Department of Neurology, University of California, San Francisco, Memory and Aging Center, 350 Parnassus Avenue, Box 1207, Suite 905, San Francisco, CA 94143-1207, USA.
J Neurol Neurosurg Psychiatry. 2010 Feb;81(2):140-5. doi: 10.1136/jnnp.2008.166041. Epub 2009 Feb 9.
Diminished ability to perceive one's own impairments, whether cognitive or social, is common in dementia, in particular frontotemporal dementia (FTD), where 'lack of insight' is listed as a core diagnostic feature. Yet, there is no currently accepted method for measuring insight in dementia. The most commonly used methods, which involve comparing patients' opinions of their level of impairment with the opinions of care givers or close family members, are subjective and require the participation of a knowledgeable informant. Here, the authors introduce a new method that allows objective quantification of an individual's awareness of their cognitive abilities and relies upon objective bedside testing.
The authors administered several tests of everyday, real-world functions to patients with FTD (n=10) and Alzheimer's disease (AD, n=10) and to control subjects (n=10). Prior to the tasks, participants were asked to predict their performance using a percentile-based rating system. They were also asked to estimate their performance after task completion. Differences between their self-rated and actual performances were calculated.
Whereas the control group showed very little discrepancy between pretest predictions, post-task estimates and actual performance (mean difference of 3.9 percentile points for prediction/3.0 percentile points for post-task estimate), both patient groups overpredicted and overestimated their performance, with a significantly greater discrepancy for FTD (49.0/54.3 percentile points) than AD (27.2/28.3 percentile points).
Failures of insight and self-awareness of cognitive dysfunction can be objectively measured in dementia without the assistance of an informant, which will facilitate further study of this key component of higher cognitive functioning.
在痴呆症中，无论是认知还是社交能力下降，都难以察觉自己的损伤，尤其是额颞叶痴呆（FTD），“缺乏洞察力”被列为核心诊断特征。然而，目前还没有用于测量痴呆症患者洞察力的公认方法。最常用的方法是将患者对自己损伤程度的看法与护理人员或近亲的看法进行比较，这些方法具有主观性，并且需要有知识的信息提供者的参与。在这里，作者介绍了一种新方法，可以客观地量化个体对自身认知能力的意识，并且依赖于客观的床边测试。
作者对 10 例 FTD 患者和 10 例阿尔茨海默病（AD）患者以及 10 例对照受试者进行了日常真实世界功能的多项测试。在任务之前，参与者被要求使用基于百分位的评分系统预测他们的表现。他们还被要求在任务完成后估计自己的表现。计算他们自我评估与实际表现之间的差异。
对照组在预测试预测、任务后估计和实际表现之间的差异非常小（预测时的平均差异为 3.9 个百分点，任务后估计时为 3.0 个百分点），而两个患者组均过度预测和高估了他们的表现，FTD 组（49.0/54.3 个百分点）比 AD 组（27.2/28.3 个百分点）差异更大。
在没有信息提供者帮助的情况下，可以客观地测量痴呆症患者的洞察力和认知功能障碍的自我意识，这将有助于进一步研究这种高级认知功能的关键组成部分。
