Awareness of Deficits in Dementia

对痴呆症缺陷的认识

• 批准号: 7888075
• 负责人: HOWARD J ROSEN
• 金额: $ 29.52万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7888075
• 关键词: Accounting; Age; Alzheimer' s Disease; Awareness; Behavior; Brain imaging; Brain region; Caregivers; Cerebrum; Cognitive; Conscious; Data; Dementia; Diagnostic; Disease; Emotional; Emotions; Ensure; Episodic memory; Evaluation; Event; Failure; Family; Family Caregiver; Frontotemporal Dementia; Functional disorder; Galvanic Skin Response; Goals; Health; Heart Rate; Hemispatial Neglect; Hippocampus (Brain); Home environment; Individual; Injury; Judgment; Knowledge; Lead; Learning; Life; Magnetic Resonance Imaging; Measures; Medial; Memory; Modeling; Monitor; Motivation; Nerve Degeneration; Neurologic; Parahippocampal Gyrus; Parietal Lobe; Participant; Patients; Performance; Physiologic Monitoring; Physiological; Play; Process; Quality of life; Questionnaires; Recommendation; Rehabilitation therapy; Relative (related person); Resistance; Risk Behaviors; Role; Safety; Self Perception; Semantics; Societies; Structure; Supervision; Syndrome; System; Testing; Thinking; Time; Tissues; Update; Work; base; behavior measurement; behavior test; compliance behavior; disability; entorhinal cortex; executive function; expectation; falls; gray matter; neglect; nervous system disorder; neuromechanism; prevent; public health relevance; response; standard measure

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.

描述（由申请人提供）：该提案描述了一项计划，该计划研究了痴呆症患者中对一个人的不依赖性的意识，称为厌食症。厌氧症会导致患者的残疾，并使家庭和看护人沮丧。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其限制的潜在风险行为，需要监督以确保其安全性。尽管在阿尔茨海默氏病中厌氧症很常见，但它在额颞痴呆症中更为常见，原因尚不清楚。我们开发了一个模型，试图解释特定认知能力的失败，包括监测一个人的表现和情感，我们已经制定了一项计划来测试这些因素是否导致厌氧症，以及阿尔茨海默氏病和额局局部痴呆症患者的促成因素是否有所不同。我们将研究100个健康的老年人，50例阿尔茨海默氏病患者和50例额颞痴呆症患者。我们将追求以下具体目标：a）定义绩效监控，其他额叶/执行功能，记忆和对AD和FTD中厌氧的情感反应性的相对贡献。我们假设：1）在FTD中，即使考虑到记忆和执行功能的贡献，认知任务期间的性能监测和生理激活也会与厌氧症相关。 2）在AD中，而不是FTD中，在认知测试上的最新表现记忆将对厌氧症做出重大贡献。我们假设1）右侧轨道额皮层中的组织损失将预测在测试过程中的生理激活，性能监测的行为估计以及FTD和AD的总体自我意识水平[在控制其他相关脑区域的贡献之后。 2）内侧时间区域（海马，内嗅皮层，帕拉希皮膜回和）的组织损失将显着预测AD的整体自我意识水平，在考虑了内侧OFC后。性能监测（越来越降低[FOK]）以及诊断组的总体自我意识水平。如果确认这些假设，我们将对痴呆症患者不知道自己的缺陷有一个清晰的想法。 公共卫生相关性：痴呆症患者通常不知道，或者略微意识到他们的思维问题以及这些缺陷对生活的影响。该项目将试图理解为什么使用神经科学家开发的认知测试并使用脑成像，痴呆症患者对残疾的认识如此差。