Benke Thomas, Karagiannis George
Clinic of Neurology, Medical University, Innsbruck, Austria.
J Alzheimers Dis. 2025 Jan;103(2):419-428. doi: 10.1177/13872877241302423. Epub 2024 Nov 29.
Unawareness or anosognosia of memory impairment is a common phenomenon in patients with Alzheimer's disease (AD). Different findings have been reported regarding its presentation, assessment procedure, and cognitive correlates.
To assess memory awareness of early AD patients predictively (before memory testing) and online (immediately after performing a memory test).
All participants were outpatients of a memory clinic. AD patients were compared with participants having mild cognitive impairment (MCI) and a group with normal cognitive aging (NC). We used a performance-based assessment procedure to measure self-perceived memory abilities. An anosognosia ratio was calculated by matching self-estimates with objective memory scores derived from the Consortium to Establish a Registry for Alzheimer's disease Neuropsychological battery.
Memory anosognosia in terms of self-overestimation was found in almost half of the AD sample, only rarely in MCI, and was not present in NC. Most AD patients had both, a low prediction and also a deficient online accuracy of self-estimation. Memory overestimators were older, less educated, and had significantly poorer neuropsychological scores. A stepwise linear regression analysis showed that memory anosognosia was predicted by age, everyday functional abilities and neuropsychological variables, including executive and mnestic abilities.
Poor cognitive and memory functions combined with memory anosognosia are a hallmark of early AD. Further, mnemonic anosognosia as assessed by performance based measures separates AD patients already in the early disease stage from subjects with MCI or normal controls. Our findings highlight the importance of assessing memory self-appraisal in subjects attending a memory clinic, in addition to clinical and cognitive variables.
记忆障碍的无意识或失认症在阿尔茨海默病（AD）患者中是一种常见现象。关于其表现、评估程序和认知相关性，已有不同的研究结果报道。
前瞻性地（在记忆测试前）和在线地（在进行记忆测试后立即）评估早期AD患者的记忆意识。
所有参与者均为记忆门诊的门诊患者。将AD患者与轻度认知障碍（MCI）参与者和正常认知老化（NC）组进行比较。我们使用基于表现的评估程序来测量自我感知的记忆能力。通过将自我估计与源自阿尔茨海默病神经心理成套测验注册库联盟的客观记忆分数相匹配，计算失认症比率。
在几乎一半的AD样本中发现了自我高估方面的记忆失认症，在MCI中很少见，而在NC中不存在。大多数AD患者自我估计的预测性和在线准确性都很低。记忆高估者年龄较大、受教育程度较低，神经心理分数明显较差。逐步线性回归分析表明，记忆失认症可由年龄、日常功能能力和神经心理变量（包括执行和记忆能力）预测。
认知和记忆功能差以及记忆失认症是早期AD的一个标志。此外，通过基于表现的测量评估的记忆失认症在疾病早期阶段就将AD患者与MCI患者或正常对照区分开来。我们的研究结果强调了在记忆门诊对受试者进行记忆自我评估的重要性，除了临床和认知变量之外。
