1
|
Leocadi M, Canu E, Paldino A, Agosta F, Filippi M. Awareness impairment in Alzheimer's disease and frontotemporal dementia: a systematic MRI review. J Neurol 2023; 270:1880-1907. [PMID: 36512063 DOI: 10.1007/s00415-022-11518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
This review aims to define awareness impairment and related disturbances in neurodegenerative diseases, including Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) spectrum of disorders. An update of the available scientific literature on the use of magnetic resonance imaging (MRI) in the study of awareness in these disorders is also offered. MRI plays an important role in the characterization of neurodegenerative signatures and can increase our knowledge on brain structural and functional correlates of awareness. In the reviewing process, we established a-priori criteria and we searched the scientific literature for relevant articles on this topic. In summary, we selected 36 articles out of 1340 publications retrieved from PubMed. Based on this selection, this review discusses the multiple terms used to define different or overlapping aspects of awareness impairment, and specifically summarizes recent application of MRI for investigating anosognosia, social cognition, including theory of mind and emotional processing, free will, and autonoetic awareness alterations in different neurodegenerative disorders, with most of these studies focused on AD and FTLD. This systematic review highlights the importance of awareness impairment and related domains in neurodegenerative disorders, especially in AD and FTLD, and it outlines MRI structural and functional correlates in these populations.
Collapse
Affiliation(s)
- Michela Leocadi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Angela Paldino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
2
|
Lie Ken Jie C, Finn YF, Bish M, Carlson E, Kumlien C, Chan EA, Leung DY. Mechanisms Driving Postgraduate Health and Social Science Students' Cultural Competence: An Integrated Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1707-1721. [PMID: 35476677 PMCID: PMC9592147 DOI: 10.1097/acm.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals. METHOD The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC. RESULTS Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity. CONCLUSIONS CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.
Collapse
Affiliation(s)
- Christopher Lie Ken Jie
- C. Lie Ken Jie is a medical student, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Yvonne F. Finn
- Y.F. Finn is a lecturer, clinical skills and clinical methods, School of Medicine, and vice dean for internationalization, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland; ORCID: https://orcid.org/0000-0002-9935-8453
| | - Melanie Bish
- M. Bish is associate professor, associate head, and director of academic partnerships, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4305-6760
| | - Elisabeth Carlson
- E. Carlson is professor, Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden; ORCID: https://orcid.org/0000-0003-0077-9061
| | - Christine Kumlien
- C. Kumlien is professor and vice dean, Department of Care Science, Faculty of Health and Society, Malmö University, and Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; ORCID: https://orcid.org/0000-0002-1437-5060
| | - E. Angela Chan
- E.A. Chan is associate professor and associate head of undergraduate education, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong; ORCID: https://orcid.org/0000-0003-4411-6200
| | - Doris Y.L. Leung
- D.Y.L. Leung is adjunct assistant professor, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong; ORCID: https://orcid.org/0000-0002-9636-3118
| |
Collapse
|
3
|
Giannouli V, Tsolaki M. Self-Awareness of Cognitive Efficiency, Cognitive Status, Insight, and Financial Capacity in Patients with Mild AD, aMCI, and Healthy Controls: An Intriguing Liaison with Clinical Implications? Neurol Int 2022; 14:628-637. [PMID: 35997360 PMCID: PMC9396975 DOI: 10.3390/neurolint14030051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: This study compares objective measures of cognitive performance with subjective perception of specific performance on neuropsychological tests examining basic cognitive domains, including, for the first time, financial capacity. Additionally, differences in assessment between single- and multiple-domain aMCI, mild AD, and healthy elderly regarding insight are examined. Methods: Participants completed a number of neuropsychological tests and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). After every test, participants were asked to complete the Clinical Insight Rating scale (CIR) and to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. Results: These preliminary findings show significant differences in the self-assessment patterns of the four groups in measures of verbal memory, visuospatial perception and memory, executive functions, tests of attention, and financial capacity. Mild AD expressed the highest overestimations, followed by single- and multiple-domain aMCI as well as controls. Accuracy of self-report is not uniform across groups and functional areas. Conclusions: Unawareness of memory deficits in both MCI subtypes is contradictory to subjective memory complaints as being an important component for clinical diagnosis. Financial capacity is overestimated in MCI and mild AD, a finding that has a plethora of clinical and legal implications.
