Anosognosia in older people with early-stage Alzheimer's disease

Abstract

A large body of literature has suggested people with Alzheimer’s Disease (AD) are particularly prone to experiencing impairments in insight.  This poses significant implications for our understanding of AD, the mechanisms underlying self-awareness and the clinical management of such individuals.

The first paper of this thesis explores the literature in this field and discusses the tentative findings to date, together with the methodological difficulties associated with studying impaired insight.  It goes on critically to explore current models of this phenomenon, with the clinical implications of these models considered in relation to the treatment of people with AD.  The paper concludes that the impairments in insight exhibited by people with AD are heterogeneous and are likely to be best explained as representing a number of subtypes.

The second paper of this thesis describes a study that aimed to investigate Agnew and Morris’s (1998) model of memory awareness, by exploring the dimensions of awareness exhibited by a sample of people in the early stages of AD.  This study found that a significant proportion of people with early-stage AD were able to improve their awareness after exposure to memory tasks and that they were able to generalise this improvement from a task specific level to a global level of memory awareness.  Furthermore, whilst this improvement was retained after a 20-minute delay period, there was evidence that with a longer delay this would have reset to pre-testing levels.  Such findings are in keeping with Agnew and Morris’s (1998) mnemonic anosognosia sub-type.

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