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Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances.

Abstract

OBJECTIVE

The purpose of this study was to evaluate symptoms associated with impaired insight in patients with Alzheimer disease (AD).

BACKGROUND

Although unawareness of deficits is common in AD, the relation of awareness to psychiatric and behavioral disturbances has not been extensively studied.

METHOD

We conducted a cross-sectional investigation of 91 patients with probable AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Awareness of cognitive and functional deficits was measured with the Inaccurate Insight item from the Neurobehavioral Rating Scale. Psychiatric and behavioral symptoms were measured using factor scores and individual items from the Neurobehavioral Rating Scale. Global cognitive deficits were measured using the Mini-Mental State Examination (MMSE).

RESULTS

Stepwise regression analysis showed that insight was associated with MMSE score, depression/anxiety factor score, and agitation/disinhibition factor score. Variables not associated with awareness of deficits included patient age, behavioral retardation factor score, verbal output disturbance factor score, and psychosis factor score. Post hoc analyses showed a positive relation (i.e., greater insight, more symptomatology) between deficit awareness and symptoms of depressed mood and anxiety. There was a negative relation (i.e., greater insight, less symptomatology) between insight and symptoms of hostility, agitation, inattention, and tension. In a follow-up stepwise regression analysis, increased deficit awareness was associated with a higher MMSE score, greater depressed mood, and decreased agitation.

CONCLUSIONS

These findings suggest that patients with AD may experience symptoms of depressed mood in relation to increased awareness of decrements in functioning. The data also indicate that patients with poor insight demonstrate greater agitated behavior. Consistent with previous research, impaired insight was higher in the later stages of the illness.

Authors+Show Affiliations

Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles School of Medicine, and Veterans Affairs Medical Center, Greater Los Angeles Healthcare System, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10780626

Citation

Harwood, D G., et al. "Impaired Insight in Alzheimer Disease: Association With Cognitive Deficits, Psychiatric Symptoms, and Behavioral Disturbances." Neuropsychiatry, Neuropsychology, and Behavioral Neurology, vol. 13, no. 2, 2000, pp. 83-8.
Harwood DG, Sultzer DL, Wheatley MV. Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances. Neuropsychiatry Neuropsychol Behav Neurol. 2000;13(2):83-8.
Harwood, D. G., Sultzer, D. L., & Wheatley, M. V. (2000). Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 13(2), 83-8.
Harwood DG, Sultzer DL, Wheatley MV. Impaired Insight in Alzheimer Disease: Association With Cognitive Deficits, Psychiatric Symptoms, and Behavioral Disturbances. Neuropsychiatry Neuropsychol Behav Neurol. 2000;13(2):83-8. PubMed PMID: 10780626.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired insight in Alzheimer disease: association with cognitive deficits, psychiatric symptoms, and behavioral disturbances. AU - Harwood,D G, AU - Sultzer,D L, AU - Wheatley,M V, PY - 2000/4/26/pubmed PY - 2000/6/10/medline PY - 2000/4/26/entrez SP - 83 EP - 8 JF - Neuropsychiatry, neuropsychology, and behavioral neurology JO - Neuropsychiatry Neuropsychol Behav Neurol VL - 13 IS - 2 N2 - OBJECTIVE: The purpose of this study was to evaluate symptoms associated with impaired insight in patients with Alzheimer disease (AD). BACKGROUND: Although unawareness of deficits is common in AD, the relation of awareness to psychiatric and behavioral disturbances has not been extensively studied. METHOD: We conducted a cross-sectional investigation of 91 patients with probable AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Awareness of cognitive and functional deficits was measured with the Inaccurate Insight item from the Neurobehavioral Rating Scale. Psychiatric and behavioral symptoms were measured using factor scores and individual items from the Neurobehavioral Rating Scale. Global cognitive deficits were measured using the Mini-Mental State Examination (MMSE). RESULTS: Stepwise regression analysis showed that insight was associated with MMSE score, depression/anxiety factor score, and agitation/disinhibition factor score. Variables not associated with awareness of deficits included patient age, behavioral retardation factor score, verbal output disturbance factor score, and psychosis factor score. Post hoc analyses showed a positive relation (i.e., greater insight, more symptomatology) between deficit awareness and symptoms of depressed mood and anxiety. There was a negative relation (i.e., greater insight, less symptomatology) between insight and symptoms of hostility, agitation, inattention, and tension. In a follow-up stepwise regression analysis, increased deficit awareness was associated with a higher MMSE score, greater depressed mood, and decreased agitation. CONCLUSIONS: These findings suggest that patients with AD may experience symptoms of depressed mood in relation to increased awareness of decrements in functioning. The data also indicate that patients with poor insight demonstrate greater agitated behavior. Consistent with previous research, impaired insight was higher in the later stages of the illness. SN - 0894-878X UR - https://www.unboundmedicine.com/medline/citation/10780626/Impaired_insight_in_Alzheimer_disease:_association_with_cognitive_deficits_psychiatric_symptoms_and_behavioral_disturbances_ L2 - http://www.diseaseinfosearch.org/result/349 DB - PRIME DP - Unbound Medicine ER -