Multidimensional Assessment of Awareness in Early-Stage Dementia

Multidimensional Assessment of Awareness in Early-Stage Dementia

11 Pages · 2011 · 240 KB · English

Niece/nephew. Sibling. Friend. Coresident with PwD. 66. 26. 3. 3. 3. 74. VaD = Vascular dementia; AChEI = acetylcholinesterase in- hibitor. Table 3. Scores on cognitive reflection. At the level of evaluative judgement, awareness scores for memory (MFD), ADLs (FAD) and social functioning (SFD) were

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Fax +41 61 306 12 34 EMail [email protected] wwwkargercom Original Research Article Dement Geriatr Cogn Disord 2011;31:317–327 DOI: 101159/000327356 Multidimensional Assessment of Awareness in EarlyStage Dementia: A Cluster Analytic Approach Linda Clare   a Christopher J Whitaker   a Sharon M Nelis   a Anthony Martyr   a Ivana S Markova   b Ilona Roth   c Robert T Woods   a Robin G Morris   d a   Bangor University, Bangor , b   University of Hull, Hull , c   Open University, Milton Keynes , and d   Kings College London Institute of Psychiatry, London , UK mensional assessment offers a more robust approach to classifying PwD according to level of awareness and hence to examining correlates and predictors of awareness Copyright © 2011 S Karger AG, Basel Introduction The many empirical studies exploring aspects of awareness in people with dementia are characterised by variability and inconsistency of results concerning the nature of awareness in dementia and its interrelation ships with other factors [1] Neuropsychological investi gations have focused on memory, executive function and language, but have not yielded consistent associations [2] The literature presents conf licting findings on the rela tionship between mood and awareness, and with regard to associations between awareness and disease severity or personal characteristics such as age and gender [3] Sev eral studies have demonstrated that carers who experi ence more burden rate their relatives’ functioning more poorly [4] , but again an association is not consistently found [5] Similarly, some studies have reported an asso ciation with selfreported quality of life for the person with dementia (PwD) [6] , but others have found no such association [7] The cause of this variability and inconsis Key Words Anosognosia  Insight  Metacognition  Alzheimer’s disease  Vascular dementia Abstract Background/Aims: Research on awareness in dementia has yielded variable and inconsistent associations between awareness and other factors This study examined aware ness using a multidimensional approach and applied cluster a n a l y t i c t e c h n i q u e s t o i d e n t i f y a s s o c i a t i o n s b e t w e e n t h e l e v el of awareness and other variables Methods: Participants were 101 individuals with earlystage dementia (PwD) and their carers Explicit awareness was assessed at 3 levels: performance monitoring in relation to memory, evaluative judgement in relation to memory, everyday activities and socioemotional functioning, and metacognitive reflection in relation to the experience and impact of the condition Implicit awareness was assessed with an emotional Stroop task Results: Different measures of explicit awareness scores were related only to a limited extent Cluster analysis yielded 3 groups with differing degrees of explicit aware ness These groups showed no differences in implicit aware ness Lower explicit awareness was associated with greater age, lower MMSE scores, poorer recall and naming scores, lower anxiety and greater carer stress Conclusion: Multidi Accepted: March 7, 2011 Published online: April 21, 2011 Prof Linda Clare School of Psycholog y, Bangor

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