Skip to main content Accessibility help
×
Home
Hostname: page-component-5bf98f6d76-zn7qb Total loading time: 0.314 Render date: 2021-04-21T04:55:10.909Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer’s disease

Published online by Cambridge University Press:  24 October 2019

Anna Fischer
Affiliation:
Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Gávea, Rio de Janeiro, RJ, 22451-900, Brazil
Marcia Cristina Nascimento Dourado
Affiliation:
Institute of Psychiatry, Federal University of Rio de Janeiro, Avenida Venceslau Brás, 71, Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
Jerson Laks
Affiliation:
Institute of Psychiatry, Federal University of Rio de Janeiro, Avenida Venceslau Brás, 71, Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
Jesus Landeira-Fernandez
Affiliation:
Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Gávea, Rio de Janeiro, RJ, 22451-900, Brazil
Robin G. Morris
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London SE5 8AF, United Kingdom
Daniel C. Mograbi
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London SE5 8AF, United Kingdom
Corresponding
E-mail address:

Abstract

Objectives:

To investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness in a non-clinically depressed sample of participants with mild to moderate Alzheimer’s disease (AD) in Brazil.

Methods:

People with AD (PwAD) aged 60 years or older were recruited from an outpatient unit at the Center of AD of the Federal University of Rio de Janeiro, Brazil. Measures of awareness of condition (Assessment Scale of the Psychosocial Impact of the Diagnosis of Dementia), cognitive function (Mini-Mental State Examination), mood state (Cornell Scale for Depression in Dementia), and functionality (Pfeffer Functional Activities Questionnaire) were applied to 264 people with mild to moderate AD and their caregivers. Hypotheses were tested statistically using SEM approach. Three competing models were compared.

Results:

The first model, in which the influence of mood state and cognitive function on awareness was mediated by functionality, showed a very good fit to the data and a medium effect size. The competing models, in which the mediating variables were mood state and cognitive function, respectively, only showed poor model fit.

Conclusion:

Our model supports the notion that the relationship between different factors and awareness in AD is mediated by functionality and not by depressive mood state or cognitive level. The proposed direct and indirect effects on awareness are discussed, as well as the missing direct influence of mood state on awareness. The understanding of awareness in dementia is crucial and our model gives one possible explanation of its underlying structure in AD.

Type
Original Research Article
Copyright
© International Psychogeriatric Association 2019 

Access options

Get access to the full version of this content by using one of the access options below.

