Sugar intake and craving during alcohol withdrawal in alcohol use disorder inpatients.

To assess whether changes in sugar intake and craving occur during alcohol withdrawal in humans, we conducted a prospective, observational study in a university hospital addictions treatment center. Recruited patients had severe alcohol use disorder and were hospitalized for 7 days in the short-stay unit for alcohol withdrawal and then for 6 weeks in the rehabilitation unit. During the hospital stay, they had no access to alcohol but had full access to sweet products and beverages in a shop and vending machines located inside the hospital. Alcohol craving was assessed using a visual analogue scale on Days 1, 15, and 45. Sugar craving, sweet products stored by patients in their rooms, and weight were assessed on the same days. Thirty-five patients were included. Sugar craving increased in 14 patients during the hospital stay, whereas no change was observed in the remaining 21. Significant increases in both the amounts of sweet products stored in the patients' rooms (p < 0.02) and weight (p < 0.05) were observed only in the sugar craving group. During the same period, alcohol craving decreased significantly in all patients. Changes in tobacco smoking were not different according to the sugar craving status and therefore cannot explain the observed differences. In conclusion, increased intake and craving for sugar after alcohol withdrawal were observed in 40% of the patients included in our prospective study, and these results were similar to those of a study conducted in the alcohol post-dependent state model in rats.

Relationships between metacognitive beliefs, social evaluative threat and worry.

A worry state is assumed to emerge from the interaction between metacognitive beliefs, and the appraisal of environmental demands (Wells & Matthews, 1994). The aim of this study was to show that metacognitive beliefs moderate the effect of sources of social evaluative threat on worry. Our sample (N = 174) completed a working memory task in two contexts (threatful vs. neutral), while both pre- and post-task measures subjective stress states were recorded. Our results confirmed significant effects of sources of social evaluative threat and metacognitive beliefs on worry. The interaction metacognition * threat context effect on worry was not significant. Our findings support the hypothesis that worry is a form of subjective stress explained by a combination of outcome uncontrollability and social evaluative threat. Social evaluative threat and metacognitive beliefs appeared as two, independent predictors of a worry state. Our results are discussed in reference to the Self Regulative model of stress.

Determination of MoCA Cutoff Score in Patients with Alcohol Use Disorders.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) score is a convenient and promising tool for estimating alcoholic patients' global cognitive functioning, a major challenge for all specialized alcohol treatment centers. However, whether or not the score should be corrected for education level and whether the proposed cutoff is relevant in patients with alcohol use disorders (AUD) should be determined. METHODS: We compared the MoCA scores in patients hospitalized for AUD with and without cognitive impairment assessed by a battery of neuropsychological (NP) tests. Sensitivity, specificity, and cutoff of the MoCA score were analyzed using receiver operating characteristic curve analysis. RESULTS: Thirty-one patients with and 25 without cognitive impairment were included in the study. There were 40 men and 16 women, with a mean age of 49.5 years. The mean uncorrected MoCA score was 23.1 ± 3.3 in those with and 27.0 ± 1.9 in those without cognitive impairment. NP tests were significantly correlated with the MoCA score. Uncorrected MoCA scores identified more than 80% of the patients with a cutoff score equal to 26, to obtain similar accuracy with the corrected score required using a cutoff score equal to 27. CONCLUSIONS: Our results confirm that the MoCA test is a convenient and reliable screening tool to measure cognition defects in alcoholic patients. As using the 1-point education adjustment increases the cutoff score by 1 point, it is suggested to use the noncorrected score and the usual cutoff, that is, 26. Being easy to administer and only moderately time-consuming, the MoCA score should be used extensively in addiction treatment centers.

Coping profiles, perceived stress and health-related behaviors: a cluster analysis approach.