Collapse
|
4
|
Oliveira ICD, Rocha Neto HG, Nascimento I, Pinto VAM, Appolinario JC, Cavalcanti MT. Patients and physician’s self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective This study explores the relationship between patients’ self-assessment and physicians’ evaluation regarding clinical stability. Methods This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient’s physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician’s global clinical impression over the six previous months. The patients’ self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients’ self-evaluation was considered as our standard. Results The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians’ evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. Conclusion The data analysis confirms our hypothesis that the self-assessment made by patients with SMD was accurate regarding their health condition, and that the self-assessment made by patients who considered themselves stable agree with the physicians’ evaluation.
Collapse
Affiliation(s)
| | - Helio G. Rocha Neto
- Federal University of Rio de Janeiro, Brazil; University of Lisbon, Portugal
| | | | | | | | | |
Collapse
|
5
|
Calil V, Silveira de Souza A, Sudo FK, Santiago-Bravo G, Assunção N, Drummond C, Rodrigues F, Soares R, Oliveira N, Teldeschi A, Bernardes G, Lima G, Lima C, Lima MA, Mattos P. Anosognosia for memory in dementia with Lewy bodies compared with Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:1059-1064. [PMID: 33594752 DOI: 10.1002/gps.5521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Anosognosia is the inability to recognize one's own symptoms. Although dementia with Lewy bodies (DLB) is the second most common degenerative dementia, there is little evidence of memory deficit awareness in this condition. The objectives of this research were to compare anosognosia between individuals with DLB and dementia due to Alzheimer's disease (AD) and to evaluate whether medial temporal atrophy, a marker of AD pathology, could help to explain different rates of anosognosia in DLB and dementia due to AD. METHODS/DESIGN This is a cross-sectional study that took place at the Memory Clinic of D'Or Institute for Research and Education (IDOR). Twenty individuals with DLB and 20 with dementia due to AD were included in this study. We assessed anosognosia for memory using an index derived from subjective memory complaints (using the Memory Complaint Questionnaire) and from the performance in memory neuropsychological testing (Rey Auditory Verbal Learning Test). Thirty-one participants also underwent brain Magnetic Resonance Imaging to evaluate hippocampal atrophy with a visual scale (MTA-score [medial temporal atrophy score]). RESULTS There was no significant difference between groups regarding age, years of education, sex or time of disease. Individuals with DLB had a higher index of anosognosia than dementia due to AD (2.92 and 1.87; p = 0.024), meaning worse awareness of memory deficits. MTA-score was slightly higher in dementia due to AD than in DLB, albeit without statistical significance. CONCLUSION Our study was the first to demonstrate that anosognosia for memory is worse in DLB than in dementia due to AD. This finding supports the hypothesis that anosognosia in DLB is a heterogeneous phenomenon.
