Do I Have Symptoms of Dementia: A Discursive Study of Awareness and Shame Among People With Advanced Dementia.

BACKGROUND AND OBJECTIVES: This study explores the narrated experiences of individuals with advanced stages of late-onset dementia, focusing on their diagnosis awareness. Such framing is motivated by 2 reasons. Firstly, there is a lack of consensus regarding the prevalence of anosognosia among people with dementia. Secondly, research on anosognosia often neglects to address the important issues of shame and stigma associated with receiving a dementia diagnosis. RESEARCH DESIGN AND METHODS: For this qualitative study, a total of 27 participants ranging in age from 66 to 94 were involved. The data collected were analyzed using textual-oriented discourse analysis. RESULTS: Our findings indicated that individuals with dementia struggled to comprehend the medical terminology used to describe their experiences within biomedical standards. The interviewees utilized 5 negative discourses on dementia, which shaped their attitudes toward the condition and people diagnosed with it. These discourses depicted dementia as an illness, negative aging, a devaluation, a burden, and a life tragedy. Moreover, study participants did not outright reject the diagnosis but rather negotiated its acceptance within the context of shame associated with dementia. DISCUSSION AND IMPLICATIONS: The concept of anosognosia can serve as a mechanism of social control and stigmatization of people with dementia within the dominant biomedical discourse.

Undoubtedly unaware of homonymous hemianopia: The contribution of overconfidence to anosognosia of hemianopia.

A new functional deficit caused by a stroke can be understood as a situation of uncertainty that has to prompt deficit discovery and subsequent incorporation into an altered self-perception. Anosognosia for visual field deficits is frequent after stroke. For hemiplegia, patients' performance in a riddle test provided evidence that the inability to generate and adjust beliefs in face of uncertainty contributes to anosognosia for hemiplegia. In this prospective study, the same riddles are used in patients with homonymous hemianopia due to a first-ever stroke in the posterior cerebral artery territory and in an age-matched control cohort. The riddles create a situation of uncertainty that is resolved with five successive clues which progressively delimit the target word. After each clue, patients have to guess the target word and rate their confidence in the answer's correctness. Patients were tested once during the hospital stay. According to the Bisiach score for anosognosia, 12 out of 29 patients were unaware of their visual field deficits. All patients with anosognosia for hemianopia had right hemisphere lesions. Patients with and without anosognosia did not differ significantly in global cognitive impairment, mental flexibility or memory function. Importantly, patients with anosognosia showed higher confidence ratings than patients without anosognosia and controls in the first two clues (situations of uncertainty). This was demonstrated by a significant interaction effect in a mixed ANOVA with the factors group (anosognosia, nosognosia, controls) and riddle clues. An exploratory lesion subtraction analysis showed a high proportion of deficit unawareness in patients with lesions in the right fusiform and (para)hippocampal gyri. Our findings suggest that overconfidence in situations of uncertainty might contribute to the appearance of anosognosia for hemianopia. Because this has been demonstrated before in anosognosia for hemiplegia, we suggest that overconfidence is a supra-modal contributor to deficit unawareness.

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores / Impact of Alzheimer's disease related anosognosia in caregivers' quality of life / Impacto de la anosognosia asociada con la demencia de Alzheimer en la calidad de vida de los cuidadores

Impacto da Anosognosia Associada à Demência de Alzheimer na Qualidade de Vida de Cuidadores. A Demência de Alzheimer (DA) apresenta como um dos sintomas a anosognosia, um prejuízo na capacidade de o indivíduo julgar alterações decorrentes da doença. Relaciona-se a diversos comprometimentos cognitivo/comportamentais e é apontada como tendo significativo impacto sobre a qualidade de vida (QV) dos cuidadores. Avaliamos o impacto da anosognosia relacionada à DA sobre QV de cuidadores. Foram avaliados 50 pares paciente-cuidador com Exame Cognitivo de Addenbrooke, Questionário de Demência Ampliado e Escala de QV na DA. Observamos que cuidadores de pacientes com sinais de anosognosia apresentavam menores escores de QV, sendo que pacientes com sinais de anosognosia apresentam pior desempenho cognitivo. Escores de anosognosia e QV apresentaram correlação negativa, enquanto QV e quadro cognitivo apresentou correlação positiva. Controlando o funcionamento cognitivo, observamos que a anosognosia apresenta maior impacto na QV em indivíduos com quadro cognitivo mais grave. Palavras-chave: demência de alzheimer, qualidade de vida, cuidadores, anosognosia (AU).

