Awareness Of Memory Deficits Research Articles

Memory Impairment and Awareness of Memory Deficits in Early-Stage Alzheimer's Disease

In addition to their memory impairment, individuals with Alzheimer's disease (AD) often suffer from deficits in self-awareness. Awareness of memory deficits or metamemory is a multifaceted function, comprising on-line self-monitoring, generalized self-beliefs of memory efficacy, and generalized knowledge about memory functions. Awareness of memory problems in early-stage AD is a matter of clinical importance from a humanistic point of view, because higher levels of awareness may be associated with better future outcomes. Current methods of measuring awareness tend to fall into two categories, i.e., to introduce a questionnaire assessing patient/caregiver discrepancies; or to ask a patient to prospectively predict or retrospectively postdict their own memory performances. Characteristics of each measure as well as relationship between the two measures were discussed. For the performance prediction/postdiction paradigm, we used recognition memory of auditory verbal learning tests and awareness of memory deficits were examined in 24 individuals with early-stage AD. In addition to their significantly impaired recognition memory, individuals with AD displayed underawareness of memory deficits even at this early stage. They retrospectively overestimated memory performance after actual performance, but appeared to benefit from feedback and displayed intact on-line awareness of memory dysfunction, leading to normal prediction of the second session. However, individuals with AD again failed to retrospectively incorporate incidents of memory failure into generalized self-belief systems. Brain/behavior correlational analyses suggest that the prefrontal cortex and posterior dorsomedial regions including the precuneus may be involved in self-awareness.

老年期認知症患者の病識―生活健忘チェックリストを用い， 介護者を対照とした研究―

We examined the level of awareness of memory deficits in 63 patients with Alzheimer's disease (AD), 17 patients with dementia with Lewy bodies (DLB), 14 patients with vascular dementia (VaD), and 56 patients with amnestic mild cognitive impairment (MCI). The unawareness of memory impairment was evaluated with a standardized memory questionnaire system based on the Everyday Memory Checklist (EMC). The EMC scores for the patient's own rating, the caregivers' rating and the unawareness score, defined as the discrepancy between these (caregiver rating-patient rating), were analyzed. Although the EMC self-rating scores were comparable among the four groups, the EMC scores in caregivers were significantly higher in the AD group than in the DLB, VaD, and MCI groups. Therefore, the unawareness scores were significantly higher in the AD groups than in other groups. When an unawareness score of 9 or more was defined as significant, impaired awareness was found in 41 (65%) patients with AD, 1 (6%) patient with DLB, 5 (36%) patients with VaD, and in 19 (34%) patients with MCI. We found that impaired awareness was found in two-thirds of patients with mild AD and even in one-third of patients with MCI. However, other dementias, in particular DLB, had less severe and less frequent unawareness of memory deficits than AD, suggesting the difference in the pathophysiology between them.

Validation of a memory inventory for the assessment of awareness of memory deficits in Alzheimer's disease in Chinese elderly

This paper describes the development and validation of the Memory Inventory for Chinese (MIC), for measuring the awareness of memory deficits in the Chinese population with Alzheimer's disease (AD). A combination of qualitative and quantitative approaches was adopted. The MIC was developed with focus group discussion and pilot testing. It has a patient and a caregiver version. A consecutive series of 79 new out-patients with the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorder Association (NINCDS-ADRDA) criteria of probable and possible AD and 20 non-demented elderly subjects were recruited. A high internal consistency was found, with Cronbach alpha of 0.89 for the patient version and 0.90 for the caregiver version of MIC. The inter-rater reliability was satisfactory. For validity assessment, the caregiver score of the MIC correlated significantly with cognitive score of the subject as assessed by the Mini-Mental State Examination (rp = -0.37; p < 0.01). The Memory Deficit Awareness Score, calculated by subtracting the patient score from the caregiver score, correlated significantly with clinician ratings of awareness of memory impairment (rs = -0.67; p < 0.01). The MIC appears to be a culturally appropriate and valid instrument for the measurement of awareness of memory deficits in Chinese patients with AD. Potential applications of the MIC should be further explored in other subtypes of dementia and in prospective studies.

Memory Impairment and Awareness of Memory Deficits inEarly-Stage Alzheimer's Disease

Recognition memory of auditory verbal learning tests and awareness of memory deficits were examined in 24 individuals with early-stage Alzheimer's disease (AD) using a performance prediction-postdiction paradigm. Individuals with AD displayed impaired recognition memory, and recognition performance correlated positively with regional cerebral blood flow at rest in bilateral prefrontal areas and the left medial temporal area. In addition, underawareness of memory deficits was also marked even at this early stage. Individuals with AD retrospectively overestimated memory performance after actual performance, but appeared to benefit from feedback, and displayed intact online awareness of memory dysfunction, leading to normal prediction of the second session. However, individuals with AD failed to retrospectively incorporate incidents of memory failure into generalized self-belief systems. Brain/ behavior correlational analyses suggest that the prefrontal cortex and posterior dorsomedial regions including the precuneus may be involved in self-awareness.

