Abstract
Patients with Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) may present anosognosia for their cognitive deficits. Three different methods have been usually used to measure anosognosia in patients with AD and MCI, but no studies have established if they share similar neuroanatomical correlates. The purpose of this study was to investigate if anosognosia scores obtained with the three most commonly used methods to assess anosognosia relate to focal atrophy in AD and MCI patients, in order to improve understanding of the neural basis of anosognosia in dementia. Anosognosia was evaluated in 27 patients (15 MCI and 12 AD) through clinical rating (Clinical Insight Rating Scale, CIRS), patient-informant discrepancy (Anosognosia Questionnaire Dementia, AQ-D), and performance discrepancy on different cognitive domains (self-appraisal discrepancies, SADs). Voxel-based morphometry correlational analyses were performed on magnetic resonance imaging (MRI) data with each anosognosia score. Increasing anosognosia on any anosognosia measurement (CIRS, AQ-D, SADs) was associated with increasing gray matter atrophy in the medial temporal lobe including the right hippocampus. Our results support a unitary mechanism of anosognosia in AD and MCI, in which medial temporal lobes play a key role, irrespectively of the assessment method used. This is in accordance with models suggesting that anosognosia in AD is primarily caused by a decline in mnemonic processes.
Highlights
Awareness of our own performance is a critical component of normal cognition that gives us the ability to recognize our limits and plan our behavior
There were no significant differences in age, years of education, reported duration of cognitive complain, and gender between the Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI) groups (Table 1)
There was a negative correlation between Self-appraisal Discrepancy (SAD)-Stroop and MMSE (Sperman’s Rho, rs = −0.60, p = 0.001), whereas all other measures of anosognosia did not correlate with severity of disease
Summary
Awareness of our own performance is a critical component of normal cognition that gives us the ability to recognize our limits and plan our behavior . Many previous studies exploring aspects of anosognosia in people with MCI and AD have led to heterogeneous and sometimes inconsistent findings concerning the association of anosognosia with neuropsychological and psychiatric characteristics (Kaszniak and Edmons, 2010; Starkstein et al, 2010; De Carolis et al, 2015), severity of disease (Sunderaraman and Cosentino, 2017), and underlying neuroanatomical correlates (Zamboni and Wilcock, 2011; Cosentino et al, 2015) The cause of this variability may in part reflect different approaches used to study insight, that can be broadly classified in clinical approaches adopting the clinical concept of anosognosia or approaches from cognitive psychology adopting the concept of metacognition (Sunderaraman and Cosentino, 2017). Variations of this method have been traditionally used to assess meta-cognitive abilities in healthy subjects in cognitive psychology studies, but have recently been increasingly used to measure online and immediate insight in patients with dementia (Martyr et al, 2014)
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