Using cluster analytical procedure, this study aimed (i) to determine whether people could be differentiated on the basis of coping profiles (or unique combinations of coping strategies); and (ii) to examine the relationships between these profiles and perceived stress and health-related behaviors. A sample of 578 French students (345 females, 233 males; M(age)= 21.78, SD(age)= 2.21) completed the Perceived Stress Scale-14 ( Bruchon-Schweitzer, 2002), the Brief COPE ( Muller and Spitz, 2003) and a series of items measuring health-related behaviors. A two-phased cluster analytic procedure (i.e. hierarchical and non-hierarchical-k-means) was employed to derive clusters of coping strategy profiles. The results yielded four distinctive coping profiles: High Copers, Adaptive Copers, Avoidant Copers and Low Copers. The results showed that clusters differed significantly in perceived stress and health-related behaviors. High Copers and Avoidant Copers displayed higher levels of perceived stress and engaged more in unhealthy behavior, compared with Adaptive Copers and Low Copers who reported lower levels of stress and engaged more in healthy behaviors. These findings suggested that individuals' relative reliance on some strategies and de-emphasis on others may be a more advantageous way of understanding the manner in which individuals cope with stress. Therefore, cluster analysis approach may provide an advantage over more traditional statistical techniques by identifying distinct coping profiles that might best benefit from interventions. Future research should consider coping profiles to provide a deeper understanding of the relationships between coping strategies and health outcomes and to identify risk groups.

Validation of the TTM processes of change measure for physical activity in an adult French sample.

BACKGROUND: Processes of change (POC) are constructs from the transtheoretical model that propose to examine how people engage in a behavior. However, there is no consensus about a leading model explaining POC and there is no validated French POC scale in physical activity PURPOSE: This study aimed to compare the different existing models to validate a French POC scale. METHOD: Three studies, with 748 subjects included, were carried out to translate the items and evaluate their clarity (study 1, n = 77), to assess the factorial validity (n = 200) and invariance/equivalence (study 2, n = 471), and to analyze the concurrent validity by stage × process analyses (study 3, n = 671). RESULTS: Two models displayed adequate fit to the data; however, based on the Akaike information criterion, the fully correlated five-factor model appeared as the most appropriate to measure POC in physical activity. The invariance/equivalence was also confirmed across genders and student status. Four of the five existing factors discriminated pre-action and post-action stages. CONCLUSION: These data support the validation of the POC questionnaire in physical activity among a French sample. More research is needed to explore the longitudinal properties of this scale.

Examination of the hierarchical structure of the brief COPE in a French sample: empirical and theoretical convergences.

This study aimed to determine whether the various factors of coping as measured by the Brief COPE could be integrated into a more parsimonious hierarchical structure. To identify a higher structure for the Brief COPE, several measurement models based on prior theoretical and hierarchical conceptions of coping were tested. First, confirmatory factor analysis (CFA) results revealed that the Brief COPE's 14 original factors could be represented more parsimoniously with 5 higher order dimensions: problem-solving, support-seeking, avoidance, cognitive restructuring, and distraction (N = 2,187). Measurement invariance across gender was also shown. Second, results provided strong support for the cross-validation and the concurrent validity of the hierarchical structure of the Brief COPE (N = 584). Results indicated statistically significant correlations between Brief COPE factors and trait anxiety and perceived stress. Limitations and theoretical and methodological implications of these results are discussed.

Evaluation of the Effectiveness of Therapy for Anxiety in Williams Beuren Syndrome Using a Smartphone App: Protocol for a Single-Case Experiment.

BACKGROUND: Williams syndrome (WS-OMIM 194050, orphaned number: Orpha 904) is a rare condition mostly associated with intellectual disability. People with Williams syndrome are 8 times more likely to have anxiety disorders than the general population. Therapeutic solutions to treat the anxiety remain limited, particularly nonpharmacological therapy. However, cognitive behavioral therapy (CBT) has been found efficacious in managing anxiety disorders and can be used for people with intellectual disability. OBJECTIVE: This paper describes a protocol to assess the efficiency of a CBT program based on digital support for people with Williams syndrome and anxiety based on a research methodology designed for rare diseases. METHODS: We will recruit 5 individuals with Williams syndrome and anxiety. They will participate in 9 CBT sessions. Participants will perform daily self-assessments of anxiety using a digital app, which will allow for ecological and repeated evaluation of their anxiety. This digital app will provide support for each therapy session. Anxiety and quality of life will be externally assessed before and after the program and at a 3-month follow-up. This is a single-case intervention research design with multiple baselines implying repeated measures of judgment criteria. The present protocol ensures high internal validity and will help identify encouraging contributions for later clinical trials. RESULTS: Participant recruitment and data collection began in September 2019, and we project that the study findings will be available for dissemination by spring 2023. CONCLUSIONS: This study will allow the assessment of the efficiency of a CBT program based on digital support to treat anxiety in people with Williams syndrome. Finally, the program could be used as an example of nonpharmacological therapy for rare diseases. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03827525; https://clinicaltrials.gov/ct2/show/NCT03827525. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44393.