References

Aalten, P., Van Valen, E., Clare, L., Kenny, G. and Verhey, F. (2005). Awareness in dementia: a review of clinical correlates. Aging and Mental Health, 9, 414422. doi: 10.1080/13607860500143075.CrossRefGoogle ScholarPubMed
Aalten, P., Van Valen, E., De Vugt, M. E., Lousberg, R., Jolles, J. and Verhey, F. R. J. (2006). Awareness and behavioral problems in dementia patients: a prospective study. International Psychogeriatrics, 18, 317. doi: 10.1017/S1041610205002772.CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in Dementia. Biological Psychiatry, 23, 271284. doi: 10.1016/0006-3223(88)90038-8.CrossRefGoogle ScholarPubMed
American Psychiatric Association, (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.Google Scholar
Arkin, S. and Mahendra, N. (2001). Insight in Alzheimer’s patients: results of a longitudinal study using three assessment methods. American Journal of Alzheimer’s Disease and Other Dementias, 16, 211224. doi: 10.1177/153331750101600401.CrossRefGoogle ScholarPubMed
Barrett, P. (2007). Structural equation modelling: adjudging model fit. Personality and Individual Differences, 42, 815824. doi: 10.1016/j.paid.2006.09.018.CrossRefGoogle Scholar
Baune, B. T., Miller, R., McAfoose, J., Johnson, M., Quirk, F. and Mitchell, D. (2010). The role of cognitive impairment in general functioning in major depression. Psychiatry Research, 176, 183189. doi: 10.1016/j.psychres.2008.12.001.CrossRefGoogle ScholarPubMed
Bertolucci, P. H., Brucki, S. M., Campacci, S. R. and Juliano, Y. (1994). The Mini-Mental State Examination in a general population: impact of educational status. Arquivos de Neuropsiquiatria, 52, 17. doi: 10.1590/S0004-282X1994000100001.CrossRefGoogle Scholar
Bertrand, E., Dourado, M. C. N., Laks, J., Morris, R. G., Landeira-Fernandez, J. and Mograbi, D. C. (2016). Mood-congruent recollection and anosognosia in Alzheimer’s disease. Cortex, 84, 5562. doi: 10.1016/j.cortex.2016.09.001.CrossRefGoogle ScholarPubMed
Byrne, B. M. (1998). Structural Equation Modeling with Lisrel, Prelis, and Simplis: Basic Concepts, Applications, and Programming. Multivariate applications book series (2nd ed.). Mahwah: Routledge.Google Scholar
Cines, S. et al. (2015). Examining the pathways between self-awareness and well-being in mild-moderate Alzheimer’s Disease. The American Journal of Geriatric Psychiatry, 23, 12971306. doi: 10.1016/j.jagp.2015.05.005.CrossRefGoogle Scholar
Clare, L. et al. (2012a). Longitudinal trajectories of awareness in early-stage dementia. Alzheimer Disease & Associated Disorders, 26, 140147. doi: 10.1097/WAD.0b013e31822c55c4.CrossRefGoogle ScholarPubMed
Clare, L. et al. (2012b). The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: testing a biopsychosocial model. International Journal of Geriatric Psychiatry, 27, 167177. doi: 10.1002/gps.2705.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). United States of America: Lawrence Erlbaum Associates. doi: 10.1234/12345678.Google Scholar
Cummings, J. L., Ross, W., Absher, J., Gornbein, J. and Hadjiaghai, L. (1995). Depressive symptoms in Alzheimer disease: assessment and determinants. Alzheimer Disease and Associated Disorders, 9, 8793. doi: 10.1097/00002093-199509020-00005.CrossRefGoogle ScholarPubMed
David, A. S. (2004). The clinical importance of insight: an overview. In: Amador, X. F. E. and David, A. S. E. (Eds.), Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (pp. 359392). New York: Oxford University Press.CrossRefGoogle Scholar
Derouesne, C., Thibault, S., Lagha-Pierucci, S., Baudouin-Madec, V., Ancri, D. and Lacomblez, L. (1999). Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type. International Journal of Geriatric Psychiatry, 14, 10191030. doi: 10.1002/(SICI)1099-1166(199912)14:12<1019:AID-GPS61>3.0.CO;2-F.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Dourado, M. C. N. N., Laks, J. and Mograbi, D. (2016). Functional status predicts awareness in late-onset but not in early-onset Alzheimer Disease. Journal of Geriatric Psychiatry and Neurology, 29, 313319. doi: 10.1177/0891988716640372.CrossRefGoogle ScholarPubMed
Dourado, M. C. N. et al. (2014). Awareness of disease in dementia: factor structure of the assessment scale of psychosocial impact of the diagnosis of dementia. Journal of Alzheimer’s Disease, 41, 947956. doi: 10.3233/JAD-140183.CrossRefGoogle ScholarPubMed
Ecklund-Johnson, E. and Torres, I. (2005). Unawareness of deficits in Alzheimer’s disease and other dementias: operational definitions and empirical findings. Neuropsychology Review, 15, 147166. doi: 10.1007/s11065-005-9026-7.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Horning, S. M., Melrose, R. and Sultzer, D. (2014). Insight in Alzheimer’s disease and its relation to psychiatric and behavioral disturbances. International Journal of Geriatric Psychiatry, 29, 7784. doi: 10.1002/gps.3972.CrossRefGoogle ScholarPubMed
