Cognitive reserve and anosognosia in questionable and mild dementia

• Published in: Archives of clinical neuropsychology Vol. 20; no. 4; pp. 505 - 515
• Main Authors: Spitznagel, Mary Beth, Tremont, Geoffrey
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.06.2005; Elsevier
• Subjects: Adult and adolescent clinical studies; Aged; Aged, 80 and over; Agnosia - etiology; Agnosia - physiopathology; Anosognosia; Biological and medical sciences; Cognition - physiology; Cognitive reserve; Dementia; Dementia - physiopathology; Dementia - psychology; Educational Status; Female; Humans; Male; Medical sciences; Middle Aged; Neuropsychological Tests; Organic mental disorders. Neuropsychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reading; Self Concept; Cognitive reserve; Anosognosia; Dementia; Human; Nervous system diseases; Central nervous system disease; Interindividual comparison; Degenerative disease; Cognition; Elderly; Cerebral disorder
• ISSN: 0887-6177; 1873-5843
• DOI: 10.1016/j.acn.2004.11.003

Cognitive reserve (CR) theory posits that the clinical presentation of individuals with the same brain disease varies based upon premorbid variables (e.g., education, occupation, reading ability). Anosognosia (decreased insight regarding one's deficits) is common in dementia and has implications for safety, treatment, and caregiver burden. The current study examined the role of CR in anosognosia in individuals with mild dementia. Participants were individuals diagnosed with questionable or mild dementia (Clinical Dementia Rating 0.5 or 1) after neuropsychological evaluation. Anosognosia was measured by informant–patient discrepancy on the Cognitive Difficulties Scale. High and Low CR groups were created based upon reading performance. Low CR showed greater anosognosia than High CR. Anosognosia was associated with reduced reading performance, even after controlling for global cognitive decline. These findings suggest CR is related to anosognosia in questionable and mild dementia, and have clinical implications for the assessment of awareness in dementia.