Abstract
Background Awareness of deficits is a complex phenomenon. In this study, we examined the relationships among various measures of awareness of cognitive deficits in dementia, and investigated the unique association between clinician ratings and alternative approaches to assessing awareness. Methods Participants included 108 patients with very mild (n = 50) or mild (n = 58) dementia. Awareness of cognitive difficulties was assessed by clinician ratings, informant ratings, patients' reports of cognitive difficulties, discrepancies between patients' and informants' reports of cognitive difficulties, and patients' perceptions of performance on neuropsychological tests. Correlational analyses were used to assess associations among these measures of awareness, and ordinal logistic regression was used to examine the unique relationship between clinician ratings of awareness and the other approaches. Results All measures of awareness were significantly correlated with one another. Coefficients ranged from 0.26 to −0.64. Patients categorized as unaware by either clinicians or informants reported fewer cognitive difficulties. Of the awareness measures evaluated, clinician ratings had the strongest correlation with measures of global cognition. In the regression analysis, only informant global ratings and patients' reports of cognitive difficulties were significantly associated with clinician ratings. The model's classification accuracy was satisfactory for patients in the “intact awareness” and “severe unawareness” categories, but not for those in the “mild unawareness” category. Conclusions Although measures of awareness likely share overlapping variance, they are not interchangeable. Each potentially elucidates unique aspects of the complex phenomenon of awareness, with clinician assessment being the most suited for ambiguous cases. When clinician assessment is not feasible, informant rating (but not patient-informant discrepancy) would be a valid substitute.
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