Awareness of Disease and Its Domains in Young-onset and Late-onset Dementia: The Role of Executive Function.

INTRODUCTION: Executive function (EF) involves a general cognitive process linked to strategic organization and control of complex goal-oriented tasks. In young-onset dementia (YOD), especially Alzheimer's disease, the symptoms that stand out in the initial stage are deficits in attention, visual-spatial function, praxis, and language. The present study aims to investigate what components of EF differ in young and late-onset dementia (LOD) and its impact on awareness and its domains. METHODS: Using a cross-sectional design, we included 44 people with YOD and 70 with LOD. We assessed awareness and its domains, cognition, dementia severity, EF, functionality, and neuropsychiatric symptoms. RESULTS: The YOD group was more impaired in general cognition ( P =0.017) and had a worse performance in Wechsler Digit Span Backward (DSB) ( P =0.007) and Phonemic fluency task (FAS) ( P =0.046) tests. In the LOD group, deficits in EF had a greater impact on awareness and on most domains (awareness total score, cognitive functioning and health condition, functional activity impairments and social function). CONCLUSIONS: Our study findings support the heterogeneity of awareness, not only with regard to the difference between the domains and the measures of EF, but also to the groups studied.

A Longitudinal Evaluation of the Pattern of Social Cognition Impairment in Brazilians With Alzheimer's Disease.

BACKGROUND: Social cognition (SC) impairments contribute to the dependence of people with Alzheimer disease (AD), influencing their functional disability and the burden on family members and caregivers. Our objective was to longitudinally investigate the relationship between SC and cognitive and clinical variables in persons with AD and their caregivers. We also evaluated the different SC predictors from 3 perspectives: people with AD, caregivers of people with AD, and discrepancy analysis. METHODS: In all, 137 dyads (people with AD and their caregivers) underwent 2 assessments: at baseline (M1) and after 1 year (M2). During follow-up, 58 dyads were excluded, and the study was thus concluded with 79. RESULTS: Longitudinal analysis of the people with AD showed that while some cognitive functions declined (which is consistent with disease progression), SC impairments showed a more stable pattern. Another interesting result was related to SC predictors. For people with AD, SC was associated with cognition at both time points. For caregivers, besides cognition, other predictors included reduced functional abilities and quality of life in people with AD. These results are consistent with the discrepancy predictors. CONCLUSION: The stable pattern in SC functioning over 12 months in AD suggests that this neurocognitive domain may be influenced more by emotional processing than by cognitive impairment. In addition, the SC predictors showed that the investigation of different points of view enables a more global understanding, contributing to better and more targeted treatment for the patient.

Quality of Life of People With Alzheimer Disease: Comparison Between Dyads Degree of Kinship.

The quality of life (QoL) of people with Alzheimer disease (PwAD) may be influenced by the type of relationship between carer and the PwAD. Dyads of 98 PwAD/carers (N = 49 spouse-carers; N = 49 nonspouses carers) were measured about QoL, cognition, dementia severity, awareness of disease, functionality, depression, anxiety, and burden of care. Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse and nonspouse self-report PwAD QoL (PQOL) and to compare carers' ratings of PwAD QoL (C-PQOL). The total score of QoL for spouse and nonspouse PwAD showed no significant difference (P = .29). The linear regression demonstrated that higher awareness of disease was significantly related to spouse PQOL (P = .001). Nonspouse PQOL was negatively related to lower depression (P = .007). The total score of QoL for spouse and nonspouse C-PQOL showed no significant difference (P = .14). The linear regression demonstrated that depression of spouse-PwAD (P < .001) and burden of care (P = .001) were negatively related to spouse-dyads' C-PQOL. The nonspouse-dyads C-PQOL was negatively related to depression of nonspouse-PwAD (P < .001), awareness of disease (P = .001), and the mood of the carer (P = .01). Spouse and nonspouse PwAD evaluate PQOL better than carers (C-PQOL). No significant difference was found in the total PQOL and C-PQOL of spouse and nonspouse, but dyads evaluated differently about what is important to assess QoL.