'Bad news consultations' with oncology nurses: Impact on perceived stress and patient experience.

PURPOSE: 'Bad News Consultations' (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC. METHOD: This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC). RESULTS: Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = -1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = -0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares. CONCLUSION: Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway.

Relationships between Attentional Bias and craving in Alcohol Use Disorder: Role of metacognitions.

Researchers have claimed that craving and Attentional Bias (AB) towards alcohol-related cues can be explained by a common incentive-salience mechanism. However, the exact relationship between AB and craving is a matter of debate. The aim of this study was to show that metacognitions moderate the effect of AB on craving. A sample of 38 alcohol abusers undergoing post-withdrawal treating in a hospital setting completed the visual Dot Probe Detection Task (DPDT), while both pre- and post-task measures of craving were recorded. Our results confirmed significant effects of both exposure to pictures of alcohol, and metacognitions, on craving; in particular, the interaction Metacognition * DPDT was significant. Although we initially confirmed a significant main effect of AB on craving, it became non-significant when adjusted for inter-subject variance, and metacognitions. The effect of the interaction AB * Metacognition on craving was not significant. Our findings support the hypothesis that craving and AB share variance, but the relationship appears to be spurious, and caused by confounding factors. We discuss these results with reference to the metacognitive model of addiction.

Role of non-pharmacological interventions for healthy ageing.

The range of non-pharmacological interventions (NPIs) available for people over 60 years of age is continuously expanding, both in terms of prevention and therapy. They have been empirically selected for centuries and more recently developed through epigenetic studies, clinical trials and technological innovations, and their development has increased and diversified around the world. Residual questions concern: 1) the scope of such treatments which appears to overlap with alternative medicines, 2) their evaluation, which some researchers say is impossible, and 3) their implementation in the elderly, which appears to be overly complicated. This article addresses these three questions and presents digital tools developed by the CEPS University Platform facilitating the evaluation of NPIs in the field of healthy aging. The transformation of the health system, which has become necessary to meet the needs of baby boomers, will widen the arsenal of health-related solutions. The combination of approaches to medicine and health has become personalised, comprehensive and integrative. NPIs will play a major role in the coming century. These practices differ from alternative medicines, general public health messages and socio-cultural approaches through continuous research, a quality approach and traceability of use. NPIs today constitute a complementary ecosystem for biomedical treatments which are increasingly becoming economically and legally consolidated.

Demographic Characteristics, Motivation and Perception of Change as Determinants of Memory Compensation Self-Reports After Acquired Brain Injury.

INTRODUCTION: Individuals with brain injuries experience cognitive and emotional changes that have long-lasting impacts on everyday life. In the context of rehabilitation, surveys have stressed the importance of compensating for memory disturbances to ease the impact of disorders on day-to-day autonomy. Despite extensive research on the nature of neurocognitive impairments following brain injury, few studies have looked at patients' perceptions of these day-to-day compensations. This study examines these perceptions; in particular, what brain-injured people believe they do to compensate for memory deficiencies in everyday life. It also investigates the determinants of reported compensation strategies (age, gender, perceived stress, change awareness and motivation to succeed). METHODS: Eighty patients and 80 controls completed the French Memory Compensation Questionnaire, a self-report measure of everyday memory compensation. Five forms of compensation were investigated: External and Internal strategies, Reliance on social help, and investments in Time and Effort, along with two general factors: the degree of importance attached to Success (motivation) and perceptions of Change. Participants also completed measures of demographic and emotional aspects that may affect everyday compensation perceptions. RESULTS: The brain-injured group reported significantly more frequent use of memory compensation strategies than controls, with the exception of External aids. Large effects were observed for Reliance and Effort. Demographic, motivation and perception of change determinants were found to have different effects depending on the compensation strategy, and mediated the direct effect of brain injury on reported compensation. CONCLUSION: Clinical and rehabilitation neuropsychologists often seek to have a better sense of how their patients perceive their compensatory behaviors. In practice, such an understanding is needed to help select appropriate methods and improve the long-term impact of rehabilitation programs: memory rehabilitation will fail if neuropsychologists do not deal, first and foremost, with the emotional and metacognitive issues surrounding traumatic brain injury (TBI), rather than focusing on cognitive efficiency.

