Affiliations: [a] INSERM, Paris, France | [b] Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Départment de Neurologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France | [c] Institut du Cerveau et de la Moelle Epinière (ICM), CNRS UMR 7225 - INSERM U1127 Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Paris, France | [d] Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Université Pierre et Marie Curie - Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France | [e] Dipartimento di Scienze della Vita, Università degli Studi di Trieste, Italy
Correspondence:
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Correspondence to: Gianfranco Dalla Barba, Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), Département de neurologie, Hôpital de la Pitié-Salpêtrière, 47, bd de l’Hôpital, 75651 Paris Cedex 13, France. Tel.: +33 42 16 75 52; gdallabarba@units.it
Abstract: 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 underlyingneurodegenerative pathology.
