Anosognosia in Early- and Late-Onset Dementia and Its Association With Neuropsychiatric Symptoms

Manuela Tondelli; Chiara Galli; Giulia Vinceti; Luigi Fiondella; Simone Salemme; Chiara Carbone; Maria Angela Molinari; Annalisa Chiari; Giovanna Zamboni

doi:10.3389/fpsyt.2021.658934

Anosognosia in Early- and Late-Onset Dementia and Its Association With Neuropsychiatric Symptoms

Front Psychiatry. 2021 May 13:12:658934. doi: 10.3389/fpsyt.2021.658934. eCollection 2021.

Authors

Manuela Tondelli^{1

2}, Chiara Galli², Giulia Vinceti^{1

3

4}, Luigi Fiondella^{1

3}, Simone Salemme^{1

3}, Chiara Carbone^{1

3}, Maria Angela Molinari², Annalisa Chiari⁴, Giovanna Zamboni^{1

3

4

5}

Affiliations

¹ Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy.
² Primary Care Department, Azienda Unitá Sanitaria Locale di Modena, Modena, Italy.
³ Center for Neurosciences and Neurotechnology, Università di Modena e Reggio Emilia, Modena, Italy.
⁴ Neurology Unit, Baggiovara Hospital, Azienda Ospedaliero Universitaria di Modena, Modena, Italy.
⁵ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

Abstract

Background: The symptom anosognosia or unawareness of disease in dementia has mainly been studied in patients with late-onset dementia (LOD, ≥65 years), whereas little is known on whether it is also present in patients with early-onset dementia (EOD, <65 years). We aimed at investigating differences in anosognosia between LOD and EOD, by also studying its association with different clinical variants of EOD and the presence of neuropsychiatric symptoms. Methods: A total of 148 patients, 91 EOD and 57 LOD, were recruited and underwent extended clinical assessment and caregiver interview that included questionnaires aimed at measuring anosognosia and neuropsychiatric symptoms. Differences in anosognosia between EOD and LOD and between subgroups with different clinical variants were investigated, as well as correlation between anosognosia and neuropsychiatric symptoms. A regression analysis was applied to explore the association between anosognosia and development of neuropsychiatric symptoms during disease progression. Results: Median levels of anosognosia were not significantly different between EOD and LOD. Anosognosia increased overtime with disease progression and was higher in frontotemporal dementia patients or, more precisely, in frontotemporal dementia and Alzheimer's disease variants associated with involvement of the frontal lobes. Higher levels of early anosognosia were associated with higher frequency and severity of subsequent neuropsychiatric symptoms, in particular apathy, later in the course of the disease. Conclusion: Anosognosia is a frequent symptom of EOD, occurring in 94.5% of all-cause EOD, and it is associated with higher risk of developing neuropsychiatric symptoms during disease progression. Recognising anosognosia may be helpful for clinicians and families to reduce diagnostic delay and improve disease managment.

Keywords: Alzheimer's disease; anosognosia; apathy; early onset dementia; frontotemporal dementia; late onset dementia; neuropsychiatric symptoms.