Awareness and behavioural and psychological symptoms of dementia (BPSD) impact in Alzheimer's disease

The terms insight or deficit awareness have been used interchangeably to refer the lack of knowledge or recognition of one's deficit. Our aim was to investigate if this lack could influence Alzheimer’s disease patients ability to understand and making decision in the different stage of disease. Methods and materials: We enrolled 126 patients affected by Alzheimer's disease according to NINCS-ADRDA criteria. (61% women and 39% men), mean age 73.9, mean MMSE 15.97. The cognitive level was investigated with MMSE. While psychological and behavioral disorders were assessed by NPI. The stress impact on caregivers was evaluated by CBI. The instrumental and activities of daily living were evaluated by IADL, and ADL. For assessing awareness: AQ-D, CIRS for evaluate insight. All the participant gave informed consent. Results: The MMSE correlated with AQD-A (p <.001) and AQD-B (p <.0001). Schooling had a negative correlation with AQD-A (p<.01) and with standardized residuals (p <.05) and the correlation between AQD-B and schooling was significant (p =.06). Age did not correlate with any measurement of the AQ-D test. Anosognosia in the AQD-A test was predicted by MMSE (p <.01) and by schooling (p <.05); it was also present in a high percentage as low was the schooling and as high was the dementia grade. On the other hand, anosognosia in the AQD-B test was predicted only by MMSE (p <.0001). CIRS correlated with all three forms of AQ-D test (at least p <.0001). In the end, caregivers’ distress resulted correlated with all NPI scales except for apathy scale. Distress Pearson Correlations was also present for psychosis: P=0.605, allucinations P=0.603, agitation P=0.594, depression P=0.483, apathy P=0.169, disinibition P=0.401, irritability P=0.547, wandering P=0.609, sleep problems P=0.282, appetite change P=0.472. Discussion and Conclusions: Awareness disorders and BPSD had important implications for relationships with caregivers and family members. This study examined a large number of caregivers suffering from anxiety and depression related to the BPSD type and to AD severity. The high percentage of anosognosia found in this study showed a lack in the construct of awareness, in the patient's decision-making capacity and also in the possibility to provide a patient’s conscious choice (such as to release an informed consent) about his own health. Particular attention should be given to caregivers with the implementation of psychoeducational pathways and the use of a psychological counseling in order to better manage this convoluted disease and his several implications. References: - McGlynn SM1, Schacter DL. Unawareness of deficits in neuropsychological syndromes. J Clin Exp Neuropsychol. 1989 Mar;11(2):143-205. - Migliorelli R, Teson A, Sabe L et al. Anosognosia in Alzheimer’s disease: a study of associated factors. J Neuropsychiatry Clin Neurosci (1995) 7:338–344 - Ott BR, Lafleche G, Whelihan WM, Buongiorno GW, Albert MS, Fogel BS. Impaired awareness of deficits in Alzheimer's disease. Alzheimer Dis Assoc Disord. 1996;10:68-76 - McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neu-rology 1984;34:939–44. - MF Folstein, SE Folstein, PR McHugh Journal of Psychiatric Research 1975; 12: 189-198 - Novak M. e Guest C Caregiver Burden Inventory (CBI) , Gerontologist, 29, 798 - 803, 1989) - Katz S, Downs TD, Cash HR, et al: “Progress in the development of the index of ADL.” Gerontologist 10:20-30, 1970. - Lawton M.P. e Brody E.M (Activity of Daily living, Gerontologist, 9:179-186, 1969) - Gambina G, Valbusa V, Corsi N, Ferrari F, Sala F, Broggio E, Condoleo MT, Surdo V, et al Awareness Questionnaire Disease In Dementia Migliorelli et al., 1995 The Italian validation of the Anosognosia Questionnaire for Dementia in Alzheimer's disease Am J Alzheimers Dis Other Demen. 2015 Sep;30(6): 635-44