Perception of change in sexual activity in Alzheimer's disease: views of people with dementia and their spouse-caregivers.

INTRODUCTION: The onset of Alzheimer's disease (AD) affects couples' relationship. We investigated the perception of change and sexual satisfaction in spouse-caregivers and their partners diagnosed with AD. METHODS: We compared 74 dyads of people with Alzheimer's disease (PwAD)/spouse-caregivers and 21 elderly dyads control. We assessed sexual satisfaction with Questionnaire on Sexual Experience and Satisfaction (QSES), cognition using a Mini-Mental State Examination (MMSE), disease severity using a Clinical Dementia Rating scale (CDR), awareness of disease with Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), functionality with Pfeffer Functional Activities Questionnaire (FAQ), depressive symptoms with Cornell Scale for Depression in Dementia (CSDD), quality of life using a Quality of Life in Alzheimer's Disease Scale (QoL-AD), and burden using a Zarit Burden Interview (ZBI). RESULTS: We found differences between the perception and no perception of change in sexual activity of PwAD (p < 0.001), spouse-caregivers (p < 0.01), and controls (p < 0.05). Moderate to severe sexual dissatisfaction was observed in 36.5% of PwAD, 65% of spouse-caregivers, and 31% of controls. PwAD sexual satisfaction was related to cognitive impairment (p < 0.05). Spouse-caregivers sexual satisfaction was related to gender (p < 0.05) and the presence of sexual activity (p < 0.001). CONCLUSIONS: The perception of change with higher sexual dissatisfaction, were significant in PwAD and their spouse-caregivers, in comparison with couples of elderly without dementia.

Structural and Dynamic Characterization of the Molecular Hub Early Region 1A (E1A) from Human Adenovirus.

The small-DNA human adenovirus encodes one of the most versatile molecular hubs, the E1A protein. This protein is essential for productive viral infection in human cells and a vast amount of biologically relevant data are available on its interactions with host proteins. Up to now, however, no high-resolution structural and dynamic information on E1A is available despite its important biological role. Among the different spliced variants of E1A, two are expressed at high level in the early stage of infection. These are 243 and 289 residues isoforms. Herein, we present their NMR characterization, showing that they are both highly disordered, but also demonstrate a certain heterogeneous behavior in terms of structural and dynamic properties. Furthermore, we present the characterization of the isolated domain of the longer variant, known as CR3. This study opens the way to understanding at the molecular level how E1A functions.

Spouse-caregivers' quality of life in Alzheimer's disease.

BACKGROUND: The relationship between sexuality and quality of life (QoL) of spouse-caregivers remains unclear. We designed this study to evaluate the relationship between sexual satisfaction and spouse-caregivers' QoL, and to determine the influence of the clinical characteristics of people with dementia (PWD) on spouse-caregivers' self-reported QoL. METHODS: Using a cross-sectional design, 54 PWD and their spouse-caregivers completed the QoL in Alzheimer's Disease scale (QoL-AD), questionnaire on sexual experience and satisfaction (QSES), Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), Pfeffer functional activities questionnaire (FAQ), the Cornell scale for depression in dementia (CSDD) and Zarit burden interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced the spouse-caregivers' QoL ratings. RESULTS: We did not find a significant difference in QoL between male and female spouse-caregivers (p = 0.71). We also found that 13% of males and 48.1% of females demonstrated moderate to severe sexual dissatisfaction. However, we did not find a significant correlation between spouse-caregivers' QoL and sexual satisfaction (p = 0.41). The linear regression indicated that impaired awareness and lower QoL of PWD were significantly related to spouse-caregivers' QoL (p = 0.000). CONCLUSIONS: The spouse-caregivers' QoL is influenced by awareness of disease and PWD QoL. Our study would be helpful for the development of adequate psycho-educational approaches to increase spouse-caregivers' QoL, considering the specificities of the couples' relationship.

Effective Immobilization of Agrobacterium sp. IFO 13140 Cells in Loofa Sponge for Curdlan Biosynthesis.

