Anosognosia for prospective and retrospective memory deficits: Assessment and theoretical considerations.

OBJECTIVE: Patients who suffer from memory loss after an Acquired Brain Injury (ABI) may also suffer from anosognosia, or unawareness of their memory loss. How we define and measure anosognosia can have critical implications for its study and clinical assessment. Commonly used measures often lack standardization and reliability checks for responses. Moreover, these methods rely heavily on cognitive abilities (e.g., language abilities) that are often affected after brain injury. The aim of this study is to elucidate how to best conceptualize and detect anosognosia for memory loss by introducing a new method of assessment, the Visual-Analogue Test for Anosognosia for memory impairment (VATAmem). METHOD: A total of 51 patients (M = 61 years, M = 13 years of education) with memory difficulties after ABI were recruited from outpatient clinics. A total of 73 informants were also recruited (M = 51 years old, M = 13 years of education). Both patients and informants evaluated the severity of patients' everyday memory mistakes on the VATAmem, for prospective and retrospective memory deficits by using visual analogue scales, vignettes, and check questions to ensure reliability. RESULTS AND CONCLUSION: A total of 30% of the patients were deemed unaware of their memory deficits. Patients were less aware of their prospective (29%) than their retrospective memory difficulties (18%). The new method of assessment provided by the VATAmem reduced possible false positives and enhanced reliability. We conclude that careful consideration of methodology is a key step to interpreting anosognosia findings within a theoretical framework. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test.

Alzheimer's disease (AD) affects temporary memory for bound features more remarkably than for individual features. Such selective impairments manifest from presymptomatic through dementia stages via titration procedures. A recent study suggested that without titration and with high memory load the binding selectivity may disappear in people at risk of AD such as those with Mild Cognitive Impairment (MCI). We compared data from two studies on temporary binding which assessed people with MCI and controls using different memory loads (2 or 3 items). Selective binding impairments were found in MCI, but relative to controls, such selectivity was contingent upon memory load (i.e., present with 2 items). Further analysis with MCI people who tested positive to neuroimaging biomarkers (i.e., hippocampal atrophy) confirmed that this specific binding impairments are a feature of prodromal AD. The temporary binding task has been recently suggested by consensus papers as a potential screening tool for AD. The results presented here inform on task properties that can maximize the reliability of this new assessment tool for the detection of memory impairments in prodromal cases of AD.

The need for harmonisation and innovation of neuropsychological assessment in neurodegenerative dementias in Europe: consensus document of the Joint Program for Neurodegenerative Diseases Working Group.

Cognitive, behavioural, and functional assessment is crucial in longitudinal studies of neurodegenerative dementias (NDD). Central issues, such as the definition of the study population (asymptomatic, at risk, or individuals with dementia), the detection of change/decline, and the assessment of relevant outcomes depend on quantitative measures of cognitive, behavioural, and functional status.Currently, we are far from having available reliable protocols and tools for the assessment of dementias in Europe. The main problems are the heterogeneity of the tools used across different European countries, the lack of standardisation of administration and scoring methods across centres, and the limited information available about the psychometric properties of many tests currently in widespread use. This situation makes it hard to compare results across studies carried out in different centres, thus hampering research progress, in particular towards the contribution to a "big data" common data set.We present here the results of a project funded by the Joint Program for Neurodegenerative Diseases (JPND) and by the Italian Ministry of Health. The project aimed at providing a consensus framework for the harmonisation of assessment tools to be applied to research in neurodegenerative disorders affecting cognition across Europe. A panel of European experts reviewed the current methods of neuropsychological assessment, identified pending issues, and made recommendations for the harmonisation of neuropsychological assessment of neurodegenerative dementias in Europe.A consensus was achieved on the general recommendations to be followed in developing procedures and tools for neuropsychological assessment, with the aim of harmonising tools and procedures to achieve more reliable data on the cognitive-behavioural examination. The results of this study should be considered as a first step to enhancing a common view and practise on NDD assessment across European countries.

