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Vol. 30, No. 1, 2010
Issue release date: August 2010
Free Access
Dement Geriatr Cogn Disord 2010;30:83–92
(DOI:10.1159/000318752)

Awareness of Memory Abilities in Community-Dwelling Older Adults with Suspected Dementia and Mild Cognitive Impairment

Lin F.a, e · Wharton W.b, d · Dowling N.M.c, d · Ries M.L.b, d · Johnson S.C.b, d, e · Carlsson C.M.b, d, e · Asthana S.b, d, e · Gleason C.E.b, d, e
aSchool of Nursing, bSection of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, and cDepartment of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, dWisconsin Alzheimer’s Disease Research Center and eGeriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veteran’s Hospital, Madison, Wisc., USA
email Corresponding Author

Abstract

Aims: To examine awareness of memory abilities by groups (healthy control, suspected dementia/mild cognitive impairment, MCI, and diagnosed dementia/MCI), and to describe group differences in the relationship between awareness and cognitive performance in a community sample. Methods: In a cross-sectional design, 183 subjects were evaluated in a community setting and categorized into 3 groups based on their cognitive performance and reported medical history. Awareness of memory abilities was quantified using a published anosognosia ratio (AR) comparing the estimated to the objective memory performance by subjects. Each group was further categorized into ‘overestimators’, ‘accurate estimators’, and ‘underestimators’ based on their AR scores. Results: The suspected and diagnosed dementia/MCI groups had significantly higher AR scores than the controls. The suspected group also had a significantly larger proportion (96.2%) of overestimators than the diagnosed (73.3%) and control groups (26.1%). Impaired awareness in overestimators of the suspected and diagnosed groups was correlated with deficits in executive function, language or global cognition. Conclusion: Impaired awareness of memory abilities was prevalent in community-dwelling older adults with suspected and diagnosed dementia or MCI. Those with suspected dementia or MCI were more likely to overestimate their memory abilities than their diagnosed counterparts, suggesting that limited awareness of deficits may hinder utilization of dementia diagnostic services.


 goto top of outline Key Words

  • Anosognosia
  • Dementia
  • Mild cognitive impairment
  • Memory
  • Neuropsychology
  • Community-dwelling

 goto top of outline Abstract

Aims: To examine awareness of memory abilities by groups (healthy control, suspected dementia/mild cognitive impairment, MCI, and diagnosed dementia/MCI), and to describe group differences in the relationship between awareness and cognitive performance in a community sample. Methods: In a cross-sectional design, 183 subjects were evaluated in a community setting and categorized into 3 groups based on their cognitive performance and reported medical history. Awareness of memory abilities was quantified using a published anosognosia ratio (AR) comparing the estimated to the objective memory performance by subjects. Each group was further categorized into ‘overestimators’, ‘accurate estimators’, and ‘underestimators’ based on their AR scores. Results: The suspected and diagnosed dementia/MCI groups had significantly higher AR scores than the controls. The suspected group also had a significantly larger proportion (96.2%) of overestimators than the diagnosed (73.3%) and control groups (26.1%). Impaired awareness in overestimators of the suspected and diagnosed groups was correlated with deficits in executive function, language or global cognition. Conclusion: Impaired awareness of memory abilities was prevalent in community-dwelling older adults with suspected and diagnosed dementia or MCI. Those with suspected dementia or MCI were more likely to overestimate their memory abilities than their diagnosed counterparts, suggesting that limited awareness of deficits may hinder utilization of dementia diagnostic services.

