title: Insight, cognition and quality of life in Alzheimer's disease.
abstract: BACKGROUND
  The detrimental impact of dementia upon patient health-related quality of life (HRQL) is well established, as is the importance of improving HRQL. However, relatively little is known about the natural history of HRQL in dementia and those factors influencing it. This limited knowledge potentially restricts the evaluation of the efficacy of interventions designed to improve HRQL. One such area concerns the relationship between HRQL and patient insight. It remains unclear what impact, if any, impaired insight has upon a patient's HRQL. The present study aimed to investigate the relationship between insight and HRQL in a sample of patients with Alzheimer's disease (AD) and their carers.
  
  
  METHODS
  256 patients with AD were recruited as part of AddNeuroMed, a multicentre European AD biomarkers study. Of these, 174 completed a quality-of-life measure in addition to a comprehensive battery of clinical and neuropsychological assessments.
  
  
  RESULTS
  Insight was found to be differentially related to patient perceptions of HRQL in mild and moderate dementia. Within moderate dementia, impaired insight was associated with better perceived HRQL. Conversely, cognition, but not insight, was associated with impaired HRQL in mild dementia. Insight was not found to be associated with carer perceptions of patient HRQL.
  
  
  CONCLUSIONS
  Impairment of insight is associated with better HRQL in moderate dementia. This finding has implications for interventions which focus on increasing patient awareness and orientation, as impairment of insight appears to have a positive impact upon HRQL.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychology PO77, De Crespigny Park, London SE5 8AF, UK. Catherine.hurt@iop.kcl.ac.uk
authors.forename: C S
authors.initials: CS
authors.lastname: Hurt
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: C
authors.initials: C
authors.lastname: Tunnard
authors.forename: D L
authors.initials: DL
authors.lastname: Whitehead
authors.forename: M
authors.initials: M
authors.lastname: Tsolaki
authors.forename: P
authors.initials: P
authors.lastname: Mecocci
authors.forename: I
authors.initials: I
authors.lastname: Kloszewska
authors.forename: H
authors.initials: H
authors.lastname: Soininen
authors.forename: B
authors.initials: B
authors.lastname: Vellas
authors.forename: S
authors.initials: S
authors.lastname: Lovestone
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001364:Awareness; D017028:Caregivers / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D017281:Cost of Illness; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life / Q000523:psychology*