P1‐484: Understanding Anosognosia in Alzheimer's Patients

Anosognosia is one of the most important aspects of Alzheimer disease (AD) treatment, especially for those medical procedures that require informed consent. Anatomical, psychological and social factors justify the extreme variability of anosognosia's clinical presentation and also depression and patient's personality may have an influence on it. The aim of this study was to assess patient's anosognosia with a simple method which could be used quickly in ordinary practice. In our department we completed the Mini Mental State Examination (MMSE) and the Clinical Dementia Rating Scale (CDR) with an anosognosia scale for dementia (AQ-D, Migliorelli 1995) and a 10 points self-administrated visual analogical scale for cognitive-function self-evaluation which was completed before and after MMSE. We studied 60 consecutive AD patients, 31 females and 29 males, with a diagnosis of mild-moderate Alzheimer disease (NINCDS-ADRDA). In our population, CDR range was 1-2 and MMSE range was 11-25. We found no correlations between CDR and MMSE and the anosognosia self evaluation, even if there was a correlation between MMSE and caregiver AQ-D. Only 20% of our patients realize a worsening at the visual analogical scale after doing MMSE; moreover 18% of our patients improved their score at the same scale after doing MMSE (this group of patients had also lower scores of AQ-D scale). After a caregiver interview, all the patients revealed a more severe cognitive deficit, and in some cases caregiver retailed compensative strategies used by the patient to gloss over his deficit. Anosognosia seems to be independent from the severity of the illness; moreover the grade of frontal impairment could explain different levels of awareness. Besides our patients, even if anosognosic, seem to show an “implicit” awareness that validated scales are not able to detect. In order to elaborate new instruments, more sensitive to these aspects, it could be useful to take in consideration the specific pattern of activity, behavior and personal interests and experiences of each subject.