Examining the Pathways Between Self-Awareness and Well-Being in Mild to Moderate Alzheimer Disease

Overview

Journal Am J Geriatr Psychiatry

Publisher Elsevier

Specialty Geriatrics

Date 2015 Nov 13

PMID 26560509

Citations 10

Authors

Sarah Cines

Meagan Farrell

Jason Steffener

Liz Sullo

Edward Huey

Jason Karlawish

Stephanie Cosentino

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the relationship between awareness of memory loss and psychological well-being in a nonclinically depressed sample of participants with mild to moderate Alzheimer disease (AD).

Methods: Study participants (N = 104) enrolled through Columbia University Medical Center and the University of Pennsylvania completed clinical and cognitive assessments. Participants were rated with regard to their degree of awareness of memory deficits and completed questionnaires relating to their psychological well-being, including mood and quality of life (QOL). Mediating models were used to establish the relationship between awareness, depression, and QOL and to examine potential mediators of awareness and depression, including psychological distress, objective memory deficits, and negative self-ratings.

Results: There was a direct association between awareness of memory deficits and depressed mood but not awareness and QOL. However, there was an indirect association between awareness and QOL through depression. Neither psychological distress, memory deficits, nor negative self-ratings mediated the relationship between awareness and depression.

Conclusion: Awareness is associated with depressed mood in nonclinically depressed participants with mild to moderate AD. However, depressed mood does not appear to reflect the direct psychological reaction to awareness of memory loss. Moreover, awareness has only an indirect association with QOL via depressed mood. These results suggest that preserved awareness does not have a direct negative impact on overall psychological well-being in AD.

Citing Articles

The role of dyadic cognitive report and subjective cognitive decline in early ADRD clinical research and trials: Current knowledge, gaps, and recommendations.

Nosheny R, Amariglio R, Sikkes S, Van Hulle C, Bicalho M, Dowling N Alzheimers Dement (N Y). 2022; 8(1):e12357.

PMID: 36226046 PMC: 9530696. DOI: 10.1002/trc2.12357.

Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme.

Alexander C, Martyr A, Gamble L, Savage S, Quinn C, Morris R BMC Geriatr. 2021; 21(1):511.

PMID: 34563135 PMC: 8467163. DOI: 10.1186/s12877-021-02468-4.

Awareness of Cognitive Decline in Patients With Alzheimer's Disease: A Systematic Review and Meta-Analysis.

Cacciamani F, Houot M, Gagliardi G, Dubois B, Sikkes S, Sanchez-Benavides G Front Aging Neurosci. 2021; 13:697234.

PMID: 34413767 PMC: 8370471. DOI: 10.3389/fnagi.2021.697234.

Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans.

Farrell M, Jia Y, Berkman L, Wagner R J Aging Health. 2021; 33(10):803-816.

PMID: 34029165 PMC: 8919501. DOI: 10.1177/08982643211012839.

The Association Between Impaired Awareness and Depression, Anxiety, and Apathy in Mild to Moderate Alzheimer's Disease: A Systematic Review.

Azocar I, Livingston G, Huntley J Front Psychiatry. 2021; 12:633081.

PMID: 33613344 PMC: 7889585. DOI: 10.3389/fpsyt.2021.633081.

References

Harwood D, Sultzer D, Wheatley M . Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances. Neuropsychiatry Neuropsychol Behav Neurol. 2000; 13(2):83-8. View

Arkin S, Mahendra N . Insight in Alzheimer's patients: results of a longitudinal study using three assessment methods. Am J Alzheimers Dis Other Demen. 2001; 16(4):211-24. PMC: 10833994. DOI: 10.1177/153331750101600401. View

Logsdon R, Gibbons L, McCurry S, Teri L . Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002; 64(3):510-9. DOI: 10.1097/00006842-200205000-00016. View

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Deckel A, Morrison D . Evidence of a neurologically based "denial of illness" in patients with Huntington's disease. Arch Clin Neuropsychol. 1996; 11(4):295-302. View

Ready R, Ott B, Grace J . Patient versus informant perspectives of Quality of Life in Mild Cognitive Impairment and Alzheimer's disease. Int J Geriatr Psychiatry. 2004; 19(3):256-65. DOI: 10.1002/gps.1075. View

Feher E, Larrabee G, Crook 3rd T . Factors attenuating the validity of the Geriatric Depression Scale in a dementia population. J Am Geriatr Soc. 1992; 40(9):906-9. DOI: 10.1111/j.1532-5415.1992.tb01988.x. View

Hoe J, Katona C, Roch B, Livingston G . Use of the QOL-AD for measuring quality of life in people with severe dementia--the LASER-AD study. Age Ageing. 2005; 34(2):130-5. DOI: 10.1093/ageing/afi030. View

Karlawish J, Casarett D, James B, Xie S, Kim S . The ability of persons with Alzheimer disease (AD) to make a decision about taking an AD treatment. Neurology. 2005; 64(9):1514-9. DOI: 10.1212/01.WNL.0000160000.01742.9D. View

10.

Kashiwa Y, Kitabayashi Y, Narumoto J, Nakamura K, Ueda H, Fukui K . Anosognosia in Alzheimer's disease: association with patient characteristics, psychiatric symptoms and cognitive deficits. Psychiatry Clin Neurosci. 2006; 59(6):697-704. DOI: 10.1111/j.1440-1819.2005.01439.x. View

11.

Cosentino S, Stern Y . Metacognitive theory and assessment in dementia: do we recognize our areas of weakness?. J Int Neuropsychol Soc. 2006; 11(7):910-9. DOI: 10.1017/s1355617705050964. View

12.

Vogel A, Mortensen E, Hasselbalch S, Andersen B, Waldemar G . Patient versus informant reported quality of life in the earliest phases of Alzheimer's disease. Int J Geriatr Psychiatry. 2006; 21(12):1132-8. DOI: 10.1002/gps.1619. View

13.

Ahmed S, Mitchell J, Arnold R, Dawson K, Nestor P, Hodges J . Memory complaints in mild cognitive impairment, worried well, and semantic dementia patients. Alzheimer Dis Assoc Disord. 2008; 22(3):227-35. DOI: 10.1097/WAD.0b013e31816bbd27. View

14.

Nakaaki S, Murata Y, Sato J, Shinagawa Y, Hongo J, Tatsumi H . Impact of depression on insight into memory capacity in patients with Alzheimer disease. Alzheimer Dis Assoc Disord. 2008; 22(4):369-74. DOI: 10.1097/WAD.0b013e3181820f58. View

15.

Banerjee S, Samsi K, Petrie C, Alvir J, Treglia M, Schwam E . What do we know about quality of life in dementia? A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health related quality of life in people with dementia. Int J Geriatr Psychiatry. 2008; 24(1):15-24. DOI: 10.1002/gps.2090. View

16.

Price C, Garrett K, Jefferson A, Cosentino S, Tanner J, Penney D . Leukoaraiosis severity and list-learning in dementia. Clin Neuropsychol. 2009; 23(6):944-61. PMC: 2866111. DOI: 10.1080/13854040802681664. View

17.

Hurt C, Banerjee S, Tunnard C, Whitehead D, Tsolaki M, Mecocci P . Insight, cognition and quality of life in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2009; 81(3):331-6. DOI: 10.1136/jnnp.2009.184598. View

18.

Karttunen K, Karppi P, Hiltunen A, Vanhanen M, Valimaki T, Martikainen J . Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. Int J Geriatr Psychiatry. 2011; 26(5):473-82. DOI: 10.1002/gps.2550. View

19.

Slavin M, Brodaty H, Kochan N, Crawford J, Trollor J, Draper B . Prevalence and predictors of “subjective cognitive complaints” in the Sydney Memory and Ageing Study. Am J Geriatr Psychiatry. 2011; 18(8):701-10. DOI: 10.1097/jgp.0b013e3181df49fb. View

20.

Cosentino S, Metcalfe J, Cary M, de Leon J, Karlawish J . Memory Awareness Influences Everyday Decision Making Capacity about Medication Management in Alzheimer's Disease. Int J Alzheimers Dis. 2011; 2011:483897. PMC: 3109698. DOI: 10.4061/2011/483897. View