Anosognosia in Very Mild Alzheimer’s Disease but Not in Mild Cognitive Impairment

Vol. 19, No. 5-6, 2005

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Original Research Article

Anosognosia in Very Mild Alzheimer's Disease but Not in Mild Cognitive Impairment
E. Kalbe^a, E. Salmon^b, D. Perani^c, V. Holthoff^d, S. Sorbi^e, A. Elsner^a, S. Weisenbach^a, M. Brand^f, O. Lenz^a, J. Kessler^a, S. Luedecke^d, P. Ortelli^c, K. Herholz^a

^aDepartment of Neurology, University Hospital, and Max Planck Institute for Neurological Research, Cologne, Germany;
^bCyclotron Research Centre, University of Liège, Liège, Belgium;
^cVita Salute San Raffaele University, and Department of Neurology San Raffaele-Ville Turro, Milan, Italy;
^dDepartment of Psychiatry and Psychotherapy, Dresden University of Technology, Dresden, Germany;
^eDepartment of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy;
^fDepartment of Physiological Psychology, University of Bielefeld, Bielefeld, Germany

Address of Corresponding Author

Dement Geriatr Cogn Disord 2005;19:349-356 (DOI: 10.1159/000084704)

Key Words

Anosognosia
Self-awareness
Insight
Dementia
Cognitive dysfunction
Alzheimer's disease
Mild cognitive impairment

Abstract

Objective: To study awareness of cognitive dysfunction in patients with very mild Alzheimer's disease (AD) and subjects with mild cognitive impairment (MCI). Methods: A complaint interview covering 13 cognitive domains was administered to 82 AD and 79 MCI patients and their caregivers. The patient groups were comparable according to age and education, and Mini Mental State Examination (MMSE) scores were 24 in all cases. The discrepancy between the patients' and caregivers' estimations of impairments was taken as a measure of anosognosia. Results: Self-reports of cognitive difficulties were comparable for AD and MCI patients. However, while in comparison to caregivers MCI patients reported significantly more cognitive impairment (p < 0.05), AD patients complained significantly less cognitive dysfunctions (p < 0.001). Conclusions: While most MCI patients tend to overestimate cognitive deficits when compared to their caregiver's assessment, AD patients in early stages of disease underestimate cognitive dysfunctions. Anosognosia can thus be regarded as a characteristic symptom at a stage of very mild AD (MMSE 24) but not MCI. Accordingly, medical history even in mildly affected patients should always include information from both patient and caregiver.

Author Contacts

Dr. Elke Kalbe
Max Planck Institute for Neurological Research
Gleueler Strasse 50, DE-50931 Cologne (Germany)
Tel. +49 221 4726312, Fax +49 221 4726298
E-Mail Elke.Kalbe@pet.mpin-koeln.mpg.de

Article Information

Accepted: September 9, 2004
Published online: March 30, 2005
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 3, Number of References : 47

Medline Abstract (ID 15802909)

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