Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Arch Clin Neuropsychol. 2020 May 22;35(4):365-376. doi: 10.1093/arclin/acz065.
To examine the neuropsychological correlates of anosognosia for instrumental activities of daily living (IADLs) in older adults with mild cognitive impairment (MCI) and mild dementia.
Participants (n = 103; age range = 54-88, 52% female) with MCI and mild dementia were recruited from neurology and geriatrics clinics for cross-sectional analysis. They completed neuropsychological tests along with subjective and performance-based assessments of six IADLs: financial management, driving, grocery shopping, nutrition evaluation, telephone use, and medication management. For each IADL, participants were classified as having anosognosia when there was objective difficulty but no subjective complaints.
Depending on functional domain, 13-39% of the sample had objective IADL difficulty, and of those, 65-93% lacked insight into these deficits. Binomial logistic regression models controlling for demographic variables revealed that measures of global cognition, executive function, visual attention, and verbal memory predicted classification of anosognosia, and these relationships varied across IADLs. In contrast, basic auditory attention, working memory, depressive symptoms, nor cognitive reserve were significantly related to anosognosia for any IADL.
Results support the Conscious Awareness Model, which theorizes that accurate metacognitive output is reliant on attentional, memory, and executive functioning systems. Findings from this study suggest that anosognosia for different IADLs may arise from breakdowns at varying points in this model, explaining both inter- and intra-patient variability in self-awareness of functional deficits.
研究轻度认知障碍（MCI）和轻度痴呆老年人工具性日常生活活动（IADLs）失认症的神经心理学相关性。
从神经病学和老年病学诊所招募了 103 名参与者（年龄范围为 54-88 岁，52%为女性）进行横断面分析。他们完成了神经心理学测试以及六项 IADLs 的主观和基于表现的评估：财务管理、驾驶、购物、营养评估、电话使用和药物管理。对于每项 IADL，如果存在客观困难但没有主观抱怨，则将参与者归类为存在失认症。
根据功能域的不同，13-39%的样本存在客观的 IADL 困难，其中 65-93%的人对这些缺陷缺乏洞察力。控制人口统计学变量的二项逻辑回归模型显示，整体认知、执行功能、视觉注意力和言语记忆的测量预测了失认症的分类，并且这些关系在不同的 IADL 中有所不同。相比之下，基本听觉注意力、工作记忆、抑郁症状或认知储备与任何 IADL 的失认症均无显著相关性。
结果支持意识知觉模型，该模型理论认为准确的元认知输出依赖于注意力、记忆和执行功能系统。本研究的结果表明，不同的 IADL 失认症可能源于该模型中不同的点出现故障，从而解释了自我意识到功能缺陷的个体间和个体内变异性。