[French adaptation and validation of the scale to assess unawareness of mental disorder]. / La SUMD (Scale to Assess Unawareness of Mental Disorder) : validation et adaptation française dans une population de patients souffrant de schizophrénie.

OBJECTIVES: To validate the French version of the Scale to Assess Unawareness of Mental Disorder (SUMD) in patients with schizophrenia. METHOD: One hundred patients with schizophrenic disorders were included. Our statistical analyses evaluated interrater reliability, theoretical validity, and convergent or divergent validity. Finally, an exploratory factor analysis was conducted. RESULTS: The results revealed good psychometric properties for the French version of the SUMD. Both interrater reliability (ICC ranged from 0.68 to 1.00) and internal consistency (Cronbach 0.70) were satisfactory. Criterion validity was confirmed by high correlation values between SUMD scores and scores on the Positive and Negative Syndrome Scale G12 item evaluating insight. Moreover, as hypothesized, there were few associations between SUMD scores and clinical variables. Finally, Principal Component Analyses confirmed the hypothesis of 2 distinct insight dimensions (consciousness and attribution) for both present and past aspects. CONCLUSIONS: This French version of the SUMD is a reliable and valid measure of insight in schizophrenia. The clinical relevance of its measure and the development of psychosocial interventions to improve insight into illness in patients with schizophrenia are discussed.

[Role of non-pharmacological interventions for healthy aging]. / Rôle des interventions non médicamenteuses pour vieillir en bonne santé.

Non-pharmacological interventions (NPIs) are continuously expanding for people over 60, both in terms of prevention and therapy. Selected empirically for centuries or recently appeared with the help of epigenetic studies, clinical trials and technological innovations, their development increase and are diversified around the world. Residual questions concern 1) their perimeter which seems to overlap with alternative medicines, 2) their evaluation which seems impossible according to some researchers, and 3) their implementation in the elderly which seems too fastidious. This article answers these three questions and then presents digital tools developed by the CEPS University Platform facilitating the evaluation of NPIs in the field of successful aging. The transformation of the health system, which has become necessary to meet the needs of baby-boomers, will widen the arsenal of solutions relevant to health, their combination of medicine and health approach that have become personalized, comprehensive and integrative. NPIs will play a major role there during the century. These practices are distinguished from alternative medicines, general public health messages and socio-cultural offers by continuous research, a quality approach and traceability of use. NPIs today constitute a complementary ecosystem for biomedical treatments whose economic and legal consolidation is increasing.

Predictive value of age for coping: the role of self-efficacy, social support satisfaction and perceived stress.

OBJECTIVES: The present study was prompted by the lack of agreement on how coping changes with age. We postulate that the effect of age on coping is mediated by coping resources, such as self-efficacy, perceived stress and social support satisfaction. METHOD: The participants in the study were community dwelling and aged between 22 and 88 years old. Data were collected using the General Self Efficacy Scale, the Social Support Questionnaire, the Perceived Stress Scale, the Geriatric Depression Scale, the Social Readjustment Rating Scale (life-events) and the Way of Coping Checklist. RESULTS: We performed path analyses for two competitive structural models: M1 (age does not directly affect coping processes) and M2 (age directly affects coping processes). Our results supported a modified version of M2. Age was not found to predict either of two coping strategies: problem-focused coping is predicted by self-efficacy and social support satisfaction; emotion-focused coping is predicted by social support satisfaction and perceived stress. DISCUSSION: Changes in coping over the lifespan reflect the effectiveness with which a person's adaptive processes deal with age-associated changes in self-referred beliefs and environment perception.

