Loss of awareness in Alzheimer’s disease (AD): Considerations of lack of insight and legal liabilities in the United States

Abstract

Background: Clinicians and researchers have commonly observed deficits in awareness in patient’s suffering from Alzheimer’s disease (AD). The most frequently noted deficits involve a patient’s inability to recognize their own cognitive limitations. This abnormality of awareness in AD is referred to as anosognosia. The presence of anosognosia may have significant implications as a person becomes less aware of how their performance of common daily activities has deteriorated. This lack of awareness not only places the individual and society at risk. The US legal system has addressed these issues in past cases, which have set precedence for determining legal responsibility. Objective(s): In this study the Cole Anosognosia Scale for Alzheimer’s disease (CAS-AD) is used to explore the patients’ insight towards their personal driving skills. Identifying anosognosia patients makes it easier for the clinician to advise caregiver’s, as well as to make them understand the importance of limiting certain patient activities (driving).Methods: The CAS-AD and Driver’s Awareness Scale was used for the study. The CAS-AD measure a patient’s knowledge of their own cognitive deficits and behavioral changes based on generally observed symptoms of AD. The responses are compared to a set of responses reported by their caregiver. The Driver’s Awareness Scale also uses a format that compares the patient’s responses to 10 driving questions to the response of the patient’s caregiver. 48 Mild to Moderate AD patients and their caregivers participated in the study. The subjects were divided into two groups: those with anosognosia and those without. A statistical analysis was performed to determine if there was a significant difference between patients with and without anosognosia in regards to insight towards driving behavior. Conclusions: Significantly less insight towards driving behavior was found in patients with anosognosia compared to those without ( 0.05, t -2.408, p 0.019). The study shows the importance of identifying an AD patient with anosognosia in a clinical setting. Convincing a patient or a caregiver of restricting the patient’s driving (and other behaviors) is potentially easier when the clinician is supported by the results of an objective test and by explaining the potential legal liability associated with the restricted behaviors.