Copyright © 2010 S. Karger AG, Basel


 goto top of outline References
  1. Sternberg SA, Wolfson C, Baumgarten M: Undetected dementia in community-dwelling older people: the Canadian Study of Health and Aging. J Am Geriatr Soc 2000;48:1430–1434.
  2. Babinski J: Contribution to the study of mental disturbance in organic cerebral hemiplegia (anosognosia) (in French). Rev Neurol (Paris) 1914;12:845–848.
  3. Twamley EW, Ropacki SA, Bondi MW: Neuropsychological and neuroimaging changes in preclinical Alzheimer’s disease. J Int Neuropsychol Soc 2006;12:707–735.
  4. Tabert MH, Albert SM, Borukhova-Milov L, et al: Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology 2002;58:758–764.
  5. Kashiwa Y, Kitabayashi Y, Narumoto J, Nakamura K, Ueda H, Fukui K: Anosognosia in Alzheimer’s disease: association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry Clin Neurosci 2005;59:697–704.
  6. Starkstein SE, Jorge R, Mizrahi R, Robinson RG: A diagnostic formulation for anosognosia in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2006;77:719–725.
  7. Hannesdóttir K, Morris RG: Primary and secondary anosognosia for memory impairment in patients with Alzheimer’s disease. Cortex 2007;43:1020–1030.
  8. Gallo DA, Chen JM, Wiseman AL, Schacter DL, Budson AE: Retrieval monitoring and anosognosia in Alzheimer’s disease. Neuropsychology 2007;21:559–568.
  9. Agnew SK, Morris RG: The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: a review of the literature and a proposed model. Aging Ment Health 1998;2:7–19.
  10. Okonkwo OC, Griffith HR, Vance DE, Marson DC, Ball KK, Wadley VG: Awareness of functional difficulties in mild cognitive impairment: a multidomain assessment approach. J Am Geriatr Soc 2009;57:978–984.
  11. Vogel A, Stokholm J, Gade A, Andersen BB, Hejl AM, Waldemar G: Awareness of deficits in mild cognitive impairment and Alzheimer’s disease: do MCI patients have impaired insight? Dement Geriatr Cogn Disord 2004;17:181–187.
  12. Souchay C: Metamemory in Alzheimer’s disease. Cortex 2007;43:987–1003.
  13. Barrett AM, Eslinger PJ, Ballentine NH, Heilman KM: Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control subjects. Neurology 2005;64:693–699.
  14. Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5:165–173.

    External Resources

  15. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV). Washington, American Psychiatric Association, 1994.
  16. Gauthier S, Reisberg B, Zaudig M, et al: Mild cognitive impairment. Lancet 2006;367:1262–1270.
  17. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271–276.

    External Resources

  18. Stroop JR: Studies of interference in serial verbal reactions. J Exp Psychol Gen 1935;18:643–662.

    External Resources

  19. Spreen O, Strauss E: A Compendium of Neuropsychological Tests. New York, Oxford University Press, 1998.
  20. Northern California Neurobehavioral Group: Manual for the Neurobehavioral Cognitive Status Examination. Fairfax, Northern California Neurobehavioral Group, 2001.
  21. Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  22. Sunderland T, Hill JL, Mellow AM, et al: Clock drawing in Alzheimer’s disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725–729.
  23. Morris JC, Edland S, Clark C, et al: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). 4. Rates of cognitive change in the longitudinal assessment of probable Alzheimer’s disease. Neurology 1993;43:2457–2465.
  24. Smith G, della Sala S, Logie RH, Maylor EA: Prospective and retrospective memory in normal ageing and dementia: a questionnaire study. Memory 2000;8:311–321.
  25. Welsh KA, Butters N, Mohs RC, et al: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). 5. A normative study of the neuropsychological battery. Neurology 1994;44:609–614.
  26. Mitrushina MN, Boone KB: Handbook of Normative Data for Neuropsychological Assessment. New York, Oxford University Press, 2005.
  27. Wagner MT, Spangenberg KB, Bachman DL, O’Connell P: Unawareness of cognitive deficit in Alzheimer disease and related dementias. Alzheimer Dis Assoc Disord 1997;11:125–131.
  28. SPSS 16.0 for Windows. Chicago, SPSS, 2007.
  29. Games PA, Howell JF: Pairwise multiple comparison procedures with unequal N’s and/or variances: a Monte Carlo study. J Educ Behav Stat 1976;1:113.

    External Resources

  30. MacKinnon JG, Davidson R: Estimation and Inference in Econometrics. New York, Oxford University Press, 1993.
  31. Hayes AF, Cai L: Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation. Behav Res Methods 2007;39:709.
  32. Clement F, Belleville S, Gauthier S: Cognitive complaint in mild cognitive impairment and Alzheimer’s disease. J Int Neuropsychol Soc 2008;14:222–232.
  33. Vogel A, Hasselbalch SG, Gade A, Ziebell M, Waldemar G: Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer’s disease. Int J Geriatr Psychiatry 2005;20:238–246.
  34. Kalbe E, Salmon E, Perani D, et al: Anosognosia in very mild Alzheimer’s disease but not in mild cognitive impairment. Dement Geriatr Cogn Disord 2005;19:349–356.
  35. Clare L: Awareness in early-stage Alzheimer’s disease: a review of methods and evidence. Br J Clin Psychol 2004;43:177–196.
  36. Ries ML, Jabbar BM, Schmitz TW, et al: Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. J Int Neuropsychol Soc 2007;13:450–461.
  37. Johnson SC, Ries ML, Hess TM, et al: Effect of Alzheimer disease risk on brain function during self-appraisal in healthy middle-aged adults. Arch Gen Psychiatry 2007;64:1163–1171.
  38. Palmer K, Backman L, Winblad B, Fratiglioni L: Detection of Alzheimer’s disease and dementia in the preclinical phase: population-based cohort study. BMJ 2003;326:245.
  39. Roberts JL, Clare L, Woods RT: Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord 2009;28:95–109.
  40. Purser JL, Fillenbaum GG, Wallace RB: Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations. J Am Geriatr Soc 2006;54:335–338.
  41. Crowe M, Andel R, Wadley V, et al: Subjective cognitive function and decline among older adults with psychometrically defined amnestic MCI. Int J Geriatr Psychiatry 2006;21:1187–1192.

