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Symptoms Underlying Unawareness of Memory Impairment in Patients With Mild Alzheimer’s Disease

Psychiatry and Behavioral Science, Osaka University Graduate School of Medicine, Osaka, Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, kazui{at}psy.med.osaka-u.ac.jp

Nobutsugu Hirono, MD, PhD

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Department of Humanities and Sciences, Kobe Gakuin University, Kobe

Mamoru Hashimoto, MD, PhD

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Sawa Hospital, Osaka

Yoko Nakano, MD, PhD

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Departments of Neurology and Gastroentestinology, University of Fukui Faculty of Medical Sciences, Matsuoka-cho

Keiji Matsumoto, MD

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Department of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki-city

Yohoko Takatsuki

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Kobe University Graduate School of Medicine Faculty of Health Sciences, Kobe

Etsuro Mori, MD, PhD

Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji, Division of Neuropsychology/Behavioral Neurology, Department of Disability Science, Tohoku University Graduate School of Medicine, Sendai, Japan

Yoshitaka Ikejiri, MD, PhD

Psychiatry and Behavioral Science, Osaka University Graduate School of Medicine, Osaka

Masatoshi Takeda, MD, PhD

Psychiatry and Behavioral Science, Osaka University Graduate School of Medicine, Osaka

Patients with Alzheimer’s disease (AD) are often unaware of their cognitive impairment. This unawareness might have a multifactorial etiology, including impairment of cognitive domains and psychiatric symptoms. We conducted this study to determine the factors underlying unawareness of memory impairment (UMI) in patients with AD. In 103 patients with mild AD, the UMI was quantified as the difference between the patient’s self-rating and the rating of the patient’s caregiver on a standardized memory questionnaire system, the Everyday Memory Checklist. We then examined the relationships between UMI and memory, attention, language, visuospatial/constructive perception, frontal lobe function, and psychiatric symptoms. UMI was positively associated with memory impairment and delusions when effects of age, sex, and education were partialled out, suggesting that these symptoms are involved in the formation of UMI in the patients. Thus, existing treatments for memory impairment and delusions may be beneficial for increasing the awareness of mild AD patients of their cognitive impairment.

Key Words: unawareness • memory impairment • cognitive impairment • psychiatric symptom • delusion • Alzheimer’s disease

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