a Department of Psychology , University of Alabama at Birmingham , Birmingham , AL , USA.
b Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
J Clin Exp Neuropsychol. 2019 Jul;41(5):544-553. doi: 10.1080/13803395.2019.1586839. Epub 2019 Mar 14.
Prior research examining self-awareness of deficits in those with mild cognitive impairment (MCI) has been inconsistent, suggesting that preservation of insight at this disease stage may be conditional on the domain(s) examined as well as individual characteristics. The current study is the first to examine differences in objective performance and self-awareness of difficulties between older adults with amnestic single- (MCI-ASD) and multidomain MCI (MCI-AMD) across six instrumental activities of daily living (IADLs).
Seventy-five individuals (M = 73.9 years, range = 55-88 years; 56% female) with MCI-ASD (n = 30) and MCI-AMD (n = 45) were recruited primarily from a hospital-based memory disorders clinic. Participants were administered self-report and objective measures assessing six functional domains: financial management, driving, telephone use, nutrition evaluation, grocery shopping, and medication management. Self-awareness discrepancy scores were calculated for each of these IADLs, and participants were classified as either "overestimating ability" or "accurately/underestimating ability."
Individuals with MCI-AMD performed significantly worse on objective measures of financial management, driving, and nutrition evaluation than those with MCI-ASD. Across MCI subtypes, participants were most likely to lack awareness of their difficulties in nutrition evaluation (31%), financial management (25%), and driving (23%) domains. Individuals with MCI-AMD were significantly more likely than those with MCI-ASD to overestimate performance on driving and telephone use domains.
Individuals with MCI-AMD are more likely than those with MCI-ASD to have impairment in their everyday function and to lack awareness into their IADL difficulties. When possible, clinicians should obtain objective measures in combination with detailed informant reports of functional abilities in order to evaluate capacity to independently engage in various daily activities. Finally, level of self-awareness varies across IADL domains, providing further evidence that insight is not a unitary construct.
先前研究检查轻度认知障碍（MCI）患者的自我意识缺陷，结果并不一致，这表明在疾病早期，这种洞察力的保留可能取决于所检查的领域以及个体特征。本研究首次检查了在六个日常工具性活动（IADL）中，遗忘型单域 MCI（MCI-ASD）和多域 MCI（MCI-AMD）老年人之间客观表现和对困难的自我意识的差异。
75 名参与者（M = 73.9 岁，范围为 55-88 岁；56%为女性）患有 MCI-ASD（n = 30）和 MCI-AMD（n = 45），主要从医院为基础的记忆障碍诊所招募。参与者接受了自我报告和客观测量，评估了六个功能领域：财务管理、驾驶、电话使用、营养评估、杂货购物和药物管理。为每个 IADL 计算了自我意识差异得分，并将参与者分为“高估能力”或“准确/低估能力”。
与 MCI-ASD 相比，MCI-AMD 患者在财务管理、驾驶和营养评估的客观测量中表现明显更差。在 MCI 亚型中，参与者最有可能缺乏对营养评估（31%）、财务管理（25%）和驾驶（23%）领域的困难的自我意识。MCI-AMD 患者比 MCI-ASD 患者更有可能高估他们在驾驶和电话使用领域的表现。
与 MCI-ASD 相比，MCI-AMD 患者的日常功能障碍更有可能，并且缺乏对他们的 IADL 困难的自我意识。在可能的情况下，临床医生应该结合详细的功能能力信息报告，获得客观的测量，以评估独立参与各种日常活动的能力。最后，自我意识在不同的 IADL 领域有所不同，这进一步证明了洞察力不是一个单一的结构。
