title: Awareness of cognitive deficits and clinical competence in mild to moderate Alzheimer's disease: their relevance in clinical practice.
abstract: Awareness of cognitive deficits and clinical competence were investigated in 79 mild to moderate Alzheimer's disease patients. Awareness was assessed by the anosognosia questionnaire for dementia, and clinical competence by specific neuropsychological tests such as trail making test-A, Babcock story recall test, semantic and phonemic verbal fluency. The findings show that 66 % of the patients were aware of memory deficits, while the 34 % were unaware. Deficit in awareness correlated with lower scores on the Mini Mental State Examination test that, in the score range from 24.51 to 30 and from 19.50 to 24.50, appeared to be a significant predictor of level of awareness. None of the AD patients had fully preserved clinical competence, only 7 patients (9 %) had partially preserved clinical competence and 72 patients (91 %) had completely lost clinical competence. All the patients with partially preserved clinical competence (9 %) were aware of their memory deficit. The study indicates that neuropsychological tests used for the assessment of executive functions are not suitable for investigating clinical competence. Therefore, additional and specific tools for the evaluation of clinical competence are necessary. Indeed, these might allow clinicians to identify AD patients who, despite their deficits in selected functions, retain their autonomy of choice as well as recognize those patients who should proceed to the nomination of a legal representative.
authors: G
authors: G
authors: Gambina
authors: A
authors: A
authors: Bonazzi
authors: V
authors: V
authors: Valbusa
authors: M  T
authors: M
authors: Condoleo
authors: O
authors: O
authors: Bortolami
authors: E
authors: E
authors: Broggio
authors: F
authors: F
authors: Sala
authors: G
authors: G
authors: Moretto
authors: V
authors: V
authors: Moro
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology*; D001364:Awareness / Q000502:physiology*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology*; D003657:Decision Making / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
references: Am J Psychiatry. 2001 May;158(5):712-7
references: 11329391
references: Alzheimer Dis Assoc Disord. 1995 Summer;9(2):101-4
references: 7662321
references: Am J Geriatr Psychiatry. 2010 Dec;18(12):1133-40
references: 20808100
references: Int J Geriatr Psychiatry. 2005 Mar;20(3):238-46
references: 15717342
references: J Psychiatr Res. 1982-1983;17(1):37-49
references: 7183759
references: Behav Brain Res. 2011 Nov 20;225(1):259-69
references: 21777624
references: J Clin Exp Neuropsychol. 1993 Mar;15(2):231-44
references: 8491848
references: Am J Geriatr Psychiatry. 2009 May;17(5):428-36
references: 19390300
references: J Am Geriatr Soc. 1997 Apr;45(4):458-64
references: 9100715
references: N Engl J Med. 2007 Nov 1;357(18):1834-40
references: 17978292
references: Hum Brain Mapp. 2006 Jul;27(7):588-97
references: 16247783
references: Ital J Neurol Sci. 1996 Aug;17(4):305-9
references: 8915764
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: Encephale. 2004 Nov-Dec;30(6):570-7
references: 15738860
references: Drugs Aging. 2012 Aug 1;29(8):607-14
references: 22574633
references: Neuroscientist. 2008 Apr;14(2):203-22
references: 18057389
references: JAMA. 1963 Sep 21;185:914-9
references: 14044222
references: Brain. 2011 Apr;134(Pt 4):1061-76
references: 21385751
references: Am J Psychiatry. 2006 Aug;163(8):1323-34
references: 16877642
references: Lancet Neurol. 2007 Aug;6(8):734-46
references: 17616482
references: Gerontologist. 1969 Autumn;9(3):179-86
references: 5349366
references: Psychiatry Clin Neurosci. 2005 Dec;59(6):697-704
references: 16401246
references: Acta Neuropsychiatr. 2010 Aug;22(4):180-7
references: 25385123
references: J Alzheimers Dis. 2012;29(4):761-72
references: 22349686
references: J Neurol Neurosurg Psychiatry. 2006 Jun;77(6):719-25
references: 16549411
references: Eur Neurol. 1996;36(6):378-84
references: 8954307
references: Neuropsychol Rev. 2004 Sep;14(3):131-42
references: 15673234
references: Neurology. 1984 Jul;34(7):939-44
references: 6610841