Awareness of Deficits in Dementia

描述（由申请人提供）：本提案描述了一项研究计划，旨在研究痴呆患者对自身残疾缺乏认识，称为病感失认症。病感失认症导致患者残疾，并使家庭和护理人员感到沮丧。缺乏认识可能会阻止患者遵守治疗建议，并导致他们追求超出其限制的潜在危险行为，需要监督以确保其安全。虽然病感失认症在阿尔茨海默病中很常见，但在额颞叶痴呆中更常见，其原因尚不清楚。我们已经开发了一个模型，试图解释疾病感缺失如何从特定认知能力的失败中发展出来，包括监测一个人的表现和情绪，我们已经设计了一个计划来测试这些因素是否有助于疾病感缺失，以及阿尔茨海默病和额颞叶痴呆患者的贡献因素是否不同。我们将研究100名健康老年人，50名阿尔茨海默病患者和50名额颞叶痴呆患者。我们将追求以下具体目标：A）确定AD和FTD中表现监控、其他额叶/执行功能、记忆和情绪反应对疾病感失认的相对贡献。我们假设：1）在FTD中，即使在考虑了记忆和执行功能的贡献之后，认知任务期间的表现监测和生理激活也与病感失认相关。2)在AD中，而不是在FTD中，对认知测试中最近表现的记忆将对病感失认症产生重要作用。我们假设：1）右侧内侧眶额皮质的组织损失将预测FTD和AD患者在测试期间的生理激活、性能监测的行为估计以及自我意识的总体水平[在控制其他相关脑区的贡献后]。2)在考虑了内侧眶额皮层的影响后，内侧颞区（海马、内嗅皮层、海马旁回）的组织损失将显著预测AD中自我意识的总体水平。为了检查表现监测、生理激活和病感失认症之间的关系：我们假设认知测试期间的生理激活将与表现监测的行为测量（错误后减慢[和FOK降低]）以及诊断组的自我意识总体水平相关。如果这些假设得到证实，我们将更清楚地了解为什么痴呆症患者没有意识到他们的缺陷。

DESCRIPTION (provided by applicant): This proposal describes a plan to study lack of awareness of one's disabiltities, called anosognosia, in patients with dementia. Anosognosia contributes to patients' disabilities and frustrates families and caregivers. Lack of awareness may prevent patients from adhering to treatment recommendations, and causes them to pursue potentially risky behaviors that are beyond their limits, requiring supervision to ensure their safety. Although anosognoia is very common in Alzheimer's disease, it is even more common in Frontotemporal dementia, and the reasons for this are not clear. We have developed a model attempting to explain how anosognosia could develop from failures of specific cognitive abilities, including monitoring one's performance and emotion, and we have devised a plan to test whether these factors contribute to anosognosia, and whether the contributing factors differ in patients with Alzheimer's disease and Frontotemporal dementia. We will study 100 healthy older individuals, 50 patients with Alzheimer's disease, and 50 patients with Frontotemporal dementia. We will pursue the following specific aims: A) To define the relative contributions of performance monitoring, other frontal/executive functions, memory, and emotional reactivity to anosognosia in AD and FTD. We hypothesize that: 1) In FTD, performance monitoring and physiological activation during cognitive tasks will be correlated with anosognosia even after accounting for the contributions of memory and executive functions. 2) In AD, but not FTD, memory for recent performance on cognitive testing will make a significant contribution to anosognosia.; We hypothesize that 1) tissue loss in the right medial orbitofrontal cortex will predict physiological activation during testing, behavioral estimates of performance monitoring, and overall level of self-awareness in both FTD and AD [after controlling for the contributions of other relevant brain regions. 2) tissue loss in medial temporal regions (hippocampus, entorhinal cortex, parahippocampal gyrus) will significantly predict overall level of self awareness in AD, after the effects of medial OFC are taken into account.] To examine the relationship between performance monitoring, physiological activation, and anosognosia: We hypothesize that physiological activation during cognitive testing will correlate with behavioral measures of performance-monitoring (post-error slowing [and decreased FOK]) and with overall level of self- awareness across diagnostic groups. If these hypotheses are confirmed, we will have a much clearer idea of why patients with dementia are not aware of their deficits.