Collapse
Affiliation(s)
- Victor Calil
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Department of Neurology, Hospital Glória D'Or, Rio de Janeiro, Brazil.,Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Felipe Kenji Sudo
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | - Naima Assunção
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Claudia Drummond
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Department of Speech and Hearing Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Rodrigues
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Department of Speech and Hearing Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rejane Soares
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Natalia Oliveira
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Alina Teldeschi
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Gabriel Bernardes
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Gabriel Lima
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Camila Lima
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Marco Antonio Lima
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Evandro Chagas National Institute of Infectious Disease (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paulo Mattos
- Memory Clinic, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Calil V, Sudo FK, Santiago-Bravo G, Lima MA, Mattos P. Anosognosia in dementia with Lewy bodies: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:334-342. [PMID: 34133514 DOI: 10.1590/0004-282x-anp-2020-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anosognosia, i.e. lack of awareness of one's own symptoms, is a very common finding in patients with dementia and is related to neuropsychiatric symptoms and worse prognosis. Although dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia, literature on anosognosia in this disease is scarce. OBJECTIVES This paper aimed to review the current evidence on anosognosia in patients with DLB, including its prevalence in comparison with other neurological conditions, its severity and anatomical correlations. METHODS Database searches were performed in PubMed, Web of Knowledge and PsycINFO for articles assessing anosognosia in DLB. A total of 243 studies were retrieved, but only six were included in the review. RESULTS Potential risk of selection, comparison or outcome biases were detected in relation to all the studies selected. Most of the studies used self-report memory questionnaires to assess cognitive complaints and compared their results to scores from informant-based instruments or to participants' cognitive performance in neuropsychological tasks. Subjects with DLB had worse awareness regarding memory than healthy older controls, but the results concerning differences in anosognosia between DLB and Alzheimer's disease (AD) patients were inconsistent across studies. Presence of AD pathology and neuroimaging biomarkers appeared to increase the prevalence of anosognosia in individuals with DLB. CONCLUSION Anosognosia is a common manifestation of DLB, but it is not clear how its prevalence and severity compare with AD. Co-existence of AD pathology seems to play a role in memory deficit awareness in DLB.
Collapse
Affiliation(s)
- Victor Calil
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro RJ, Brazil
| | | | | | - Marco Antonio Lima
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.,Fundação Oswaldo Cruz, Rio de Janeiro RJ, Brazil
| | - Paulo Mattos
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Instituto de Ciências Biomédicas, Programa de Ciências Morfológicas, Rio de Janeiro RJ, Brazil.,Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil
| |
Collapse
|
7
|
Cesur Atintas M, Kirlangic Şimsek B. Examining the effects of psychodrama practice: a study on psychological well-being, hopelessness and insight in emerging adults. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s11620-020-00560-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
França G, Laranjeira E, Silva F, Monteiro L, Moreira AM, Carvalho S. Attachment Style and Insight in Schizophrenia: a Cross-Sectional Study. Psychiatr Q 2020; 91:31-43. [PMID: 31768908 DOI: 10.1007/s11126-019-09675-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Attachment theory provides a model for understanding impairments in social and interpersonal functioning. Schizophrenia is a neuropsychiatry disorder frequently associated with compromised social functioning and limited social support networks. However, the relationship between attachment style and psychopathology dimensions, including insight, isn't fully understood To determine whether there is a relationship between the attachment style and markers for severity of schizophrenia and insight. We conducted a cross-sectional study of 41 patients with schizophrenia and 34 patients with non-psychotic disorders used as a control group. Patients were assessed using semi-structured diagnostic interviews and self-reporting questionnaires, including Adult Attachment Scale-Revised. The schizophrenia group was also given the Positive and Negative Syndrome Scale and the Markova and Berrios Insight Scale. Insecure attachment was overrepresented in the schizophrenic group, and this difference was mainly accounted for lower levels of dependence, representing a moderate effect size (Cohen's d = 0.32). In the schizophrenia group, the closeness and the dependence subscale were negatively correlated with psychopathology severity. Using a multiple regression analysis, the insight was predicted by attachment anxiety, accounting for 20% of the total variance (R2 = 0.199, p <0.05). Our data confirm previous evidence that insecure attachment is associated with schizophrenia and suggest that the less comfortable the patient is with closeness and intimacy the greater the severity of symptoms. Furthermore, our findings indicate that higher separation anxiety might predict a better insight.