 goto top of outline Author Contacts

Carey E. Gleason, PhD
Madison VA GRECC (D4211)
2500 Overlook Terrace
Madison, WI 53705 (USA)
Tel. +1 608 280 7000, Fax +1 608 280 7165, E-Mail ceg@medicine.wisc.edu


 goto top of outline Article Information

Accepted: June 17, 2010
Published online: August 12, 2010
Number of Print Pages : 10
Number of Figures : 2, Number of Tables : 3, Number of References : 41
Additional supplementary material is available online - Number of Parts : 1


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 30, No. 1, Year 2010 (Cover Date: August 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Aims: To examine awareness of memory abilities by groups (healthy control, suspected dementia/mild cognitive impairment, MCI, and diagnosed dementia/MCI), and to describe group differences in the relationship between awareness and cognitive performance in a community sample. Methods: In a cross-sectional design, 183 subjects were evaluated in a community setting and categorized into 3 groups based on their cognitive performance and reported medical history. Awareness of memory abilities was quantified using a published anosognosia ratio (AR) comparing the estimated to the objective memory performance by subjects. Each group was further categorized into ‘overestimators’, ‘accurate estimators’, and ‘underestimators’ based on their AR scores. Results: The suspected and diagnosed dementia/MCI groups had significantly higher AR scores than the controls. The suspected group also had a significantly larger proportion (96.2%) of overestimators than the diagnosed (73.3%) and control groups (26.1%). Impaired awareness in overestimators of the suspected and diagnosed groups was correlated with deficits in executive function, language or global cognition. Conclusion: Impaired awareness of memory abilities was prevalent in community-dwelling older adults with suspected and diagnosed dementia or MCI. Those with suspected dementia or MCI were more likely to overestimate their memory abilities than their diagnosed counterparts, suggesting that limited awareness of deficits may hinder utilization of dementia diagnostic services.



 goto top of outline Author Contacts

Carey E. Gleason, PhD
Madison VA GRECC (D4211)
2500 Overlook Terrace
Madison, WI 53705 (USA)
Tel. +1 608 280 7000, Fax +1 608 280 7165, E-Mail ceg@medicine.wisc.edu


 goto top of outline Article Information

Accepted: June 17, 2010
Published online: August 12, 2010
Number of Print Pages : 10
Number of Figures : 2, Number of Tables : 3, Number of References : 41
Additional supplementary material is available online - Number of Parts : 1


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 30, No. 1, Year 2010 (Cover Date: August 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Sternberg SA, Wolfson C, Baumgarten M: Undetected dementia in community-dwelling older people: the Canadian Study of Health and Aging. J Am Geriatr Soc 2000;48:1430–1434.
  2. Babinski J: Contribution to the study of mental disturbance in organic cerebral hemiplegia (anosognosia) (in French). Rev Neurol (Paris) 1914;12:845–848.
  3. Twamley EW, Ropacki SA, Bondi MW: Neuropsychological and neuroimaging changes in preclinical Alzheimer’s disease. J Int Neuropsychol Soc 2006;12:707–735.
  4. Tabert MH, Albert SM, Borukhova-Milov L, et al: Functional deficits in patients with mild cognitive impairment: prediction of AD. Neurology 2002;58:758–764.
  5. Kashiwa Y, Kitabayashi Y, Narumoto J, Nakamura K, Ueda H, Fukui K: Anosognosia in Alzheimer’s disease: association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry Clin Neurosci 2005;59:697–704.
  6. Starkstein SE, Jorge R, Mizrahi R, Robinson RG: A diagnostic formulation for anosognosia in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2006;77:719–725.
  7. Hannesdóttir K, Morris RG: Primary and secondary anosognosia for memory impairment in patients with Alzheimer’s disease. Cortex 2007;43:1020–1030.
  8. Gallo DA, Chen JM, Wiseman AL, Schacter DL, Budson AE: Retrieval monitoring and anosognosia in Alzheimer’s disease. Neuropsychology 2007;21:559–568.
  9. Agnew SK, Morris RG: The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: a review of the literature and a proposed model. Aging Ment Health 1998;2:7–19.
  10. Okonkwo OC, Griffith HR, Vance DE, Marson DC, Ball KK, Wadley VG: Awareness of functional difficulties in mild cognitive impairment: a multidomain assessment approach. J Am Geriatr Soc 2009;57:978–984.
  11. Vogel A, Stokholm J, Gade A, Andersen BB, Hejl AM, Waldemar G: Awareness of deficits in mild cognitive impairment and Alzheimer’s disease: do MCI patients have impaired insight? Dement Geriatr Cogn Disord 2004;17:181–187.
  12. Souchay C: Metamemory in Alzheimer’s disease. Cortex 2007;43:987–1003.
  13. Barrett AM, Eslinger PJ, Ballentine NH, Heilman KM: Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control subjects. Neurology 2005;64:693–699.
  14. Sheikh JI, Yesavage JA: Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5:165–173.

