Awareness Of Cognitive Impairment Research Articles

Delivering Optimal Care to People with Cognitive Impairment in Parkinson's Disease: A Qualitative Study of Patient, Caregiver, and Professional Perspectives.

Cognitive impairment is common in Parkinson's disease (PD) and associated with lower quality of life. Cognitive impairment in PD manifests differently to other dementia pathologies. Provision of optimal care requires knowledge about the support needs of this population. Eleven people with PD and cognitive impairment (PwP), 10 family caregivers, and 27 healthcare professionals were purposively sampled from across the United Kingdom. Semistructured interviews were conducted in 2019-2021, audio-recorded, transcribed, and analysed using reflexive thematic analysis. Cognitive impairment in PD conveyed increased complexity for clinical management and healthcare interactions, the latter driven by multifactorial communication difficulties. Techniques that helped included slow, simple, and single messages, avoiding topic switching. Information and emotional support needs were often unmet, particularly for caregivers. Diagnostic pathways were inconsistent and awareness of cognitive impairment in PD was poor, both contributing to underdiagnosis. Many felt that PwP and cognitive impairment fell through service gaps, resulting from disjointed, nonspecific, and underresourced services. Personalised care was advocated through tailoring to individual needs of PwP and caregivers facilitated by flexibility, time and continuity within services, and supporting self-management. This study highlights unmet need for people with this complex condition. Clinicians should adapt their approach and communication techniques for this population and provide tailored information and support to both PwP and caregivers. Services need to be more streamlined and collaborative, providing more time and flexibility. There is a need for wider awareness and deeper understanding of this condition and its differences from other types of dementia.

Subjective vs informant-reported cognitive complaints have differential clinical significance in covert cerebral small vessel disease

ObjectiveSubjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI. MethodIn the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15). ResultsSubjective cognitive complaints correlated significantly with informant reports (r=0.40–0.50, p<0.001). After controlling for demographics, subjective and informant DEX and PRMQ were not related to MCI, memory or executive functions. Instead, subjective DEX and PRMQ significantly associated with GDS-15 and informant DEX and PRMQ with WMH volume and A-IADL. ConclusionsNeither subjective nor informant-reported cognitive complaints associated with objective cognitive performance. Informant-evaluations were related to functional impairment and more severe WMH, whereas subjective complaints only associated with mild depressive symptoms. These findings suggest that awareness of cognitive impairment may be limited in early-stage cSVD and highlight the value of informant assessments in the identification of patients with functional impairment.

Unravelling the complex interactions between self-awareness, cognitive change, and mood at 6-months post-stroke using the Y-shaped model

ABSTRACT We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the “Y-shaped” process model. Patients (n = 143; M age = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients’ capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.

In vivo exploration of synaptic projections in frontotemporal dementia

The purpose of this exploratory research is to provide data on synaptopathy in the behavioral variant of frontotemporal dementia (bvFTD). Twelve patients with probable bvFTD were compared to 12 control participants and 12 patients with Alzheimer’s disease (AD). Loss of synaptic projections was assessed with [18F]UCBH-PET. Total distribution volume was obtained with Logan method using carotid artery derived input function. Neuroimages were analyzed with SPM12. Verbal fluency, episodic memory and awareness of cognitive impairment were equally impaired in patients groups. Compared to controls, [18F]UCBH uptake tended to decrease in the right anterior parahippocampal gyrus of bvFTD patients. Loss of synaptic projections was observed in the right hippocampus of AD participants, but there was no significant difference in [18F]UCBH brain uptake between patients groups. Anosognosia for clinical disorder was correlated with synaptic density in the caudate nucleus and the anteromedial prefrontal cortex. This study suggests that synaptopathy in bvFTD targets the temporal social brain and self-referential processes.

Nurses’ Awareness of Cognitive Impairment in Individuals with Amyotrophic Lateral Sclerosis

Nurses’ Awareness of Cognitive Impairment in Individuals with Amyotrophic Lateral Sclerosis

Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia.

Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.

Mental and Physical Self-Awareness of Alzheimer Patients: Decreased Awareness of Amnesia and Increased Fear of Falling Compared to Views of Families: The Tajiri and Wakuya Projects

Introduction: The purpose of this study is to examine self-awareness of patients with Alzheimer disease (AD) regarding forgetfulness and physical status, with the goal of further psychological understanding of these patients. Methods: The 255 subjects included 33 healthy volunteers and 48 patients with mild cognitive impairment who were elderly community residents selected from the 2017 Wakuya Project and 174 consecutive outpatients with AD at the Tajiri Clinic. Test data were selected from a pooled database. Results from the Mini-Mental State Examination, Clinical Dementia Rating (CDR), Short Falls Efficacy Scale International (FES), and Everyday Memory Checklist (EMC) were used in the study. FES and EMC data were also obtained from family members for comparison. Results: EMC scores in the AD groups (mild to moderate and moderate to severe) were significantly higher (more complaining memory impairment) than those in the CDR 0 (healthy) group and significantly lower (less self-awareness for memory impairment) than the corresponding EMC scores of families of the subjects. In contrast, FES scores of the AD groups did not differ significantly from those of the CDR 0 group, and these scores were higher (more fear of falling) than those of family members. Additionally, family-FES scores of the AD groups were higher than those of the CDR 0 and 0.5 groups. Conclusion: The results showed an evidence of the heterogeneity of awareness, an emotional response (concern or fear, FES), and a cognitive appraisal of function (EMC). These may be explained whereby awareness of/fear of falling increases with AD due to a preserved emotional awareness, whereas awareness of cognitive impairment is impaired due to memory deficits.

PET‐[18F]UCB‐H for assessing synaptic density in FTD

AbstractBackgroundThe behavioural variant of fronto‐temporal dementia (FTD) is characterized by clinical symptoms including behavioural and cognitive changes and by neurodegenerative involvement of the anterior part of the brain. The objective was to study the in vivo distribution of synaptic loss.Method12 patients with possible FTD and frontotemporal hypometabolism on FDG‐PET (mean disease duration of 4 years) were compared to 12 control participants and 12 patients with Alzheimer’s disease, matched for age, sex and education. Measures of verbal fluency, episodic memory and awareness of cognitive impairment did not differ between patients groups. We used [18F]UCBH‐PET to assess the regional loss of synaptic density. Total distribution volume was obtained with Logan method and carotid artery derived input function. SPM12 was used to analyze pve‐corrected PET and MRI images.ResultA significant decrease of [18F]UCBH uptake was observed in the right anterior parahippocampal gyrus of FTD patients, while atrophy was observed in the ventromedial prefrontal cortex. Loss of synaptic density was observed in the right hippocampus of AD participants, while atrophy extended from the right hippocampus to bilateral posterior associative cortices. AD patients showed lower [18F]UCBH uptake in the precuneus that FTD patients. Anosognosia for clinical symptoms was correlated with synaptic density in caudate nucleus and prefrontal cortex in FTD, and with synaptic density in posterior hippocampus in AD.ConclusionSynaptic loss was predominant in the anterior parahippocampal gyrus of our bvFTD patients. This region is part of the limbic network and the perceptive social brain. A validated measure of anosognosia (a characteristic but variable symptom in bvFTD) was related to synaptic density in two interconnected regions, caudate nucleus and anteromedial prefrontal cortex, the later being involved in self‐reference.