The effect of funding sources on donepezil randomised controlled trial outcome: a meta-analysis.

OBJECTIVE: To investigate whether there is a difference in the treatment effect of donepezil on cognition in Alzheimer disease between industry-funded and independent randomised controlled trials. DESIGN: Fixed effects meta-analysis of standardised effects of donepezil on cognition as measured by the Mini Mental State Examination and the Alzheimer's Disease Assessment Scale-cognitive subscale. DATA SOURCES: Studies included in the meta-analyses reported in the National Institute for Health and Care Excellence (NICE) technical appraisal 217 updated with new studies through a PubMed search. ELIGIBILITY CRITERIA: Inclusion criteria were double-blind, placebo-controlled trials of any length comparing patients diagnosed with probable Alzheimer disease (according to the NINCDS-ADRDA/DSM-III/IV criteria) taking any dosage of donepezil. Studies of combination therapies (eg, donepezil and memantine) were excluded, as were studies that enrolled patients with a diagnosis of Alzheimer disease associated with other disorders (eg, Parkinson's disease and Down's syndrome). RESULTS: Our search strategy identified 14 relevant trials (4 independent) with suitable data. Trials sponsored by pharmaceutical companies reported a larger effect of donepezil on standardised cognitive tests than trials published by independent research groups (standardised mean difference (SMD)=0.46, 95% CI 0.37 to 0.55 vs SMD=0.33, 95% CI 0.18 to 0.48, respectively). This difference remained when only data representing change up to 12 weeks from baseline were analysed (industry SMD=0.44, 95% CI 0.34 to 0.53 vs independent SMD=0.35, 95% CI 0.18 to 0.52). Analysis revealed that the effect of funding as a moderator variable of study heterogeneity was not statistically significant at either time point. CONCLUSIONS: The effect size of donepezil on cognition is larger in industry-funded than independent trials and this is not explained by the longer duration of industry-funded trials. The lack of a statistically significant moderator effect may indicate that the differences are due to chance, but may also result from lack of power.

Development of Android apps for cognitive assessment of dementia and delirium.

The next generation of medical technology applications for hand-held portable platforms will provide a core change in performance and sophistication, transforming the way health care professionals interact with patients. This advance is particularly apparent in the delivery of cognitive patient assessments, where smartphones and tablet computers are being used to assess complex neurological conditions to provide objective, accurate and reproducible test results. This paper reports on two such applications (apps) that have been developed to assist healthcare professionals with the detection and diagnosis of dementia and delirium.

Cognitive approach to the assessment of limb apraxia.

A new instrument for the assessment of the different levels of gesture processing, as identified by recent cognitive models of apraxia, is presented. The battery comprises thirteen tasks -- eight assess the production of meaningful gestures both on command and on imitation, four tasks assess the ability to recognize and identify gestures, and one task assesses imitation of meaningless gestures. The battery encompasses a novel test of gesture production on visual command. A total of 60 healthy British volunteers were tested with the entire battery. On the whole, participants made more errors with pantomimes than with other tasks. Their scores served as norms.

List effect in apraxia assessment.

Imitation tests encompassing intermingled meaningful and meaningless items are normally used to assess ideomotor apraxia, implicitly assuming that they would test the lexical and the non-lexical route, respectively. However, these mixed lists might induce a "list composition" effect similar to that found in word recognition studies where familiar material can be processed via the non-lexical route. This hypothesis was put to test by examining praxis skills of 23 left-hemisphere damaged patients using the same gestures in two formats: pure and mixed lists (i.e., meaningless or meaningful gestures administered separately or intermingled, respectively). Results showed that patients performed better on the imitation task when pure lists were used. Moreover, asymmetries of performance were observed. Patient SL scored better in the imitation of meaningful gestures in the pure list than in the mixed list condition. Patient CA performed poorly in the imitation of meaningless gestures only in the mixed list condition. Dissociations observed in imitation tasks could be biased by the use of mixed lists. Also "pure" lists should be used for the diagnosis of imitation deficits in apraxia.