Anosognosia in dementia with Lewy bodies: a systematic review

ABSTRACT Background: Anosognosia, i.e. lack of awareness of one’s own symptoms, is a very common finding in patients with dementia and is related to neuropsychiatric symptoms and worse prognosis. Although dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia, literature on anosognosia in this disease is scarce. Objectives: This paper aimed to review the current evidence on anosognosia in patients with DLB, including its prevalence in comparison with other neurological conditions, its severity and anatomical correlations. Methods: Database searches were performed in PubMed, Web of Knowledge and PsycINFO for articles assessing anosognosia in DLB. A total of 243 studies were retrieved, but only six were included in the review. Results: Potential risk of selection, comparison or outcome biases were detected in relation to all the studies selected. Most of the studies used self-report memory questionnaires to assess cognitive complaints and compared their results to scores from informant-based instruments or to participants’ cognitive performance in neuropsychological tasks. Subjects with DLB had worse awareness regarding memory than healthy older controls, but the results concerning differences in anosognosia between DLB and Alzheimer’s disease (AD) patients were inconsistent across studies. Presence of AD pathology and neuroimaging biomarkers appeared to increase the prevalence of anosognosia in individuals with DLB. Conclusion: Anosognosia is a common manifestation of DLB, but it is not clear how its prevalence and severity compare with AD. Co-existence of AD pathology seems to play a role in memory deficit awareness in DLB.

Consciência da doença na demência do tipo Alzheimer: uma revisão sistemática de estudos longitudinais

OBJETIVOS: Avaliar as definições, métodos de avaliação e hipóteses etiológicas utilizadas em estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer. MÉTODO: Pesquisa, nas bases de dados Medline, ISI, Lilacs e SciELO, de estudos longitudinais sobre consciência da doença na demência do tipo Alzheimer entre 1999 e 2009. As palavras-chave utilizadas foram: "Alzheimer", "dementia", "anosognosia", "awareness of deficit", "awareness of disease", "insight" e "longitudinal study". Os artigos examinados foram classificados conforme as hipóteses etiológicas encontradas. RESULTADOS: Os nove artigos selecionados foram divididos em duas áreas: hipóteses etiológicas biológicas e hipóteses etiológicas psicossociais. Os termos "falta de consciência dos déficits", "consciência do déficit", "insight" e "negação do déficit de memória" são utilizados nos estudos como sinônimos do termo "anosognosia", mesmo sendo, conceitualmente, diferentes. O método de avaliação mais utilizado foi o uso de questionários de discrepância entre os relatos dos pacientes e cuidadores. CONCLUSÕES: Os estudos longitudinais apresentam hipóteses etiológicas heterogêneas, além da inexistência de um padrão conceitual e metodológico de avaliação. Essas dificuldades impossibilitam a obtenção de resultados homogêneos, o que gera a necessidade de aprofundamento dos estudos na área.

Awareness of disease in Alzheimer's dementia: description of a mild to moderate sample of patient and caregiver dyads in Brazil

Background: Impairment of deficit awareness is a clinically relevant feature of dementia affecting the maintenance of decision capacities, management and safety of patients with risk behaviors, and caregiver burden. This study assessed awareness of disease of patient/caregiver dyads and the relationship between unawareness on various domains and sociodemographic variables among elderly Brazilians with Alzheimer's disease (AD).Methods: The dyads (n = 52), stratified by clinical severity and age groups, responded to the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD). Statistical tests were used to compare clinical and sociodemographic variables and to calculate differences in rates of discrepant responses among mild and moderate dyads and between age groups, rates of discrepant responses among the ASPIDD domains, and association between awareness and age/age at onset.Results: Awareness of deficits did not differ significantly among mild patients, whereas moderate patients showed impaired recognition on all domains. Older moderate dyads showed more discrepant responses, as compared to younger dyads at both severity stages. Mild patients could associate the disease with the cognitive deficits and recognized impairments on other domains. There was no significant relation of awareness with age at onset.Conclusion: Mild AD patients could associate the disease process with the presence of cognitive deficits, and also the changes in the emotional response with difficulties in social, family, and affective relations. Moderate AD patients were less aware of the symptoms and did not attribute them to the disease.