A large body of evidence highlights the social cognitive impairment in neurodegenerative diseases such Alzheimer disease (AD). This study investigated the relationship among social and emotional functioning (SEF), awareness of disease, and other clinical aspects in people with AD (PwAD). A consecutive series of 50 people with mild to moderate AD and their 50 family caregivers were assessed. There was a significant difference between self-rated SEF and informant-rated SEF. In 56% of PwAD, self-rated SEF is lower than informant-rated SEF. People with AD mostly presented with mildly impaired awareness of the disease (56%), 20% had moderately impaired awareness of the disease, and 6% were unaware of the disease. The multivariate linear regression showed that informant-rated SEF was related to the social functioning, and relationships, domains of awareness of disease, and the PwAD informant-rated quality of life. The relationship between SEF and awareness of social functioning and relationship domain shows that they are comprised of judgments related to perceptions about oneself, values, and beliefs qualitatively different from awareness of memory or functionality, which can be directly observed.
AdolphsR. The neurobiology of social cognition. Curr Opin Neurol. 2001;11(2):231–239. doi:10.1016/S0959-4388(00)00202-6.
2.
NelisSMClareLMartyrA. Awareness of social and emotional functioning in people with early-stage dementia and implications for carers. Aging Ment Health. 2011;15(8):961–969. doi:10.1080/13607863.2011.575350.
3.
MoreauNVialletFChampagne-LavauM. Using memories to understand others: The role of episodic memory in theory of mind impairment in Alzheimer disease. Ageing Res Rev. 2013;12(4):833–839. doi:10.1016/j.arr.2013.06.005.
4.
CosentinoSZahodneLBBrandtJ. Social cognition in Alzheimer’s disease: a separate construct contributing to dependence. Alzheimers Dement. 2014;10(6):818–826. doi:10.1016/j.jalz.2013.12.021.
5.
HarciarekMCosentinoS. Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. Int Rev Psychiatry. 2013;25(2):178–196. doi:10.3109/09540261.2013.763340.
6.
KempJDesprésOSellalFDufourA. Theory of mind in normal ageing and neurodegenerative pathologies. Ageing Res Rev. 2012;11(2):199–219. doi:10.1016/j.arr.2011.12.001.
7.
HenryJDvon HippeWMolenberghsPLeeTSachdevPS. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol. 2016;12(1):28–39. doi:10.1038/nrneurol.2015.229.
8.
KumforFIrishMLeytonC. Tracking the progression of social cognition in neurodegenerative disorders. J Neurol Neurosurg Psychiatry. 2014;85(10):1076–1083. doi:10.1136/jnnp-2013-307098.
9.
DermodyNWongSAhmedbRPiguetOHodgesJRIrishM. Uncovering the neural bases of cognitive and affective empathy deficits in Alzheimer’s disease and the behavioral-variant of frontotemporal dementia. J Alzheimers Dis. 2016;53(3):801–816. doi:10.3233/JAD-160175.
10.
DouradoMCNMograbiDCSantosRL. Awareness of disease in dementia: factor structure of the assessment scale of psychosocial impact of the diagnosis of dementia. J Alzheimers Dis. 2014;41(3):947–956. doi:10.3233/JAD-140183.
11.
HannesdottirKMorrisRG. Primary and secondary anosognosia for memory impairment in patients with Alzheimer’s disease. Cortex. 2007;43(7):1020–1030. doi:10.1016/S0010-9452(08)70698-1.
12.
MarkováISBerriosGE. The ‘object’ of insight assessment: relationship to insight ‘structure’. Psychopathology. 2001;34(5):245–252. doi:10.1159/000049317.
13.
LacerdaIBSousaMFBSantosRL. Concepts and objects of awareness in Alzheimer’s disease: an updated systematic review. J Bras Psiquiatr. 2016;65(1):99–109. doi:10.1590/0047-2085000000110.
14.
DouradoMCNLaksJMograbiD. Functional status predicts awareness in late-onset but not in early-onset Alzheimer disease. J Geriatr Psychiatry Neurol. 2016:1–7. doi:10.1177/0891988716640372.
15.
MartyrAClareLNelisSM. Dissociation between implicit and explicit manifestations of awareness in early stage dementia: evidence from the emotional stroop effect for dementia-related words. Int J Geriatr Psychiatry. 2011;26(1):92–99.doi:10.1002/gps.2495.
16.
MarkováISClareLWhitakerCJ. Phenomena of awareness in dementia: heterogeneity and its implications. Conscious Cogn. 2014;25:17–26. doi:10.1016/j.concog.2014.01.008.
17.
DouradoMMarinhoVSoaresC. Awareness of disease in Alzheimer’s dementia: description of a mild to moderate sample of patient and caregiver dyads in Brazil. Int Psychogeriatr. 2007;19(4):733–744. doi:10.1017/S1041610207005492.
18.
AgnewSKMorrisRG. The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: a review of the literature and a proposed model. Aging Ment Health. 1998;2(1):7–19.
19.
ClareL. Managing threats to self: awareness in early stage Alzheimer’s disease. Soc Sci Med. 2003;57(6):1017–1029. doi:10.1016/S027719536(02)0047618.
20.
RosenHJ. Anosognosia in neurodegenerative disease. Neurocase. 2011;17(3):231–241. doi:10.1080/13554794.2010.522588.