Amyotrophic lateral sclerosis in Nordland county, Norway, 2000–2015: prevalence, incidence, and clinical features

Objective: There are some indications of increasing incidence of amyotrophic lateral sclerosis (ALS). Awareness of cognitive impairment in ALS has increased in recent years. We describe the epidemiology and clinical features of ALS in a county in northern Norway over a period of 15 years. Methods: All patients with motor neuron disease (MND) living in Nordland County in the period 2000–2015 were identified and the medical records were scrutinized. The average annual incidence was calculated for the whole period and for five-year periods. Prevalence point was 1 January 2015. Results: We identified 74 cases with MND. The crude point prevalence was 4.1 per 100,000. The average annual incidence was 2.1 per 100,000 for the whole period, 2.0 in the period 2000–2004, 2.3 in 2005–2009, and 2.0 in 2010–2014. All except one of the 22 patients with other forms of MND developed ALS during the course of the disease. The mean survival time was 38 months, patients with bulbar symptoms at diagnosis had a mean survival time of 29 months and those with solely spinal symptoms had a mean survival time of 50 months. Seven patients were diagnosed with frontotemporal dementia (FTD). Conclusion: The incidence was stable during the study period. Other forms of MND converts to clinical ALS given time. Survival time is almost two years shorter in patients with bulbar symptoms at the first examination, compared to those with solely symptoms from spinal muscles. FTD was found in 9% of the patients.

Abstract P164: Cognitive Impairment Among Adults With Incident Heart Failure

Background: Cognitive impairment is as high as 70% among adults with heart failure (HF) and its prevalence increases with the duration and severity of HF. However, little is known about the prevalence of cognitive impairment early in the course of HF. This is important, as high cognitive impairment at diagnosis would suggest that earlier screening would be warranted. We examined the prevalence and correlates of cognitive impairment among adults with incident HF. Methods: We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, an observational, longitudinal cohort study of 30,239 community-dwelling adults &gt; 45 recruited from 2003 to 2007. Blacks and residents of the stroke belt were oversampled. Global cognitive status was assessed annually by telephone with the Six-item Screener (SIS) and the diagnosis of incident HF was validated by physicians using medical records and standard clinical criteria. Participants who were hospitalized for incident HF from 2004 until 2016 with a SIS completed &gt; 1 month but &lt; 18 months before the index hospitalization were included. After determining the prevalence of cognitive impairment among this cohort, we identified which of their baseline characteristics were independently associated with cognitive impairment using multivariable logistic regression. We then compared the prevalence of cognitive impairment among adults with incident HF to the prevalence of cognitive impairment among age, sex, and race matched participants without HF, stratifying by 10-year Framingham Coronary Heart Disease Risk Scores (FRS) (&lt;10%, 10-20%, and &gt; 20%). Results: Of the 436 participants with incident HF, 14.9% had cognitive impairment. In an age-adjusted model, older age (OR 1.04 [95% CI 1.01 - 1.08], black race (OR 1.88 [95% 1.08-3.28]), &lt; high school education (OR 1.89 [95% 1.02-3.51]), and anticoagulation (OR 3.01 [95% 1.05 - 8.63]) were independently associated with higher odds of cognitive impairment, whereas female sex (OR 0.54 [95% 0.31 - 0.94]) was associated with lower odds of cognitive impairment. The prevalence of cognitive impairment among participants with incident HF was higher than the prevalence of cognitive impairment among controls with low FRS (9.4%) but was less than the prevalence of cognitive impairment among controls with high FRS (21.9%). Conclusion: The prevalence of cognitive impairment among adults with incident HF was greater than the prevalence of cognitive impairment among matched participants with low CHD risk, but less than the prevalence of cognitive impairment among matched participants with the highest CHD risk. This suggests that the majority of cognitive decline in HF may occur later in the course of the disease. Increased awareness of cognitive impairment among newly diagnosed patients, as well as ways to mitigate cognitive decline in the context of HF management, are warranted.