Collapse
Affiliation(s)
- Gustavo França
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal.
| | - Erika Laranjeira
- Center for Economics and Finance, Oporto University, Porto, Portugal
| | - Fabio Silva
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Lília Monteiro
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Ana Maria Moreira
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| | - Serafim Carvalho
- Adult Psychiatry Department, Hospital de Magalhães Lemos, R. Prof. Álvaro Rodrigues, 4149-003, Porto, Portugal
| |
Collapse
|
9
|
Vilar C, Guerra A, Falcão J, Hazin I. DIALOGIA E INSIGHT: NARRATIVAS DE PAIS E FILHOS SOBRE O TRANSTORNO DE ASPERGER. PSICOLOGIA & SOCIEDADE 2020. [DOI: 10.1590/1807-0310/2020v32202824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O presente estudo objetivou investigar os processos de insight em sujeitos com Transtorno de Asperger (TA). Entende-se por insight o conhecimento do próprio diagnóstico e os sentidos construídos a partir deste. O desenvolvimento doinsight é aqui compreendido não como função restrita à vida mental pessoal, mas como fenômeno intersubjetivo, forjado nas relações sociais. O arcabouço teórico que subsidia a presente pesquisa é a perspectiva genética de desenvolvimento avançada pela psicologia histórico-cultural. Para tanto, foram propostas a três díades de pais e adolescentes diagnosticados com TA duas tarefas de produção narrativa que investigaram aspectos relacionados às experiências Asperger. Os resultados sugerem que a característica central dos processos de insight no TA pode ser descrita como disrupção na transição do modo monológico para o modo dialógico de pensamento. Acredita-se que os resultados aqui encontrados contribuem para a compreensão da singularidade e eventicidade da existência e da experiência subjetiva.
Collapse
Affiliation(s)
| | - Amanda Guerra
- Universidade Federal do Rio Grande do Norte, Brazil; Université d’Angers, France
| | - Jorge Falcão
- Universidade Federal do Rio Grande do Norte, Brazil
| | - Izabel Hazin
- Universidade Federal do Rio Grande do Norte, Brazil
| |
Collapse
|
10
|
Muñoz-Neira C, Tedde A, Coulthard E, Thai NJ, Pennington C. Neural correlates of altered insight in frontotemporal dementia: a systematic review. NEUROIMAGE-CLINICAL 2019; 24:102066. [PMID: 31795052 PMCID: PMC6889795 DOI: 10.1016/j.nicl.2019.102066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022]
Abstract
Fractionating insight into objects aids its neuroanatomical exploration in dementia. Distinctive neural correlates seem to underpin different insight objects in FTD. Altered insight into disease/health condition mostly involves right frontal areas. Altered insight into social cognition implicates frontal, temporal and limbic areas. Frontal, medial temporal and parietal areas underpin insight into memory problems.
Altered insight into disease or specific symptoms is a prominent clinical feature of frontotemporal dementia (FTD). Understanding the neural bases of insight is crucial to help improve FTD diagnosis, classification and management. A systematic review to explore the neural correlates of altered insight in FTD and associated syndromes was conducted. Insight was fractionated to examine whether altered insight into different neuropsychological/behavioural objects is underpinned by different or compatible neural correlates. 6 databases (Medline, Embase, PsycINFO, Web of Science, BIOSIS and ProQuest Dissertations & Theses Global) were interrogated between 1980 and August 2019. 15 relevant papers were found out of 660 titles screened. The studies included suggest that different objects of altered insight are associated with distinctive brain areas in FTD. For example, disease unawareness appears to predominantly correlate with right frontal involvement. In contrast, altered insight into social cognition potentially involves, in addition to frontal areas, the temporal gyrus, insula, parahippocampus and amygdala. Impaired insight into memory problems appears to be related to the frontal lobes, postcentral gyrus, parietal cortex and posterior cingulate. These results reflect to a certain extent those observed in other neurodegenerative conditions like Alzheimer's disease (AD) and also other brain disorders. Nevertheless, they should be cautiously interpreted due to variability in the methodological aspects used to reach those conclusions. Future work should triangulate different insight assessment approaches and brain imaging techniques to increase the understanding of this highly relevant clinical phenomenon in dementia.
