The use of virtual reality as a perspective-taking manipulation to improve self-awareness in Alzheimer's disease.

Lack of awareness of symptoms or having a condition referred to as anosognosia is a common feature of individuals with Alzheimer's Disease (AD). Previous literature on AD reported difficulties in evaluating self-abilities, often showing underestimation of limitations. There is increasing evidence that the perspective through which information is presented may moderate the performance appraisal and that anosognosia in AD might be a consequence of a deficit in assuming a third-person perspective. In this context, some studies showed that subjects may better recognize self-and other-difficulties when exposed to a third-person perspective. Considering the variety of approaches aiming to investigate the lack of awareness, there is still a scarcity of methods that provide great ecological validity and consider more than one facet of awareness, thus failing to offer more accurate evaluations of daily experiences. The present paper primarily addresses the theme of the multidimensional character of awareness of abilities in AD and the effect of perspective-taking on its trajectories. The focus turns to virtual reality as a promising tool for a greater evaluation of perspective-taking and self-awareness. Particularly, these systems offer the possibility to involve users in cognitive and sensorimotor tasks that simulate daily life conditions within immersive and realistic environments, and a great sense of embodiment. We propose that virtual reality might allow a great level of complexity, veracity, and safety that is needed for individuals with AD to behave according to their actual abilities and enable to explore the liaison between the subject's viewpoint, performance, and self-evaluation. In addition, we suggest promising clinical implications of virtual reality-based methods for individualized assessments, investigating specific impacts on subjects' life and possible improvements in their awareness.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer's disease.

OBJECTIVES: To investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness in a non-clinically depressed sample of participants with mild to moderate Alzheimer's disease (AD) in Brazil. METHODS: People with AD (PwAD) aged 60 years or older were recruited from an outpatient unit at the Center of AD of the Federal University of Rio de Janeiro, Brazil. Measures of awareness of condition (Assessment Scale of the Psychosocial Impact of the Diagnosis of Dementia), cognitive function (Mini-Mental State Examination), mood state (Cornell Scale for Depression in Dementia), and functionality (Pfeffer Functional Activities Questionnaire) were applied to 264 people with mild to moderate AD and their caregivers. Hypotheses were tested statistically using SEM approach. Three competing models were compared. RESULTS: The first model, in which the influence of mood state and cognitive function on awareness was mediated by functionality, showed a very good fit to the data and a medium effect size. The competing models, in which the mediating variables were mood state and cognitive function, respectively, only showed poor model fit. CONCLUSION: Our model supports the notion that the relationship between different factors and awareness in AD is mediated by functionality and not by depressive mood state or cognitive level. The proposed direct and indirect effects on awareness are discussed, as well as the missing direct influence of mood state on awareness. The understanding of awareness in dementia is crucial and our model gives one possible explanation of its underlying structure in AD.

[The features of insight in schizophrenia, a bibliographic review]. / Características del insight en la esquizofrenia. Una revisión bibliográfica.

Treatment of schizophrenia remains a huge challenge. Despite advances in recent decades in pathophysiology, genetics, and therapeutics, overall outcomes in the evolution of patients do not appear to have undergone such significant changes. Cognition is particularly important, bearing in mind that it is a determining factor in functionality, and this, in turn, in social, family, academic and work performance. Cognitive variables may include the ability to Insight as a form of self-recognition that goes beyond disease awareness. Like all cognitive functions, it is also impaired in patients and hinders, perhaps like no other, adherence to treatment, with the possibility of poor evolution, relapses and worse prognosis. The objective of this paper is to investigate, through a literature review, the characteristics of Insight and what is its importance in the clinical and prognostic of schizophrenia.

Anosognosia in Amnestic Mild Cognitive Impairment Is Related to Diminished Hippocampal Volume Comparable to Alzheimer's Disease Dementia: Preliminary MRI Findings.

Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer's disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest (hippocampus and cingulum cortex gray matter, cingulum bundle white matter): aMCI subjects with anosognosia (n = 6), aMCI subjects without anosognosia (n = 12), AD subjects with anosognosia (n = 6), and AD subjects without anosognosia (n = 9). aMCI subjects with anosognosia displayed a significantly lower gray matter density (GMD) in the bilateral hippocampus than aMCI subjects without anosognosia, which was accounted for by bilateral hippocampal differences. Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology.

Anosognosia for memory in dementia with Lewy bodies compared with Alzheimer's disease.

OBJECTIVES: Anosognosia is the inability to recognize one's own symptoms. Although dementia with Lewy bodies (DLB) is the second most common degenerative dementia, there is little evidence of memory deficit awareness in this condition. The objectives of this research were to compare anosognosia between individuals with DLB and dementia due to Alzheimer's disease (AD) and to evaluate whether medial temporal atrophy, a marker of AD pathology, could help to explain different rates of anosognosia in DLB and dementia due to AD. METHODS/DESIGN: This is a cross-sectional study that took place at the Memory Clinic of D'Or Institute for Research and Education (IDOR). Twenty individuals with DLB and 20 with dementia due to AD were included in this study. We assessed anosognosia for memory using an index derived from subjective memory complaints (using the Memory Complaint Questionnaire) and from the performance in memory neuropsychological testing (Rey Auditory Verbal Learning Test). Thirty-one participants also underwent brain Magnetic Resonance Imaging to evaluate hippocampal atrophy with a visual scale (MTA-score [medial temporal atrophy score]). RESULTS: There was no significant difference between groups regarding age, years of education, sex or time of disease. Individuals with DLB had a higher index of anosognosia than dementia due to AD (2.92 and 1.87; p = 0.024), meaning worse awareness of memory deficits. MTA-score was slightly higher in dementia due to AD than in DLB, albeit without statistical significance. CONCLUSION: Our study was the first to demonstrate that anosognosia for memory is worse in DLB than in dementia due to AD. This finding supports the hypothesis that anosognosia in DLB is a heterogeneous phenomenon.

Análisis neuropsicológico de un caso con anosognosia / Neuropsychological analysis of a case with anosognosia

Resumen La anosognosia es un trastorno neuropsicológico que genera en el paciente una incapacidad para tener un estado de conciencia pleno sobre su enfermedad o déficit, producto de una injuria cerebral. En este artículo reportamos el análisis de un caso que producto de un traumatismo craneoencefálico presentó esta alteración cerebral. El análisis neuropsicológico inicia con la descripción clínica del caso, su estado premórbido, el relato familiar del estado actual y un análisis neuropsicológico que sustenta la hipótesis diagnóstica de anosognosia. Se discute el caso presentado en base a la necesidad de realizar diagnósticos precisos y proponer programas de rehabilitación neuropsicológica para que los pacientes con anosognosia sufran el menor impacto posible en las actividades de su vida diaria producto del trastorno cerebral adquirido.

Anosognosia is a neuropsychological disorder that generates in the patient an inability to have a state of full awareness about their disease or deficit due to brain injury. In this article we report the analysis of a case that, due to a head injury, presented this brain disorder. The neuropsychological analysis begins with the clinical description of the case, its premorbid status, the family report of the current state and a neuropsychological analysis of the symptoms presented that support the diagnostic hypothesis of anosognosia. The case presented is discussed based on the need to make accurate diagnoses and propose neuropsychological rehabilitation programs so that patients with anosognosia suffer the least possible impact on the activities of their daily lives as a result of acquired brain disorder.

Bioethical implications of end-of-life decision-making in patients with dementia: a tale of two societies.

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.

The Petrified Self 10 Years After: Current Evidence for Mnemonic anosognosia.

Lack of awareness about disease, its symptoms and consequences, also termed anosognosia, is a common feature of Alzheimer's disease (AD). It has been hypothesized that memory disorder may be a key contributing factor to anosognosia, with people with AD not being able to update their personal information about performance and relying on older consolidated material about ability. This potentially outdated sense of self has been named, as a metaphor, the petrified self. In the current review, evidence from the past 10 years in relation to this concept is critically appraised. In particular, focus is given to empirical evidence produced on anterograde memory deficits about performance, the profile of autobiographical retrograde memory loss and the role of frontal lobes in anosognosia in AD. Finally, wider consequences of this metaphor for the understanding of selfhood in dementia are discussed.

Patterns of discrepancies in different objects of awareness in mild and moderate Alzheimer's disease.

Objectives: Awareness is considered a heterogeneous and non-linear phenomenon in dementia. We aim to investigate patterns of change of different domains of awareness (awareness of cognitive functioning and health condition, activities of daily living, emotional state, social functioning, and relationships) in people with mild and moderate Alzheimer's disease (AD) and aspects related to each domain.Method: Cross-sectional assessment of dyads of people with AD (PwAD) and caregivers (n = 128; CDR1 = 74, CDR2 = 54). PwAD completed assessments about quality of life, cognition and their awareness of disease. Caregivers provided information about PwAD and received quality of life and burden of care assessments.Results: Mild AD group showed a mildly impaired awareness (n = 40; 54.05%), while moderate AD group, showed higher presence of moderately impaired awareness (n = 22; 40.74%). There was a significant difference between groups in awareness of cognitive functioning and health condition (p < 0.004), functional activity impairments (p < 0.001) and total score of awareness (p < 0.01). Conversely, awareness of emotional state (p = 0.22) and of social functioning and relationship (p = 0.44) presented no significant difference between groups. Unawareness of functional activity impairments showed higher discrepancy scores between PwAD and caregivers in both groups.Conclusions: Significant differences were found only in patterns of discrepancies in awareness of cognitive functioning and health condition, of ADL and socio-emotional functioning. Different factors are related to different domains in mild and moderate group, reinforcing the heterogeneity of awareness in dementia. ADL deficits have an important role in awareness phenomenon, independent of the severity of disease.

The Relationship Between Social Cognition and Awareness in Alzheimer Disease.

A large body of evidence highlights the social cognitive impairment in neurodegenerative diseases such Alzheimer disease (AD). This study investigated the relationship among social and emotional functioning (SEF), awareness of disease, and other clinical aspects in people with AD (PwAD). A consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. There was a significant difference between self-rated SEF and informant-rated SEF. In 56% of PwAD, self-rated SEF is lower than informant-rated SEF. People with AD mostly presented with mildly impaired awareness of the disease (56%), 20% had moderately impaired awareness of the disease, and 6% were unaware of the disease. The multivariate linear regression showed that informant-rated SEF was related to the social functioning, and relationships, domains of awareness of disease, and the PwAD informant-rated quality of life. The relationship between SEF and awareness of social functioning and relationship domain shows that they are comprised of judgments related to perceptions about oneself, values, and beliefs qualitatively different from awareness of memory or functionality, which can be directly observed.

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores / Impact of Alzheimer's disease related anosognosia in caregivers' quality of life / Impacto de la anosognosia asociada con la demencia de Alzheimer en la calidad de vida de los cuidadores

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores. A Demência de Alzheimer (DA) apresenta como um dos sintomas a anosognosia, um prejuízo na capacidade de o indivíduo julgar alterações decorrentes da doença. Relaciona-se a diversos comprometimentos cognitivo/comportamentais e é apontada como tendo significativo impacto sobre a qualidade de vida (QV) dos cuidadores. Avaliamos o impacto da anosognosia relacionada à DA sobre QV de cuidadores. Foram avaliados 50 pares paciente-cuidador com Exame Cognitivo de Addenbrooke, Questionário de Demência Ampliado e Escala de QV na DA. Observamos que cuidadores de pacientes com sinais de anosognosia apresentavam menores escores de QV, sendo que pacientes com sinais de anosognosia apresentam pior desempenho cognitivo. Escores de anosognosia e QV apresentaram correlação negativa, enquanto QV e quadro cognitivo apresentou correlação positiva. Controlando o funcionamento cognitivo, observamos que a anosognosia apresenta maior impacto na QV em indivíduos com quadro cognitivo mais grave. Palavras-chave: demência de alzheimer, qualidade de vida, cuidadores, anosognosia (AU).

Impacto de Anosognosia asociada a la demencia de Alzheimer en la calidad de vida de cuidadores. Anosognosia es uno de los síntomas de la demencia de Alzheimer (AD), y se considera que tiene un impacto significativo en la calidad de vida (QOL) de los cuidadores. Evaluamos el impacto de la anosognosia relacionada con AD en los cuidadores de calidad de vida. Hubo 50 pares paciente y su cuidador con el examen cognitivo de Addenbrooke, Cuestionario Ampliado de y Escala de calidad de vida. Hemos observado que los cuidadores de pacientes con signos anosognosia tenían menores puntuaciones de calidad de vida con los pacientes con peor rendimiento cognitivo. Anosognosia y la calidad de vida mostraron una correlación de negativa, mientras que la calidad de vida y el marco cognitivo presentaron correlación positiva. Controlando el funcionamiento cognitivo, observamos que la anosognosia tiene mayor impacto en la calidad de vida en pacientes con marco cognitivo más severo. Palabras clave: enfermedad de alzheimer, calidad de vida, cuidadores, anosognosia (AU).

Alzheimer's disease (AD) has anosognosia as one of its symptoms, defined as a change in the individual's ability to judge their difficulties, and is observed as having a significant impact on quality of life of caregivers. This study evaluated the impact of anosognosia related to AD in quality of life (QoL) of caregivers. Fifty AD patients were evaluated through the Addenbrooke's Cognitive Examination, Dementia Questionnaire ­ expanded, while caregivers were evaluated using the Scale of QoL in AD and Dementia Questionnaire (caregiver versions). We observed that caregivers of patients with signs of anosognosia had lower scores on QoL and these patients had worse cognitive scores. Anosognosia and QoL were negatively correlated, as QoL and cognitive functioning. Controlling for cognitive functioning, we observed that anosognosia has a greater impact on QoL in individuals with more severe cognitive impairments (AU).

Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review.

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.

Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review / Conceitos e objetos da consciência na doença de Alzheimer: uma revisão sistemática atualizada

ABSTRACT Objectives To compare and discuss the objects of awareness in Alzheimer’s disease (AD): awareness of cognitive deficits, of functional activities, of social-emotional functioning and behavioral impairment. Methods A search in the PsycINFo, Pilots, PubMed/Medline and ISI electronic databases according to Prisma methodology was performed. We included studies about awareness in people with AD published between 2010 and 2015, with the combination of keywords: “Alzheimer AND awareness of deficits”, “Alzheimer AND anosognosia”, “Alzheimer AND insight”, “dementia AND awareness of deficits”, “dementia AND anosognosia”, “dementia AND insight”. The articles were categorized according to the specific object of awareness. Results Seven hundred and ten records were identified and, after application of the exclusion criteria, 191 studies were retrieved for potential use. After excluding the duplicates, 46 studies were included. Most studies assessed the cognitive domain of awareness, followed by the functional, social-emotional, and behavioral impairment domains. Memory deficits were not sufficient to explain impaired awareness in AD. Longitudinal studies did not find discrepancies between patients and caregivers’ reports, indicating that awareness is not related to cognition. Conflicting findings were observed, including the relation between awareness, mood, severity of disease, and personal characteristics. Conclusions The studies show lack of conceptual consensus and significant methodological differences. The inclusion of samples without differentiation of dementia etiology is associated to symptomatic differences, which affect awareness domains. Awareness in AD is a complex and multidimensional construct. Different objects elicit different levels of awareness.

RESUMO Objetivos Comparar e discutir os objetos de consciência na doença de Alzheimer (DA): consciência dos déficits cognitivos, das atividades funcionais, do funcionamento socioemocional e prejuízos comportamentais. Métodos Realizou-se uma busca nas bases de dados PsycINFo, Pilots, PubMed/Medline e ISI de acordo com a metodologia do Prisma. Os artigos incluídos, publicados entre 2010 e 2015, avaliavam a consciência na DA com as combinações de palavras-chave: “Alzheimer AND consciência do déficit”, “Alzheimer AND anosognosia”, “Alzheimer AND insight”, “demência AND consciência do déficit”, “demência AND anosognosia”, “demência AND insight”. Os artigos foram categorizados conforme os objetos específicos da consciência. Resultados Setecentos e dez estudos foram identificados e, após a aplicação dos critérios de exclusão, 191 foram selecionados. Após a exclusão dos duplicados, 46 estudos foram incluídos. A maioria dos estudos avaliou o domínio cognitivo da consciência, seguido do funcional, do funcionamento socioemocional e prejuízos comportamentais. Déficits na memória não se mostraram suficientes para explicar o prejuízo da consciência na DA. Os estudos longitudinais não encontraram discrepâncias entre os relatos de pacientes e cuidadores, indicando que a consciência não está relacionada à cognição. Observaram-se controvérsias nos resultados na relação entre consciência, humor, gravidade da doença e características pessoais. Conclusões Os estudos demonstraram falta de consenso conceitual e diferenças metodológicas significativas. A inclusão de amostras sem diferenciação da etiologia demencial está associada a diferenças sintomáticas que afetam os domínios da consciência. A consciência na DA é um constructo complexo e multidimensional. Diferentes objetos suscitam diferentes níveis de consciência.

Insight in bipolar disorder: a comparison between mania, depression and euthymia using the Insight Scale for Affective Disorders / O insight no transtorno bipolar: uma comparação entre mania, depressão e eutimia usando a Escala de Insight para Transtornos Afetivos

Objective: To evaluate whether having general insight into bipolar disorder and its symptoms is affected by the mood state of the patient, using the Insight Scale for Affective Disorders, a hetero-application scale for people with mood disorders.Methods: Ninety-five patients with bipolar disorder were evaluated and divided into different groups according to the mood state presented during assessment (i.e., euthymia, mania and depression). Sociodemographic and clinical data (Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impressions Scale) were recorded. Insight was evaluated using the Insight Scale for Affective Disorders.Results: Patients with bipolar disorder in mania show less insight about their condition than patients in depression or euthymia, and less insight about their symptoms than patients with depression, with the exception of awareness of weight change.Conclusions: Loss of insight during mania may have important implications for treatment compliance and adherence and needs to be taken into account in the clinical management of people with bipolar disorder.

Objetivo: Avaliar se o insight global sobre transtorno bipolar e sobre seus sintomas é afetado pelo estado de humor do paciente, usando a Escala de Insight para Transtornos Afetivos, uma escala de heteroaplicação para pacientes com transtorno do humor.Métodos: Noventa e cinco pacientes com transtorno bipolar foram avaliados e divididos em diferentes grupos de acordo com o estado de humor presente durante a avaliação (i.e., eutimia, mania e depressão). Dados sociodemográficos e clínicos (Escala de Depressão de Hamilton, Escala de Avaliação de Mania de Young e Escala de Impressão Clínica Global) foram registrados. Oinsight foi avaliado usando a Escala de Insight para Transtornos Afetivos.Resultados: Pacientes bipolares em mania apresentaram menor insightsobre sua condição do que pacientes em depressão ou eutimia, e menorinsight sobre seus sintomas do que pacientes em depressão, exceto para consciência de mudança de peso.Conclusões: A perda de insight durante a mania pode ter importantes implicações para aceitação do e aderência ao tratamento e precisa ser levada em conta no manejo clínico de pacientes bipolares.

Awareness of disease is different for cognitive and functional aspects in mild Alzheimer's disease: a one-year observation study.

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Awareness of disease in dementia: factor structure of the assessment scale of psychosocial impact of the diagnosis of dementia.

Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (α = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.

Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus ona specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the majorneurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a casestudy example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoreticalmodel of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed...

Cognitive anosognosia and behavioral changes in probable Alzheimers disease patients / Anosognosia cognitiva e alterações comportamentais em pacientes com provável doença de Alzheimer

Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. OBJECTIVE: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). METHODS: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. RESULTS: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. CONCLUSION: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. OBJETIVO: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. MÉTODOS: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. RESULTADOS: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. CONCLUSÃO: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.

Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients.

Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. OBJECTIVE: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). METHODS: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. RESULTS: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. CONCLUSION: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. OBJETIVO: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. MÉTODOS: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. RESULTADOS: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. CONCLUSÃO: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.