Impact of perceived stress on cognitive performance: Moderating effect of mild cognitive impairment and Alzheimer's disease.

INTRODUCTION: Stress is a well-known determinant of cognitive performance in both younger and older adults. However, the moderating effect of pathological aging on this relationship remains insufficiently documented. We hypothesize that mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients will report higher perceived stress than control older adults, when asked to complete an effortful cognitive task. We also hypothesize that the deleterious effect of perceived stress on cognitive performance is more evident in MCI and AD patients. METHOD: The 131 participants consisted of: 25 functional older adults, 35 nonamnestic-MCI patients, 35 amnestic-MCI patients, and 36 AD patients. They were asked to complete the Victoria Stroop test and report their level of perceived stress at four times: before the test (i.e., baseline) and after each part of the test (three, increasingly effortful levels of cognitive requirement). RESULTS: Overall, perceived stress increased in the most effortful condition-except for AD patients, who reported a decline. A positive main effect of perceived stress on response latency was confirmed. However, this effect became negative in all participants when the model accounted for the difficulty of the task. DISCUSSION: The results suggest that the ability to perceive the stress levels generated by an effortful cognitive task may be altered in AD. They also suggest that the Stroop task may generate a form of perceived stress favoring engagement, and AD patients may not benefit from its positive effects on performance. They put into questions the usual clinical interpretations.

Validity of the French Prospective and Retrospective Memory Questionnaire (PRMQ) in healthy controls and in patients with no cognitive impairment, mild cognitive impairment and Alzheimer disease.

Introduction: The Prospective and Retrospective Memory Questionnaire (PRMQ) is one of the most commonly used scales to assess both retrospective memory (RM) and prospective memory (PM) complaints. This study aimed to: 1/replicate the previous results concerning the PRMQ latent structure in a French version and 2/provide its psychometric properties in a normal and clinical population. Method: This observational study included 488 participants divided into five subgroups. A sample of 168 healthy participants (no memory consultation sought), served as controls. Patients were recruited in a memory clinic: 98 "functional" patients (subjective memory complaints but no memory impairment), 83 amnestic-Mild Cognitive Impairment (a-MCI), 82 non-amnestic-MCI (na-MCI) and 57 Alzheimer Disease (AD) patients. Structure, validity, consistency, reliabilitiy and reproducibility of the PRMQ were calculated. Novelty, Area Under the Receiver-Operating Characteristics (AUROC) curve, was used to determine the optimal cut-off, to distinguish "functional" patients from control participants. Results: The optimal fit model of the French PMRQ was not a tri but a bi-partite model, with a RM and a PM subscale. The convergent validity showed significant correlation with cognitive difficulties (r = .82 and .78, respectively), anxiety (r = .44 and .48, respectively) and depression (r = .23) scales. Cronbach's alpha was good (α = .79 and .88), as well as the reproducibility (r = .71 and .80). The interaction [Subgroups of participants x PMRQ Subscales] was significant [F(4, 483) = 11.46; p < .001]. The power discrimination was adequate (AUROC = .71 and .74) for detecting "functional" patients compared with controls, in particular for the PM subscale (sensitivity 66.6%, specificity 77.4%). Conclusions: The PMRQ, with minor changes, was validated in its French form with satisfactory psychometric qualities. This self-rating tool appears useful for identifying significant memory complaints in a normal population and may also be helpful in discriminating between functional/na-MCI and a-MCI/AD patients.

Age differences in temperament, character and depressive mood: a cross-sectional study.

