Variability in estimating the self-awareness of memory deficits
20 March 2015
Last update: 09/03/15 13:32
The March International Psychogeriatrics Article of the Month is entitled ‘Awareness of memory deficits in subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease and Parkinson’s disease’ by Johann Lehrner, Sandra Kogler, Claus Lamm, Doris Moser, Stefanie Klug, Gisela Pusswald, Peter Dal-Bianco, Walter Pirker and Eduard Auff
As the world population ages, we face sharp rises in prevalence rates for neurodegenerative diseases. In order to minimize entailing individual and societal burdens, early diagnosis is becoming increasingly important. Efforts to enable early recognition of impending cognitive decline led to the development of the concept of Mild Cognitive Impairment (MCI), which describes a transitional stage between normal age-related memory decline and dementia. Yet, not all individuals diagnosed with MCI can be considered as being in a prodromal phase of dementia. Accordingly, ongoing research is now focusing on the identification of (a) those individuals with MCI who are most likely to convert to dementia and (b) asymptomatic individuals in a pre-MCI stage. Yet, which early markers are available for their identification?
With some evidence pointing towards a connection between low memory awareness – an inability to (fully) recognize memory deficits – and subsequent memory decline, awareness measures bear potential as an important marker of underlying dementia pathologies. However, as research in this field is defined by inconsistencies, this hypothesis needs further investigation.
We therefore used data concerning our patients’ subjective memory appraisals and objective memory performance to create an awareness index, which allowed us to compare levels of awareness (and frequencies of memory overestimation) across healthy elderly people and patients with varying degrees of memory impairment. Our question was whether our approach would reveal characteristic awareness differences similar to prior research.
As expected, our findings suggest that self-awareness of memory deficits decreases as cognitive deficits – especially memory deficits – increase. Accordingly, the highest rate of overestimation of memory function was found among patients suffering from Alzheimer’s disease (63%), followed by amnestic MCI patients without and with Parkinson’s disease (46%, 38%), while patients with cognitive deficits other than memory (non-amnestic MCI) showed a tendency towards underestimation of memory function. Our analyses further revealed considerable between-group overlaps in awareness scores and strong influences of non-cognitive factors such as depression.
The main implication of our study is that memory awareness reflects objective deterioration to some extent, but that there is considerable inter-individual variability in awareness. It is this variability which gives rise to the question whether differences in awareness are predictive of future conversion to dementia.
We hold the view that research in this field is important insofar as awareness measures are of high practical relevance: As opposed to biomarkers and neuroimaging technologies, which are of restricted availability in primary care settings, both measures of subjective memory complaint and objective memory performance provide easily, time- and cost efficiently accessible sources of information. Moreover, they count among the standard repertoire of diagnosis in MCI and other dementia-related diseases. Researchers could use these data to further explore the diagnostic and predictive validity of awareness measures. We hope that our work inspires further research concerning memory awareness and strongly welcome any comments and remarks.
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According to this blog, Priv. Doz. Mag. Dr. Johann Lehrner (the blogger) and his 8 co-authors affiliated with two distinguished universities in Vienna, Austria reported using “data concerning our patients’ subjective memory appraisals and objective memory performance to create an awareness index…,” in the context of an ageing world population experiencing ” sharp rises in prevalence rates for neurodegenerative diseases” coupled to a presumed need to “minimize entailing individual and societal burdens.” Unexpectedly, their 2015 paper in the research journal International Psychogeriatrics provides the germ of an idea for eventually quantifying unjust societal stigma against the ageing population of human persons on the basis of not only advanced age and neurodegenerative pathologies such as Alzheimer’s and Parkinson’s diseases but also associated progression of mood and thought disorders from first occurrence at much earlier stages when these people were employed in the workplace but were subject to work stressors whose impacts they were unable to manage. That is, could not tests be devised to measure an “awareness index” for those (call them “colleagues”) who have known on a longitudinal basis specific persons (call them “co-workers”) now regarded by the medical establishment as “patients” but whom they had first met in the workplace long before they became patients? Here, the investigator could develop test instruments for measuring (1) the subjective awareness possessed by the “colleague” of the loss of memory or of some other cognitive function in the “co-worker” (now a “patient”) such as attention or reasoning, plus (2) the objective awareness as mentioned in the blog, and apply this cognitive function index to two situations in which (a) the “co-worker” is disclosed to the “colleague” as a “patient” (with such disclosure being subject to a consent agreement signed by the “co-worker” and a confidentiality agreement signed by the “colleague”), and (b) in which no such disclosure is made. The difference of the difference mentioned could then serve as a patient stigma index.