Awareness of cognitive impairment in individuals with essential tremor

ObjectiveThe extent to which individuals with ET who have clinically significant cognitive impairment are aware of their cognitive changes is unclear. Reduced awareness has important implications for everyday function and decision-making. Methods150 individuals with ET (109 Normal Cognition (ET-NC group), and 30 with MCI and 11 dementia (ET-CI group)) completed self-ratings and objective assessments of memory, language, and executive functioning. Discrepancy scores were calculated to assess awareness of cognitive functioning. One sample t-tests evaluated whether mean discrepancy scores in each group were comparable to zero (i.e., accurate). Analyses of covariance (ANCOVA) compared discrepancy scores across two groups controlling for age and education. ResultsIn the ET-NC group, discrepancy scores for language (M=−0.08, SD=1.10) and executive functioning (M=−0.01, SD=0.99) were comparable to zero. Memory discrepancy scores (M=0.32, SD=1.22) were greater than zero. In the ET-CI group, memory, (M=0.78, SD=1.01), language, (M=0.46, SD=0.95), and executive (M=0.39, SD=1.14) discrepancy scores were all greater than zero. Discrepancy scores were larger in ET-CI group than in ET-NC group for memory: F(1,148)=4.02, p=0.047, language: F(1,148)=6.16, p=0.014, and executive: F(1,148)=4.51, p=0.035. ConclusionsIndividuals with ET and normal cognition accurately assessed their language and executive abilities, demonstrating mild overconfidence in memory function. Individuals with ET and cognitive impairment overestimated their performance in all domains of functioning. Since ET is linked to increased risk for cognitive impairment, and such impairment may not be accurately perceived, cognitive functioning should be proactively and regularly screened in ET.

For a Cognitive Model of Subjective Memory Awareness.

The clinical challenge in subjective memory decline (SMD) is to identify which individuals will present memory deficits. Since its early description from Babinsky, who coined the term 'anosognosia' (i.e., the lack of awareness of deficit), the awareness of cognitive impairment is crucial in clinical neuropsychology. We propose a cognitive model in which SMD and anosognosia can be considered two opposite forms of distorted awareness of cognitive performance and can be accounted for within a model in which consciousness of memory performance can vary in a continuum from normal awareness of performance (preserved or impaired) to anosognosia through a disorder of consciousness related to SMD that we call "cognitive dysgnosia", i.e., awareness of normal performance as impaired. This model suggests that the neuropsychological assessment of memory performance should always be coupled with a deep evaluation of awareness of the subject's memory profile, which allow to better identify the disorder of consciousness with or without cognitive impairment. In this line, it seems necessary to develop more sensitive neuropsychological tools in order to discriminate, within the SMD, individuals who are likely to develop clinical Alzheimer's disease from those whose memory decline complaint is not associated with an underlying neurodegenerative pathology.

Dutch family physicians' awareness of cognitive impairment among the elderly.

BackgroundDementia is often not formally diagnosed in primary care. To what extent this is due to family physicians’ (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs’ awareness of cognitive impairment by comparing their evaluation of the absence or presence of cognitive impairment in older patients without an established diagnosis of dementia, with a reference test of cognitive functioning. In addition, we assessed which patient characteristics were associated with con- and discordance between FPs’ evaluation of cognition and results of the reference test.MethodsThe design was a nested diagnostic study. FPs (n = 29) of 15 primary care practices classified the cognitive status of all their patients ≥ 65 years of age (n = 7865) into four categories, based on recollection and medical records. All patients categorized as ‘possible cognitive impairment or dementia’ and a sample of patients categorized as ‘no signs of cognitive impairment’ randomly selected to match age and gender were offered to receive a reference test of cognitive function (the CAMCOG) to verify the FPs’ label. This reference test could yield three outcomes: no cognitive impairment, amnestic mild cognitive impairment (aMCI) or dementia. Reference test results were weighted back to the original samples to provide estimates for the correct categorization of elderly as ‘possible cognitive impairment or dementia’ (positive predictive value [PPV]) and ‘no signs of cognitive impairment’ (negative predictive value [NPV]). Cognitive functioning was not assessed for patients evaluated by FPs as ‘probable dementia’ and ‘unknown or no recent contact’. Characteristics associated with the con- or discordance of the FPs’ classification and the reference test were assessed using logistic regression.ResultsComplete reference test results were obtained from 318 elderly. FPs labeled 8.3 % of elderly ‘possible cognitive impairment or dementia’. The PPV of this label for a CAMCOG score suggestive of dementia or aMCI was 47.1 % (95 %-confidence interval: 43.5 – 62.4 %). FPs labeled 83.7 % ‘no signs of cognitive impairment’. The 1-NPV of this label for a CAMCOG score suggestive of dementia or aMCI was 12.5 % (95 %-CI 8.2 – 16.8 %). FPs labeled 3.6 % as ‘probable dementia’ and 4.5 % as ‘unknown or no recent contact’. The odds that FPs’ suspicion of cognitive impairment were confirmed by the CAMCOG were higher if persons were ADL dependent (OR 2.24 [95 %-CI 1.16 – 4.35]). The odds of FPs being unaware of the presence of cognitive impairment were higher in the older elderly (OR 1.15 [95 %-CI 1.09 – 1.23] per year).ConclusionEvaluation of FPs’ classification of the global cognitive function of elderly without a firm diagnosis of dementia showed both over- and unawareness of the presence of cognitive impairment. FPs were more often unaware of cognitive impairment in the older elderly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0105-1) contains supplementary material, which is available to authorized users.

