Standardised measurement of self-awareness deficits in FTD and AD
Standardised measurement of self-awareness deficits in FTD and AD
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DOI：
10.1136/jnnp.2008.166041
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发表时间：
2010-02-01
影响因子：
11
通讯作者：
Rosen, Howard J.
中科院分区：
文献类型：
--
作者：
Williamson, Craig;Alcantar, Oscar;Rosen, Howard J.
在痴呆症中，尤其是额颞叶痴呆（FTD）中，感知自身缺陷（无论是认知障碍还是社交障碍）的能力下降是很常见的，“缺乏洞察力”被列为核心诊断特征。然而，目前还没有公认的方法来衡量痴呆症的洞察力。最常用的方法是将患者对自身损伤程度的看法与护理人员或亲密家庭成员的意见进行比较，这种方法是主观的，需要知识渊博的信息提供者的参与。在这里，作者介绍了一种新的方法，可以客观量化个人对他们的认知能力的认识，并依赖于客观的床边测试。方法：作者对FTD （n=10）和阿尔茨海默病（AD, n=10）患者和对照组（n=10）进行了日常、现实功能测试。在执行任务之前，参与者被要求使用基于百分位数的评分系统来预测他们的表现。他们还被要求在任务完成后评估自己的表现。计算他们的自我评价和实际表现之间的差异。结果对照组在测试前预测、任务后估计和实际表现之间的差异很小（预测的平均差异为3.9个百分点/任务后估计的平均差异为3.0个百分点），但两组患者都高估和高估了他们的表现，FTD的差异（49.0/54.3个百分点）明显大于AD（27.2/28.3个百分点）。洞察力和认知功能障碍的自我意识的失败可以在没有信息提供者的帮助下客观地测量痴呆症，这将有助于进一步研究这一高级认知功能的关键组成部分。
Background Diminished ability to perceive one's own impairments, whether cognitive or social, is common in dementia, in particular frontotemporal dementia (FTD), where 'lack of insight' is listed as a core diagnostic feature. Yet, there is no currently accepted method for measuring insight in dementia. The most commonly used methods, which involve comparing patients' opinions of their level of impairment with the opinions of care givers or close family members, are subjective and require the participation of a knowledgeable informant. Here, the authors introduce a new method that allows objective quantification of an individual's awareness of their cognitive abilities and relies upon objective bedside testing.Methods The authors administered several tests of everyday, real-world functions to patients with FTD (n=10) and Alzheimer's disease (AD, n=10) and to control subjects (n=10). Prior to the tasks, participants were asked to predict their performance using a percentile-based rating system. They were also asked to estimate their performance after task completion. Differences between their self-rated and actual performances were calculated.Results Whereas the control group showed very little discrepancy between pretest predictions, post-task estimates and actual performance (mean difference of 3.9 percentile points for prediction/3.0 percentile points for post-task estimate), both patient groups overpredicted and overestimated their performance, with a significantly greater discrepancy for FTD (49.0/54.3 percentile points) than AD (27.2/28.3 percentile points).Discussion Failures of insight and self-awareness of cognitive dysfunction can be objectively measured in dementia without the assistance of an informant, which will facilitate further study of this key component of higher cognitive functioning.