Curdlan production by Agrobacterium sp. IFO13140 immobilized on loofa sponge, alginate and loofa sponge with alginate was investigated. There was no statistically-significant difference in curdlan production when the microorganism was immobilized in different matrices. The loofa sponge was chosen because of its practical application and economy and because it provides a high stability through its continued use. The best conditions for immobilization on loofa sponge were 50 mg of cell, 200 rpm and 72 h of incubation, which provided a curdlan production 1.50-times higher than that obtained by free cells. The higher volumetric productivity was achieved by immobilized cells (0.09 g/L/h) at 150 rpm. The operating stability was evaluated, and until the fourth cycle, immobilized cells retained 87.40% of the production of the first cycle. The immobilized cells remained active after 300 days of storage at 4 °C. The results of this study demonstrate success in immobilizing cells for curdlan biosynthesis, making the process potentially suitable for industrial scale-up. Additional studies may show a possible contribution to the reduction of operating costs.

Cardiac autonomic regulation during exposure to auditory stimulation with classical baroque or heavy metal music of different intensities.

OBJECTIVES: The effects of chronic music auditory stimulation on the cardiovascular system have been investigated in the literature. However, data regarding the acute effects of different styles of music on cardiac autonomic regulation are lacking. The literature has indicated that auditory stimulation with white noise above 50 dB induces cardiac responses. We aimed to evaluate the acute effects of classical baroque and heavy metal music of different intensities on cardiac autonomic regulation. STUDY DESIGN: The study was performed in 16 healthy men aged 18-25 years. All procedures were performed in the same soundproof room. We analyzed heart rate variability (HRV) in time (standard deviation of normal-to-normal R-R intervals [SDNN], root-mean square of differences [RMSSD] and percentage of adjacent NN intervals with a difference of duration greater than 50 ms [pNN50]) and frequency (low frequency [LF], high frequency [HF] and LF/HF ratio) domains. HRV was recorded at rest for 10 minutes. Subsequently, the volunteers were exposed to one of the two musical styles (classical baroque or heavy metal music) for five minutes through an earphone, followed by a five-minute period of rest, and then they were exposed to the other style for another five minutes. The subjects were exposed to three equivalent sound levels (60-70dB, 70-80dB and 80-90dB). The sequence of songs was randomized for each individual. RESULTS: Auditory stimulation with heavy metal music did not influence HRV indices in the time and frequency domains in the three equivalent sound level ranges. The same was observed with classical baroque musical auditory stimulation with the three equivalent sound level ranges. CONCLUSION: Musical auditory stimulation of different intensities did not influence cardiac autonomic regulation in men.

"Sexual activity for me is something else. It's the same as always: Sex aside and our love for each other." Changes in sexual activity in dementia from the view of spouse-carers'.

The study aimed to explore the impact of Alzheimer's disease (AD) on spouse-carer's lives and the ways it affects their marital relationship and sexual activity. Data were obtained from qualitative interviews conducted with 11 spouse-carers of people with AD. Using interpretative phenomenological analysis (IPA), three themes emerged: psychological and emotional impact, social impact, and sexual impact. Some spouse-carers reported stress, poor emotional well-being, frustration, doubts about how to deal with the situation, sadness, loneliness, perception of losing connection with the partner, and feelings of companionship disappearing. Meanwhile, other spouse-carers reported closer relations and greater affection for their care-recipients after the diagnosis. Changes in sexual activity were attributed to aging and/or the effects of the illness. Gender influenced the perception of changes in the marital relationship but not in sexual activity. Participants reported conflicting perspectives towards the importance of sexual activity in the marital relationship and the replacement of sexual intercourse with other modes of expressing affection. We believe that understanding the specificities of marital relationships of couples in whom one spouse was diagnosed with AD would be helpful for developing coping strategies for persons living with dementia and their spouses.

The relationship between burden and caregiver's sleep disturbances in dementia: a systematic review.

