Whether and to what extent persons with Alzheimer's disease (AD) are aware of or deny their deficits has important implications for their diagnosis, treatment, management, and mood. As a result, deficit awareness and denial have considerable influence on family members' and professionals' communication with persons with AD, and exerts a major impact on care requirements. The theoretical significance of the study of these phenomena lies in aiding the development of a neuropsychological approach to understanding the brain systems and neural mechanisms involved in awareness and denial. Despite their clinical and theoretical significance, awareness and denial in AD have received little systematic study. Limitations of previous studies of awareness and denial include failure to distinguish the two phenomena conceptually; assessment of only a single domain of deficit; measuring multiple domains of deficit but combining the results into a single scale; relying solely on informant report as the gold standard for assessing unawareness or denial in the impaired individual; and paying limited attention to the correlates of awareness and denial. This research is designed to carefully describe awareness and denial among persons with AD, characterizing variations by domain of deficit across persons with AD and measuring awareness in multiple ways. A scale, developed in the first year of this pilot, and covering multiple domains of deficit consistent with a diagnosis of AD, will be administered 60 pairs of persons with AD and their caregivers. Pairs also will be asked to predict their own and each other's performance prior to specific neuropsychological tests and then to rate their performance after the tests have been taken. Determining correlates of awareness and denial among AD patients will contribute to understanding of the neuropsychological basis of these phenomena. Assessment will include the relationship between awareness of and denial of deficits and dementia severity, activities of daily living, depression, hallucinations, and delusions; and objective assessment of memory functions, language abilities, and visuospatial capacities, and executive functions. In addition, the relationship between awareness and denial in persons with AD and the emotional health of their caregivers will be explored.
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