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      Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients Translated title: Anosognosia cognitiva e alterações comportamentais em pacientes com provável doença de Alzheimer

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          Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study.


          To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC).


          Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured.


          The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness.


          These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

          Translated abstract

          Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo.


          Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles.


          vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados.


          Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais.


          Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.

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          Most cited references 92

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          Neuropathological stageing of Alzheimer-related changes

           H Braak,  E Braak (1991)
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            Neuropathological stageing of Alzheimer-related changes.

             E Braak,  H Braak (1990)
            Eighty-three brains obtained at autopsy from nondemented and demented individuals were examined for extracellular amyloid deposits and intraneuronal neurofibrillary changes. The distribution pattern and packing density of amyloid deposits turned out to be of limited significance for differentiation of neuropathological stages. Neurofibrillary changes occurred in the form of neuritic plaques, neurofibrillary tangles and neuropil threads. The distribution of neuritic plaques varied widely not only within architectonic units but also from one individual to another. Neurofibrillary tangles and neuropil threads, in contrast, exhibited a characteristic distribution pattern permitting the differentiation of six stages. The first two stages were characterized by an either mild or severe alteration of the transentorhinal layer Pre-alpha (transentorhinal stages I-II). The two forms of limbic stages (stages III-IV) were marked by a conspicuous affection of layer Pre-alpha in both transentorhinal region and proper entorhinal cortex. In addition, there was mild involvement of the first Ammon's horn sector. The hallmark of the two isocortical stages (stages V-VI) was the destruction of virtually all isocortical association areas. The investigation showed that recognition of the six stages required qualitative evaluation of only a few key preparations.
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              The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.

              We developed a new instrument, the Neuropsychiatric Inventory (NPI), to assess 10 behavioral disturbances occurring in dementia patients: delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, and aberrant motor activity. The NPI uses a screening strategy to minimize administration time, examining and scoring only those behavioral domains with positive responses to screening questions. Both the frequency and the severity of each behavior are determined. Information for the NPI is obtained from a caregiver familiar with the patient's behavior. Studies reported here demonstrate the content and concurrent validity as well as between-rater, test-retest, and internal consistency reliability; the instrument is both valid and reliable. The NPI has the advantages of evaluating a wider range of psychopathology than existing instruments, soliciting information that may distinguish among different etiologies of dementia, differentiating between severity and frequency of behavioral changes, and minimizing administration time.

                Author and article information

                Dement Neuropsychol
                Dement Neuropsychol
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                Apr-Jun 2013
                Apr-Jun 2013
                : 7
                : 2
                : 197-205
                [1 ]PhD, Adjunct Professor, Faculty of Ceilandia, UnB, Brasilia DF, Brazil.
                [2 ]PhD, Full Professor, Laboratory of Neurosciences and Behavior, Institute of Biology, UnB, Brasília DF, Brazil.
                Author notes
                Corina Satler. Faculty of Ceilandia / University of Brasilia / Campus UnB Ceilandia – 72220-140 Brasilia DF – Brazil. E-mail address: satler@

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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