Starkstein S E, Sabe L, Chemerinski E, Jason L, Leiguarda R
Department of Behavioral Neurology and Neuropsychiatry, Raúl Carrea Institute of Neurological Research, Buenos Aires, Argentina.
J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):485-90. doi: 10.1136/jnnp.61.5.485.
To examine the presence of different dimensions of unawareness in patients with probable Alzheimer's disease.
A consecutive series of 170 patients with probable Alzheimer's disease were assessed with the anosognosia questionnaire-dementia (AQ-D) which includes items related to cognitive deficits and behavioural problems.
A factor analysis of the AQ-D produced two factors: a "cognitive unawareness" factor, which loaded on items of memory, spatial and temporal orientation, calculation, abstract reasoning, and praxis, and a "behavioural unawareness" factor which loaded on items of irritability, selfishness, inappropriate emotional display, and instinctive disinhibition. A stepwise forward regression analysis showed significant correlations between the cognitive unawareness factor and more severe cognitive deficits, delusions, and apathy, but less depression. On the other hand, the behavioural unawareness factor correlated significantly with higher mania and pathological laughing scores. Whereas the cognitive unawareness factor showed a significant correlation with cognitive tests assessing verbal comprehension and long term memory, and was significantly associated with a longer duration of illness, no significant correlations were found between the behavioural unawareness factor and the neuropsychological tasks.
Unawareness of cognitive deficits and unawareness of behavioural problems may constitute independent phenomena in Alzheimer's disease. Whereas unawareness of cognitive deficits is related to the severity of intellectual impairment and the presence of delusional apathetic mood, unawareness of behavioural problems may be part of a disinhibition syndrome.
研究可能患有阿尔茨海默病的患者中不同维度的无意识状态。
对连续的170例可能患有阿尔茨海默病的患者进行失认症问卷 - 痴呆（AQ - D）评估，该问卷包括与认知缺陷和行为问题相关的项目。
对AQ - D进行因子分析产生了两个因子：一个“认知无意识”因子，它负载于记忆、空间和时间定向、计算、抽象推理及实践等项目上；另一个“行为无意识”因子，它负载于易怒、自私、不适当的情绪表现及本能脱抑制等项目上。逐步向前回归分析显示，认知无意识因子与更严重的认知缺陷、妄想和冷漠显著相关，但与抑郁的相关性较小。另一方面，行为无意识因子与较高的躁狂和病理性发笑评分显著相关。虽然认知无意识因子与评估言语理解和长期记忆的认知测试显著相关，且与病程较长显著相关，但行为无意识因子与神经心理学任务之间未发现显著相关性。
认知缺陷的无意识状态和行为问题的无意识状态可能是阿尔茨海默病中的独立现象。认知缺陷的无意识状态与智力损害的严重程度及妄想性冷漠情绪的存在有关，而行为问题的无意识状态可能是脱抑制综合征的一部分。