Caregivers of people living with dementia (PLwD) have a high burden degree that leads to health issues, including sleep. Objective: This study aimed to analyze the impacts of the caregiving burden on caregiver's sleep disturbances. Methods: This systematic review involved a qualitative analysis of publications on Web of Science and Pubmed/Medline databases published between February 2018 and August 2022. Results: A total of 27 studies were identified and analyzed. Caregiver's sleep presents impairments in sleep latency, sleep fragmentation, sleep duration, subjective sleep quality, daytime dysfunction, and insomnia. Caregiver's distress and depressive symptoms have a dual relationship with sleep problems. Conclusion: Sleep disturbances presented by caregivers are correlated with higher burden levels and lead to more vulnerability to psychiatric symptoms and health issues.

Cuidadores de pessoas com demência possuem alto grau de sobrecarga que impacta de forma objetiva o sono e suas dimensões. Objetivo: Este estudo teve o objetivo de analisar o impacto da sobrecarga nas alterações do sono do cuidador. Métodos: Esta revisão sistemática envolveu a análise de resultados quantitativos e qualitativos de publicações das bases de dados Web of Science e PubMed/ Medical Literature Analysis and Retrieval System Online (Medline) publicadas entre fevereiro de 2018 e agosto de 2022. Resultados: O total de 27 estudos foi identificado e analisado. Cuidadores apresentam prejuízos na latência, fragmentação, duração e qualidade subjetiva do sono, disfunção diurna e insônia. O estresse e sintomas depressivos apresentados pelo cuidador possuem com o sono uma relação bidirecional. Conclusão: Os distúrbios do sono apresentados pelos cuidadores estão correlacionados com o alto nível de sobrecarga e geram maior vulnerabilidade para sintomas psiquiátricos e problemas de saúde.

Domains of quality of life in Alzheimer's disease vary according to caregiver kinship.

INTRODUCTION: Compared to other types of caregiver, spouse-caregivers tend to be closer to people with Alzheimer's disease (PwAD) because of their different position in the relationship. We designed this study to compare the differences in caregivers' quality of life (QoL) and domains of QoL according to the kinship relationship between the members of caregiving dyads. METHODS: We assessed QoL of 98 PwAD and their family caregivers (spouse-caregivers, n = 49; adult children, n = 43; and others, n = 6). The PwAD and their caregivers completed questionnaires about their QoL, awareness of disease, cognition, severity of dementia, depression, and burden of caring. RESULTS: The comparison between caregiver types showed that spouse-caregivers were older, with higher levels of burden and lower scores for cognition. Caregivers' total QoL scores were not significantly different according to type of kinship. However, there were significant differences in the domains physical health (p = 0.04, Cohen's d [d] = -0.42), marriage (p = 0.01, d = 1.31), and friends (p = 0.04, d = -0.41), and life as a whole showed a trend to difference (p = 0.08, d = -0.33). When QoL domains were analyzed within dyads, there were significant differences between members of spouse dyads in the domains energy (p = 0.01, d = -0.49), ability to do things for fun (p = 0.01, d = -0.48), and memory (p = 0.000, d = -1.07). For non-spouse dyads, there were significant differences between caregivers and PwAD for the QoL domains memory (p = 0.004, d = -0.63), marriage (p = 0.001, d = -0.72), friends (p = 0.001, d = -0.65), and ability to do chores (p = 0.000, d = -0.76). CONCLUSIONS: Differences were only detected between spouse/non-spouse-caregivers when QoL was analyzed by domains. We speculate that spouse and non-spouse caregivers have distinct assessments and perceptions of what is important to their QoL.

The Relationship between Social Cognition and Executive Functions in Alzheimer's Disease: A Systematic Review.

INTRODUCTION: Social Cognition (SC) is a complex construct that reflects a wide variety of implicit and explicit cognitive processes. Many neurocognitive domains are associated with SC and the Executive Function (EF) is the most representative one. We conducted a systematic review aiming at clarifying whether SC impairments are associated with dysfunction on EF in people with Alzheimer Disease (AD). METHODS: The search, based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA), was undertaken between January 2007 and December 2019 using Pubmed, SciELO, BIREME and Thomson Reuters Web of Science electronic databases. The keywords were SC, AD, EF, Neuropsychological functioning and Executive Disorder. RESULTS: One hundred thirty-six articles were identified and fifteen were included. These studies are not in agreement about the extent of SC deficits in AD, mainly in the mild stage of the disease. EF deficits, specifically inhibition and the ability to manipulate verbal information, are associated with the impairment in SC in AD. SC decreases with the disease progression, a relationship explained by global cognition impairment and SC specific symptoms. CONCLUSION: SC impairment is associated with disease progression, mainly because of the decline in EF. Studies on SC components are unequal, contributing to a frequent generalization of Theory of Mind results, and often hampering the investigation of other components, mainly empathy. More precise knowledge about SC functioning in AD may contribute to a better understanding of the behavioral changes and interpersonal interactions.

