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Awareness of Deficit in Alzheimer's Disease

对阿尔茨海默病缺陷的认识

基本信息

批准号：
8309184
负责人：
STEPHANIE Ann COSENTINO
金额：
$ 9.71万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-15 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8309184
关键词：
Address Affect Alzheimer&apos s Disease Area Awareness Blood flow Brain Brain region Caregivers Clinic Clinical Cognition Cognitive Communities Conscious Data Decision Making Dementia Deterioration Development Diagnosis Disadvantaged Disease Elderly Employee Strikes Etiology Evaluation Failure Frequencies Functional Imaging Future Heterogeneity Hippocampus (Brain)Impaired cognition Individual Informed Consent Investigation Knowledge Language Learning Life Light Link Longitudinal Studies Measures Medial Memory Memory Loss Monitor Moods Nature Neuroanatomy Participant Patient Self-Report Patients Performance Persons Public Health Quality of life Research Research Personnel Role Self Care Self Perception Staging Symptoms Temporal Lobe Visuospatial Work base brain volume clinically relevant cognitive change decision-making capacity imaging modality improved instrument mild neurocognitive impairment neuroimaging neuropathology novel patient safety prognostic programs skills tool

项目摘要

DESCRIPTION (provided by applicant): Disordered awareness of memory loss is a striking symptom displayed by a subset of patients with early Alzheimer's disease (AD). This metacognitive disturbance threatens patient safety and poses significant challenges for clinicians and caregivers, yet virtually nothing is known regarding its etiology, nature, clinical correlates, neuroanatomic substrates, or prognostic relevance. The proposed study aims to break ground in the study of metacognition in AD by implementing a rigorous methodological framework that will objectively measure specific memory monitoring abilities across patients with a range of awareness levels. Carefully manipulating the experimental task to assess online error recognition and implicit learning will shed light on the disrupted mechanisms that give rise to disordered awareness of memory loss in AD. The proposed study will also examine the neuroanatomic context in which disordered awareness occurs by evaluating metacognitive variables in relation to the integrity of specific areas of the brain previously linked with aspects of self-awareness. Structural and functional imaging modalities will be applied to evaluate this issue. Finally, the proposed study will bridge the gap between cognitive assesment and clinical utility by examining the manner in which deficits in metamemory relate to decision making capacity and quality of life, two critical issues in the everyday lives of persons with Alzheimer's disease. Future neuroimaging, cognitive and metacognitive evaluations will be done in the context of a community based, longitudinal study. Such a framework will facilitate study of metacognitive change in individuals through the course of normal cognition, memory decline, and dementia diagnosis, bearing particular light on awareness of deficit in the earliest stages of memory loss, before patients present to the clinic. Results may have significant implications for the diagnosis of Mild Cognitive Impairment (MCI), a condition which is believed to herald the onset of AD, but is defined in part by subjective memory complaint. Results may also inform the assessment of capacity to provide informed consent for research participation in persons with AD. To the extent that disordered awareness is associated with a particular neuroanatomic profile, and disordered awareness reduces decision making capacity, research programs may systematically exclude a clinical subtype, of AD. The proposed study serves as a spring board for studying these and other clinically relevant issues.

描述（由申请人提供）：记忆丧失意识障碍是早期阿尔茨海默病（AD）患者亚组表现出的显著症状。这种元认知障碍威胁到患者的安全，并对临床医生和护理人员提出了重大挑战，但几乎没有什么是已知的病因，性质，临床相关性，神经解剖基板，或预后的相关性。这项拟议的研究旨在通过实施一个严格的方法框架，客观地测量具有一系列意识水平的患者的特定记忆监测能力，从而在AD的元认知研究中取得突破。仔细操纵实验任务，以评估在线错误识别和内隐学习将揭示中断的机制，导致AD记忆丧失的意识紊乱。拟议的研究还将通过评估元认知变量与先前与自我意识方面相关的大脑特定区域的完整性来检查神经解剖学背景。将应用结构和功能成像模式来评估这个问题。最后，拟议中的研究将弥合认知评估和临床效用之间的差距，通过检查的方式，在元记忆赤字与决策能力和生活质量，在阿尔茨海默氏症患者的日常生活中的两个关键问题。未来的神经影像学、认知和元认知评价将在基于社区的纵向研究中进行。这样一个框架将有助于通过正常认知，记忆衰退和痴呆症诊断过程中的个体元认知变化的研究，特别是在患者出现临床之前，在记忆丧失的最早阶段对缺陷的认识。结果可能对轻度认知障碍（MCI）的诊断有重要意义，MCI是一种被认为预示AD发作的疾病，但部分由主观记忆障碍定义。结果还可以为评估AD患者参与研究提供知情同意的能力提供信息。在某种程度上，意识障碍与特定的神经解剖学特征相关，并且意识障碍降低了决策能力，研究计划可能会系统地排除AD的临床亚型。拟议的研究作为研究这些和其他临床相关问题的跳板。