Deficits of Insight and Judgment in Alzheimers Disease: Diagnostic Strategy and Clinical Significance

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During the next three decades the number of persons older than 85 years will more than double, and the health care need of this burgeoning population are assuming greater importance. Recent studies suggest that the prevalence of dementia in Australia will increase from 172 000 cases in 2000 to 588 000 in 2050. This rapid increase in number of dementia cases will result in an increasing burden for caregivers, and in financial terms, for the working-age population. One of the main clinical problems suffered by individuals of dementia is psychological and behavioural changes such as poor insight, irritability and apathy. These problems account for a large proportion of medical expenses, predict early institutionalization, and are associated with poor quality of life of caregivers. Unfortunately, little is known about the true frequency of problems of insight in dementia, about their impact upon caregivers, and about how to best diagnose the problems of loss of insight and judgment in this condition. Our study will examine the frequency and clinical correlates of poor insight and judgment in dementia, it will establish whether these problems predict other common behavioural problems of Alzheimer’s disease such as apathy and dangerous behaviours, and will demonstrate the reliability and validity of a specific instrument to measure insight and judgment in dementia. This will facilitate the early recognition and adequate treatment of behavioural problems in patients with dementia; it will improve patients’ quality of life, and will have a positive impact on both caregivers’ psychological well-being and on clinical practice.