The free energy landscape of the oncogene protein E7 of human papillomavirus type 16 reveals a complex interplay between ordered and disordered regions.

When present, structural disorder makes it very challenging to characterise the conformational properties of proteins. This is particularly the case of proteins, such as the oncogene protein E7 of human papillomavirus type 16, which contain both ordered and disordered domains, and that can populate monomeric and oligomeric states under physiological conditions. Nuclear magnetic resonance (NMR) spectroscopy is emerging as a powerful method to study these complex systems, most notably in combination with molecular dynamics simulations. Here we use NMR chemical shifts and residual dipolar couplings as structural restraints in replica-averaged molecular dynamics simulations to determine the free energy landscape of E7. This landscape reveals a complex interplay between a folded but highly dynamical C-terminal domain and a disordered N-terminal domain that forms transient secondary and tertiary structures, as well as an equilibrium between a high-populated (98%) dimeric state and a low-populated (2%) monomeric state. These results provide compelling evidence of the complex conformational heterogeneity associated with the behaviour and interactions of this disordered protein associated with disease.

The relationship between burden and caregiver's sleep disturbances in dementia: a systematic review / A relação entre sobrecarga e sono do cuidador na demência: um estudo de revisão sistemática

ABSTRACT Caregivers of people living with dementia (PLwD) have a high burden degree that leads to health issues, including sleep. Objective: This study aimed to analyze the impacts of the caregiving burden on caregiver's sleep disturbances. Methods: This systematic review involved a qualitative analysis of publications on Web of Science and Pubmed/Medline databases published between February 2018 and August 2022. Results: A total of 27 studies were identified and analyzed. Caregiver's sleep presents impairments in sleep latency, sleep fragmentation, sleep duration, subjective sleep quality, daytime dysfunction, and insomnia. Caregiver's distress and depressive symptoms have a dual relationship with sleep problems. Conclusion: Sleep disturbances presented by caregivers are correlated with higher burden levels and lead to more vulnerability to psychiatric symptoms and health issues.

RESUMO Cuidadores de pessoas com demência possuem alto grau de sobrecarga que impacta de forma objetiva o sono e suas dimensões. Objetivo: Este estudo teve o objetivo de analisar o impacto da sobrecarga nas alterações do sono do cuidador. Métodos: Esta revisão sistemática envolveu a análise de resultados quantitativos e qualitativos de publicações das bases de dados Web of Science e PubMed/ Medical Literature Analysis and Retrieval System Online (Medline) publicadas entre fevereiro de 2018 e agosto de 2022. Resultados: O total de 27 estudos foi identificado e analisado. Cuidadores apresentam prejuízos na latência, fragmentação, duração e qualidade subjetiva do sono, disfunção diurna e insônia. O estresse e sintomas depressivos apresentados pelo cuidador possuem com o sono uma relação bidirecional. Conclusão: Os distúrbios do sono apresentados pelos cuidadores estão correlacionados com o alto nível de sobrecarga e geram maior vulnerabilidade para sintomas psiquiátricos e problemas de saúde.

Monitoring HPV-16 E7 phosphorylation events.

HPV-16 E7 is one of the key proteins that, by interfering with the host metabolism through many protein-protein interactions, hijacks cell regulation and contributes to malignancy. Here we report the high resolution investigation of the CR3 region of HPV-16 E7, both as an isolated domain and in the full-length protein. This opens the way to the atomic level study of the many interactions in which HPV-16 E7 is involved. Along these lines we show here the effect of one of the key post-translational modifications of HPV-16 E7, the phosphorylation by casein kinase II.