Hu, L. T. and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 155. doi: 10.1080/10705519909540118.CrossRefGoogle Scholar
Jackson, D. L. (2003). Revisiting sample size and number of parameter estimates: some support for the N:q hypothesis. Structural Equation Modeling, 10, 128141. doi: 10.1207/S15328007SEM1001_6.CrossRefGoogle Scholar
Lacerda, I. B., Santos, R. L., Neto, J. P. S. and Dourado, M. C. N. (2017). Factors related to different objects of awareness in Alzheimer disease. Alzheimer Disease and Associated Disorders, 31, 335342. doi: 10.1097/WAD.0000000000000210.CrossRefGoogle ScholarPubMed
Lehrner, J. et al. (2014). Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease. International Psychogeriatrics, 27, 357366. doi: 10.1017/S1041610214002245.CrossRefGoogle ScholarPubMed
Lopez, O. L., Becker, J. T., Somsak, D., Dew, M. A. and DeKosky, S. T. (1994). Awareness of cognitive deficits and anosognosia in probable Alzheimer’s disease. European Neurology, 34, 277282. doi: 10.1159/000117056.CrossRefGoogle ScholarPubMed
MacCallum, R. C. and Austin, J. T. (2000). Applications of structural equation modeling in psychological research. Annual Review of Psychology, 51, 201236. doi: 10.1146/annurev.psych.51.1.201.CrossRefGoogle ScholarPubMed
Maia, A. L. G. et al. (2006). Application of the Brazilian version of the CDR scale in samples of dementia patients. Arquivos de Neuropsiquiatria, 64, 485489. doi: 10.1590/S0004-282X2006000300025.CrossRefGoogle ScholarPubMed
McDonald, R. P. and Ho, M. H. R. (2002). Principles and practice in reporting structural equation analyses. Psychological Methods, 7, 6482. doi: 10.1037//1082-989X.7.1.64.CrossRefGoogle ScholarPubMed
Michon, A., Deweer, B., Pillon, B., Agid, Y. and Dubois, B. (1994). Relation of anosognosia to frontal lobe dysfunction in Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 57, 805809. doi: 10.1136/jnnp.57.7.805.CrossRefGoogle ScholarPubMed
Mograbi, D. C., Brown, R. G. and Morris, R. G. (2009). Anosognosia in Alzheimer’s disease - The petrified self. Consciousness and Cognition, 18, 9891003. doi: 10.1016/j.concog.2009.07.005.CrossRefGoogle ScholarPubMed
Mograbi, D. C. et al. (2012). Unawareness of memory impairment in dementia: a population-based study. International Psychogeriatrics, 24, 931939. doi: 10.1017/S1041610211002730.CrossRefGoogle ScholarPubMed
Mograbi, D. C. and Morris, R. G. (2014). On the relation among mood, apathy, and anosognosia in Alzheimer’s disease. Journal of the International Neuropsychological Society, 20, 27. doi: 10.1017/S1355617713001276.CrossRefGoogle ScholarPubMed
Mograbi, D. C. and Morris, R. G. (2018). Anosognosia. Cortex, 103, 385386. doi: 10.1016/j.cortex.2018.04.001.CrossRefGoogle ScholarPubMed
Mograbi, D. C. et al. (2018). The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country. International Journal of Geriatric Psychiatry, 33, 807813. doi: 10.1002/gps.4765.CrossRefGoogle Scholar
Mondragón, J.D., Maurits, N.M. and De Deyn, P.P. (2019). Functional Neural correlates of anosognosia in mild cognitive impairment and Alzheimer’s disease: a systematic review. Neuropsychology Review, 29, 139165. doi: 10.1007/s11065-019-09410-x.CrossRefGoogle ScholarPubMed
Morris, R. G. and Hannesdottir, K. (2004). Loss of “awareness” in Alzheimer’s disease. In: Morris, R. G. and Becker, J. T. (Eds.), The Cognitive Neuropsychology of Alzheimer’s Disease (pp. 275296). Oxford: Oxford University Press.Google Scholar
Morris, R. G. and Mograbi, D. C. (2013). Anosognosia, autobiographical memory and self knowledge in Alzheimer’s disease. Cortex, 49, 15531565. doi: 10.1016/j.cortex.2012.09.006.CrossRefGoogle ScholarPubMed
Ott, B. R., Lafleche, G., Whelihan, W. M., Buongiorno, G. W., Albert, M. S. and Fogel, B. S. (1996). Impaired awareness of deficits in Alzheimer disease. Alzheimer Disease and Associated Disorders, 10, 6876. doi: 10.1097/00002093-199601020-00003.CrossRefGoogle ScholarPubMed
Patel, V. and Prince, M. (2001). Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India. Psychological Medicine, 31, 2938. doi: 10.1017/S0033291799003098.CrossRefGoogle Scholar
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Chance, J. M. and Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323329. doi: 10.1093/geronj/37.3.323.CrossRefGoogle Scholar
Portugal, M. G. et al. (2012). Validation of Montgomery-Åsberg rating scale and Cornell scale for depression in dementia in Brazilian elderly patients. International Psychogeriatrics, 24, 12911298. doi: 10.1017/S1041610211002250.CrossRefGoogle Scholar
Reed, B. R., Jagust, W. J. and Coulter, L. (1993). Anosognosia in Alzheimer’s disease: relationships to depression, cognitive function, and cerebral perfusion. Journal of Clinical and Experimental Neuropsychology, 15, 231244. doi: 10.1080/01688639308402560.CrossRefGoogle ScholarPubMed