INTRODUCTION: This study explores the effect of age on mean-levels of the personality traits defined in Cloninger's personality taxonomy, and investigates the relevance of personality traits for predicting depression levels in adults aged 18 to 94 years. METHOD: We divided our sample (466 participants) into four age groups (young adult, adult, mature adult and elderly). Personality was measured using the Temperament and Character Inventory, and depression was assessed using the Hospital Anxiety and Depression Scale. RESULTS: Analysis of variance showed mean-level changes for all the personality traits except Self-D. Post hoc analyses revealed a decrease in the level of novelty seeking with age and an increase in the level of self-transcendence for the two oldest age groups. Reward dependence was highest among the youngest participants, whereas harm avoidance was highest for both the youngest and the oldest age groups. Depression correlated positively with harm avoidance and age but negatively with self-transcendence. DISCUSSION: Impulsiveness, curiosity and social dependency decrease with age, whereas spirituality increases. Young and elderly adults are more fearful and socially inhibited. Harm avoidance and self-transcendence are the most relevant personality traits for predicting levels of depression.

[Interventions based on mindfulness for the elderly chronic pain: review of the literature]. / Les interventions basées sur la pleine conscience pour le sujet âgé douloureux chronique : revue de la littérature.

The chronic pain-bio-psycho-social phenomenon would index a transition between a pain alarm and a pain disease, with reshaping of the inhibitive brain areas and a takeover of psychological factors on the modulatory systems. The current treatment of elders' chronic pain suffers from many limits, and this article addresses this issue by discussing a new and innovative non-pharmacological intervention (mindfulness therapy) to reduce consequences of chronic pain in daily-life. Mindfulness therapy mainly targets two transdiagnostic mental processes - avoidance and self-centered ruminations - which leads to emotional dysregulation in chronic pain patients. Although many studies documented the beneficial effect of mindfulness therapy on psychological symptoms in adults, there is still a lack of studies testing the effect of mindfulness therapy on emotional regulation and psychological symptoms in elderly population with chronic pain. It is therefore necessary to investigate therapeutic efficacy with this population. In conclusion, we formulate several lines of research to test the hypothesis that the effect of the mindfulness therapy on targeted processes would improve elders' ability to cope with chronic pain and would reduce disturbances associated with chronic pain.

[Unawareness of deficits in Alzheimer's disease: a multidimentional approach]. / La méconnaissance des troubles dans la maladie d'Alzheimer: nécessité d'une approche multidimensionnelle.

Partial or complete unawareness of deficits in Alzheimer's disease (AD) may result in delaying diagnosis and difficulties for caring. Many theories have been proposed to explain unawareness of neurological or cognitive deficits. Neurological theories use the term of anosognosia to describe unawareness as a consequence of the severity and location of brain lesions. They predict an association between the unawareness of deficits in AD and the severity of dementia or location of the lesions in the right cerebral hemisphere or in the frontal regions. More recent theories have been based on models derived from cognitive neuropsychology. Some models have been designed to explain unawareness of specific deficits such as the memory disorders, others are more extensive based on models of consciousness of the Self. Psychopathological theories postulate that unawareness of deficits is the consequence of a psychological defense mechanism, termed denial. Therefore, unawareness of deficits in AD should be linked to the premorbid personality, abilities to cope with the disease and its consequences more than to the severity and location of brain lesions. The validity of each theory is discussed according to the data from the literature. However, the analysis of the literature is clouded by many methodological difficulties due to the variability of terminology and tools used to assess the unawareness. Moreover, most studies were too narrowly focused on specific points, not taking into account a global model of insight. Nevertheless, some conclusions can be drawn from the available data: 1) the nature of the unawareness of deficits in AD is multidimensional. Terms such anosognosia or denial do not describe single phenomena but correspond to disturbances of various neurological, neuropsychological and psychopathological mechanisms, which can not be explained by a single theory; 2) unawareness should no more be considered as a category but according to a dimensional approach. There is a wide range of levels of unawareness, which can vary from one moment to an other and during the progression of the disease; 3) neurological, neuropsychological and psychopathological mechanisms implicated in unawareness probably coexist in various degrees depending, on one hand, on the disease severity and type of deficits and, on the other hand, on the history and personality of the patient, his(her) familial support, but also on the social perception of the disease. To improve our understanding of the unawareness of deficits in AD, we propose to come back to a detailed clinical description investigating extensively the various aspects of insight.