Abstract

Background: The symptom anosognosia or unawareness of disease in dementia has mainly been studied in patients with late-onset dementia (LOD, ≥65 years), whereas little is known on whether it is also present in patients with early-onset dementia (EOD, <65 years). We aimed at investigating differences in anosognosia between LOD and EOD, by also studying its association with different clinical variants of EOD and the presence of neuropsychiatric symptoms.Methods: A total of 148 patients, 91 EOD and 57 LOD, were recruited and underwent extended clinical assessment and caregiver interview that included questionnaires aimed at measuring anosognosia and neuropsychiatric symptoms. Differences in anosognosia between EOD and LOD and between subgroups with different clinical variants were investigated, as well as correlation between anosognosia and neuropsychiatric symptoms. A regression analysis was applied to explore the association between anosognosia and development of neuropsychiatric symptoms during disease progression.Results: Median levels of anosognosia were not significantly different between EOD and LOD. Anosognosia increased overtime with disease progression and was higher in frontotemporal dementia patients or, more precisely, in frontotemporal dementia and Alzheimer's disease variants associated with involvement of the frontal lobes. Higher levels of early anosognosia were associated with higher frequency and severity of subsequent neuropsychiatric symptoms, in particular apathy, later in the course of the disease.Conclusion: Anosognosia is a frequent symptom of EOD, occurring in 94.5% of all-cause EOD, and it is associated with higher risk of developing neuropsychiatric symptoms during disease progression. Recognising anosognosia may be helpful for clinicians and families to reduce diagnostic delay and improve disease managment.

Highlights

  • Patients with dementia frequently are not aware of their cognitive difficulties, a neurological symptom indicated as anosognosia

  • We collected demographic data, clinical information such as type of dementia diagnosis at the moment of recruitment and duration of disease from symptoms onset until recruitment, neuropsychological measures including the MMSE [13] at the moment of recruitment and when patients had been first seen in the Modena dementia service, and measurement of anosognosia at the moment of recruitment and when patients had been first seen in the Modena dementia service

  • Considering the whole cohort, 86 patients were diagnosed as Alzheimer’s disease (AD) (52 EOD, 35 LOD), 28 patients as FTD (23 EOD, 5 LOD), 12 patients with DLB (3 EOD, 9 LOD), 9 as vascular dementia (VaD) (6 EOD, 3 LOD), 7 patients with ayptical parkinsonism (5 EOD, 2 LOD), and 6 with other dementia

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Summary

Introduction

Patients with dementia frequently are not aware of their cognitive difficulties, a neurological symptom indicated as anosognosia. Research into anosognosia has mainly focused in dementia in old age [late-onset dementia, ≥65 years, (LOD)]. One first study focusing on early- vs late-onset Alzheimer’s disease (AD) found that AD-EOD were more aware of their cognitive disturbances (i.e., had less anosognosia) compared to AD-LOD [9]; on the contrary, Dourado et al did not find significant differences between these two groups [10]. The symptom anosognosia or unawareness of disease in dementia has mainly been studied in patients with late-onset dementia (LOD, ≥65 years), whereas little is known on whether it is present in patients with early-onset dementia (EOD,

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