Anosognosia in Very Mild Alzheimer’s Disease but Not in Mild Cognitive Impairment

• Published in: Dementia and geriatric cognitive disorders 2005-01, Vol.19 (5-6), p.349-356
• Main Authors: Kalbe, E., Salmon, E., Perani, D., Holthoff, V., Sorbi, S., Elsner, A., Weisenbach, S., Brand, M., Lenz, O., Kessler, J., Luedecke, S., Ortelli, P., Herholz, K.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Agnosia - diagnosis; Agnosia - etiology; Alzheimer Disease - complications; Alzheimer Disease - diagnosis; Alzheimer's disease; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; anosognosia; Biological and medical sciences; Cognition Disorders - complications; Cognition Disorders - diagnosis; cognitive dysfunction; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; dementia; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Human health sciences; Humans; insight; Intensive care medicine; Male; Medical History Taking; Medical sciences; Middle Aged; mild cognitive impairment; Neurologie; Neurology; Neuropharmacology; Original Research Article; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Regression Analysis; Sciences de la santé humaine; Sciences sociales & comportementales, psychologie; self awareness; Severity of Illness Index; Social & behavioral sciences, psychology; Sociologie & sciences sociales; Sociology & social sciences
• ISSN: 1420-8008; 1421-9824; 1421-9824
• DOI: 10.1159/000084704

Objective: To study awareness of cognitive dysfunction in patients with very mild Alzheimer’s disease (AD) and subjects with mild cognitive impairment (MCI). Methods: A complaint interview covering 13 cognitive domains was administered to 82 AD and 79 MCI patients and their caregivers. The patient groups were comparable according to age and education, and Mini Mental State Examination (MMSE) scores were ≧24 in all cases. The discrepancy between the patients’ and caregivers’ estimations of impairments was taken as a measure of anosognosia. Results: Self-reports of cognitive difficulties were comparable for AD and MCI patients. However, while in comparison to caregivers MCI patients reported significantly more cognitive impairment (p < 0.05), AD patients complained significantly less cognitive dysfunctions (p < 0.001). Conclusions: While most MCI patients tend to overestimate cognitive deficits when compared to their caregiver’s assessment, AD patients in early stages of disease underestimate cognitive dysfunctions. Anosognosia can thus be regarded as a characteristic symptom at a stage of very mild AD (MMSE ≧24) but not MCI. Accordingly, medical history even in mildly affected patients should always include information from both patient and caregiver.