title: Clinical associations of anosognosia in mild cognitive impairment and Alzheimer's disease.
abstract: OBJECTIVE
  While loss of insight of cognitive deficits is a common phenomenon in patients with Alzheimer's disease (AD), there is a lack of consensus regarding the presence of impaired insight among patients with mild cognitive impairment (MCI). We aim to investigate the clinical, cognitive, and behavioral associations of anosognosia in AD and MCI subjects.
  
  
  METHODS
  A consecutive series of 87 subjects (30 healthy older patients, 21 MCI, and 36 AD) each accompanied by a caregiver, underwent clinical assessment including the evaluation of insight using the Anosognosia Questionnaire for Dementia (AQD). We also separately assessed Intellectual Function (AQD-IF) and Behavior domains of the AQD scale. Regression models were subsequently used to investigate associations of AQD scores with cognitive and other neuropsychiatric symptoms, including depression and apathy.
  
  
  RESULTS
  Both AD and MCI groups demonstrated significant anosognosia compared with the healthy control group. In the AD group, 55.6% had "Mild Anosognosia," and 27.8% had "Severe Anosognosia." In the MCI group, 42.9% showed "Mild Anosognosia," and 9.5% had "Severe Anosognosia." Greater levels of AQD-Total and AQD-IF were associated with lower Mini-mental state examination and higher apathy scores in the AD group. In the MCI group, caregiver burden was significantly associated with AQD-Total (p = 0.016) and AQD-IF (p = 0.039).
  
  
  CONCLUSIONS
  The results indicated that anosognosia is common in both AD and MCI patients and associated with cognitive dysfunction and apathy in AD. The findings of this study warrant further research to delineate the mechanisms of anosognosia as it poses a challenge to treatment outcomes.
authors.affiliation: Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: E
authors.identifier: http://orcid.org/0000-0002-6437-8024
authors.initials: E
authors.lastname: Mak
authors.affiliation: Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Chin
authors.affiliation: Department of Neurology, Singapore General Hospital, Singapore, Singapore.
authors.forename: L T
authors.initials: LT
authors.lastname: Ng
authors.affiliation: Department of Neurology, Singapore General Hospital, Singapore, Singapore.
authors.forename: D
authors.initials: D
authors.lastname: Yeo
authors.affiliation: Department of Neurology, Singapore General Hospital, Singapore, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Hameed
mesh_terms: D000328:Adult; D000368:Aged; D000377:Agnosia / Q000209:etiology*; D000544:Alzheimer Disease / Q000150:complications* / Q000523:psychology; D057565:Apathy; D016022:Case-Control Studies; D003071:Cognition; D060825:Cognitive Dysfunction / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales
keywords: Alzheimer's disease; cognitive impairment; dementia; neuropsychology