Mnemonic anosognosia in Alzheimer's disease is caused by a failure to transfer online evaluations of performance: Evidence from memory training programs.
BACKGROUND
There is a debate about the ability of patients with Alzheimer's disease to build an up-to-date representation of their memory function, which has been termed mnemonic anosognosia. This form of anosognosia is typified by accurate online evaluations of performance, but dysfunctional or outmoded representations of function more generally.


METHODS
We tested whether people with Alzheimer's disease could adapt or change their representations of memory performance across three different six-week memory training programs using global judgements of learning.


RESULTS
We showed that whereas online assessments of performance were accurate, patients continued to make inaccurate overestimations of their memory performance. This was despite the fact that the magnitude of predictions shifted according to the memory training. That is, on some level patients showed an ability to change and retain a representation of performance over time, but it was a dysfunctional one. For the first time in the literature we were able to use an analysis using correlations to support this claim, based on a large heterogeneous sample of 51 patients with Alzheimer's disease.


CONCLUSIONS
The results point not to a failure to retain online metamemory information, but rather that this information is never used or incorporated into longer term representations, supporting but refining the mnemonic anosognosia hypothesis.
a Faculty of Psychology and Sciences of Education , University of Coimbra , Coimbra , Portugal.
Ana Rita
AR
Silva
a Faculty of Psychology and Sciences of Education , University of Coimbra , Coimbra , Portugal.
Maria Salomé
MS
Pinho
b Department of Informatics Engineering , University of Coimbra , Coimbra , Portugal.
Luís
L
Macedo
c Laboratoire de Psychologie & NeuroCognition (CNRS UMR 5105) , Université Grenoble Alpes , Grenoble , France.
Céline
C
Souchay
c Laboratoire de Psychologie & NeuroCognition (CNRS UMR 5105) , Université Grenoble Alpes , Grenoble , France.
Christopher
C
Moulin
D000368:Aged; D000369:Aged, 80 and over; D000377:Agnosia / Q000523:psychology*; D000544:Alzheimer Disease / Q000523:psychology*; D005260:Female; D006801:Humans; D007858:Learning / Q000502:physiology; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged
Dementia; Global judgements of learning; Memory training; Metacognition