Impaired awareness, behavior disturbance, and caregiver burden in Alzheimer disease.

Caregiver burden, the stress experienced as a result of caregiving, is determined by many factors. This study examined the contributions of the patient's awareness of memory deficit and behavioral disturbance to caregiver burden in Alzheimer disease. Participants were 41 patients with Alzheimer disease and their caregivers. Dementia severity, functional impairment, awareness of memory deficit, and behavioral disturbance were measured and examined in relation to caregiver burden. Positive correlations were found between caregiver burden and both impaired awareness of memory deficit and behavioral disturbance. Regression analyses demonstrated that both impaired patient awareness of memory deficit and behavioral disturbance contributed to caregiver burden over and above dementia severity and functional impairment. However, when both were entered together into regression equations, only behavioral disturbance contributed to caregiver burden. Of the problem behaviors, measures of disinhibition contributed most to caregiver burden. These data further our understanding of the multiple contributors to caregiver burden. We conclude that both patient awareness of memory deficit and behavioral disturbance impact caregiver burden, with behavioral disturbance making the greater contribution.

Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type

To study the unawareness of cognitive deficits in patients with mild dementia of Alzheimer type (DAT). Retrospective study. We surveyed the medical records of outpatients meeting the NINCDS-ADRDA criteria for probable DAT who were able to complete the Cognitive Difficulties Scale (CDS) and had a close informant relative (IR) who could complete the family form of the same questionnaire. A department of neurology in a general teaching hospital. Eighty-eight patients, aged 73.2+/-8.6 years with a mean MMSE score of 22.5+/-3.2. Fifty-two of the 88 patients had a follow-up examination after a mean interval of 21 months. Awareness of cognitive deficits was mainly assessed as the difference between the scores on the CDS completed by the IR and the patient (Index of Unawareness, IU). Two secondary assessments of unawareness were performed: (1) an assessment by the clinician on the basis of the patient's answers to questions probing the awareness of memory deficits; (2) an evaluation by the IR of the frequency of behavioural manifestations of unawareness in everyday life. SPECT was performed in 78 patients to study the relationship between unawareness and the topography of perfusion deficits. Awareness of the cognitive deficits varied greatly between patients, according to the assessment method used and the stage of progression of the disease. Most patients with mild DAT were cognitively aware of their cognitive deficits but failed to appraise their severity and their consequences in everyday life. Decreased awareness was positively correlated with age and perfusion deficits in the frontal regions and negatively with the anxious symptomatology. However, the main correlate of unawareness was apathy. The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits.

Awareness of memory deficit in alzheimer's disease patients and memory-impaired older adults

Abstract Unawareness of memory deficit has been observed in Alzheimer's disease (AD), but the various aspects of this phenomenon have not all been investigated simultaneously. In addition, it is unclear whether elderly persons with circumscribed memory impairment also display diminished awareness. A comprehensive approach addressing various metamemory dimensions was used to investigate memory awareness in AD, memory-impaired, and elderly control subjects. the results showed that the AD patients reported no more memory decline than did the memory-impaired or control subjects, while the informants reported greater decline for AD subjects. A comparison between self- and informant ratings showed that the AD patients were unaware of the extent of their memory decline. Diminished self-monitoring abilities were observed in the AD patients' tendency to overestimate their performance, and to make intrusion errors with few self-corrections. the findings revealed diminished memory awareness across metamemory measures in AD patients but not among memory-impaired individuals.

On the neuropsychology of metamemory: Contributions from the study of amnesia and dementia

Neurologic syndromes in which there is impaired deficit-awareness (termed “anosognosia”) provide useful observations for understanding the nature of metacognition and its neurobiologic correlates. Anosognosia can occur in various disorders, including stroke, head injury, particular amnesic syndromes, and various dementing illnesses (e.g., Alzheimer's disease). Research on anosognosia for memory impairment is important both for its clinical implications and for its contributions toward understanding the neural correlates of, and processes by which, persons are aware of, monitor, and develop beliefs about their own memory functioning (i.e., metamemory). Following a brief introduction to anosognosia, a review is provided of research on awareness of memory deficit in persons with neurologic amnesia or dementia syndromes. Particular emphasis is placed upon the examination of how different experimental methods shed light on specific questions about metamemory impairment.

A process approach to memory book training for neurological patients

This article describes a process approach to training memory book usage as a compensatory strategy for neurological patients. Clinicians who recommend memory books to patients need to consider the physical, cognitive, social and emotional strengths and weaknesses of the individual as they assist with the design and implementation of such books. Throughout the process, a major focus of this approach is on the need to raise awareness of memory deficits while minimizing patient resistance. By individualizing a memory book, clients tend to view it as a tool which can maximize their independence. Support from the discharge environment may be necessary in some areas to maintain optimum performance.