Zanetti O, Vallotti B, Frisoni G B, Geroldi C, Bianchetti A, Pasqualetti P, Trabucchi M
Alzheimer Disease Unit IRCCS, S. Giovanni di Dio, S. Cuore Fatebenefratelli Hospital, Brescia, Italy.
J Gerontol B Psychol Sci Soc Sci. 1999 Mar;54(2):P100-6. doi: 10.1093/geronb/54b.2.p100.
Lack of insight or impaired awareness of deficits in patients with dementia is a relatively neglected area of study. The aim of this study was to evaluate insight in a group of demented patients with two assessment scales and to assess their relationship with the cognitive level of disease severity. Sixty-nine consecutive patients affected by Alzheimer's disease (n = 37) and vascular dementia (n = 32) with a wide range of cognitive impairment (MMSE = 17.0 +/- 6.4) were recruited. Insight was evaluated with the Guidelines for the Rating of Awareness Deficits (GRAD)--specifically targeted to memory deficits--and the Clinical Insight Rating scale (CIR), evaluating a broader spectrum of insight (reason for the visit, cognitive deficits, functional deficits, and perception of the progression of the disease). In the whole sample, GRAD and CIR were significantly associated with MMSE (Spearman's coefficient = .51, p < .001; and r = -.55, p < .001) and with Clinical Dementia Rating scale (-.57, p < .001; and r = .57, p < .001) respectively. The shape of the relationship of MMSE with CIR and GRAD scales was assessed with spline smoothers suggesting that the relationship follows a trilinear pattern and is similar for both scales. Insight was uniformly high for MMSE scores > or = 24, showed a linear decrease between MMSE scores of 23 and 13, and was uniformly low for MMSE scores < or = 12. The trilinear model of the association between insight and cognitive status reflects more closely the observable decline of insight and can provide estimates of when the decline of insight begins and ends.
痴呆患者缺乏洞察力或对缺陷的意识受损是一个相对被忽视的研究领域。本研究的目的是使用两种评估量表评估一组痴呆患者的洞察力，并评估其与疾病严重程度认知水平的关系。招募了69例连续的阿尔茨海默病患者（n = 37）和血管性痴呆患者（n = 32），他们具有广泛的认知障碍（MMSE = 17.0 +/- 6.4）。使用专门针对记忆缺陷的《意识缺陷评分指南》（GRAD）和评估更广泛洞察力范围（就诊原因、认知缺陷、功能缺陷和对疾病进展的感知）的临床洞察力评分量表（CIR）来评估洞察力。在整个样本中，GRAD和CIR分别与MMSE显著相关（Spearman系数 =.51，p <.001；r = -.55，p <.001）以及与临床痴呆评定量表（-.57，p <.001；r =.57，p <.001）。使用样条平滑器评估MMSE与CIR和GRAD量表关系的形状，表明这种关系呈三线模式，且两种量表相似。对于MMSE评分>或= 24，洞察力始终较高；在MMSE评分为23至13之间呈线性下降；对于MMSE评分<或= 12，洞察力始终较低。洞察力与认知状态之间关联的三线模型更紧密地反映了可观察到的洞察力下降情况，并可以提供洞察力下降开始和结束时间的估计。