Quality of life in mild dementia: patterns of change in self and caregiver ratings over time.

OBJECTIVES:: To determine changes over time in self and caregiver ratings of quality of life (QoL) in people with dementia (PwD) and to identify factors associated with changes in QoL ratings. METHODS:: In this longitudinal study, 69 people with mild Alzheimer's disease and their caregivers were assessed at baseline and after 1 year. We examined the association of QoL ratings with the following variables at the two time points: awareness of disease, cognitive status, mood, functionality, neuropsychiatric symptoms, and caregiver burden. Multivariate regression analyses were conducted to examine the contribution of co-factors. RESULTS:: At baseline, PwD self-ratings of QoL were associated with caregiver ratings of PwD QoL (p = 0.001). Caregiver ratings were associated with PwD mood (p = 0.001) and self-rated QoL (p = 0.001). After 1 year, caregiver ratings of PwD QoL changed significantly (p = 0.049, d = -0.27), whereas PwD self-ratings did not (p = 0.89, d = 0.09). PwD awareness of disease changed significantly (p = 0.001) at 1 year, having declined in 25.4% and improved in 12.3% of participants. PwD QoL self-ratings were associated with caregiver ratings (p = 0.001). Caregiver ratings of PwD QoL after 1 year were associated with PwD mood (p = 0.029), self-reported QoL (p = 0.001), and awareness of disease (p = 0.033). CONCLUSIONS:: The association between self and caregiver ratings of PwD QoL was maintained over 1 year. The primary factors accounting for the change in caregiver ratings were PwD mood and awareness of disease. QoL and cognitive impairment seem to be relatively independent in mild dementia.

Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants.

INTRODUCTION: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience. OBJECTIVE: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia. METHODS: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia. RESULTS AND CONCLUSIONS: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress.

Facial expression recognition in Alzheimer's disease: a longitudinal study.

Facial recognition is one of the most important aspects of social cognition. In this study, we investigate the patterns of change and the factors involved in the ability to recognize emotion in mild Alzheimer's disease (AD). Through a longitudinal design, we assessed 30 people with AD. We used an experimental task that includes matching expressions with picture stimuli, labelling emotions and emotionally recognizing a stimulus situation. We observed a significant difference in the situational recognition task (p ≤ 0.05) between baseline and the second evaluation. The linear regression showed that cognition is a predictor of emotion recognition impairment (p ≤ 0.05). The ability to perceive emotions from facial expressions was impaired, particularly when the emotions presented were relatively subtle. Cognition is recruited to comprehend emotional situations in cases of mild dementia.

Cross-cultural adaptation of the Social and Emotional Questionnaire on Dementia for the Brazilian population.

CONTEXT AND OBJECTIVE: Impairments in social and emotional functioning may affect the communication skills and interpersonal relationships of people with dementia and their caregivers. This study had the aim of presenting the steps involved in the cross-cultural adaptation of the Social and Emotional Questionnaire (SEQ) for the Brazilian population. DESIGN AND SETTING: Cross-cultural adaptation study, conducted at the Center for Alzheimer's Disease and Related Disorders in a public university. METHODS: The process adopted in this study required six consecutive steps: initial translation, translation synthesis, back translation, committee of judges, pretesting of final version and submission to the original author. RESULTS: In general, the items had semantic, idiomatic, conceptual and experiential equivalence. During the first pretest, people with dementia and their caregivers had difficulties in understanding some items relating to social skills, which were interpreted ambiguously. New changes were made to allow better adjustment to the target population and, following this, a new pretest was performed. This pre-test showed that the changes were relevant and gave rise to the final version of the instrument. There was no correlation between education level and performance in the questionnaire, among people with dementia (P = 0.951). CONCLUSION: The Brazilian Portuguese version of the Social and Emotional Questionnaire was well understood and, despite the cultural and linguistic differences, the constructs of the original version were maintained.

Awareness of disease is different for cognitive and functional aspects in mild Alzheimer's disease: a one-year observation study.

Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating Scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.