Course and Determinants of Anosognosia in Alzheimer’s Disease: A 12-Month Follow-up

Article type: Research Article

Authors: Turró-Garriga, Oriol^{a; b} | Garre-Olmo, Josep^{a; c; *} | Calvó-Perxas, Laia^a | Reñé-Ramírez, Ramón^d | Gascón-Bayarri, Jordi^d | Conde-Sala, Josep Lluís^{a; e}

Affiliations: [a] Health, Aging and Disability Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia-Spain | [b] Department of Neurology, Institut d’Assistència Sanitária-Institut Catalá de Salut de Girona, Salt, Catalonia-Spain | [c] Department of Medical Sciences, University of Girona, Girona, Catalonia-Spain | [d] Dementia Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Catalonia-Spain | [e] Faculty of Psychology, University of Barcelona, Barcelona, Catalonia-Spain

Correspondence: [*] Correspondence to: Josep Garre Olmo, Edifici Mancomunitat 1, Parc Hospitalari Martí i Juliá, c/ Dr. Castany s/n 17191 Salt, Girona, Catalonia-Spain. Tel.: +34 6303034241833; Fax: +34 08721116161; E-mail: josep.garre@ias.cat.

Abstract: Anosognosia in Alzheimer’s disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1–47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6–48.0), persistence was 80.0% (95% CI = 69.9–90.1) and remission was 20.0% (95% CI = 9.9–30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severity.

Keywords: Alzheimer’s disease, anosognosia, caregivers, epidemiological dementia study, incidence, insight, dementia, longitudinal studies, neuropsychiatric disorders

DOI: 10.3233/JAD-150706

Journal: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 357-366, 2016