21.
ClareLNelisSMMartyrA. The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: testing a biopsychosocial model. Int J Geriatr Psychiatry. 2012;27(2):167–177. doi:10.1002/gps.2705.
22.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders - Text Revision, (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association; 2000.
23.
MorrisJ. The CDR: current version and scoring rules. Neurol. 1993;43(11):2412–2414. doi:10.1212/ WNL.43.11.2412-a.
24.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Psychiatry Res. 1975;12(3):189–198. doi:0022-3956(75)90026-6.
25.
BramhamJMorrisRGHornakJBullockPPolkeyCE. Social and emotional functioning following bilateral and unilateral neurosurgical prefrontal cortex lesions. J Neuropsychol. 2009;3(pt 1):125–143. doi:10.1348/174866408X293994.
26.
BelfortTBramhamJSimões NetoP. Cross-cultural adaptation of the social and emotional questionnaire on dementia for the Brazilian population. São Paulo Med J. 2015;133(4):298–306. doi:10.1590/1516-3180.2014.00180501.
27.
SchultzRRSivieroMOBertolucciPHF. The cognitive subscale of the “Alzheimer’s Disease Assessment Scale” in a Brazilian sample. Braz J Med Biol Res. 2001;34(10):1295–1302. doi:10.1590/S0100-879X2001001000009.
28.
BertolucciPHBruckiSMCampacciSRJulianoY. O Mini-Exame do Estado Mental em uma população geral. Impacto da escolaridade. Arq Neuropsiquiatr. 1994;52(1):1–7. doi:10.1590/S0004-282X1994000100001.
29.
Wechsler D WaisIII.Escala de Inteligência Wechsler para Adultos: Manual/David Weschsler; Adaptação e padronização de uma amostra brasileira Elizabeth do Nascimento; [Tradução Maria Cecília de Vilhena Moraes Silva]. 1st ed. São Paulo, Brazil: Casa do Psicologo; 2004.
30.
MaiaALGGodinhoCFerreiraED. Application of the Brazilian version of the CDR scale in samples of dementia patients. Arq Neuropsiquiatr. 2006;64(2B):485–489. doi:10.1590/s0004-282x2006000300025.
31.
AlexopoulosGSAbramsRCYoungRCShamoianCA. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23(3):271–284. doi:10.1016/0006-3223(88)90038-8.
32.
PortugalMGCoutinhoESFAlmeidaC. Validation of Montgomery-Åsberg rating scale and Cornell scale for depression in dementia in Brazilian elderly patients. Int Psychogeriatr. 2012;24(8):291–1298. doi:10.1017/S1041610211002250.
33.
PfefferRIKurosakiTTHarrahCHChanceJMFilosS. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323–329. doi:10.1093/geronj/37.3.323.
34.
CummingsJLMegaMGrayK. The neuropsychiatric inventory. Comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(11):2308–2314. doi:10.1212/WNL.44.12.2308.
35.
CamozzatoALKochhannRSimeoniC. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for Alzheimer’s disease patients and their caregivers. Int Psychogeriatr. 2008;20(2):383–393. doi:10.1017/s1041610207006254.
36.
LogsdonRGGibbonsLEMcCurrySMTeriL. Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002;64(3):510–519. doi:10.1097/00006842-200205000-00016.
37.
NovelliMMPCNitriniRCaramelliP. Validation of the Brazilian version of the quality of life scale for patients with Alzheimer’s disease and their caregivers (QOL-AD). Aging Ment Health. 2010;14(5):624–631. doi:10.1080/13607861003588840.
38.
ZaritSHReeverKEBach-PetersonJ. Relatives of the impaired elderly: Correlates of feeling of burden. Gerontol. 1980;20(6):649–655. doi:10.1093/geront/20.6.649.
39.
ScazufcaM. Brazilian version of the Burden Interview scale for the assessment of burden of care in carers of people with mental illnesses. Rev Bras Psiquiatr. 2002;24:12–17. doi:10.1590/S1516-44462002000100006.
40.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New Jersey, NJ: Lawrence Erlbaum Associates; 1988.
41.
ClareLNelisSMMartyrA. Longitudinal trajectories of awareness in early-stage dementia. Alzheimer Dis Assoc Disord. 2012;26(2):140–147.
42.
ClareLMarkováISRothIMorrisRG. Awareness in Alzheimer’s disease and associated dementias: theoretical framework and clinical implications. Aging Ment Health. 2011;15(8):936–944. doi:10.1080/13607863.2011.583630.
43.
Byrne-DavisLMTBennettPDWilcockGK. How are quality of life ratings made? Toward a model of quality of life in people with dementia. Qual Life Res. 2006;15(5):855–865.
44.
LazarusRSFolkmanS. Stress Appraisal and Coping. New York, NY: Springer; 1984.
45.
SousaMFSantosRLArcoverdeC. Quality of life in dementia: the role of noncognitive factors in the ratings of people with dementia and family caregivers. Int Psychogeriatr. 2013;25(7):1097–1105. doi:10.1017/S1041610213000410.
46.
ReadyROttBRGraceJ. Patient versus informant perspectives of quality of life in Mild Cognitive Impairment and Alzheimer’s disease. Int J Geriatr Psychiatry. 2004;19(3):256–265. doi:10.1002/gps.1075.
