ANOSOGNOSIA AND BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN PATIENTS WITH ALZHEIMER'S DISEASE AFFECT CAREGIVER BURDEN. A MULTIDIMENSIONAL TEST ASSESSMENT

Objective: To evaluate the impact of anosognosia and behavioural and psychological symptoms (BPS) on the caregiver burden in a population of patients with Alzheimer’s disease (AD). Patients: We enrolled in the study 70 patients with MMSE of > 15 and the diagnosis of probable AD according to the NINCDS-ADRDA criteria (McKhann, G., et al. 1984) consecutively attending the UVA Centre of our Department in Messina in the period of January 20011-January 2012. Mean age was 77.7 + 4.04 years and the mean MMSE score was 23.25 +3.80. A population of 50 subjects matched for age and sex were enrolled as a control group. Methods: Inclusion criteria were: age > 50 years, diagnosis of probable AD according to the NINCDS-ADRD. The following neuropsychological test batteries were used: MMSE, Clock Drawing Test, Rey auditory verbal learning , The Rey-Osterrieth Complex Figure Test (ROCF), digit span, Corsi Block-Tapping Task, category and letter verbal fluency, trail-making test (A et B) Wisconsin Card Sorting Task, Raven Progressive Matrices Task. Anosognosia was assessed through Anosognosia questionnaire dementia (AQ-D), Guidelines for the Rating of Awareness Deficits (GRAD), Clinical Insight Rating Scale (CIRS), A.D.L, I.A.D.L. Caregiver Burden Inventory. Results: 50.0% of patients resulted aware of their cognitive impairment, 26.3% showed partial awareness and 23,7% were totally unaware. The presence of neuropsychiatric symptoms in patients was positively correlated with increase in caregiver burden. In particular, 70% of the caregivers showed an average score of 22.9 (CBI), which was correlated to a moderate cognitive impairment of the patient and bizarre behaviour. Discussion: Starkstein et al. (1996, 2006) divided the domains of anosognosia (loss of insight) into two domains: lack of cognitive awareness and lack of behavioral awareness. The present study supports the hypothesis that anosognosia is not a simple consequence of cognitive deficit but rather a wider behavioural disorder. Neuropsychiatric symptoms may not only increase the patients' own distress levels but also affect the distress of caregivers. Thus, it is important to assess anosognosia in patients with AD. References: Starkstein SE, et al. Two domains of anosognosia in Alzheimer's disease. J. Neurol. Neurosurg. Psychiatry (1996); 61:485-490 Starkstein SE, et al.A diagnostic formulation for anosognosia in Alzheimer's disease J Neurol Neurosurg Psychiatry(2006);77: 719-725 Tabert MH, et al. Functional deficits in patients with mild cognitive impairment: prediction of AD Neurology (2002);58:758-764