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Impaired Awareness of Deficits in Alzheimer's Disease: The Role of Everyday Executive Dysfunction

Published online by Cambridge University Press:  20 September 2012

Martina Amanzio*
Affiliation:
Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy National Institute Neuroscience, Turin, Italy
Lene Vase
Affiliation:
Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus C, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus C, Denmark
Daniela Leotta
Affiliation:
Martini Hospital, Alzheimer Assessment Unit, UVA and Neurology Unit, Turin, Italy
Renato Miceli
Affiliation:
Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
Sara Palermo
Affiliation:
Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
Giuliano Geminiani
Affiliation:
Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy National Institute Neuroscience, Turin, Italy
*
Correspondence and reprint requests to: Martina Amanzio, Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy. E-mail: [email protected]

Abstract

The present study analyzed the awareness of deficits in 117 mild Alzheimer's disease participants. Since few studies have examined the cognitive and behavioral domains of reduced awareness in detail, we performed a domain-specific assessment using the Awareness of deficit Questionnaire – Dementia scale with the novel aim of describing the relationship with everyday executive dysfunction. Through the use of the subtests of the Behavioral Assessment of the Dysexecutive Syndrome, we hypothesized that executive cognitive functions may play an important role in the reduced awareness of deficits. We also considered other variables of interest to provide a novel comprehensive explanation of this phenomenon. Our first approach to the study was a factor analysis considering the role of these variables in the awareness of deficits; subsequently, regression analysis models were used to define which variables were associated with a reduction of awareness in cognitive and behavioral domains. In particular, the factors retained from the factor analysis, in terms of inhibition, self-monitoring, set-shifting, and mood orientation changes, appear to be important skills for awareness of instrumental activities of daily living (R2 = .32). We also found hypo manic mood orientation and a tendency through apathy to be prominent indications of reduced behavioral awareness (R2 = .13). (JINS, 2013, 18, –)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Agnew, S.K., Morris, R.G. (1998). The heterogeneity of anosognosia for memory impairment in Alzheimer's disease: A review of the literature and a proposed model. Aging and Mental Health, 2, 915.CrossRefGoogle Scholar
Allain, P., Chaudet, H., Nicoleau, S., Etcharry-Bouyx, F., Barr, J., Dubas, F., Le Gall, D. (2007). [A study of action planning in patients with Alzheimer's disease using the zoo map test]. Revue Neurologique (Paris), 163(2), 222230.CrossRefGoogle ScholarPubMed
Amanzio, M., Geminiani, G., Leotta, D., Cappa, S. (2008). Metaphor comprehension in Alzheimer's disease: Novelty matters. Brain and Language, 107, 110.CrossRefGoogle ScholarPubMed
Amanzio, M., Torta, D.M., Sacco, K., Cauda, F., D'Agata, F., Duca, S., Geminiani, G.C. (2011). Unawareness of deficits in Alzheimer's disease: Role of the cingulate cortex. Brain, 134, 10611076.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorder (4th ed.). Washington, DC: American Psychiatric Association Press.Google Scholar
Assal, F., Cummings, J.L. (2002). Neuropsychiatric symptoms in the dementias. Current Opinion in Neurology, 15, 445450.CrossRefGoogle ScholarPubMed
Auchus, A.P., Goldstein, F.C., Green, J., Green, R.C. (1994). Anosognosia in Alzheimer's disease. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 7, 2529.Google Scholar
Baddeley, A.D. (1986). Working memory. Oxford: Clarendon Press.Google ScholarPubMed
Barrett, A.M., Eslinger, P.J., Ballentine, N.H., Heilman, K.M. (2005). Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control subjects. Neurology, 64, 693699.CrossRefGoogle ScholarPubMed
Bech, P., Rafaelsen, O.J., Kramp, P., Bolwing, T.G. (1978). The mania rating scale: Scale construction and inter-observer agreement. Neuropharmacology, 17, 430431.CrossRefGoogle ScholarPubMed
Buckner, R.L. (2004). Memory and executive function in aging AD: Multiple factors that cause decline and reserve factors that compensate. Neuron, 44(1), 195208.CrossRefGoogle ScholarPubMed
Chen, P., Ratcliff, G., Belle, S.H., Cauley, J.A., DeKosky, S.T., Ganguli, M. (2000). Cognitive tests that best discriminate between presymptomatic AD and those who remain non demented. Neurology, 55(12), 18471853.CrossRefGoogle Scholar
Clare, L. (2004a). The construction of awareness in early-stage Alzheimer's disease: A review of concepts and models. British Journal of Clinical Psychology, 43, 155175.CrossRefGoogle ScholarPubMed
Clare, L. (2004b). Awareness in early-stage Alzheimer's disease: A review of methods and evidence. British Journal of Clinical Psychology, 43, 177196.CrossRefGoogle ScholarPubMed
Clare, L., Nelis, S.M., Martyr, A., Roberts, J., Whitaker, C.J., Markova, I.S., Morris, R.G. (2012). The influence of psychological, social and contextual factors on the expression and measurement of awareness in early stage dementia: Testing a biopsychosocial model. International Journal of Geriatric Psychiatry, 27, 167177.CrossRefGoogle ScholarPubMed
Cools, R., Brouwer, W.H., de Jong, R., Slooff, C. (2000). Flexibility, inhibition, and planning: Frontal dysfunctioning in schizophrenia. Brain and Cognition, 43(1-3), 108112.Google ScholarPubMed
Derouesne, C., Poitreneau, J., Hugonot, L., Kalafat, M., Dubois, B., Laurent, B. (1999). Mini-Mental State Examination: A useful method for the evaluation of the cognitive status of patients by the clinician. Consensual French version. Presse Médicale, 28(21), 11411148.Google ScholarPubMed
Drewe, E. (1985). Go-no-go learning after frontal lobe lesions in humans. Cortex, 11, 816.CrossRefGoogle Scholar
Duke, L.M., Kaszniak, A.W. (2000). Executive control functions in degenerative dementias: A comparative review. Neuropsychology Review, 10(2), 7599.CrossRefGoogle ScholarPubMed
Eslinger, P.J., Moore, P., Troiani, V., Antani, S., Cross, K., Kwok, S., Grossman, M. (2007). Oops! Resolving social dilemmas in frontotemporal dementia. Journal of Neurology, and Neurosurgery, and Psychiatry, 78, 457460.CrossRefGoogle ScholarPubMed
Espinosa, A., Alegret, M., Boada, M., Vinyes, G., Valero, S., Martinez-Lage, P., Tirraga, L. (2009). Ecological assessment of executive functions in mild cognitive impairment and mild Alzheimer's disease. Journal of the International Neuropsychological Society, 15(5), 751757.CrossRefGoogle ScholarPubMed
Feher, E.P., Larrabee, G.J., Sudilovsky, A., Crook, T.H. (1994). Memory self-report in Alzheimer's disease and in age-associated memory impairment. Journal of Geriatric Psychiatry and Neurology, 7, 5865.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975). Mini-mental state. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Galeone, F., Pappalardo, S., Chieffi, S., Iavarone, A., Carlomagno, S. (2011). Anosognosia for memory deficit in amnestic mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 26(7), 695701. doi:10.1002/gps.2583CrossRefGoogle ScholarPubMed
Gil, R., Arroyo-Anllo, E.M., Ingrand, P., Gil, M., Neau, J.P., Ornon, C., Bonnaud, V. (2001). Self-consciousness and Alzheimer's disease. Acta Neurologica Scandinavica, 104, 296300.CrossRefGoogle ScholarPubMed
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 5055.CrossRefGoogle ScholarPubMed
Hamilton, M.A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 5662.CrossRefGoogle ScholarPubMed
Hannesdottir, K., Morris, R.G. (2007). Primary and secondary anosognosia for memory impairment in patients with Alzheimer's disease. Cortex, 43, 10201030.CrossRefGoogle ScholarPubMed
Harwood, D.G., Sultzer, D.L., Wheatley, M.A. (2000). Impaired insight in Alzheimer's disease: Association with cognitive deficits, psychiatric symptoms, behavioral disturbances. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 13, 8388.Google ScholarPubMed
Kashiwa, Y., Kitabayashi, Y., Narumoto, J., Nakamura, K., Ueda, H., Fukui, K. (2005). Anosognosia in Alzheimer's disease: Association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry and Clinical Neuroscience, 59, 697704.CrossRefGoogle ScholarPubMed
Kaszniak, A.W., Zak, M.G. (1996). On the neuropsychology of metamemory: Contributions from the study of amnesia and dementia. Learning and Individual Differences, 8, 355381.CrossRefGoogle Scholar
Katz, S., Ford, A.B., Moskovitz, R.W., Jackson, B.A., Jaffe, M.W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. Journal of the American Medical Association, 185, 914919.CrossRefGoogle Scholar
Kotler-Cope, S., Camp, C.J. (1995). Anosognosia in Alzheimer disease. Alzheimer Disease and Associated Disorders, 9(1), 5256.CrossRefGoogle ScholarPubMed
Lawton, M.P., Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.CrossRefGoogle ScholarPubMed
Lezak, M.D., Howieson, D.B., Loring, D.W. (2004). Neuropsychological assessment. (4th ed., pp. 636637). Oxford: Oxford University Press.Google Scholar
Litvan, I., Agid, Y., Calne, D., Campbell, G., Dubois, B., Duvoisin, R.C., Zee, D.S. (1996). Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): Report of the NINDS-SPSP international workshop. Neurology, 47, 19.CrossRefGoogle ScholarPubMed
Litvan, I., Agid, Y., Goetz, C., Jankovic, J., Wenning, G.K., Brandel, J.P., Bartko, J.J. (1997). Accuracy of the clinical diagnosis of corticobasal degeneration: A clinicopathologic study. Neurology, 48, 119125.CrossRefGoogle ScholarPubMed
Lyon, G.R., Krasnegor, N.A. (Eds.) (1996). Attention, memory and executive function. Baltimore: Brookes.CrossRefGoogle Scholar
Loebel, J.P., Dager, S.R., Berg, G., Hyde, T.S. (1990). Fluency of speech and self-awareness of memory deficit in Alzheimer's disease. International Journal of Geriatric Psychiatry, 5, 4145.CrossRefGoogle Scholar
Logan, G.D. (1985). Executive control of thought and action. Acta Psychologica, 60, 193210.CrossRefGoogle Scholar
Lopez, O.L., Becker, J.T., Somsak, D., Dew, M.A., DeKosky, S.T. (1994). Awareness of cognitive deficits and anosognosia in probable Alzheimer's disease. European Journal of Neurology, 34, 277282.CrossRefGoogle ScholarPubMed
Mangone, C.A., Hier, D.B., Gorelick, P.B., Ganellen, R.J., Langenberg, P., Boarman, R., Dollear, W.C. (1991). Impaired insight in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 4, 189193.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, M., Price, D., Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease. Neurology, 34, 939944.CrossRefGoogle ScholarPubMed
Michon, A., Deweer, B., Pillon, B., Agid, Y., Dubois, B. (1994). Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 57, 805809.CrossRefGoogle ScholarPubMed
Migliorelli, R., Tenson, A., Sabe, L., Petracca, G., Petracchi, M., Leiguarda, R., Starkstein, S. (1995). Anosognosia in Alzheimer's disease: A study of associated factors. The Journal of Neuropsychiatry and Clinical Neurosciences, 7, 338344.Google ScholarPubMed
Millar, D., Griffiths, P., Zermansky, A.J., Burn, D.J. (2006). Characterizing behavioral and cognitive dysexecutive changes in progressive supranuclear palsy. Movement Disorders, 21, 199207.CrossRefGoogle ScholarPubMed
Miyake, A., Friedman, N.P., Emerson, A.H.W., Howerter, A., Wager, T.D. (2000). The unity and diversity of executive functions and their contributions to complex frontal lobe tasks: A latent variable analysis. Cognitive Psychology, 41, 49100.CrossRefGoogle ScholarPubMed
Morris, R., Hannesdottir, G.K. (2004). Loss of “awareness” in Alzheimer's disease. In R.G. Morris & J.T. Becker (Eds.), Cognitive neuropsychology of Alzheimer's. Oxford: Oxford University Press.CrossRefGoogle Scholar
Ott, B.R., Lafleche, G., Whelihan, W.M., Buongiorno, G.W., Albert, M.S., Fogel, B.S. (1996). Impaired awareness of deficits in Alzheimer disease. Alzheimer Disease and Associated Disorder, 10, 6876.CrossRefGoogle ScholarPubMed
Piquard, A., Derouesné, C., Lacomblez, L., Siéroff, E. (2004). Planning and activities of daily living in Alzheimer's disease and frontotemporal dementia. Psychologie Neuropsychiatrie du Vieillissement, 2(2), 147156.Google ScholarPubMed
Rabbit, P. (Ed.). (1997). Methodology of frontal and executive function. Hove, UK: Psychology Press.Google Scholar
Reed, B.R., Jagust, W.J., Coulter, L. (1993). Anosognosia in Alzheimer's disease: Relationships to depression, cognitive function, and cerebral perfusion. Journal of Clinical and Experimental Neuropsychology, 15, 231244.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S.H., de Leon, M.J., Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 11361139.Google ScholarPubMed
Rodrigues Gouveia, P.A., Dozzi Brucki, S.M., Fleury Malheiros, S.M., Bueno, O.F.A. (2007). Disorders in planning and strategy application in frontal lobe lesion patients. Brain and Cognition, 63, 240246.CrossRefGoogle Scholar
Rosen, W.G., Mohs, R.C., Davis, K.L. (1984). A new rating scale for Alzheimer's Disease. The American Journal of Psychiatry, 141, 13561364.Google ScholarPubMed
Rymer, S., Salloway, S., Norton, L., Malloy, P., Correia, S., Monast, D. (2002). Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease. Alzheimer Disease and Associate Disorders, 16(4), 248253.CrossRefGoogle ScholarPubMed
Sebastian, M.V., Menor, J., Elosua, M.R. (2006). Attentional dysfunction of the central executive in AD: Evidence from dual task and perseveration errors. Cortex, 42(7), 10151020.CrossRefGoogle ScholarPubMed
Seltzer, B., Vasterling, J.J., Mathias, C.W., Brennan, A. (2001). Clinical and neuropsychological correlates of impaired awareness of deficits in Alzheimer disease and Parkinson disease: A comparative study. Journal of Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 14, 122129.Google ScholarPubMed
Seltzer, B., Vasterling, J.J., Yoder, J.A., Thompson, K.A. (1997). Awareness of deficit in Alzheimer's disease: Relation to caregiver burden. Gerontologist, 37(1), 2024.CrossRefGoogle ScholarPubMed
Sevush, S. (1999). Relationship between denial of memory deficit and dementia severity in Alzheimer's disease. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 12, 8894.Google Scholar
Sevush, S., Leve, N. (1993). Denial of memory deficit in Alzheimer's disease. American Journal of Psychiatry, 150, 748751.Google ScholarPubMed
Shallice, T., Burgess, P.W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727741.CrossRefGoogle ScholarPubMed
Smith, E.E., Jonides, J. (1999). Storage and executive processes in the frontal lobes. Science, 283, 16571661.CrossRefGoogle ScholarPubMed
Spinnler, H., Tognoni, G. (1987). Standardizzazione e taratura italiana di test neuropsicologici. Italian Journal of Neurological Sciences, (Suppl. 8 to 6).Google Scholar
Starkstein, S.E., Chemerinski, E., Sabe, L., Kuzis, G., Petracca, G., Tesòn, A., Leiguarda, R. (1997). Prospective longitudinal study of depression and anosognosia in Alzheimer's disease. The British Journal of Psychiatry, 171, 4752.CrossRefGoogle ScholarPubMed
Starkstein, S.E., Garau, M.L., Cao, A. (2004). Prevalence and clinical correlates of disinhibition in dementia. Cognitive and Behavioral Neurology, 17, 139147.CrossRefGoogle ScholarPubMed
Starkstein, S.E., Jorge, R., Mizrahi, R., Robinson, R.G. (2006). A diagnostic formulation for anosognosia in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 719725.CrossRefGoogle ScholarPubMed
Starkstein, S.E., Migliorelli, R., Teson, A., Petracca, G., Chemerinsky, E., Manes, F., Leiguarda, R. (1995). Prevalence and correlates of pathological affective display in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 59, 5560.CrossRefGoogle ScholarPubMed
Starkstein, S.E., Sabe, L., Chemerinski, E., Jason, L., Leigarda, R. (1996). Two domains of anosognosia in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 61, 485490.CrossRefGoogle ScholarPubMed
Vasterling, J.J., Seltzer, B., Foss, J.W., Vanderbrook, V. (1995). Unawareness of deficit in Alzheimer's disease: Domain-specific differences and disease correlates. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 8, 2632.Google Scholar
Verhey, F.R., Ponds, R.W., Rozendaal, N., Jolles, J. (1995). Depression, insight, and personality changes in Alzheimer's disease and vascular dementia. Journal of Geriatric Psychiatry and Neurology, 8(1), 2327.Google ScholarPubMed
Vogel, A., Hasselbalch, S.G., Gade, A., Ziebell, M., Waldemar, G. (2005). Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 20, 238246.CrossRefGoogle ScholarPubMed
Weinstein, E.A., Friedland, R.P., Wagner, E.E. (1994). Denial/unawareness of impairment and symbolic behavior in Alzheimer's disease. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 7, 176184.Google Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., Evans, J.J. (1996). BADS: Behavioural assessment of the dysexecutive syndrome. Bury St. Edmonds, UK: Thames Valley Test Company.Google Scholar
Wood, R.L., Liossi, C. (2007). The relationship between general intellectual ability and performance on ecologically valid executive tests in a severe brain injury sample. Journal of the International Neuropsychological Society, 13(1), 9098.CrossRefGoogle Scholar
Zanetti, O., Vallotti, B., Frisoni, G.B., Geroldi, C., Bianchetti, A., Pasqualetti, P., Trabucchi, M. (1999). Insight in dementia: When does it occur? Evidence for a nonlinear relationship between insight and cognitive status. Journal of Gerontology, 54, 100106.CrossRefGoogle ScholarPubMed