Abstract
ABSTRACT Objectives To compare and discuss the objects of awareness in Alzheimer’s disease (AD): awareness of cognitive deficits, of functional activities, of social-emotional functioning and behavioral impairment. Methods A search in the PsycINFo, Pilots, PubMed/Medline and ISI electronic databases according to Prisma methodology was performed. We included studies about awareness in people with AD published between 2010 and 2015, with the combination of keywords: “Alzheimer AND awareness of deficits”, “Alzheimer AND anosognosia”, “Alzheimer AND insight”, “dementia AND awareness of deficits”, “dementia AND anosognosia”, “dementia AND insight”. The articles were categorized according to the specific object of awareness. Results Seven hundred and ten records were identified and, after application of the exclusion criteria, 191 studies were retrieved for potential use. After excluding the duplicates, 46 studies were included. Most studies assessed the cognitive domain of awareness, followed by the functional, social-emotional, and behavioral impairment domains. Memory deficits were not sufficient to explain impaired awareness in AD. Longitudinal studies did not find discrepancies between patients and caregivers’ reports, indicating that awareness is not related to cognition. Conflicting findings were observed, including the relation between awareness, mood, severity of disease, and personal characteristics. Conclusions The studies show lack of conceptual consensus and significant methodological differences. The inclusion of samples without differentiation of dementia etiology is associated to symptomatic differences, which affect awareness domains. Awareness in AD is a complex and multidimensional construct. Different objects elicit different levels of awareness.
Highlights
Empirical research has recently focused on exploring awareness in people with dementia (PwD)[1,2]
We proposed to discuss the concepts and domains used to evaluate types of awareness, such as awareness of cognitive deficits, of social-emotional status and behavioral impairment and awareness of functional activities
The first moment of evaluation showed that impairment in awareness was associated to deficits in ADL, cognitive impairments, and higher PwD quality of life ratings
Summary
Empirical research has recently focused on exploring awareness in people with dementia (PwD)[1,2]. Awareness is the recognition of changes caused by the deficits related to the disease process It includes three dimensions: the ability to recognize a specific deficit, the emotional response to the difficulties and the ability to understand the impact of the impairment in the functional activities[3,4]. Three main factors determine clinical phenomena of awareness: the underlying concept selected by the clinician/researcher, the measure used to elicit it, and the specific object of awareness chosen[6,7]. These factors may be variable in dementia research
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