    External Resources

  15. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV). Washington, American Psychiatric Association, 1994.
  16. Gauthier S, Reisberg B, Zaudig M, et al: Mild cognitive impairment. Lancet 2006;367:1262–1270.
  17. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271–276.

    External Resources

  18. Stroop JR: Studies of interference in serial verbal reactions. J Exp Psychol Gen 1935;18:643–662.

    External Resources

  19. Spreen O, Strauss E: A Compendium of Neuropsychological Tests. New York, Oxford University Press, 1998.
  20. Northern California Neurobehavioral Group: Manual for the Neurobehavioral Cognitive Status Examination. Fairfax, Northern California Neurobehavioral Group, 2001.
  21. Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  22. Sunderland T, Hill JL, Mellow AM, et al: Clock drawing in Alzheimer’s disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725–729.
  23. Morris JC, Edland S, Clark C, et al: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). 4. Rates of cognitive change in the longitudinal assessment of probable Alzheimer’s disease. Neurology 1993;43:2457–2465.
  24. Smith G, della Sala S, Logie RH, Maylor EA: Prospective and retrospective memory in normal ageing and dementia: a questionnaire study. Memory 2000;8:311–321.
  25. Welsh KA, Butters N, Mohs RC, et al: The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). 5. A normative study of the neuropsychological battery. Neurology 1994;44:609–614.
  26. Mitrushina MN, Boone KB: Handbook of Normative Data for Neuropsychological Assessment. New York, Oxford University Press, 2005.
  27. Wagner MT, Spangenberg KB, Bachman DL, O’Connell P: Unawareness of cognitive deficit in Alzheimer disease and related dementias. Alzheimer Dis Assoc Disord 1997;11:125–131.
  28. SPSS 16.0 for Windows. Chicago, SPSS, 2007.
  29. Games PA, Howell JF: Pairwise multiple comparison procedures with unequal N’s and/or variances: a Monte Carlo study. J Educ Behav Stat 1976;1:113.

    External Resources

  30. MacKinnon JG, Davidson R: Estimation and Inference in Econometrics. New York, Oxford University Press, 1993.
  31. Hayes AF, Cai L: Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation. Behav Res Methods 2007;39:709.
  32. Clement F, Belleville S, Gauthier S: Cognitive complaint in mild cognitive impairment and Alzheimer’s disease. J Int Neuropsychol Soc 2008;14:222–232.
  33. Vogel A, Hasselbalch SG, Gade A, Ziebell M, Waldemar G: Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer’s disease. Int J Geriatr Psychiatry 2005;20:238–246.
  34. Kalbe E, Salmon E, Perani D, et al: Anosognosia in very mild Alzheimer’s disease but not in mild cognitive impairment. Dement Geriatr Cogn Disord 2005;19:349–356.
  35. Clare L: Awareness in early-stage Alzheimer’s disease: a review of methods and evidence. Br J Clin Psychol 2004;43:177–196.
  36. Ries ML, Jabbar BM, Schmitz TW, et al: Anosognosia in mild cognitive impairment: relationship to activation of cortical midline structures involved in self-appraisal. J Int Neuropsychol Soc 2007;13:450–461.
  37. Johnson SC, Ries ML, Hess TM, et al: Effect of Alzheimer disease risk on brain function during self-appraisal in healthy middle-aged adults. Arch Gen Psychiatry 2007;64:1163–1171.
  38. Palmer K, Backman L, Winblad B, Fratiglioni L: Detection of Alzheimer’s disease and dementia in the preclinical phase: population-based cohort study. BMJ 2003;326:245.
  39. Roberts JL, Clare L, Woods RT: Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord 2009;28:95–109.
  40. Purser JL, Fillenbaum GG, Wallace RB: Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations. J Am Geriatr Soc 2006;54:335–338.
  41. Crowe M, Andel R, Wadley V, et al: Subjective cognitive function and decline among older adults with psychometrically defined amnestic MCI. Int J Geriatr Psychiatry 2006;21:1187–1192.