Mild cognitive impairment, dementia, and affective disorders in essential tremor: a prospective study.

BackgroundIt is now reported that non-motor features, cognitive and affective problems, are becoming a major factor in essential tremor (ET). The aim of this study was to investigate the prevalence of cognitive and affective dysfunction in ET and to prospectively follow-up changes in the subjects.MethodsFifty-two persons over the age of 50 years were recruited from the Movement Disorder Clinic. The subjects underwent baseline neurological, cognitive, and mood assessments and repeat assessment 2 years later.ResultsThe mean age was 68 years, with an average age of ET onset of 55.8 years and with a mean disease duration of 11.7 years. At initial cognitive assessment using various instruments and the Clinical Dementia Rating Scale, 69.2% had mild cognitive impairment (MCI). There were disturbances in phonemic fluency, verbal memory, concentration, and semantic fluency; 25% suffered from anxiety and 17.6% from depression. During the 2 years there was an annual 8.4% conversion rate to dementia, with all convertors initially suffering from MCI. Another 25% converted from no initial cognitive impairment to MCI within 2 years. At follow-up the same percentage was still suffering from anxiety.DiscussionThe study confirms our hypothesis that ET patients suffer from MCI and anxiety. Though a control group was not used, the conversion rates for patients without ET and with/without MCI are known. The uniqueness of this study is that at follow-up, those with ET and MCI had a similar conversion rate to dementia to those suffering from MCI only. Additionally, persons with ET and no initial cognitive impairment were found to be at greater risk for developing MCI than the normal population. Clinicians must increase their awareness of cognitive impairment and anxiety in persons with ET and begin immediate treatment when indicated.

Acute cognitive impairment in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplant

Few studies have examined the acute effects of autologous hematopoietic stem cell transplantation (Au-HSCT) on the neuropsychological functioning of patients with multiple myeloma (MM). The prevalence of cognitive deficits after induction chemotherapy (pre-AuHSCT) was examined in patients with MM, clinically significant changes in cognitive function 1 and 3 months post-AuHSCT were determined, and patients who may be vulnerable to cognitive decline during this period were identified. A total of 53 patients with MM were recruited pre-AuHSCT. Neuropsychological tests measuring multiple cognitive domains (attention, psychomotor speed, learning/memory, language, executive function, motor function) were administered pre-AuHSCT and 1 and 3 months post-AuHSCT. A pretreatment assessment was not available. An Overall Cognitive Function Index was computed to determine cognitive impairment pre-AuHSCT, and a practice-effect-adjusted Reliable Change Index was used to determine cognitive change over time. Overall, deficits were more frequent in learning/memory, executive function, motor function, and psychomotor speed. Before AuHSCT, 47% of patients (25/53) exhibited cognitive impairment as determined by the Overall Cognitive Function Index. One month post-AuHSCT, 49% of patients (20/41) demonstrated clinically significant decline on 1 or more measures; 3 months post-AuHSCT, 48% (14 of 29 patients) showed decline on 1 or more measures. Older patients, minorities, and those with advanced disease, more induction cycles, or postinduction deficits showed greater vulnerability to decline. Nearly half of the patients showed vulnerability to impairment in learning/memory or executive function after receiving induction therapy, and the prevalence of impairment remained high post-AuHSCT. Awareness of cognitive impairment and associated risk factors in actively treated patients is important for considering psychosocial or other support for patients with acute cognitive symptoms.

