Patients’ unawareness of their memory limitations may hinder treatment of dementia

Patients’ unawareness of their memory limitations may hinder treatment of dementia

A study conducted by IDOR’s CNA/Memory Clinic sheds light on Lewis body, the second most common cause of dementia

Researchers with Centro de Neuropsiquiatria Aplicada (CNA)/ Memory Clinic of the D’Or Institute for Research and Education (IDOR) have recently published an article about their unprecedented study on Lewy body dementia (LBD). The article, available in the International Journal of Geriatric Psychiatry, is the first of its kind to highlight that LBD patients’ awareness of their disease seems to be lower than that of patients with Alzheimer’s disease.

Despite sharing many common features, Alzheimer’s disease (AD) is mainly characterized by changes in short-term memory, while LBD’s symptoms are similar to Parkinson’s, such as slowed movement, muscle stiffness, hallucinations and cognitive fluctuations. “These diseases are different, but people who have dementia quite often have both simultaneously. When this happens, neurological manifestations are a mix of both disorders. Our study provides data about the intersection between LBD and AD”, explains the leading researcher, neurologist Dr. Victor Calil.

According to Dr. Calil, one of the dementia treatment-hampering symptoms is anosognosia, that is, the patient’s unawareness or denial of the limitations imposed by the disease. “These patients do not understand that they require dedicated care, such as specific medication and activity restrictions. Besides, this lack of understanding or acceptance may seriously affect their carer’s life quality”, he adds. Although these conditions have been widely assessed for Alzheimer’s disease, little was known till then about the relationship between anosognosia and Lewy body dementia, which is the second most common type of degenerative dementia.

In order to assess the critical role played by anosognosia in this type of dementia, researchers with the CNA/ Memory Clinic surveyed 40 subjects that were divided into two groups (20 who had LBD and 20 who had AD) and a detailed questionnaire to collect data about memory complaints was used, as well as a neuropsychological test. Subjects in both groups had about the same age and educational background, and 50% also underwent magnetic resonance to assess possible imaging disparities.

“Results showed similar performance of both groups in memory tests, although LBD patients complained less about memory issues when answering the questionnaire, which indicates their lower awareness of their limitations and hence, higher level of anosognosia”, adds Dr. Calil.

This was the first study to show that LBD patients may be less aware of their memory deficits than AD patients. Still, the researchers claim that anosognosia shows heterogeneous manifestations in LBD and believe this disease coexists with AD in some of the sampling population, which may explain their lower awareness-related results.

Anyway, these findings represent a milestone in what is known about the symptoms of both forms of dementia. “Anosognosia cannot be prevented yet, and neither is there any specific therapy for it. However, it is a critical variable to be accounted for in dementia patients’ management. Since it may represent an obstacle to treatment, awareness of the role it plays is essential for devising more patient-  and carer-customized therapeutic strategies in which non-pharmacological interventions may play a fundamental role”, says Dr. Calil.

The team of researchers with the CNA/Memory Clinic has also investigated the use of various tools to address anosognosia in various types of dementia and say they shall soon report new findings in new publications about the issue.