Collapse
Affiliation(s)
- Carlos Muñoz-Neira
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK.
| | - Andrea Tedde
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Sassari, Italy
| | - Elizabeth Coulthard
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - N Jade Thai
- Clinical Research and Imaging Centre (CRICBristol), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK
| | - Catherine Pennington
- Research into Memory, Brain sciences and dementia Group (ReMemBr Group), Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, UK; Centre for Dementia Prevention, University of Edinburgh, UK
| |
Collapse
|
11
|
Radakovic R, McGrory S, Chandran S, Swingler R, Pal S, Stephenson L, Colville S, Newton J, Starr JM, Abrahams S. The brief Dimensional Apathy Scale: A short clinical assessment of apathy. Clin Neuropsychol 2019; 34:423-435. [PMID: 31154933 DOI: 10.1080/13854046.2019.1621382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Apathy is a prominent syndrome across neurodegenerative diseases. The Dimensional Apathy Scale (DAS) assesses three apathy subtypes-executive, emotional, and initiation-and is sensitive and valid in amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and Parkinson's disease. This study describes the development of the brief DAS (b-DAS), which will enable apathy to be swiftly detected in the clinic.Method: 102 ALS and 102 AD patients' previously collected data were used. Mokken analyses were performed on item-level data of each informant/carer-rated DAS subscale (executive, emotional, and initiation) for the initial scale reduction. Item-total correlational analyses against standard apathy (convergent validity criteria) and depression (divergent validity criteria) measures and qualitative examination of items aided final item selection. Receiver operating curve analysis determined optimal cutoffs for the reduced subscales.Results: Mokken analyses suggested unidimensionality of each DAS subscale. Three items were removed that failed to satisfy monotone homogeneity model requirements, three items were removed due to validity criteria not being met, and six items were removed due to a combination of lower item scalability and item-total correlations. Item-theme examination further reduced the b-DAS to nine items, three per subscale, with a supplemental awareness deficit assessment being added. Sensitivity- and specificity-based optimal cutoffs were calculated for each b-DAS subscale.Conclusions: This study presents the b-DAS, an informant/carer-based robust yet short multidimensional apathy instrument with good convergent and divergent validity, with recommended clinical cutoffs. The b-DAS is appropriate for use in the clinic and for research to quickly and comprehensively screen for apathy subtype impairments.
Collapse
Affiliation(s)
- Ratko Radakovic
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah McGrory
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Judy Newton
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
12
|
Awareness in Dementia: Development and Evaluation of a Short Version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s) in Brazil. Alzheimer Dis Assoc Disord 2019; 33:220-225. [PMID: 30958416 DOI: 10.1097/wad.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Awareness of disease is defined as the recognition of changes caused by the deficits related to the disease process. We aimed to examine the psychometric properties of the short versions of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s), a multidimensional awareness scale. Using a cross-sectional design, we included 201 people with dementia and their family caregivers. The creation of the short versions was based on items with higher loadings on each factor, the correlations between the short versions and demographic or clinical variables and the relevance of the item to the respondent population. Three short versions were created: version 1 and 3, with 12 items and version 2, with 16 items. The short versions correlated very strongly with the full scale and with the 4 factors of the original scale, maintaining the multidimensional nature of the ASPIDD. Loss of awareness was associated with worse quality of life, decreased functionality and cognitive level, and higher caregiver burden across the short versions. Considering the appropriateness of the items and their clinical relevance, we recommend version 3 for use. With only 12 items, the time required for the completion of the scale is short, while maintaining robust psychometric properties.
Collapse
|
13
|
Abstract
SUMMARYThis refreshment summarises some of the ways in which ‘insight’ has been understood in psychiatric practice and offers some critical thoughts about the notion.DECLARATION OF INTERESTNone.
