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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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          Abstract

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

          OBJECTIVE

          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).

          METHODS

          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.

          RESULTS

          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.

          CONCLUSION

          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.

          OBJETIVO

          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.

          MÉTODOS

          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.

          RESULTADOS

          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.

          CONCLUSÃO

          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 references79

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          Executive functioning as a predictor of children's mathematics ability: inhibition, switching, and working memory.

          Children's mathematical skills were considered in relation to executive functions. Using multiple measures--including the Wisconsin Card Sorting Task (WCST), dual-task performance, Stroop task, and counting span-it was found that mathematical ability was significantly correlated with all measures of executive functioning, with the exception of dual-task performance. Furthermore, regression analyses revealed that each executive function measure predicted unique variance in mathematics ability. These results are discussed in terms of a central executive with diverse functions (Shallice & Burgess, 1996) and with recent evidence from Miyake, et al. (2000) showing the unity and diversity among executive functions. It is proposed that the particular difficulties for children of lower mathematical ability are lack of inhibition and poor working memory, which result in problems with switching and evaluation of new strategies for dealing with a particular task. The practical and theoretical implications of these results are discussed, along with suggestions for task changes and longitudinal studies that would clarify theoretical and developmental issues related to executive functioning.
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            Mathematical disabilities: cognitive, neuropsychological, and genetic components.

            Cognitive, neuropsychological, and genetic correlates of mathematical achievement and mathematical disability (MD) are reviewed in an attempt to identify the core deficits underlying MD. Three types of distinct cognitive, neuropsychological, or cognitive and neuropsychological deficits associated with MD are identified. The first deficit is manifested by difficulties in the representation or retrieval of arithmetic facts from semantic memory. The second type of deficit is manifested by problems in the execution of arithmetical procedures. The third type involves problems in the visuospatial representation of numerical information. Potential cognitive, neuropsychological, and genetic factors contributing to these deficits, and the relationship between MD and reading disabilities, are discussed. Finally, suggestions for the subtyping of mathematical disorders are offered.
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              Stroop performance in healthy younger and older adults and in individuals with dementia of the Alzheimer's type.

              Components of the Stroop task were examined to investigate the role that inhibitory processes play in cognitive changes in healthy older adults and in individuals with dementia of the Alzheimer's type (DAT). Inhibitory breakdowns should result in an increase in Stroop interference. The results indicate that older adults show a disproportionate increase in interference compared with younger adults. DAT individuals show interference proportionate to older adults but a disproportionate increase in facilitation for congruent color-word trials, and an increased intrusion of word naming on incongruent color naming trials. An ex-Gaussian analysis of response time distributions indicated that the increased interference observed in older adults was due to an increase in the tail of the distribution. Application of the process dissociation analysis of the Stroop task (D.S. Lindsay & L.L. Jacoby, 1994) indicated that older adults showed increased word process estimates, whereas DAT individuals showed differences in both color and word process estimates. Taken together, the results are consistent with an inhibitory breakdown in normal aging and an accelerated breakdown in inhibition in DAT individuals.
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                Author and article information

                Journal
                Dement Neuropsychol
                Dement Neuropsychol
                dn
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                1980-5764
                Apr-Jun 2013
                Apr-Jun 2013
                : 7
                : 2
                : 197-205
                Affiliations
                [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@ 123456unb.br
                Article
                10.1590/S1980-57642013DN70200010
                5619518
                0f851000-6c0e-4f3a-b2cd-8d1e00bd9e7f

                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.

                History
                : 18 February 2012
                : 18 April 2013
                Categories
                Original Articles

                awareness,anosognosia,insight,aging,alzheimer's disease,dementia

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