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Anosognosia in mild cognitive impairment: Relationship to activation of cortical midline structures involved in self-appraisal

Published online by Cambridge University Press:  20 March 2007

MICHELE L. RIES ,
BRITTA M. JABBAR ,
TAYLOR W. SCHMITZ ,
MEHUL A. TRIVEDI ,
CAREY E. GLEASON ,
CYNTHIA M. CARLSSON ,
HOWARD A. ROWLEY ,
SANJAY ASTHANA  and
STERLING C. JOHNSON
MICHELE L. RIES
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
BRITTA M. JABBAR
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
TAYLOR W. SCHMITZ
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
MEHUL A. TRIVEDI
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
CAREY E. GLEASON
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
CYNTHIA M. CARLSSON
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
HOWARD A. ROWLEY
Affiliation:
Department of Medicine, University of Wisconsin, Madison, Wisconsin
SANJAY ASTHANA
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
STERLING C. JOHNSON
Affiliation:
Geriatric Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin, Madison, Wisconsin
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Abstract

Awareness of cognitive dysfunction shown by individuals with Mild Cognitive Impairment (MCI), a condition conferring risk for Alzheimer's disease (AD), is variable. Anosognosia, or unawareness of loss of function, is beginning to be recognized as an important clinical symptom of MCI. However, little is known about the brain substrates underlying this symptom. We hypothesized that MCI participants' activation of cortical midline structures (CMS) during self-appraisal would covary with level of insight into cognitive difficulties (indexed by a discrepancy score between patient and informant ratings of cognitive decline in each MCI participant). To address this hypothesis, we first compared 16 MCI participants and 16 age-matched controls, examining brain regions showing conjoint or differential BOLD response during self-appraisal. Second, we used regression to investigate the relationship between awareness of deficit in MCI and BOLD activity during self-appraisal, controlling for extent of memory impairment. Between-group comparisons indicated that MCI participants show subtly attenuated CMS activity during self-appraisal. Regression analysis revealed a highly significant relationship between BOLD response during self-appraisal and self-awareness of deficit in MCI. This finding highlights the level of anosognosia in MCI as an important predictor of response to self-appraisal in cortical midline structures, brain regions vulnerable to changes in early AD. (JINS, 2007, 13, 450–461.)

Keywords

Magnetic Resonance ImagingSelf assessment (Psychology)AgnosiaAlzheimer diseaseNeocortexAging
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 3 , May 2007 , pp. 450 - 461
Copyright
© 2007 The International Neuropsychological Society

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