Impacto de Anosognosia asociada a la demencia de Alzheimer en la calidad de vida de cuidadores. Anosognosia es uno de los síntomas de la demencia de Alzheimer (AD), y se considera que tiene un impacto significativo en la calidad de vida (QOL) de los cuidadores. Evaluamos el impacto de la anosognosia relacionada con AD en los cuidadores de calidad de vida. Hubo 50 pares paciente y su cuidador con el examen cognitivo de Addenbrooke, Cuestionario Ampliado de y Escala de calidad de vida. Hemos observado que los cuidadores de pacientes con signos anosognosia tenían menores puntuaciones de calidad de vida con los pacientes con peor rendimiento cognitivo. Anosognosia y la calidad de vida mostraron una correlación de negativa, mientras que la calidad de vida y el marco cognitivo presentaron correlación positiva. Controlando el funcionamiento cognitivo, observamos que la anosognosia tiene mayor impacto en la calidad de vida en pacientes con marco cognitivo más severo. Palabras clave: enfermedad de alzheimer, calidad de vida, cuidadores, anosognosia (AU).

Alzheimer's disease (AD) has anosognosia as one of its symptoms, defined as a change in the individual's ability to judge their difficulties, and is observed as having a significant impact on quality of life of caregivers. This study evaluated the impact of anosognosia related to AD in quality of life (QoL) of caregivers. Fifty AD patients were evaluated through the Addenbrooke's Cognitive Examination, Dementia Questionnaire ­ expanded, while caregivers were evaluated using the Scale of QoL in AD and Dementia Questionnaire (caregiver versions). We observed that caregivers of patients with signs of anosognosia had lower scores on QoL and these patients had worse cognitive scores. Anosognosia and QoL were negatively correlated, as QoL and cognitive functioning. Controlling for cognitive functioning, we observed that anosognosia has a greater impact on QoL in individuals with more severe cognitive impairments (AU).

¿Qué es la anosognosia?: un reto transdisciplinario: [revisión] / What is anosognosia?: a transdisciplinary challenge: [review]

¿Qué es la Anosognosia? Esta se puede definir como un desorden neuropsicológico el cual lleva al paciente a desconocer un déficit que sufre, debido a una lesión cerebral. Sin embargo, resulta problemático definir dicho fenómeno, pues hay conceptos como negación, confabulación y negligencia, que pueden en parte explicarla, pero ¿Son estos necesarios y/o suficientes para definir el fenómeno? Al parecer, con base en toda la información clínica, hay que trabajar en una clarificación conceptual pendiente. Este artículo parte de la pregunta inicial como problema central y pretende contribuir a dicha clarificación. Para realizar lo anterior se divide el trabajo en tres partes: Primero, se hará un análisis del concepto central, Segundo, se considerarán de forma general las posibles respuestas a la pregunta desde dos marcos conceptuales y desde el psicoanálisis, Tercero y último, para concluir se realizará una síntesis de los principales puntos discutidos.

What is Anosognosia? This can be defined as a neuropsychological disorder which produces in the patient an unawareness of a deficit from which he suffers, caused by a cerebral injury. Nonetheless, the definition of the phenomenon is a problematic issue, because there are some concepts as denial, confabulation and neglect, on terms of which a definition can be build up, but ¿Are these concepts necessary and/or sufficient to define the phenomenon? It seems that, taking into account the clinical information, the definition of the main concept is an issue worth while (necessary!) working on. To address the problematic issue, this paper is divided into three parts: The first will focus on the analysis of the main concept, the second will considerate the possible general answers to the main question from two conceptual frameworks and also from psychoanalysis, and the third and last, will offer a conclusion taking into account the main points of the discussion.

Rehabilitación neuropsicológica en un caso de asterognosia / Neuropsychological rehabilitation in a case of asterognosia

Presentamos el caso de una paciente de 67 años, con un cuadro de trastornos en el reconocimiento táctil con la mano izquierda, en ausencia de perturbaciones de la sensibilidad, déficit motor, ataxia, apraxia, déficit atencional o trastornos en la denominación (asterognosia), posterior a un ACV. Sobre la base de los datos aportados por la paciente analizamos, en comparación con los modelos existentes los distintos factores que influyen en el reconocimiento táctil. Comunicamos los resultados de un ensayo terapéutico controlado, con una mejoría en el rendimiento estadísticamente significativa después de 5 meses de rehabilitación...