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Unawareness of memory impairment in dementia: a population-based study

Published online by Cambridge University Press:  17 January 2012

Daniel C. Mograbi ,
Cleusa P. Ferri ,
Ana L. Sosa ,
Robert Stewart ,
Jerson Laks ,
Richard Brown  and
Robin G. Morris
Daniel C. Mograbi*
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
Cleusa P. Ferri
Affiliation:
Section of Epidemiology, Institute of Psychiatry, King's College London, London, UK
Ana L. Sosa
Affiliation:
Section of Epidemiology, Institute of Psychiatry, King's College London, London, UK
Robert Stewart
Affiliation:
Section of Epidemiology, Institute of Psychiatry, King's College London, London, UK
Jerson Laks
Affiliation:
Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Richard Brown
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
Robin G. Morris
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, London, UK
*
Correspondence should be addressed to: Daniel C. Mograbi, Department of Psychology, Institute of Psychiatry, King's College London, P078, De Crespigny Park, SE5 8AF London, UK. Phone: +44-20-7848-5718. Email: daniel.mograbi@kcl.ac.uk.
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Abstract

Background: Unawareness of cognitive deficit in people with dementia (PwD) has wide clinical implications, impacting on help-seeking behavior, treatment compliance, and patient safety. Most studies on unawareness among PwD have been conducted in small clinical samples. This study investigated the frequency of unawareness of memory impairment in dementia, exploring regional differences and sociodemographic and health status correlates in large population-based surveys.

Methods: Community samples (total n = 15,022) from three world regions (Latin America, China, and India) were obtained using cross-sectional population-based surveys. Out of these, 897 (5.97%) PwD with memory impairment were identified using standardized interviews, diagnostic algorithms (DSM-IV or 10/66 criteria), and neuropsychological memory assessment. Unawareness of memory deficits was ascertained from the participants’ subjective report. The frequency of unawareness was calculated for each region and associations with demographic variables and health status were investigated using prevalence ratios and Poisson regressions.

Results: Regional differences in frequency of unawareness were found, from 63% in China to 81% in India. Unawareness was associated with depression in China and Latin America, dementia severity in India and Latin America, and education and socioeconomic level in Latin America.

Conclusions: Unawareness of memory impairment in PwD varies across international regions. Our data support the notion that unawareness should be seen not only as a common neurobiological feature of dementia, increasing with severity of dementia, but also as a phenomenon influenced by social and cultural factors.

Keywords

Alzheimer's diseaseanosognosiainsight10/66
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 6 , June 2012 , pp. 931 - 939
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P., Van Valen, 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
Aalten, P. et al. (2006). Awareness and behavioral problems in dementia patients: a prospective study. International Psychogeriatrics, 18, 3–17.CrossRefGoogle ScholarPubMed
Alzheimer's Disease International (2009). World Alzheimer Report 2009. London: Alzheimer's Disease International.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders IV. Washington DC: APA.Google Scholar
Clare, L., Markova, I., Verhey, F. and Kenny, G. (2005). Awareness in dementia: a review of assessment methods and measures. Aging & Mental Health, 9, 394–413.CrossRefGoogle ScholarPubMed
Clare, L., Goater, T. and Woods, B. (2006). Illness representations in early-stage dementia: a preliminary investigation. International Journal of Geriatric Psychiatry, 21, 761–767.CrossRefGoogle ScholarPubMed
Copeland, J. R., Prince, M., Wilson, K. C., Dewey, M. E., Payne, J. and Gurland, B. (2002). The Geriatric Mental State Examination in the 21st century. International Journal of Geriatric Psychiatry, 17, 729–732.CrossRefGoogle Scholar
David, A. S. (2004). The clinical importance of insight: an overview. In Amador, X. F. E. and David, A. S. E. (eds.), Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (2nd ed., pp. 359–392). New York: Oxford University Press.CrossRefGoogle Scholar
Gainotti, G. (1975). Confabulation of denial in senile dementia: an experimental design. Psychiatria Clinica, 8, 99–108.Google Scholar
Ganguli, M. et al. (1996). Cognitive test performance in a community-based nondemented elderly sample in rural India: the Indo-U.S. Cross-National Dementia Epidemiology Study. International Psychogeriatrics, 8, 507–524.Google Scholar
Hall, K., Hendrie, H., Brittain, H., Norton, J., Rodgers, D. and Prince, C. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methods in Psychiatric Research, 3, 1–28.Google Scholar
Higgins, J. P. T., Thompson, S. G., Deeks, J. J. and Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327, 557–560.Google Scholar
Lopez, O. L., Becker, J. T., Somsak, D. and Dew, M. A. (1994). Awareness of cognitive deficits and anosognosia in probable Alzheimer's disease. European Neurology, 34, 277–282.CrossRefGoogle ScholarPubMed
Markova, I. S. and Berrios, G. E. (2001). The “object” of insight assessment: relationship to insight “structure”. Psychopathology, 34, 245–252.CrossRefGoogle Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Morris, R. G. and Hannesdottir, K. (2004). Loss of “awareness” in Alzheimer's disease. In Morris, R. G. and Becker, J. T. (eds.), The Cognitive Neuropsychology of Alzheimer's Disease (pp. 275–296). Oxford: Oxford University Press.Google Scholar
Overman, A. A. and Becker, J. T. (2004). Information processing defects in episodic memory in Alzheimer's disease. In Morris, R. G. and Becker, J. T. (eds.), The Cognitive Neuropsychology of Alzheimer's Disease (pp. 121–140). Oxford: Oxford University Press.CrossRefGoogle Scholar
Ownsworth, T., Clare, L. and Morris, R. (2006). An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury. Neuropsychological Rehabilitation, 16, 415–438.CrossRefGoogle ScholarPubMed
Patel, V. and Prince, M. (2001). Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India. Psychological Medicine, 31, 29–38.CrossRefGoogle Scholar
Prince, M., Acosta, D., Chiu, H., Scazufca, M. and Varghese, M. (2003). Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361, 909–917.Google Scholar
Prince, M. et al. (2007). The protocols for the 10/66 Dementia Research Group population-based research programme. BMC Public Health, 7, 165.CrossRefGoogle Scholar
Prince, M. et al. (2008). The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study. BMC Public Health, 8, 219.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Seltzer, B., Vasterling, J. J., Yoder, J. and Thompson, K. A. (1997). Awareness of deficit in Alzheimer's disease: relation to caregiver burden. The Gerontologist, 37, 20–24.CrossRefGoogle ScholarPubMed
Sevush, S. and Leve, N. (1993). Denial of memory deficit in Alzheimer's disease. American Journal of Psychiatry, 150, 748–751.Google Scholar
Shaji, K. S., Smitha, K., Lal, K. P. and Prince, M. J. (2003). Caregivers of people with Alzheimer's disease: a qualitative study from the Indian 10/66 Dementia Research Network. International Journal of Geriatric Psychiatry, 18, 1–6.CrossRefGoogle ScholarPubMed
Spector, A., Woods, B. and Orrell, M. (2008). Cognitive stimulation for the treatment of Alzheimer's disease. Expert Review in Neurotherapeutics, 8, 751–757.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R., Mizrahi, R., Adrian, J. and Robinson, R. G. (2007). Insight and danger in Alzheimer's disease. European Journal of Neurology, 14, 455–460.CrossRefGoogle ScholarPubMed
Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448–460.Google Scholar
Weinstein, E. A. and Kahn, R. L. (1956). Patterns of social interaction in brain disease. American Journal of Psychiatry, 113, 138–142.CrossRefGoogle ScholarPubMed