Spitznagel Mary Beth, Tremont Geoffrey
Brown Medical School, Providence, RI, USA.
Arch Clin Neuropsychol. 2005 Jun;20(4):505-15. doi: 10.1016/j.acn.2004.11.003. Epub 2004 Dec 28.
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.
认知储备（CR）理论认为，患有相同脑部疾病的个体的临床表现会因病前变量（如教育程度、职业、阅读能力）而有所不同。失认症（对自身缺陷的洞察力下降）在痴呆症中很常见，并且对安全、治疗和照顾者负担都有影响。当前的研究考察了CR在轻度痴呆个体的失认症中的作用。参与者是在神经心理学评估后被诊断为可疑或轻度痴呆（临床痴呆评定量表为0.5或1）的个体。失认症通过认知困难量表上的知情者-患者差异来衡量。根据阅读表现创建了高CR组和低CR组。低CR组比高CR组表现出更严重的失认症。即使在控制了整体认知衰退之后，失认症仍与阅读表现下降有关。这些发现表明，CR与可疑和轻度痴呆中的失认症有关，并且对痴呆症意识评估具有临床意义。