Collapse
|
14
|
Strijbos D, Glas G. Self-Knowledge in Personality Disorder: Self-Referentiality as a Stepping Stone for Psychotherapeutic Understanding. J Pers Disord 2018; 32:295-310. [PMID: 29847250 DOI: 10.1521/pedi.2018.32.3.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article provides a philosophical framework to help unpack varieties of self-knowledge in clinical practice. We start from a hermeneutical conception of "the self," according to which the self is not interpreted as some fixed entity, but as embedded in and emerging from our relating to and interacting with our own conditions and activities, others, and the world. The notion of "self-referentiality" is introduced to further unpack how this self-relational activity can become manifest in one's emotions, speech acts, gestures, and actions. Self-referentiality exemplifies what emotions themselves implicitly signify about the person having them. In the remainder of the article, we distinguish among three different ways in which the self-relational activity can become manifest in therapy. Our model is intended to facilitate therapists' understanding of their patients' self-relational activity in therapy, when jointly attending to the self-referential meaning of what their patients feel, say, and do.
Collapse
Affiliation(s)
- Derek Strijbos
- Center for Developmental Disorders, Dimence Mental Health Care, Deventer, the Netherlands.,Faculty of Philosophy, Theology and Religion Studies, Radboud University, Nijmegen, the Netherlands
| | - Gerrit Glas
- Center for Developmental Disorders, Dimence Mental Health Care, Deventer, the Netherlands.,Faculty of Philosophy, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Akdoğan R, Türküm AS. Insight Scale for Nonclinical University Students: Validity and Reliability Analysis. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1080/07481756.2017.1413941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ramazan Akdoğan
- Department of Guidance and Counseling, Anadolu University, Eskişehir, Turkey
| | - A. Sibel Türküm
- Department of Guidance and Counseling, Anadolu University, Eskişehir, Turkey
| |
Collapse
|
16
|
Marková IS, Berrios GE. The construction of anosognosia: history and implications. Cortex 2014; 61:9-17. [PMID: 25481463 DOI: 10.1016/j.cortex.2014.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/16/2014] [Accepted: 09/12/2014] [Indexed: 11/28/2022]
Abstract
The construction of anosognosia as a clinical 'disorder' resulted from the convergence (in the work of various writers and culminating in Babinski) of a name, a concept, and a clinical phenomenon. During the early stages of this convergence, unawareness of neurological dysfunction was not considered as an independent clinical phenomenon. Started in the work of Anton, the process of separating it as a differentiable clinical state is completed by Babinski who reaffirmed the semiological independence of 'unawareness'. The history of the construction of 'anosognosia' parallels the late 19th century debate on the nature and brain inscription of the concept of 'consciousness'.
Collapse
Affiliation(s)
- Ivana S Marková
- Centre for Health and Population Sciences, Hull York Medical School, University of Hull, UK
| | | |
Collapse
|
17
|
Marková IS, Clare L, Whitaker CJ, Roth I, Nelis SM, Martyr A, Roberts JL, Woods RT, Morris R. Phenomena of awareness in dementia: Heterogeneity and its implications. Conscious Cogn 2014; 25:17-26. [DOI: 10.1016/j.concog.2014.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 12/31/2022]
|
18
|
Didehbani N, Shad MU, Kandalaft MR, Allen TT, Tamminga CA, Krawczyk DC, Chapman SB. Brief report: Insight into illness and social attributional style in Asperger's syndrome. J Autism Dev Disord 2013; 42:2754-60. [PMID: 22527705 PMCID: PMC3490073 DOI: 10.1007/s10803-012-1532-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A number of psychiatric illnesses have been recognized to have some level of insight deficits, including developmental disorders, such as Asperger’s Syndrome (ASP). However insight into illness has not been empirically investigated in ASP and little research has examined how individuals with ASP view their deficits. This is the first study to assess insight and the relationship between insight and externalizing bias (EB) in ASP. Participants with ASP (n = 21) and healthy controls (n = 24) were recruited. Attributional style was assessed with the internal, personal, and situational attribution questionnaire. Insight was assessed with both a clinician-administered and a self-administered measure. Results revealed that EB was negatively correlated with insight as assessed with the clinician-administered but not the self-administered measure of insight.
Collapse
Affiliation(s)
- Nyaz Didehbani
- Center for BrainHealth®, The University of Texas at Dallas, 2200 W Mockingbird Lane, Dallas, TX 75235, USA.
| | | | | | | | | | | | | |
Collapse
|