Rosen, H. J. (2011). Anosognosia in neurodegenerative disease Anosognosia in neurodegenerative disease Anosognosia in neurodegenerative disease. Neurocase, 17, 231241. doi: 10.1080/13554794.2010.522588.CrossRefGoogle ScholarPubMed
Rosen, H. J. et al. (2010). Neuroanatomical correlates of cognitive self-appraisal in neurodegenerative disease. NeuroImage, 49, 33583364. doi: 10.1016/j.neuroimage.2009.11.041.CrossRefGoogle ScholarPubMed
Spalletta, G., Girardi, P., Caltagirone, C. and Orfei, M. D. (2012). Anosognosia and neuropsychiatric symptoms and disorders in mild Alzheimer disease and mild cognitive impairment. Journal of Alzheimer’s Disease, 29, 761772. doi: 10.3233/JAD-2012-111886.CrossRefGoogle ScholarPubMed
Starkstein, S. E. (2014). Anosognosia in Alzheimer’s disease: diagnosis, frequency, mechanism and clinical correlates. Cortex, 61, 6473. doi: 10.1016/j.cortex.2014.07.019.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R., Mizrahi, R., Adrian, J. and Robinson, R. G. (2007). Insight and danger in Alzheimer’s disease. European Journal of Neurology, 14, 455460. doi: 10.1111/j.1468-1331.2007.01745.x.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R., Mizrahi, R. and Robinson, R. G. (2006). A diagnostic formulation for anosognosia in Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 77, 719725. doi: 10.1136/jnnp.2005.085373.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Sabe, L., Chemerinski, E., Jason, L. and Leiguarda, R. (1996). Two domains of anosognosia in Alzheimer’s disease. Journal of Neurology Neurosurgery and Psychiatry, 61, 485490. doi: 10.1136/jnnp.61.5.485.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Petracca, G., Chemerinski, E. and Kremer, J. (2001). Syndromic validity of apathy in Alzheimer’s disease. American Journal of Psychiatry, 158, 872877. doi:10.1176/appi.ajp.158.6.872.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Vázquez, S., Migliorelli, R., Tesón, A., Sabe, L. and Leiguarda, R. (1995). A single-photon emission computed tomographic study of anosognosia in Alzheimer’s disease. Archives of Neurology, 52, 415420. doi: 10.1001/archneur.1995.00540280105024.CrossRefGoogle ScholarPubMed
Sunderaraman, P. and Cosentino, S. (2017). Integrating the constructs of anosognosia and metacognition: a review of recent findings in dementia. Current Neurology and Neuroscience Reports, 17, 27. doi: 10.1007/s11910-017-0734-1.CrossRefGoogle ScholarPubMed
Tabachnick, B. G. and Fidell, L. S. G. (2007). Using Multivariate Statistics (5th ed.). New Jersey: Pearson Education. doi: 10.1037/022267.Google Scholar
Troisi, A., Pasini, A., Gori, G., Sorbi, T., Baroni, A. and Ciani, N. (1996). Clinical predictors of somatic and psychological symptoms of depression in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 11, 2327. doi: 10.1002/(SICI)1099-1166(199601)11:1<23:AID-GPS264>3.0.CO;2-4.3.0.CO;2-4>CrossRefGoogle Scholar
Vasterling, J. J., Seltzer, B., Foss, J. W. and Vanderbrook, V. (1995). Unawareness of deficits in Alzheimer’s disease: domain-specific differences and disease correlates. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 8, 2632.Google Scholar
Verhey, F. R. J., Rozendaal, N., Ponds, R. W. H. M. and Jolles, J. (1993). Dementia, awareness and depression. International Journal of Geriatric Psychiatry, 8, 851856. doi: 10.1002/gps.930081008.CrossRefGoogle Scholar
Verhülsdonk, S., Quack, R., Höft, B., Lange-Asschenfeldt, C. and Supprian, T. (2013). Anosognosia and depression in patients with Alzheimer’s dementia. Archives of Gerontology and Geriatrics, 57, 282287. doi: 10.1016/j.archger.2013.03.012.CrossRefGoogle ScholarPubMed
Vogel, A., Boch Waldorff, F. and Waldemar, G. (2015). Longitudinal changes in awareness over 36 months in patients with mild Alzheimer’s disease. International Psychogeriatrics, 27, 95102. doi: 10.1017/S1041610214001562.CrossRefGoogle ScholarPubMed
Wheaton, B., Muthen, B., Alwin, D. F. and Summers, G. (1977). Assessing reliability and stability in panel models. Sociological Methodology, 8, 84136. doi: 10.2307/270754.CrossRefGoogle Scholar
Wilson, R. S. et al. (2015). Temporal course and pathologic basis of unawareness of memory loss in dementia. Neurology, 85, 984991. doi: 10.1212/WNL.0000000000001935.CrossRefGoogle ScholarPubMed
Zanetti, O. et al. (1999). Insight in dementia: when does it occur? Evidence for a nonlinear relationship between insight and cognitive status. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54, 100106. doi: 10.1093/geronb/54B.2.P100.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 16
Total number of PDF views: 47 *
View data table for this chart

* Views captured on Cambridge Core between 24th October 2019 - 21st April 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer’s disease
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer’s disease
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer’s disease
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *