Abstract
Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific.
Highlights
Unawareness, lack of insight, or anosognosia refers to impaired awareness in persons with dementia [1,2,3,4,5,6,7]
The primary purpose of this paper is to describe the clinical correlates of awareness of balance in addition to the more commonly measured awareness of function in basic and instrumental activities of daily living (BADLs and IADLs, resp.) and awareness of memory
For this IRB approved study, patients who were diagnosed with no cognitive impairment were excluded, and only patients who received a diagnosis of dementia or a variant of mild cognitive impairment (MCI) were included
Summary
Unawareness, lack of insight, or anosognosia refers to impaired awareness in persons with dementia [1,2,3,4,5,6,7]. Most of the literature on awareness in persons with dementia describes the clinical correlates of one awareness domain (reviews by [1, 4, 11]), but the few studies that have contrasted awareness for different domains have found differential patterns of clinical correlates [12,13,14,15]. This paper provides further support for the modality specific nature of awareness in dementia by contrasting the clinical correlates for awareness of balance in addition to more commonly measured awareness of day-today function and memory. Awareness has been measured with clinician ratings [16, 17]; or based on discrepancy between self-report versus clinicians’
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