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Longitudinal changes in awareness over 36 months in patients with mild Alzheimer's disease

Published online by Cambridge University Press:  30 July 2014

Asmus Vogel ,
Frans Boch Waldorff  and
Gunhild Waldemar
Asmus Vogel*
Affiliation:
Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
Frans Boch Waldorff
Affiliation:
The Research Unit and Department of General Practice, University of Copenhagen, Denmark
Gunhild Waldemar
Affiliation:
Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
*
Correspondence should be addressed to: Asmus Vogel, Ph.D., Danish Dementia Research Center, Rigshospitalet Section 6911 9 Blegdamsvej, 2100 CopenhagenDenmark. Phone: +45-3545-2982. Email: [email protected].
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Abstract

Background:

Longitudinal changes in awareness in dementia have been studied with short follow-up time and mostly in small patient groups (including patients with moderate dementia). We investigated awareness in patients with mild Alzheimer's disease (AD) over 36 months and studied if a decline in awareness was associated with decline in cognition and increase in neuropsychiatric symptoms.

Methods:

Awareness was measured on a categorical scale in 95 AD patients (age ≥50 years, Mini-Mental State Examination (MMSE) score ≥20). Awareness was rated at three time points (follow-up at 12 and 36 months) where MMSE, Neuropsychiatric Inventory (NPI-Q), and Cornell scale for Depression in Dementia also were applied.

Results:

At 12 months, 26% had lower awareness rating as compared to baseline and at 36 months lower awareness ratings were found in 39%. At both visits, 16% had higher awareness rating as compared to baseline. Patients with lower awareness at 36 months as compared to baseline had a more rapid increase in NPI-Q score (p = 0.002) over 36 months as compared to patients with stable or improved awareness over 36 months. A more rapid decline in MMSE score was observed for patients with lower awareness at 36 months (as compared to baseline) but only when compared to patients in whom awareness improved over time.

Conclusions:

The results show essentially no clear relationship between cognitive decline over three years and awareness. In some cases, awareness remained stable or even improved despite significant cognitive decline. In the subgroup where awareness declined over time, overall ratings of neuropsychiatric symptoms declined more rapidly than in the remaining patients.

Keywords

dementiaAlzheimer’s diseaseawarenessinsightanosognosialongitudinal
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 95 - 102
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Aalten, P., van, V. E., Clare, L., Kenny, G. and Verhey, F. (2005). Awareness in dementia: a review of clinical correlates. Aging Mental Health, 9, 414–422.Google Scholar
Akai, T., Hanyu, H., Sakurai, H., Sato, T. and Iwamoto, T. (2009). Longitudinal patterns of unawareness of memory deficits in mild Alzheimer's disease. Geriatrics and Gerontololgy International, 9, 16–20.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284.Google Scholar
Clare, L. et al. (2012). Longitudinal trajectories of awareness in early-stage dementia. Alzheimer Disease and Associated Disorders, 26, 140–147.Google Scholar
Clare, L. and Wilson, B. A. (2006). Longitudinal assessment of awareness in early-stage Alzheimer's disease using comparable questionnaire-based and performance-based measures: a prospective one-year follow-up study. Aging Mental Health, 10, 156–165.CrossRefGoogle Scholar
Derouesne, C., Thibault, S., Lagha Pierucci, S., Baudouin Madec, V., Ancri, D. and Lacomblez, L. (1999). Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type. International Journal of Geriatric Psychiatry, 14, 1019–1030.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233–239.CrossRefGoogle ScholarPubMed
McDaniel, K. D., Edland, S. D. and Heyman, A. (1995). Relationship between level of insight and severity of dementia in Alzheimer disease. CERAD clinical investigators. Consortium to establish a registry for Alzheimer's disease. Alzheimer Disease and Associated Disorders, 9, 101–104.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Phung, K. T. et al. (2013). A three-year follow-up on the efficacy of psychosocial interventions for patients with mild dementia and their caregivers: the multicentre, rater-blinded, randomised Danish Alzheimer Intervention Study (DAISY). British Medical Journal Open, 3, e003584.Google ScholarPubMed
Reed, B. R., Jagust, W. J. and Coulter, L. (1993). Anosognosia in Alzheimer's disease: relationships to depression, cognitive function, and cerebral perfusion. Journal of Clinical and Experimental Neuropsychology, 15, 231–244.Google Scholar
Salmon, E. et al. (2006). Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Human Brain Mapping, 27, 588–597.CrossRefGoogle ScholarPubMed
Starkstein, S. E. et al. (1997). Prospective longitudinal study of depression and anosognosia in Alzheimer's disease. British Journal of Psychiatry, 171, 47–52.Google Scholar
Vasterling, J. J., Seltzer, B. and Watrous, W. E. (1997). Longitudinal assessment of deficit unawareness in Alzheimer's disease. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 10, 197–202.Google Scholar
Vogel, A., Hasselbalch, S. G., Gade, A., Ziebell, M. and Waldemar, G. (2005). Cognitive and functional neuroimaging correlates for anosognosia in mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 20, 238–246.Google Scholar
Vogel, A., Stokholm, J., Gade, A., Andersen, B. B., Hejl, A. M. and Waldemar, G. (2004). Awareness of deficits in mild cognitive impairment and Alzheimer's disease: do MCI patients have impaired insight? Dementia and Geriatric Cognitive Disorders, 17, 181–187.CrossRefGoogle ScholarPubMed
Vogel, A., Waldorff, F. B. and Waldemar, G. (2010). Impaired awareness of deficits and neuropsychiatric symptoms in early Alzheimer's disease: the Danish Alzheimer Intervention Study (DAISY). Journal of Neuropsychiatry and Clinical Neuroscience, 22, 93–99.Google Scholar
Waldemar, G. et al. (2011). The Danish Alzheimer intervention study: rationale, study design and baseline characteristics of the cohort. Neuroepidemiology, 36, 52–61.Google Scholar
Waldorff, F. B. et al. (2012). Efficacy of psychosocial intervention in patients with mild Alzheimer's disease: the multicentre, rater blinded, randomised Danish Alzheimer Intervention Study (DAISY). BMJ, 345, e4693.CrossRefGoogle ScholarPubMed