ABSTRACT
BACKGROUND: Anosognosia in Alzheimer's disease (AD) is a complicated, non-unitary phenomenon. In a clinical setting, patients with mild AD often preserve their awareness partially. We hypothesized that compensation, as well as neural dysfunction, could be correlated with anosognosia in mild AD. METHODS: The severity of anosognosia was evaluated using the Anosognosia Questionnaire for Dementia in 37 subjects with mild AD or mild cognitive impairment due to AD. The subjects also underwent single-photon emission computed tomography with N-isopropyl-p-[123 I]iodoamphetamine. Correlation between the severity of anosognosia and perfusion was assessed, and anosognosia (+) and (-) groups were compared. RESULTS: The severity of anosognosia was relatively mild; the mean Anosognosia Questionnaire for Dementia score was 6.76 ± 14.16. Subjects were divided into two groups: anosognosia (+) (n = 11) and anosognosia (-) (n = 26). In the single-photon emission computed tomography data analysis, the severity of anosognosia was correlated with both lower regional cerebral blood flows of the right prefrontal cortex and higher regional cerebral blood flows of the parietal cortex, especially the left temporo-parietal junction. CONCLUSIONS: Our results suggest that anosognosia in mild AD could be correlated with compensation as well as neural dysfunction. We speculate that this compensation may be related to the retrieval of outdated autobiographical memory.
Subject(s)
Agnosia/diagnostic imaging , Alzheimer Disease/diagnostic imaging , Cerebrovascular Circulation/physiology , Prefrontal Cortex/blood supply , Tomography, Emission-Computed, Single-Photon , Aged , Aged, 80 and over , Agnosia/psychology , Alzheimer Disease/psychology , Cognitive Dysfunction/physiopathology , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Positron-Emission Tomography , Predictive Value of Tests , Prefrontal Cortex/diagnostic imaging , Prefrontal Cortex/metabolism , Prefrontal Cortex/physiopathology , Severity of Illness IndexABSTRACT
AIMS: The purpose of the present study was to investigate the relationship between delusional thoughts (delusional ideation or misidentification) and frontal lobe function using the Japanese version of the Frontal Assessment Battery (FAB) bedside screening neuropsychological test in early stage Alzheimer's disease (AD) patients. METHODS: Forty-eight probable AD patients with Mini-Mental State Examination score >or=18 points and a clinical dementia rating score of either 0.5 or 1.0 were divided into two groups based on data obtained from interviews with their caregivers: a delusional thought group (n = 19) and a non-delusional thought group (n = 29). The FAB total and subtest scores were then compared for the two groups. RESULTS: Significant differences were found between the FAB total (P < 0.01) and subtest scores (similarities, motor series, conflicting instructions; P < 0.05) for the two groups. Multiple regression analysis showed that delusional thought was significantly associated with the FAB total score. CONCLUSIONS: In addition to episodic memory disorders, a reduction in the FAB score may reflect frontal lobe dysfunctions, including executive function, in patients with AD, leading to delusional ideation.