Self-Reported Cognitive Complaints in Elderly Bipolar Patients

Patients with bipolar disorder are at risk to develop cognitive decline in the course of their illness. This may affect their ability to monitor and detect their own cognitive functioning (anosognosia). The aim of this study was to determine whether subjective cognitive complaints were associated with objective neuropsychologic performance and to consider the role of frontal lobe dysfunction in the awareness of cognitive impairment. A total of 101 euthymic elderly bipolar patients and 74 healthy comparison subjects were assessed using a comprehensive neuropsychologic battery. The Cognitive Failure Questionnaire was used to determine subjective cognitive complaints. Elderly bipolar patients had no more subjective cognitive complaints than comparison subjects, whereas they showed less cognitive functioning in several domains. Having few subjective cognitive complaints was associated with poorer attentional and executive functioning. Impaired awareness of cognition might be a reflection of cognitive deterioration and could influence treatment. Evaluation of cognitive functioning in elderly bipolar patients should be part of the treatment program regardless of subjective complaints.

Awareness of cognitive impairment in schizophrenia and its relationship to insight into illness

BackgroundPatients with schizophrenia have been found to show unawareness of cognitive impairment. However, its frequency and its relationship to lack of insight into illness are uncertain. MethodForty-two patients with chronic schizophrenia were given tests of executive function and memory. Awareness of cognitive impairment was measured by means of discrepancy scores — differences between patient and psychologist ratings of memory and frontal/executive failures in daily life. Insight into illness was assessed using the Scale to Assess Unawareness of Mental Disorder (SUMD). ResultsA majority of the patients were found to underestimate their cognitive impairment; however, some overestimated it. Unawareness of cognitive impairment and lack of clinical insight loaded on different factors in a factor analysis, but these two factors were themselves correlated. ConclusionsThe findings suggest that both unawareness and overestimation of cognitive impairment characterise patients with schizophrenia, although the former is more common. Awareness of cognitive impairment occurs independently of insight into illness at the clinical level, although the two phenomena may be linked at a deeper level.

Oncology Nurses' Awareness of Cognitive Impairment Secondary to Chemotherapy

The purpose of this cross-sectional, descriptive pilot study was to collect frequency data for oncology nurses' awareness of cognitive impairment (CI) secondary to chemotherapy, practice patterns related to assessment and education of patients and families about CI, and access to related educational materials. A convenience sample of 34 RNs was used in conjunction with a local Oncology Nursing Society chapter meeting. An 18-item survey was developed and piloted to collect data and demographic information from participants. Participants (100%) acknowledged awareness of chemotherapy-related CI. Most (94%) had attended educational programming on the topic and agreed that their patients had mentioned CI. Only 38% of participants assessed patients for CI and 44% educated patients and families on the topic. All nurses agreed that CI had some impact on patients' ability to perform activities of daily living and that CI caused at least some degree of distress. Most participants (71%) did not have access to related patient and family educational tools. The study provided support for the development of educational programs related to appropriate patient assessment and the development and distribution of related patient and family educational tools.

How Should DSM-V Criteria for Schizophrenia Include Cognitive Impairment?

Neurocognitive impairment is considered a core component of schizophrenia and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared with healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared with their expected level if they had not developed the illness. Compared with patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and tends to be more independent of clinical symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, description of schizophrenia includes several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. We forward for consideration a proposal that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background." The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis and better treatment outcomes. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation may present challenges to diagnosticians with limited resources or insufficient expertise. Various cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.