Awareness of Deficits in Dementia

描述(由申请人提供)：这项提案描述了一项研究痴呆症患者对自身残疾缺乏认识的计划，称为病感失认症。病感缺失会导致患者的残疾，并让家人和照顾者感到沮丧。缺乏意识可能会阻止患者遵守治疗建议，并导致他们追求超出他们限制的潜在危险行为，需要监督以确保他们的安全。虽然病感失认症在阿尔茨海默病中非常常见，但在额颞痴呆中更常见，其原因尚不清楚。我们已经开发了一个模型，试图解释病感失认症是如何从特定认知能力的失败中发展起来的，包括监测一个人的表现和情绪，我们还制定了一项计划，以测试这些因素是否导致病感失认症，以及在阿尔茨海默病和额颞痴呆患者中，影响因素是否不同。我们将研究100名健康的老年人，50名阿尔茨海默病患者和50名额颞部痴呆患者。我们将追求以下具体目标：a)确定在AD和FTD中，表现监测、其他额叶/执行功能、记忆和情绪反应对失认症的相对贡献。我们假设：1)在FTD中，即使在考虑了记忆和执行功能的贡献后，认知任务中的操作监控和生理激活也会与病感失认相关。2)在AD中，而不是在FTD中，对最近认知测试表现的记忆将对失认症做出重大贡献。我们假设：1)在控制了其他相关大脑区域的贡献后，右侧内侧眶前皮质的组织丢失将预测测试中的生理激活、对行为监控的行为估计以及FTD和AD的整体自我意识水平。2)在考虑内侧OFC的影响后，内侧颞区(海马区、内嗅皮层、海马旁回)的组织丢失将显著预测AD患者的整体自我意识水平。]为了检验性能监控、生理激活和病感失认症之间的关系：我们假设认知测试中的生理激活将与性能监控的行为测量(错误后减慢[和FOK降低])相关，并与诊断组的整体自我意识水平相关。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自己的缺陷。 与公共卫生相关：痴呆症患者通常没有意识到或略微意识到他们的思维问题以及这些缺陷对他们生活的影响。这个项目将试图通过神经科学家开发的认知测试和脑成像来理解为什么痴呆症患者对自己的残疾意识如此薄弱。

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. PUBLIC HEALTH RELEVANCE: Patients with dementia are usually unaware, or marginally aware of their thinking problems and the effects these deficits have on their life. This project will attempt to understand why patients with dementia have such poor awareness of their disability using cognitive tests developed by neuroscientists, and using brain imaging.