Empirical studies exploring patients' insight or awareness into dementia have been notably prolific, particularly over the past 15 years. In contrast to the relatively consistent approach taken to the study of insight in relation to neurological states, studies examining insight in the dementias are striking in the range of different approaches taken (Kaszniak & Christenson, 1996). As was suggested in the preceding chapter, a likely explanation for the differences seen may be in part due to the particular clinical nature of dementias themselves as well as their position in occupying neurological, psychological and psychiatric professional domains. It is perhaps not surprising that, much in the same way as research on insight in functional psychiatric syndromes, outcomes from studies exploring patients' insight into dementia and clinical variables (e.g. stage of dementia, severity of dementia, level of cognitive impairment, etc.) have been particularly mixed and inconsistent (Marková & Berrios, 2000).

This chapter reviews the empirical studies exploring insight in dementia and focuses on the specific conceptual issues arising from research in this area. First, differences in definitions and underlying concepts are explored. Then, the varied approaches taken to assess insight empirically are examined and related to the likely clinical aspects of insight elicited. Lastly, the results of studies exploring the relationship between patients' insight, and various clinical and socio-demographic variables are reviewed.

The meaning of insight in relation to dementia

The first question relates to the meaning of insight in dementia.