimers Dis 2023; 95:1723-1733. [PMID: 37718816 PMCID: PMC10578267 DOI: 10.3233/jad-230552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Though not originally developed for this purpose, the Healthy Aging Brain Care Monitor (HABC-M) seems a valuable instrument for assessing anosognosia in Alzheimer's disease (AD). OBJECTIVES Our study aimed at 1) investigating the validity of the HABC-M (31 items), and its cognitive, psychological, and functional subscales, in discriminating AD patients from controls; 2) exploring whether the HABC-M discrepancy scores between the self-reports of patients/controls in these different domains and the respective ratings provided by their caregivers/informants correlate with an online measure of self-awareness; 3) determining whether the caregiver burden level, also derived from the HABC-M, could add additional support for detecting anosognosia. METHODS The HABC-M was administered to 30 AD patients and 30 healthy controls, and to their caregivers/informants. A measure of online awareness was established from subjects' estimation of their performances in a computerized experiment. RESULTS The HABC-M discrepancy scores distinguished AD patients from controls. The cognitive subscale discriminated the two groups from the prodromal AD stage, with an AUC of 0.88 [95% CI: 0.78;0.97]. Adding the caregiver burden level raised it to 0.94 [0.86;0.99]. Significant correlations between the HABC-M and online discrepancy scores were observed in the patients group, providing convergent validity of these methods. CONCLUSIONS The cognitive HABC-M (six items) can detect anosognosia across the AD spectrum. The caregiver burden (four items) may corroborate the suspicion of anosognosia. The short-hybrid scale, built from these 10 items instead of the usual 31, showed the highest sensitivity for detecting anosognosia from the prodromal AD stage, which may further help with timely diagnosis.
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Affiliation(s)
- Thomas Guieysse
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Roxane Lamothe
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Solofo Razafimahatratra
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - François-Xavier Lejeune
- Paris Brain Institute (Institut du Cerveau, ICM), Data Analysis Core, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Etienne Koechlin
- Laboratoire de Neurosciences Cognitives et Computationnelles, École Normale Supérieure, Paris, France
| | - Katia Andrade
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
- FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, Paris, France
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Razafimahatratra S, Guieysse T, Medani T, Lejeune F, Houot M, George N, La Corte V, Klarsfeld A, Dreyfus G, Pantazis D, Dubois B, Andrade K. Why don’t Alzheimer’s disease patients know that they forget? Alzheimers Dement 2021. [DOI: 10.1002/alz.053526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Thomas Guieysse
- Institute of Memory and Alzheimer’s Disease Salpêtrière Hospital Paris France
| | | | | | - Marion Houot
- Brain and Spine Institute Salpêtrière Hospital Paris France
| | - Nathalie George
- Institut du Cerveau et de la Moelle Epiniere ICM INSERM U 1127 CNRS UMR 7225 Sorbonne Universite Centre MEG‐EEG Paris France
| | - Valentina La Corte
- Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A) Départment de Neurologie Paris France
| | - André Klarsfeld
- Laboratoire Plasticité du Cerveau CNRS UMR 8249 ESPCI Paris‐PSL Paris France
| | - Gérard Dreyfus
- Laboratoire Plasticité du Cerveau CNRS UMR 8249 ESPCI Paris‐PSL Paris France
| | | | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) Department of Neurology Pitié‐Salpêtrière Hospital AP‐HP Boulevard de l'hôpital Paris, France Paris F‐75013 France
- Brain & Spine Institute (ICM) INSERM U 1127 CNRS UMR 7225 Boulevard de l'hôpital Paris, France Paris F‐75013 France
| | - Katia Andrade
- Institute of Memory and Alzheimer’s Disease Salpêtrière Hospital Paris France
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