Awareness of Disease is Different for Cognitive and Functional Aspects in Mild Alzheimer's Disease: A One-Year Observation Study

Article type: Research Article

Authors: Sousa, Maria Fernanda B.^{a; *} | Santos, Raquel L.^a | Nogueira, Marcela L.^a | Belfort, Tatiana^a | Rosa, Rachel D.L.^a | Torres, Bianca^a | Simões, Pedro^b | Mograbi, Daniel C.^{c; d} | Laks, Jerson^a | Dourado, Marcia C.N.^a

Affiliations: [a] Center for Alzheimer's Disease, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil | [b] Department of Political Sociology, Universidade Federal de Santa Catarina, Florianópolis, Brazil | [c] Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil | [d] Department of Psychology, Institute of Psychiatry, King's College London, London, UK

Correspondence: [*] Correspondence to: Maria Fernanda B. Sousa, Rua Doutor Catrambi, 161/102, 20531-005 Rio de Janeiro, Brazil. Tel.: +55 21 988490677; E-mail: maria_fernandabs@yahoo.com.br.

Abstract: Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03–1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70–0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.

Keywords: Activities of daily living, Alzheimer's disease, anosognosia, awareness, dementia, longitudinal studies, quality of life

DOI: 10.3233/JAD-140342

Journal: Journal of Alzheimer's Disease, vol. 43, no. 3, pp. 905-913, 2015