Abstract
Lack of awareness about disease, its symptoms and consequences, also termed anosognosia, is a common feature of Alzheimer’s disease (AD). It has been hypothesized that memory disorder may be a key contributing factor to anosognosia, with people with AD not being able to update their personal information about performance and relying on older consolidated material about ability. This potentially outdated sense of self has been named, as a metaphor, the petrified self. In the current review, evidence from the past 10 years in relation to this concept is critically appraised. In particular, focus is given to empirical evidence produced on anterograde memory deficits about performance, the profile of autobiographical retrograde memory loss and the role of frontal lobes in anosognosia in AD. Finally, wider consequences of this metaphor for the understanding of selfhood in dementia are discussed.
Highlights
Whilst anosognosia is more generally defined as lack of awareness about neurological impairment or illness, it can be applied to Alzheimer’s disease (AD), in which patients are frequently unaware of their cognitive deficits and the consequences of their clinical condition (Mograbi et al, 2009, 2012; Mograbi and Morris, 2018)
Our formulation has been the Cognitive Awareness Model (CAM; Agnew and Morris, 1998; Morris and Hannesdottir, 2004; Morris and Mograbi, 2013), where lack of explicit awareness is thought to be the result of cognitive impairments at different levels, with anosognosia being characterized by its heterogeneity
Two elements were highlighted in this “stone” metaphor: (1) Limited updates in self-concept because of anterograde amnesia caused by degeneration of neuronal structures that support declarative memory acquisition, such as the hippocampus; and (2) a preserved core of identity based on remote autobiographical memory (ABM), in particular of the semantic type, which has long been consolidated
Summary
Whilst anosognosia is more generally defined as lack of awareness about neurological impairment or illness, it can be applied to Alzheimer’s disease (AD), in which patients are frequently unaware of their cognitive deficits and the consequences of their clinical condition (Mograbi et al, 2009, 2012; Mograbi and Morris, 2018). Two elements were highlighted in this “stone” metaphor: (1) Limited updates in self-concept because of anterograde amnesia caused by degeneration of neuronal structures that support declarative memory acquisition, such as the hippocampus; and (2) a preserved core of identity based on remote autobiographical memory (ABM), in particular of the semantic type, which has long been consolidated. It is 10 years since the Petrified Self term was used and since a considerable amount of new evidence has been produced about the relationship between memory, self and awareness in AD. We conclude by discussing reactions to the Petrified Self metaphor and potential implications for how we view people with dementia
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