Insight and Self-awareness in Patients with Alzheimer's Disease

Abstract

Objectives: Self awareness is progressively vanishing in Alzheimer's disease (AD) patients, while insight of amnesia seemingly stays longer than self awareness. It is clinically informative to prove that the residual learning ability of the patients exists, though defective, to help construct a better individualized rehabilitative strategy. Methods: Eighty-one patients (M:F=28:53), aged 59~102, with AD dementia were divided into four groups by mini-mental status examination (MMSE) scores (early: ＞/=21, n=16; mild: 16-20, n= 19; moderate: 11-15, n=30; severe: ＜/=10, n=16). Each group was tested for 1) self awareness by asking each individual name, age, birthday and children number, 2) visual confrontation naming of 3 presented objects, namely pencil, comb, and key, and 3) insight of amnesia by asking whether or not they have memory problems. Only completing right answers to all items in each test was counted as correct response (CR). Numbers of CR in each test were collected for analysis. Results: A concordant trend was noted between the severity of AD and test results. In mild and moderate AD patients whose self awareness were vanishing (CR=42%→0%), the insight of amnesia remained to a significant degree (CR=84%→60%). In early AD, four patients denied memory problems. The test result of confrontation naming was closer to that of insight of amnesia in mild and moderate AD patients, as compared to that of self awareness. Conclusions: While self awareness is vanishing in mild and moderate AD patients, their insight of amnesia remained to a significant degree, suggesting a learning effect. The learned insight of amnesia, through daily interaction, stays longer and stronger than self awareness in mild to severe AD patients. The four patients in their early AD denying memory problems did not learn from environmental feedbacks. The closer test results of insight of amnesia with confrontation naming in mild and moderate AD patients suggest a cortical language learning process. The potential of learning in AD patients sheds guiding light on rehabilitative strategy in mild and moderate AD.