title: Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression.
abstract: BACKGROUND
  Anosognosia is a frequent symptom in Alzheimer disease (AD). The objective of this article is to describe prevalence of this condition at time of diagnosis and analyse any predisposing factors and their influence on disease progression.
  
  
  METHODS
  Observational, prospective, and analytical multi-centre study in an outpatient setting. Patients recently diagnosed with AD (NINCDS-ADRDA criteria) were included. Each patient underwent two cognitive, functional, and neuropsychiatric assessments separated by an interval of 18 months. The Clinical Insight Rating Scale was employed as a measure of anosognosia (CIR, scored 0-8). Progression was defined as an increase in the Clinical Dementia Rating Scale-sum of boxes of more than 2.5 points. The predictor variables were analysed using binary logistic regression.
  
  
  RESULTS
  The study included 127 patients, and 94 completed both assessments. Of the total, 31.5% displayed severe anosognosia (CIR 7-8); 39.4%, altered level of consciousness (CIR 3-6); and 29.1%, normal awareness (CIR 0-2). The median baseline CIR in this cohort was 4 (Q1-Q3: 1-7), and at 18 months, 6 (Q1-Q3: 3-8), P<.001. Advanced age (odds ratio (OR) 2.43; CI 95%:1.14-5.19), lower educational level (OR 2.15; CI 95%:1.01-4.58), and more marked neuropsychiatric symptoms (OR 2.66; CI 95%:1.23-5.74) were predictor variables of anosognosia. Baseline CIR was similar in the groups with and without significant clinical progression.
  
  
  CONCLUSIONS
  The large majority of patients with AD at the time of diagnosis showed significant anosognosia, and this condition was associated with advanced age, lower educational level, and more marked behavioural symptoms. Our results did not show that anosognosia had an effect on the initial clinical progression of AD after diagnosis.
authors.affiliation: Sección de Neurología, Complejo Hospitalario de Segovia, Segovia, España.
authors.forename: A
authors.initials: A
authors.lastname: Castrillo Sanz
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Río Hortega de Valladolid, Valladolid, España.
authors.forename: M
authors.initials: M
authors.lastname: Andrés Calvo
authors.affiliation: Medicina de Familia, Centro de Salud Valladolid-Rural 1, Área Oeste de Valladolid, Valladolid, España.
authors.forename: I
authors.initials: I
authors.lastname: Repiso Gento
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Río Hortega de Valladolid, Valladolid, España.
authors.forename: E
authors.initials: E
authors.lastname: Izquierdo Delgado
authors.affiliation: Sección de Neurología, Complejo Asistencial de Ávila, Ávila, España.
authors.forename: R
authors.initials: R
authors.lastname: Gutierrez Ríos
authors.affiliation: Sección de Geriatría, Complejo Hospitalario de Segovia, Segovia, España.
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez Herrero
authors.affiliation: Sección de Neurología, Complejo Hospitalario de Segovia, Segovia, España.
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez Sanz
authors.affiliation: Sección de Neurología, Hospital Universitario Río Hortega de Valladolid, Valladolid, España. Electronic address: mtola.nrl@gmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Tola-Arribas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D000544:Alzheimer Disease / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires
keywords: Alzheimer disease; Anosognosia; Demencia; Dementia; Enfermedad de Alzheimer; Estudio prospectivo; Prevalence; Prevalencia; Prospective study